Propuesta de una nueva escala de valoración de cargas de trabajo y tiempos de enfermería (VACTE©)

The scale Nine Equivalents of nursing Manpower use Score (NEMS) for the evaluation of the nursing care loads is the most well known and applied worldwide. Nevertheless, we have found a series of limitations: it does not reflect the "proper nursing activity" but only the cares related to the medical intervention. Furthermore, it is directly related to severity while integral attention to the patient implies an infinity of cares, which are not necessarily related to the severity. In addition, we understand that the planned personnel ratios may be unsuitable, with the consequent repercussions for the patient, nurses and the sanitary institution. The primary targets were: elaboration of a representative scale of all the cares and tasks made by the nurses (VACTE) in our unit, to determine if it is more precise and objective than NEMS for the measurement of the service loads and to calculate the operative ratio patient-nurse based on the new proposed scale. We made a descriptive and retrospective study on 91 patients admitted to the Intermediate Care Unit of the Fundación Hospital de Jove during the first three months of 2004. Previously we created scale VACTE, making real measurements of the time inverted in the execution of each one of the cares in 50 patients. Later, a comparison was made between the APACHE II, NEMS and VACTE scales, taking as reference the scores obtained in the same ones during the first 24 hours of the stay. The statistical analysis was made by SPSS 11.0, assuming a confidence level of 95% (p < 0.05): lineal analysis of simple regression to compare the different scales; the force of its correlation with Spearman's coefficient and we compared the independent dichotomize variables with the Mann-Whitney test. The main results determined after the study were the following: regarding the scale to evaluate seriousness applied to the patients, an average APACHE II score of 12.1 +/- 5.9 was obtained. The average value with the NEMS was 19.5 +/- 5.7 and the average one with VACTE was 365 +/- 91.2. Significant differences were found between APACHE II and the NEMS (p = 0.008) and VACTE (p < 0.001) scales. This relationship presented more force with VACTE (r = 0.43; p < 0.001) than with NEMS (r = 0.23; p = 0.002). The operative patient-nurse ratio calculated with VACTE was 2.01. Scale VACTE is representative of nursing activity and seems to be more effective than NEMS to determine service loads. The ratio planned in the unit duplicated the calculated operative ratio.

Issues and challenges in nursing and nursing education in Japan

In this editorial we discuss the challenges and issues in nursing and nurse education in Japan. These include a rapid growth in the number of universities offering nursing programs without sufficient time for preparation of faculty; issues in the traditional ways of teaching in classrooms; the appearance of nursing shortages in a country with the highest rate of longevity in the world; and the position of nursing faculty in a society that is largely male dominated.

Abuse and psychosocial stress as factors in high utilization of medical services during pregnancy

High utilization of medical services during pregnancy has not been described as most studies have focused on women who receive inadequate or no prenatal care. This paper describes the characteristics and medical utilization data of 500 pregnant women enrolled in a prospective study. High utilizers (HU), who had a mean of 7.8 utilizations (SD = 3.2), were significantly more likely to be nonwhite, low income, and younger than low utilizers (LU) who had a mean of 0.99 utilizations (SD = 1.1). HU reported a 32% rate of recent abuse compared to 9% for LU. HU also reported significantly more stress, lower self-esteem, and more ambivalence about the pregnancy. Consistent with their higher utilization, they were more likely to be diagnosed with preterm labor, hyperemesis, and gestational diabetes. HU had a higher proportion of complaints of nausea, vomiting, diarrhea, and pain and more mental health diagnoses than LU. Overall, HU were a vulnerable group characterized by recent abuse, economic disadvantage, psychosocial stress, and mental health issues. Their high utilization of medical services may have been due in large part to unmet psychosocial needs.

[The importance of a bibliographic analysis in the magazines published by Revista Rol de Enfermeria"]

This article is a preview of a project whose objective is to carry out a bibliographical analysis of the articles bearing scientific information included in the "ROL de Enfermeria" magazine over the past five years. This magazine started publication in 1978 and has as its goal contributing to the spread of scientific knowledge in the Nursing field.

Nurse Experiences as Cancer Survivors: Part I—Personal

PURPOSE/OBJECTIVES

To uncover dimensions of nurses' personal experiences of cancer survivorship.

DESIGN

Interpretive, phenomenologic.

SETTING

Metropolitan area in the northeastern United States.

SAMPLE

25 RNs diagnosed with cancer. Average age was 50 years, and 20 participants were less than five years from initial diagnosis.

METHODS

Interviews. Analysis using methodology of Newman (1994, 1999) and Van Manen (1990).

MAIN RESEARCH VARIABLES

Nurses' personal experiences of cancer survivorship.

FINDINGS

Themes of the nurses' personal experiences of survivorship included the shock of becoming a patient and multifaceted dimensions of the treatment experience, including time, coordinating their own care, the struggle to maintain normalcy, uncertainty, nonclinical self-care strategies, and encounters with caring and uncaring providers. Participants identified the need for supportive relationships both in personal and professional arenas throughout the survivorship process. The cancer experience became an opportunity for change in priorities.

CONCLUSIONS

Although nurse cancer survivors experience similar personal vulnerabilities to those of non-nurses, their vulnerabilities often are affected by their knowledge of the healthcare process and content of care with which they are most familiar. They also are affected by what they know is at stake. This particular insider vulnerability is not cited often in research literature and, therefore, is not recognized as a particular type of need that should be addressed in cancer survivorship.

IMPLICATIONS FOR NURSING

Nurse patients need providers to be sensitive to their information and support needs, which may vary because of their professional experiences and personal resources. Findings suggest that nurse patients may need supportive approaches that target their unique vulnerabilities.

Nurse Experiences as Cancer Survivors: Part II—Professional

PURPOSE/OBJECTIVES

To uncover dimensions of nurses' professional experiences of cancer survivorship.

DESIGN

Interpretive, phenomenologic.

SETTING

Metropolitan area in the northeastern United States.

SAMPLE

25 RNs diagnosed with cancer. Average age was 50 years, and 20 participants were less than five years from initial diagnosis.

METHODS

Interviews. Data were analyzed using the methodology of Newman (1994, 1999) and VanManen (1990).

MAIN RESEARCH VARIABLES

Nurses' professional experiences of cancer survivorship.

FINDINGS

Professional experiences of cancer survivorship fell into five themes: (a) role ambiguity, (b) a deepening level of compassion for patients and others, (c) self-disclosure as a therapeutic intervention, (d) becoming an advocate for change, and (e) volunteerism.

CONCLUSIONS

Cancer survivorship was a factor in reshaping participants' clinical practice. Experiencing the role of the patient affirmed the necessity of compassionate care for these participants. Nurses experienced a deepening level of compassion for patients and used self-disclosure as a therapeutic intervention. During and shortly after treatment, role ambiguity (being both patient and nurse) could cause difficulties. Nurses took action to change their clinical environment through their influence on colleagues and the healthcare system and by working through other organizations to improve patient care.

IMPLICATIONS FOR NURSING

Nurse cancer survivors can benefit from the support of colleagues and healthcare providers and an appreciation of the challenge of being both a professional and a patient. The invitation for dialogue as they return to work may help with the challenges of role ambiguity as nurse cancer survivors. Based on this study, nurses value the opportunity to enhance care environments with their two-world knowledge through compassionate care, disclosure, advocacy, and volunteering, and coworkers need to appreciate each nurse's unique response to this potentially life-changing process. Nurses in all settings can learn from their cancer survivor colleagues who have been the recipients of care to reflect on their own clinical practice in the areas of advocacy, sensitivity to patient concerns, and care experiences.

Pro-health nutritional behaviors of selected group of students of the Medical University of Warsaw

The aim of the study was the analysis of pro-health nutritional behaviors among 100 female students Medical University of Warsaw tested by the questionnaire method. The results of the study show that nutritional behaviors of students who learned human nutrition were significantly better in accordance with dietary guidelines. The most frequent consumed group of products were fruits and dairy products. Consumption of vegetables, number and regularity of meals had been better among dietetics students then among midwifery and nursing students.

[Work responsibilities. Critical care unit]

The authors quantify the work load nurses have, analyzing the relationship between the level of treatment planned and the operative level by means of a prospective study carried out over a three month period at the Anesthesia and Reanimation Unit at the Clinical University Hospital in Santiago de Compostela; this study had a total of 233 patients. The authors observed that the work load for nurses lie above the recommended values and there exists a difference between the planned treatment level and the operative treatment level.

Aferição do tempo e do custo médio do trabalho da enfermeira na consulta de enfermagem

Neste estudo, a autora objetivou caracterizar os atendimentos de Consulta de Enfermagem, segundo pacientes pré-cirúrgicos do Programa de Coronária, estimar o tempo e o custo médio do trabalho de enfermeira na realização da Consulta de Enfermagem, estudar a existência de associação/correlação entre o tempo, o custo e outras variáveis de interesse. O desenvolvimento da consulta seguiu as fases da Sistematização da Assistência de Enfermagem (SAE). A amostra foi constituída de 44 pacientes, sendo que 37 (84%) foram atendidos em consultas novas e 7 (16%) em consultas de seguimento. Os resultados alcançados foram: tempo médio igual a 48,91 minutos para as consultas novas e 22,14 minutos para as de seguimento, com um custo médio de cerca de R$ 18,01 para as consultas novas e de R$ 8,15 para as de seguimento. Os resultados mostram que o tempo médio de consultas novas superam de forma estatisticamente significativa o tempo médio das consultas de seguimento e, conseqüentemente, os custos.

[Utilization of the results or research about nursing workload in a surgical suite, based on the methodology of the "Projet de Recherche en Nursing" (PRN87)]

The aim of this study was to evaluate actual levels of nursing care delivered in a functionally aggregated Surgery Area of the Tor Vergata University Hospital in Rome, by measuring nursing workload according to the "Projet de Recherche en Nursing" (PRN87) methodology. The study was performed between February 1st and June 26, 2004. The results of the study have highlighted the fact that nursing staff is often improperly used, for example to perform many administrative activities, thereby reducing the quality and amount of direct nursing care.

Parenteral Nutrition Safe Practices: Results of the 2003 American Society for Parenteral and Enteral Nutrition Survey*

BACKGROUND

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently published a revision of its "Safe Practices for Parenteral Nutrition" guidelines. Because there is a paucity of published scientific evidence to support good practices related to ordering, compounding, and administering parenteral nutrition (PN), a survey was performed in the process of the revision to gain insight into the discrepancies between reported practices and previous guidelines.

METHODS

A web-based survey consisting of 45 questions was conducted (n = 651) June 1-30, 2003. Respondents were queried about primary practice setting, professional background, processes for writing PN orders, computer order entry of PN orders, problems with PN orders, and adverse events related to PN.

RESULTS

There were 651 survey responses, 90% of which were from hospital-based practitioners. Almost 75% of responders processed between 0 and 20 PN orders per day. Overall, physicians (78%) were responsible for writing PN orders, but dietitians and pharmacists had significant involvement. PN base components were most often ordered as percentage final concentration after admixture (eg, 20% dextrose), which is inconsistent with safe practice guidelines of ordering by total amount per day (eg, 200 g/day). There was no consistent method for ordering PN electrolytes. Approximately 45% of responders reported adverse events directly related to PN that required intervention. Of these events, 25% caused temporary or permanent harm, and 4.8% resulted in a near-death event or death.

CONCLUSIONS

Although the survey found consistency in PN practices for many areas queried, significant variation exists in the manner by which PN is ordered and labeled.

Mapping the literature of nursing: 1996-2000

INTRODUCTION

This project is a collaborative effort of the Task Force on Mapping the Nursing Literature of the Nursing and Allied Health Resources Section of the Medical Library Association. This overview summarizes eighteen studies covering general nursing and sixteen specialties.

METHOD

Following a common protocol, citations from source journals were analyzed for a three-year period within the years 1996 to 2000. Analysis included cited formats, age, and ranking of the frequency of cited journal titles. Highly cited journals were analyzed for coverage in twelve health sciences and academic databases.

RESULTS

Journals were the most frequently cited format, followed by books. More than 60% of the cited resources were published in the previous seven years. Bradford's law was validated, with a small core of cited journals accounting for a third of the citations. Medical and science databases provided the most comprehensive access for biomedical titles, while CINAHL and PubMed provided the best access for nursing journals.

DISCUSSION

Beyond a heavily cited core, nursing journal citations are widely dispersed among a variety of sources and disciplines, with corresponding access via a variety of bibliographic tools. Results underscore the interdisciplinary nature of the nursing profession.

CONCLUSION

For comprehensive searches, nurses need to search multiple databases. Libraries need to provide access to databases beyond PubMed, including CINAHL and academic databases. Database vendors should improve their coverage of nursing, biomedical, and psychosocial titles identified in these studies. Additional research is needed to update these studies and analyze nursing specialties not covered.

Mapping the general literature of American nursing

OBJECTIVES

As part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies core journals cited by general or "popular" US nursing journals and the indexing services that cover the cited journals.

METHODS

Three journals were selected for analysis: American Journal of Nursing, Nursing 96-98, and RN. The source journals were subjected to a citation analysis of articles from 1996 to 1998, followed by an analysis of database access to the most frequently cited journal titles.

RESULTS

Cited formats included journals (63.7%), books (26.6%), government documents (3.0%), Internet (0.5%), and miscellaneous (6.2%). Cited references were relatively current; most (86.6%) were published in the current decade. One-third of the citations were found in a core of 24 journal titles; one-third were dispersed among a middle zone of 94 titles; and the remaining third were scattered in a larger zone of 694 titles. Indexing coverage for the core titles was most comprehensive in PubMed/MEDLINE, followed by CINAHL and Science Citation Index.

CONCLUSIONS

Results support the popular (not scholarly) nature of these titles. While not a good source for original research, they fulfill a key role of disseminating nursing knowledge with their relevantly current citations to a broad variety of sources.

[EPINETAC study]

Daily, health professionals face biological risks, which have important repercussions for their own health, while performing their professional duties. A system which records data that quantifies and specifies the causes of work place accidents, the instruments most frequently involved in accidents, the professional categories having the greatest exposure, the tasks most at risk and the types of lesions is fundamental in order to grasp the true dimensions of these problems related to accidents and serum-borne disease transmission. Such a data base-could lead to the necessity, and highlight the importance, to increase preventive and protective measures for health personnel. To meet this objective, the EPINETAC project has been developed thanks to the information provided by 106 centers having various degrees of participation during the different years this study has taken.

Necessidades de cuidados de enfermagem em Terapia Intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS)

O estudo teve como objetivos caracterizar os pacientes internados na UTI quanto aos dados bio-sociais e de internação, e verificar as necessidades diárias de cuidados de enfermagem, segundo o NAS. A amostra foi constituída por 50 pacientes adultos admitidos consecutivamente na UTI de um Hospital Universitário do município de São Paulo. Concluiu-se que a maioria dos pacientes tinha idade acima de 60 anos, permaneceu, em média, 3,5 dias na UTI, foi procedente do Pronto Socorro e recebeu alta para a Unidade Semi-Intensiva. A média do NAS foi de 66,5% (± 9,1), constatando-se que permaneceu acima de 50,0% no decorrer de toda internação na UTI.

State of the registered nurse workfore in the United States

In this final installment of this exclusive six-part series on the state of the RN workforce in the United States, the authors summarize the major findings of each piece and offer specific and actionable recommendations for nurse leaders, educators, and policymakers.

Perceptions of empowerment and intent to stay

Investigating why nurses remain in organizations may serve as a stepping stone for future retention strategies. The relationship between intent to stay and workplace empowerment in nurses are described in this continuing education article.

Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study

BACKGROUND

The challenge posed by the worldwide nursing shortage is significant not only for workforce and facility planners, but also for those who educate nurses for practice and nurses themselves. The provision of skilled and competent advanced nurses is clearly a goal of postgraduate education. An increasing shortage of skilled and qualified nursing staff to provide the required level of care is evident in Australia.

OBJECTIVE

To determine the impact of graduate education on registered nurses' personal and professional development.

DESIGN

A longitudinal descriptive and co-relational study of postgraduate nursing students using postal survey.

SAMPLE

Five cohorts (1998-2002) of nurses who had graduated from university with a graduate diploma or master of nursing qualification were all surveyed over six years post graduation (n=151).

RESULTS

The study showed the greatest motivator to change jobs was greater job satisfaction; self esteem and their ability to carry out their role exceeded their job satisfaction; one quarter wanted to change their career and the strongest facilitator and the strongest barrier to careeradvancement were their personal situation.

CONCLUSION

This paper focuses on recent career moves, motivation, intentions and influencing factors six years after completion of their tertiary studies. This information is critical in choosing retention strategies and workforce planning.

Visualizing nursing workforce distribution: policy evaluation using geographic information systems

Health services literature suggests that geographic information systems (GIS) are useful policy evaluation tools when policy success is dependent on location. Nursing workforce distribution is an inherently local issue and nursing shortages present serious concerns for local, state and national governments. In 1991, Missouri enacted a nurse recruitment and retention policy targeting underserved (HPSA-designated) counties. Following Institutional Review Board approval, policy effectiveness was explored using a combination of GIS data visualization, spatial and classic statistics. Results of both data visualization and statistical methods do not demonstrate an expected trend of decreasing group differences between HPSA and non-HPSA-designated counties over time. Only two of the five time periods studied had significant group differences. Between 1993 and 1995, the loss in nurse to population ratios in HPSA counties was significant (U=1020, p<0.001); however, between 1999 and 2001, the growth in nurse to population ratio changes in HPSA counties was significant (U=1032, p=0.001). The GIS data visualization and statistical techniques performed suggest that current policy definitions of underserved areas may not be effective in defining areas of nursing shortages and the existing policy implementation may not be achieving the stated goals.