Escala de medición de cargas de trabajo en relación a las intervenciones de enfermería en una Unidad de Anestesia y Reanimación

Abstract

ABSTRACT Nursing staff at the reanimation ward in the hospital is the object of our study. This ward is subjected to variable and difficult to predict workloads, as they receive patients not only from the scheduled operation theatres but also from A&E, maternity complications or radiology, among others. In addition it is the reference hospital in the county. The length of the patients' stay can increase depending on the gravity of their condition and the need of intensive care, especially in the case of critical post surgery patients, being this situation more and more frequent given the population's increasing life expectancy. As a consequence, population is increasingly long-lived, complex and demanding of better quality service. Rapid and numerous technical and IT advances require compliance with the service providers' contracts and the patient's safety and security laws, and force staff to recycle continuously, resulting in great pressure while at work. These workloads can directly impact the service quality, diminishing patients' safety and increasing nursing staff's dissatisfaction and demotivation. This staff is already affected by poor hiring and role allocation due to the economic crisis, reflected in an imbalance in the ratio nurse-patient. This study focus its objectives on analysing the presence of stress due to work overload in the nursing staff within the anaesthetics and reanimation ward; the need for the identification of workload measuring tools that take into consideration not only the relationship between the levels of reanimation patients' morbimortality and the nurse-patient ratio, but also the nursing language, its interventions and activities within such ward. After an up-to-date bibliographic search and assessment of the different workload measuring tools that help in the prediction of mortality, the collection of data is initialised, according to the TISS-28 scale, as its items are compliant with the type of patients in reanimation. Results show the imbalance between nurse-patient ratios and a higher mortality index during periods with greater volume of critical patients. However, being left out other important aspects of the ward, such scale has been adjusted accordingly. NEMS is then selected as it is a simplified version of TISS-28 and adds the nursing language NANDA and other activities that add to the nursing staff's workload. This leads to a feedback loop and sharing among the ward's staff, developing a standardised care plan for the patient in reanimation. This, together with the NIC proposals will end up in the elaboration of a scale equivalent to NEMS, as well as the non-contemplated nursing interventions in the Anaesthetics and Reanimation ward. The new scale adapts NEMS-NIC REA, provides a more realistic view of the workload that such patients involve and enables a comparison with the validated NEMS. On the other hand, in order to consider the perception on work overload among the nursing staff, a questionnaire about satisfaction, stress and burnout is supplied. The obtained results demonstrate the need for workload measuring tools in the nursing unit, given the diversity of patients with different workloads, as well as the numerous activities and time required for them with a statistically significant (p=0.000) relationship between NEMS and the new adapting scale NEMS-NIC REA. Concurrently the resulting data from the questionnaire supplied to the nurses in the REA of HCUVA service unveil a worrying factor endangering its due functioning, with the risk to impact the quality of the aid offered to patients. Dissatisfaction, permanent stress, an exhausting environment to develop their work day, a general unhappiness regarding the style used in the administration of the unit and the continuous demand by most nurses in ongoing training, are only a few of the descriptors that determine the emotional process these team members are going through. The use of the scale "Adaptation NEMS-NIC REA" is based on the standardised languages internationally known by the nursing collective (NANDA-I diagnoses and Nursing Interventions) enables the simplified register of all the care provided by REA, facilitating its visibility and comparability with the care offered in other wards within the same hospital.