[Time standards of nursing in Primary Health Care: an observational study]. / Padrões de tempo médio das intervenções de enfermagem na Estratégia de Saúde da Família: um estudo observacional.

OBJECTIVE: To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU) in Brazil to substantiate the calculation of work force. METHOD: This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique. RESULTS: A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control. CONCLUSION: The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized.

Tool to measure workload of health professionals in Primary Health Care: development and validation. / Instrumento de medida de carga de trabalho dos profissionais de Saúde na Atenção Primária: desenvolvimento e validação.

Objective To develop and validate an instrument that addresses the interventions/activities carried out by the family health team as reference for staff planning. Method Methodological research developed in stages: instrument development, content validation, and pilot test in three units located in the southeastern region of Brazil. Results 39 interventions were validated in a single instrument to measure workload for clinician, dental surgeon, oral health technician/assistant, nurse, nurse assistant, and community health agent. In the pilot test, the instrument contained 100% of the interventions observed and the observers reached 93.7% agreement. Conclusion The proposed instrument is an innovating tool because of its configuration for health team and supports staff planning in primary health care.

Nursing staff in the internal medicine and surgical units of teaching hospitals: composition and cost. / Quadro de profissionais de enfermagem em unidades médico-cirúrgicas de hospitais de ensino: composição e custos.

Objective Evaluate the mean quantitative and qualitative nursing staff working in the internal medicine and surgical units of three public general teaching hospitals in the city of São Paulo, compared to projected mean staff according to the parameters of Cofen Resolution No. 293/04, as well as measure the mean cost of current and projected nursing staff. Method Quantitative, descriptive, exploratory study using prospective data collection. Results In most of the units studied, the number of nursing professionals was adequate. In two of the institutions, the percentage of nurses was lower than that recommended by Cofen. Qualitative and quantitative adjustment of the staff would represent a monthly cost increase of R$141,326 for Hospital A, R$138,989 for Hospital B, and a reduction of R$99,028 for Hospital C. Conclusion The main contribution of this study was the proposed method for qualitative and quantitative evaluation of nursing staff, in addition to determining the average cost for adjustments.

[Standardization of activities in an oncology surgical center according to nursing intervention classification]. / Padronização das atividades em centro cirúrgico oncológico segundo a classificação das intervençães de enfermagem.

This study was undertaken in a surgical center specializing in oncology, and it aimed to identify nursing activities performed during the perioperative period and to classify and validate intervention activities according to the Nursing Interventions Classification (NIC). A survey of activities was conducted using records and by direct observation of nursing care across four shifts. Activities were classified as NIC nursing interventions using the cross-mapping technique. The list of interventions was validated by nursing professionals in workshops. Forty-nine interventions were identified: 34 of direct care and 15 of indirect care. Identifying nursing interventions facilitates measuring the time spent in their execution, which is a fundamental variable in the quantification and qualification of nurses' workloads.

[The identification of nursing interventions in primary health care: a parameter for personnel staffing]. / Identificação das intervenções de enfermagem na Atenção Primária à Saúde: parâmetro para o dimensionamento de trabalhadores.

In Primary Health Care (PHC) there is empirical planning regarding the nursing staff, which causes a distortion between personnel distribution and the real needs of the health units. The objective was to identify the nursing interventions at the PHC that support personnel staffing. The following sources were: literature review of databases from 1999-2009; field observation at a Family Health Unit; survey of family forms; mapping of nursing activities and interventions according to the Nursing Interventions Classification; and validation of these interventions. A total of 169 activities were identified: 11 associated activities; five personnel activities and 153 direct and indirect care giving activities validated in seven domains, 15 classes and 46 NIC interventions. The study allowed for recognition of the nursing practices at the PHC by means of a standardized language, providing support for its application in the creation of instruments to identify the nursing workload.

[Nursing care time in a teaching hospital]. / Tempo de assistência de enfermagem em instituição hospitalar de ensino.

This is a quantitative exploratory, descriptive study performed with the objective to identify and analyze the performance of the average time of nursing care delivered to patients of the Inpatient Units of the University Hospital at University of São Paulo (UH-USP), from 2001 to 2005. The average nursing care time delivered to patients of the referred units was identified by applying of a mathematical equation proposed in the literature, after surveying data from the Medical and Statistical Service and based on the monthly working shifts of the nursing professionals. Data analysis was performed using descriptive statistics. The average nursing care time observed in most units, despite some variations, remained stable during the analyzed period. Based on this observed stability, it is concluded that the nursing staff in the referred HU-USP units has been continuously evaluated with the purposes of maintaining the average time of assistance and, thus, the quality of the care being delivered.

[Nursing staff absenteeism rates as a personnel management indicator]. / Taxa de absenteísmo da equipe de enfermagem como indicador de gestão de pessoas.

Absenteeism in nursing is a difficult problem for health organizations; hence it is an indicator that must be monitored. The objective of this study was to analyze the absenteeism rate of nursing professionals in a public hospital. Absenteeism data were collected monthly, from January to July 2008, and calculated by means of an electronic program. The mean absenteeism index for nurses varied from 5.6% to 9.7% for technicians/nursing aides. Sick leaves were the most prevalent reason for absences. The data revealed the major cause of absenteeism and pointed at the need to change policies for hiring nursing professionals, in addition to reviewing the working processes in order to improve the workers' health conditions.

The profile of EEUSP graduates of the stricto sensu program in nursing management. / Perfil de egressos da Pós-Graduação stricto sensu na área de Gerenciamento em Enfermagem da EEUSP.

The objectives of the present study were to identify and discuss on the profile of the graduates form the stricto sensu program in Nursing Administration/Management of the University of São Paulo School of Nursing, from October 2008 to June 2011, regarding the knowledge areas the graduates worked on during their master and doctoral program. This is an exploratory, descriptive, retrospective study, using documental analysis. The study population consisted of 250 graduates, 169 of which were masters and 81 doctorates. The graduates' profile permitted to identify and discuss on the retention rate for the doctorate; the type of institution that absorbs the master and doctorate graduate and the fields they work in.

Cost of nursing staffing adequacy in a neonatal unit. / Custo da adequação quantitativa de profissionais de enfermagem em Unidade Neonatal.

The objectives of this descriptive, quantitative study were: to identify the mean nursing care time provided and required by newborns (NB) hospitalized at the Neonatal Unit of the University of São Paulo University Hospital; to calculate the cost of the mean nursing care time provided and required, by NB; to assess the cost of the nursing staffing adequacy required to assist the NB. The mean nursing care times, provided by the nursing staff and required by NBs, were calculated using equations available in the literature and by applying the Nursing Activities Score. The costs of the mean nursing care times and to make nursing staffing adequate were calculated based on the hourly cost of nurses and nursing technicians. The financial impact of nursing staffing adequacy accounted for a 30% increase over the cost of the current situation.

Computerized nursing staffing: a software evaluation. / Dimensionamento informatizado de profissionais de enfermagem: avaliação de um software.

The complexity involved in operationalizing the method for nursing staffing, in view of the uncountable variable related to identifying the workload, the effective working time of the staff, and the Technical Security Index (TSI) revealed the need to develop a software program named: Computerized Nursing Staffing (DIPE, in Portuguese acronyms). This exploratory, descriptive study was performed with the objective to evaluate the technical quality and functional performance of DIPE. Participants were eighteen evaluators, ten of whom where nurse faculty or nurse hospital unit managers, and eight health informatics experts. The software evaluation was performed according to norm NBR ISO/IEC 9126-1, considering the features functionality, reliability, usability, efficiency, and maintainability. The software evaluation reached positive results and agreement among the evaluators for all the evaluated features. The reported suggestions are important for proposing further improving and enhancing the DIPE.

Conceptualization of an electronic system for documentation of nursing diagnosis, outcomes, and intervention.

Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.

[Nursing intervention identification in rooming-in]. / Identificação das intervenções de enfermagem no Sistema de Alojamento Conjunto.

Considering the need of parameters to know the workload existent in Rooming-in (RI), it is imperative to identify nursing activities in the mother-child binomial. The objectives of the study are: to identify nursing activities in the Rooming-In Unit of the HU-USP; to classify activities in nursing interventions according to the Nursing Intervention Classification (NIC), and to validate the interventions. A survey of all activities was carried out by means of clinical records and direct observation of nursing assistance in all the shifts. The content of interventions was validated with the nurses of unit, by means of the workshop technique. It was identified 43 direct and indirect nursing interventions; activities associated and personal activities of the staff. The instrument built with the number of these interventions/activities will permit to, in further studies, correlate the time expended to perform these interventions/activities and thus to propose parameters to measure the need of nursing professionals in RI.

Nurses' perception of power regarding their clinical role.

This article reports on a study on nurses' perception of power regarding their clinical role before and after implementation of a nursing diagnosis classification. Sixty clinical nurses (average age=37.2+/-7.0 years) from a Brazilian teaching hospital answered the Power as Knowing Participation in Change Tool (PKPCT) before and after the implementation of a diagnosis classification. PKPCT has four domains and provides total and partial scores. Reliability coefficients ranged from 0.88 to 0.98. Total scores were not statistically different between assessments (p=0.21), although scores in the 'Involvement in Creating Change' domain were higher in the second assessment (p=0.04). Further studies providing sound evidence regarding the impact of nursing classification systems on nurses' power perception are needed to guide decisions on teaching and clinical practice.

Dimensioning of nursing staff in outpatient chemotherapy: application of the Workload Indicators of Staffing Need.

OBJECTIVE: To apply the method developed by the World Health Organization, called Workload Indicators of Staffing Need for dimensioning the nursing staff for the care of cancer patients in a Chemotherapy outpatient clinic. METHOD: This is a quantitative, observational, documentary field study with an intentional sample. Prospective data were collected through the work sampling method. RESULTS: Seventeen nurses and 12 nursing technicians participated in the study. A total of 3,727 observations were performed and were obtained the mean times and the relative working time of 23 nurses' interventions and 18 nursing technicians' interventions. The interventions corresponded to 88.5% of the relative working time of nurses and 83.9% of nursing technicians. Personal activities accounted for 8.2% of the relative working time of nurses and 7.9% of nursing technicians. The reliability test resulted in 86.3% concordance. CONCLUSION: The similarity between the staff required according to the method studied and the current staff showed that the Workload Indicators of Staffing Need has great potential and applicability for dimensioning nursing professionals safely.

[Proposal for a model for calculating the size of nursing staff in home care]. / Proposta de modelo para dimensionamento do pessoal de enfermagem em assistência domiciliária.

Home care brings up issues related to the number of daily hours and days of nursing service from users of these services. This study was carried out in order to identify the criteria adopted by managers and nurses for calculating the nursing staff needed in home care services. Data were collected through semi-structured interviews and analyzed according to the method of content analysis. Three categories were identified: patient's eligibility, time spent in care, and professional competency profile. The steps considered were: identification of daily average work load, choice of the proportion of professional categories, nursing workers' daily journey, and identification of the technical safety index for covering planned and unplanned absences. From these variables a model for calculating nursing personnel needed in home care is proposed in order to speed up the decision making process.

[Evaluation of the Nursing Activities Score (NAS) as a nursing workload measurement tool in an adult ICU]. / Nursing Activities score (NAS) como instrumento para medir carga de trabalho de enfermagem em UTI adulto.

UNLABELLED: This is an exploratory, descriptive, prospective field study with a quantitative approach carried out at a general/adult Intensive Care Unit in the city of São Paulo. OBJECTIVES: to evaluate the NAS Nursing Activities Score--as a tool for measuring nursing workload, its use in measuring shifts, and its correspondence to the number of effective nursing personnel. Thirty-three patients, with mean age of 70 years (+/- 16.5), were classified. Most were males (66.7%). Length of stay in the ICU was 17 days (+/- 20.4); SAPSII was 41.7 (+/- 17.9), with mean probability of death of 33.5% (+/- 26.8); 63.6% were transferred to Intermediate Care Units and 18.2% died during ICU stay. Three hundred and ninety six NAS measures (shifts) were performed (134-morning, 132-afternoon, 130-evening), with averages of 55.4 (+/- 12.3) and 147 in 24-hour NAS and mean of 69.6 (+/- 18.2). NAS performed better in 24-hour application than in shifts, and proved to be an interesting tool for patient and nursing workload classification in intensive care.

Application of the Workload Indicators of Staffing Need method to predict nursing human resources at a Family Health Service.

OBJECTIVE: verify the application of the Workload Indicators of Staffing Need method in the prediction of nursing human resources at a Family Health service. METHOD: descriptive and quantitative study, undertaken at a Family Health service in the city of São Paulo. The set of sequential operations recommended in the Workload Indicators of Staffing Need method was used: definition of the professional category, type of health service and calculation of Available Work Time; definition of workload components; identification of mean time for workload components; dimensioning of staff needs based on the method, application and interpretation of the data. RESULT: the workload proposed in the Workload Indicators of Staffing Need method to nursing technicians/auxiliary nurses was balanced with the number of professionals available at the Family Health service. The Workload Indicators of Staffing Need index amounted to 0.6 for nurses and 1.0 for nursing technicians/auxiliary nurses. CONCLUSION: the application of the Workload Indicators of Staffing Need method was relevant to identify the components of the nursing professionals' workload. Therefore, it is recommendable as a nursing staffing tool at Family Health services, contributing to the access and universal health coverage.

[Nursing staff turnover: a study at a school-hospital]. / Rotatividade da equipe de enfermagem: estudo em hospital-escola.

The goal of this exploratory-descriptive study was to measure and compare nursing staff turnover levels at the University Hospital of São Paulo University. The population consisted of 255 nursing workers - 78 nurses, 20 technicians and 156 auxiliaries - who resigned from the hospital between 1997 and 2000. Turnover levels were measured by means of global indicators, admission and resignation, net replacement on the job and variation rates. Quantitative data analysis indicated a low nursing staff turnover rate at this hospital.

[Patient classification system: identification of the patient care profile at hospitalization units of the UH-USP]. / Sistema de classificação de pacientes: identificação do perfil assistencial dos pacientes das unidades de internação do HU-USP.

This exploratory-descriptive study aimed to identify the patient care profile at the Hospitalization Units of the University Hospital-USP to support human resource allocation, to evaluate the nursing staff and to ground decision-making processes on nursing care organization and planning. In order to get to know the patients' care complexity profile, the patient classification instrument was used, developed and established at the Medical Clinic Unit of the UH-USP since 1990. The study results allowed us to evaluate the adequacy of the classification system used and provided information on the patients' care profile and the work load at each Hospitalization Unit, thus, supporting management decisions on human resource allocation, care planning and service organization in view of clients' demands.

Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center.

OBJECTIVE: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC), during the transoperative period at a surgical center specializing in oncology. METHODS: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing technicians from patient reception who worked in the surgical center during the transoperative period. An instrument was developed to collect data and the interventions were validated according to NIC taxonomy. RESULTS: a total of 266 activities were identified and mapped into 49 nursing interventions, seven domains and 20 classes of the NIC. The most representative domains were Physiological-Complex (61.68%) and Health System (22.12%), while the most frequent interventions were Surgical Care (30.62%) and Documentation (11.47%), respectively. The productivity of the nursing team reached 95.34%. CONCLUSIONS: use of the Nursing Intervention Classification contributes towards the discussion regarding adequate, professional nursing staffing levels, because it shows the distribution of the work load.