Loading...
Publication
Dotação segura para a prática de enfermagem : um contributo para a gestão de unidades de saúde
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 4.66 MB | Adobe PDF |
Advisor(s)
Abstract(s)
A necessidade de adequação dos recursos de enfermagem às reais necessidades dos clientes, mantendo um equilíbrio entre a quantidade e as competências, não descurando a qualidade e segurança, tem constituído uma preocupação para os gestores. A ausência de uma metodologia consensual de suporte à operacionalização da dotação segura em enfermagem, constituiu-se como o ponto de partida desta investigação, que tem como principal objetivo desenvolver um modelo explicativo de Dotação Segura em Enfermagem (DSE) e identificar perfis de DSE. Na primeira fase efetuou-se um estudo qualitativo, exploratório, descritivo, com enfermeiros gestores, através de entrevista semiestruturada. Emergiram as Características essenciais do conceito DSE, algumas Variáveis extrínsecas passíveis de influenciar a DSE e identificaram-se indicadores de DSE. Numa segunda fase realizou-se estudo de carácter quantitativo, transversal e correlacional. A recolha de dados efetivou-se através de questionário em três amostras: enfermeiros (629), enfermeiros chefes (43) e clientes (1290), internados em 43 unidades de 8 hospitais com diferentes modelos de gestão. Os estudos de avaliação psicométrica através de análises fatoriais exploratórias e confirmatórias dos instrumentos de medida demonstraram validade e fiabilidade adequadas. As técnicas de Modelação de Equações Estruturais e da Análise de Clusters, comprovaram relações entre as variáveis de Estrutura, Processo e Resultados, tendo sido identificados dois perfis de DSE e estudado o seu impacto nos Resultados (confirmados 15 indicadores de Resultado sensíveis à DSE). A análise da relação entre as variáveis de Estrutura, de Processo e de Resultados da DSE evidenciou a influência das variáveis de Estrutura sobre os Resultados, bem como das variáveis de Processo sobre as de Resultados. A “Disponibilidade de enfermeiros com a combinação adequada de competências”, a “Disponibilidade de enfermeiros em quantidade adequada” e o “Ambiente seguro” (variáveis de Estrutura) explicam 2% da variância das variáveis de “Prestação de cuidados de enfermagem de qualidade” (variáveis de Processo),15% da variância da “Satisfação dos clientes”, 94% da variação do “Risco e da ocorrência de eventos adversos nos clientes” (variáveis de Resultado Clientes), 25% da variação de “Resultados Enfermeiros” e 100% da variação dos “Resultados Organização”. A “Disponibilidade de enfermeiros na quantidade adequada” indica um efeito direto e positivo nos “Resultados Organização” e nos “Resultados nos Enfermeiros” e nos “Resultados nos Clientes”. A “Disponibilidade de enfermeiros com combinação adequada de competências” denota um efeito significativo e positivo sobre os “Resultados nos Enfermeiros”.Relativamente à influência do Processo nos Resultados, verificou-se um efeito direto da “Prestação de cuidados de enfermagem de qualidade” na dimensão “Resultados nos Clientes” (“Satisfação dos clientes”, e “Risco e ocorrência de eventos adversos”). Das Variáveis extrínsecas à DSE o “Modelo de Gestão” da organização demonstrou um efeito significativo sobre as variáveis de Estrutura e de Resultados da DSE. A análise de Clusters expôs dois perfis de dotação das equipas de enfermagem diferenciados; o mais seguro presente em 55,8% dos serviços, surgiu maioritariamente nos hospitais com modelo de gestão “Entidade Pública Empresarial”, em serviços com taxas de ocupação mais baixas e menor carga de trabalho para os enfermeiros, com índices mais elevados de satisfação dos clientes com os cuidados de enfermagem, com menor risco/ ocorrência de sofrerem eventos adversos e com menores índices de rotatividade dos enfermeiros. O modelo DSE proposto dá resposta à efetividade da dotação de enfermagem e demonstra em simultâneo o seu efeito sobre os resultados observados. Releva-se a necessidade de maior atenção e preocupação com as questões da DSE, nomeadamente na constituição das equipas, tendo por base o mix de competências, sendo a formação e supervisão cruciais para a qualidade dos processos desenvolvidos e resultados obtidos. Adverte-se para uma atenção especial à carga de trabalho a que os profissionais de enfermagem estão sujeitos e à necessidade em contemplar no financiamento em saúde, as questões relacionadas com a Dotação Segura em Enfermagem que se constitui, como uma condição essencial para a qualidade, sustentabilidade e desenvolvimento das organizações de saúde.
The need to adequate nursing resources to the real needs of clients, maintaining a balance between quantity and skills, without neglecting quality and safety, has been a concern for managers. The absence of a consensual methodology to support the implementation of secure nurse staffing, was established as the starting point for this investigation which main goal was to develop an explanation model of Safe Nurse Staffing (SNS) and identify profiles of SNS. In the first phase we conducted a qualitative, exploratory, descriptive study with nursing managers, through semi-structured interview. Essential characteristics of SNS concept and some extrinsic variables capable of influence the SNS emerged and SNS indicators were identified. In a second phase, a study of a quantitative, transversal and correlational character was conducted. Data collection was achieved through a three sample questionnaire: nurses (629), chief-nurses (43) and clients (1290), admitted to 43 units in 8 hospitals with different management models. Psychometric assessment studies were followed through factorial exploratory analysis and confirmatory of the measuring instruments, which demonstrated adequate validity and reliability. Technics of Structural Equation Modelling and Clusters Analysis proved the relationships between Structure, Process and Results variables, identifying two SNS profiles and studied its impact on Results (confirming 15 sensitive to SNS Results indicators). The analysis of the relationship between the SNS’s Structure, Process and Results variables showed the influence of the Structure variables over Results of SNS, as well as Process variables over Results. "Availability of nurses with the right mix of skills", "Availability of nurses in adequate amount" and "Safe environment" (Structure variables) explain 2% of the variable variance of "Provision of quality nursing care" (Process variables), 15% of the variation of "Client satisfaction", 94% of the variation of "Risk and occurrence of adverse events on clients (Clients Result variables), 25% of the variation of "Nurses results" and 100% of the variation of "Organization results ". "Availability of nurses in adequate amount" denotes a direct and positive effect on "Organization Results", on "Nurses Results" and on "Clients Results". "Availability of nurses with appropriate skills mix" reveals a significant and positive effect on "Nurses Results". Regarding the influence of Process on Results, there was a direct effect found on "Provision of quality nursing care" over "Client Results" ("Client satisfaction" and "Risk and occurrence of adverse events"). Of the extrinsic variables to SNS, "Management Model" of the organization showed a significant effect over the Structure and Results variables of the SNS. The Clusters analysis exposed two different nurse staffing models profiles; the safer in 55,8% of the services appeared mostly in hospitals with a “Corporate Public Entity” management model, in services with lower occupancy rates and lower workload for nurses, with higher rates of client satisfaction with nursing care, with lower risk/ occurrence of adverse events and with lower nurse turnover rates. The proposed SNS model responds to nurse staffing effectiveness, showing simultaneously its effect on the observed results. It is noted the need for greater attention and concern for the SNS issues, particularly in setting up the teams, based on the skills mix, where the issues of training and supervision are crucial to the quality of developed processes and obtained results. Special attention is required to the workload that nurse practitioners are subject and to the need that health financing contemplates Safe Nurse Staffing as an essential condition for quality, sustainability and development of healthcare organizations.
The need to adequate nursing resources to the real needs of clients, maintaining a balance between quantity and skills, without neglecting quality and safety, has been a concern for managers. The absence of a consensual methodology to support the implementation of secure nurse staffing, was established as the starting point for this investigation which main goal was to develop an explanation model of Safe Nurse Staffing (SNS) and identify profiles of SNS. In the first phase we conducted a qualitative, exploratory, descriptive study with nursing managers, through semi-structured interview. Essential characteristics of SNS concept and some extrinsic variables capable of influence the SNS emerged and SNS indicators were identified. In a second phase, a study of a quantitative, transversal and correlational character was conducted. Data collection was achieved through a three sample questionnaire: nurses (629), chief-nurses (43) and clients (1290), admitted to 43 units in 8 hospitals with different management models. Psychometric assessment studies were followed through factorial exploratory analysis and confirmatory of the measuring instruments, which demonstrated adequate validity and reliability. Technics of Structural Equation Modelling and Clusters Analysis proved the relationships between Structure, Process and Results variables, identifying two SNS profiles and studied its impact on Results (confirming 15 sensitive to SNS Results indicators). The analysis of the relationship between the SNS’s Structure, Process and Results variables showed the influence of the Structure variables over Results of SNS, as well as Process variables over Results. "Availability of nurses with the right mix of skills", "Availability of nurses in adequate amount" and "Safe environment" (Structure variables) explain 2% of the variable variance of "Provision of quality nursing care" (Process variables), 15% of the variation of "Client satisfaction", 94% of the variation of "Risk and occurrence of adverse events on clients (Clients Result variables), 25% of the variation of "Nurses results" and 100% of the variation of "Organization results ". "Availability of nurses in adequate amount" denotes a direct and positive effect on "Organization Results", on "Nurses Results" and on "Clients Results". "Availability of nurses with appropriate skills mix" reveals a significant and positive effect on "Nurses Results". Regarding the influence of Process on Results, there was a direct effect found on "Provision of quality nursing care" over "Client Results" ("Client satisfaction" and "Risk and occurrence of adverse events"). Of the extrinsic variables to SNS, "Management Model" of the organization showed a significant effect over the Structure and Results variables of the SNS. The Clusters analysis exposed two different nurse staffing models profiles; the safer in 55,8% of the services appeared mostly in hospitals with a “Corporate Public Entity” management model, in services with lower occupancy rates and lower workload for nurses, with higher rates of client satisfaction with nursing care, with lower risk/ occurrence of adverse events and with lower nurse turnover rates. The proposed SNS model responds to nurse staffing effectiveness, showing simultaneously its effect on the observed results. It is noted the need for greater attention and concern for the SNS issues, particularly in setting up the teams, based on the skills mix, where the issues of training and supervision are crucial to the quality of developed processes and obtained results. Special attention is required to the workload that nurse practitioners are subject and to the need that health financing contemplates Safe Nurse Staffing as an essential condition for quality, sustainability and development of healthcare organizations.
Description
Keywords
Dotação de recursos para cuidados de saúde Recursos humanos de enfermagem Dotação segura enfermagem Liderança Comprometimento organizacional Modelo de gestão Allocation of resources to health care Nursing human resources Safe nursing staff Leadership Organizational commitment Management model