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Authors
Abstract(s)
A realização dos ensinos clínicos do Curso de Licenciatura em Enfermagem (CLE) em
instituições de saúde assume-se como uma problemática de estudo pertinente para as
instituições de ensino e hospitalares, de modo a melhorar os processos de aprendizagem e
a eficiência da gestão.
Neste pressuposto definimos como objetivo identificar os custos da formação dos
estudantes de enfermagem em ensino clínico nas instituições hospitalares, mensurado
através da análise do indicador de estrutura relacionado com os recursos materiais em
termos de consumo de artigos associados aos cuidados de enfermagem, do indicador de
processo relacionado com os recursos humanos, nomeadamente quanto ao tempo
despendido pelos enfermeiros na prestação de cuidados aos doentes, e indicador de
resultados no que se refere à satisfação do cidadão face aos cuidados de enfermagem
prestados, tendo sempre em perspetiva a análise comparativa dos custos hospitalares
durante a presença e ausência de estudantes de enfermagem em ensino clínico.
O presente estudo de caráter descritivo-correlacional e transversal foi realizado no Centro
Hospitalar Tondela Viseu, E.P.E., no ano de 2011, abrangendo 4 serviços de Medicina e 4
de Cirurgia, locais de realização de Ensinos Clínicos do CLE da Escola Superior de
Saúde de Viseu.
O protocolo de pesquisa incluiu um “Corpus documental” de artigos consumidos no ano,
uma grelha de observação elaborada por Ribeiro, Vieira & Cunha para registo do tempo
de cuidados diretos prestados pelos enfermeiros durante as 159 observações efetuadas no
turno da manhã, e a Escala de Satisfação do Cidadão face aos Cuidados de Enfermagem
de Rodrigues e Dias (2003), nas dimensões experiência e opinião, numa amostra de 115
cidadãos internados nos serviços de Medicina e Cirurgia.
Os resultados evidenciaram um consumo de 3.259.687 artigos, os quais aportaram o custo
total de 178.678,40€, correspondendo à presença de estudantes 90.623,64€. O acréscimo
de gastos resultantes da presença de estudantes foi de 2.568,88€ cujo custo dia de estágio
por serviço, com 10 estudantes, representa a importância de 31,71€ (0,33€ estudante/dia).
O tempo médio despendido por enfermeiro/doente na prestação de cuidados no turno foi
de 31,69 minutos, correspondendo ao período sem estudantes o tempo de 38,55 minutos e com estudantes de 27,12 minutos, sendo a diferença de tempos bastante significativa
(t=3,109;p=.002).
Em termos de satisfação do cidadão obteve-se na dimensão experiência o score de 173,92
(dp=16,21; CV=9,32%) (Máximo 196; Mínimo 28) e na opinião de 80,58 (dp=12,32;
CV= 15,29%) (Máximo 95; Mínimo 19). Nesta dimensão, os resultados relativos aos
estudantes foram superiores, obtendo-se um score de 83,78 (dp=10,29; CV=12,28%), cuja
diferença foi altamente significativa (t=-4,511; p=0,000).
As inferências evidenciam que a presença de estudantes em EC nos hospitais leva ao
acréscimo de custos em gastos de materiais (3,3€/turno), custos amortecidos pela oferta
de serviços gratuitos proporcionados pela presença desses mesmos estudantes,
correspondente a 11,43 minutos por doente. Verificou-se um custo/minuto de cuidados de
enfermagem de 1,55€ para 16 doentes com acompanhamento de estudantes, obtendo-se
assim um saldo positivo de 21,57€/turno. Como reforço positivo dos resultados obtidos
nos dois indicadores, o cidadão evidenciou melhores níveis de satisfação relativamente
aos cuidados prestados pelos estudantes.
Concluímos pois da mais-valia da realização dos ensinos clínicos de enfermagem nas
instituições hospitalares, pelo que as parcerias escola-meio clínico, deverão ser
estabelecidas e reforçadas num ambiente relacional responsável e de mútua confiança,
imprescindível para a qualidade de cuidados que se deseja nas instituições de saúde e para
o desenvolvimento de capacidades que se pretendem atingir durante o processo formativo
dos estudantes.
The Nursing Degree Course (NDC) internships realization is assumed as a pertinent study problem for the teaching and hospital institutions, in a way to improve the learning processes and the efficiency of management. Having this, a goal to identify the costs of the nursing students clinical teaching formation in hospital institutions was defined, measured through the analysis of a structure indicator related to the material resources, about the supplies consumption associated with nursing care, a process indicator related to the human resources, particularly about the time spent by nurses provisioning care to patients, and a results indicator in what concerns to the degree of citizen satisfaction facing the nursing cares provided, always having in mind the comparative analysis of the hospital costs during the presence and absence of nursing students in Clinical Teachings. The present study of a descriptive-correlational and transversal character was realized on the Hospital Centre Tondela Viseu, E.P.E., on the 2011 year, involving 4 Medicine and 4 Surgery Services, where the Clinical Teachings of the Health School of Viseu NDC take place. The research protocol included a “Documental Corpus” of the year consumed supplies, an observation grid elaborated by Ribeiro, Vieira & Cunha, for the registration of time of direct cares provided by nurses during the 159 observations realized on the morning shift, and to the Citizen Satisfaction Facing Nursing Care Scale of Rodrigues e Dias (2003) on the experience and opinion dimensions, in a sample of 115 citizens inpatient in the Medicine and Surgery services. The results highlighted a consumption of 3.259.687 items, which had a total cost of 178.678,40€, corresponding 90.623,64€ to the presence of students. The cost increase resulting from the presence of students was 2.568,88€, whose cost per day of internship per service, with 10 students, represents the amount of 31,71€ a day (0,33€ per student/day) .The average time spent per nurse/patient on care provision during the shift was 31,69 minutes, corresponding to the period without students the time of 38,55 minutes, and with students 27,12 minutes, being the time difference very significant (t=3,109; p=0,002). About the citizen satisfaction, on the experience dimension a score of 173,92 (sd= 16,21; VC= 9,32%) (Maximum 196; Minimum 28) was obtained, and on opinion 80,58 (sd= 12,32; VC= 15,29%) (Maximum 95; Minimum19). In this dimension the results relative to students were higher, obtaining a score of 83,78 (sd= 10,29; VC= 12,28%), being the difference highly significant (t= -4,511; p= 0,000). The inferences show that the presence of students in CT in the hospitals leads to costs increase in material spendings (3,3€/shift), costs damped by the offering of free services provided by the presence of the same students, corresponding to 11,43 minutes per patient. A cost/minute of nursing cares of 1,55€ for 16 patients accompanied by students was observed, leading to a positive balance of 21,57€/shift. As a positive reinforcement of the results on these two indicators, citizens evidenced better satisfaction levels relative to student rendered cares. It is thus concluded of the advantage of nursing CT realization on hospital institutions, so school-clinical environment partnerships ought to be established and reinforced in a responsible relational environment and of mutual trust, crucial to the quality of care desired for the health institutions and to the development of competences intended to be attained during the students’ formative process.
The Nursing Degree Course (NDC) internships realization is assumed as a pertinent study problem for the teaching and hospital institutions, in a way to improve the learning processes and the efficiency of management. Having this, a goal to identify the costs of the nursing students clinical teaching formation in hospital institutions was defined, measured through the analysis of a structure indicator related to the material resources, about the supplies consumption associated with nursing care, a process indicator related to the human resources, particularly about the time spent by nurses provisioning care to patients, and a results indicator in what concerns to the degree of citizen satisfaction facing the nursing cares provided, always having in mind the comparative analysis of the hospital costs during the presence and absence of nursing students in Clinical Teachings. The present study of a descriptive-correlational and transversal character was realized on the Hospital Centre Tondela Viseu, E.P.E., on the 2011 year, involving 4 Medicine and 4 Surgery Services, where the Clinical Teachings of the Health School of Viseu NDC take place. The research protocol included a “Documental Corpus” of the year consumed supplies, an observation grid elaborated by Ribeiro, Vieira & Cunha, for the registration of time of direct cares provided by nurses during the 159 observations realized on the morning shift, and to the Citizen Satisfaction Facing Nursing Care Scale of Rodrigues e Dias (2003) on the experience and opinion dimensions, in a sample of 115 citizens inpatient in the Medicine and Surgery services. The results highlighted a consumption of 3.259.687 items, which had a total cost of 178.678,40€, corresponding 90.623,64€ to the presence of students. The cost increase resulting from the presence of students was 2.568,88€, whose cost per day of internship per service, with 10 students, represents the amount of 31,71€ a day (0,33€ per student/day) .The average time spent per nurse/patient on care provision during the shift was 31,69 minutes, corresponding to the period without students the time of 38,55 minutes, and with students 27,12 minutes, being the time difference very significant (t=3,109; p=0,002). About the citizen satisfaction, on the experience dimension a score of 173,92 (sd= 16,21; VC= 9,32%) (Maximum 196; Minimum 28) was obtained, and on opinion 80,58 (sd= 12,32; VC= 15,29%) (Maximum 95; Minimum19). In this dimension the results relative to students were higher, obtaining a score of 83,78 (sd= 10,29; VC= 12,28%), being the difference highly significant (t= -4,511; p= 0,000). The inferences show that the presence of students in CT in the hospitals leads to costs increase in material spendings (3,3€/shift), costs damped by the offering of free services provided by the presence of the same students, corresponding to 11,43 minutes per patient. A cost/minute of nursing cares of 1,55€ for 16 patients accompanied by students was observed, leading to a positive balance of 21,57€/shift. As a positive reinforcement of the results on these two indicators, citizens evidenced better satisfaction levels relative to student rendered cares. It is thus concluded of the advantage of nursing CT realization on hospital institutions, so school-clinical environment partnerships ought to be established and reinforced in a responsible relational environment and of mutual trust, crucial to the quality of care desired for the health institutions and to the development of competences intended to be attained during the students’ formative process.
Description
Keywords
Educação Enfermagem Custos Satisfação cidadão Cuidados Education Nursing Costs Citizen satisfaction Care