Antônio Fernandes Costa Lima

Desenvolvimento de Sistema Eletrônico de Documentação Clínica de Enfermagem estruturado em diagnósticos, resultados e intervenções

A documentacao eletronica de enfermagem constitui documentos tecnicos, cientificos, legais e eticos de saude. Este artigo e o relato de estudo de desenvolvimento de um sistema de documentacao eletronica de enfermagem. O sistema foi desenvolvido em 4 fases (conceituacao, detalhamento, elaboracao de prototipo e implantacao) e a base de conhecimento foi organizada em hierarquia de dominios e classes, segundo a estrutura unificada das classificacoes NANDA-I, NIC e NOC. O resultado foi o desenvolvimento do sistema eletronico PROCEnf-USP (Sistema de Documentacao Eletronica do Processo de Enfermagem da Universidade de Sao Paulo) que permite a documentacao clinica e a geracao de relatorios do processo de enfermagem, alem de fornecer apoio as decisoes sobre diagnosticos, resultados esperados e intervencoes de enfermagem. Os fatores de exito desse projeto de producao tecnologica compreenderam a articulacao de diferentes areas de conhecimento, bem como a valorizacao do continuo aprimoramento teorico-pratico do processo de enfermagem da instituicao.Received: 09/15/2009 Approved: 11/12/2009 Portuguese / English: www.scielo.br/reeusp RESUMO A documentação eletrônica de enfermagem constitui documentos técnicos, científicos, legais e éticos de saúde. Este artigo é o relato de estudo de desenvolvimento de um sistema de documentação eletrônica de enfermagem. O sistema foi desenvolvido em 4 fases (conceituação, detalhamento, elaboração de protótipo e implantação) e a base de conhecimento foi organizada em hierarquia de domínios e classes, segundo a estrutura unificada das classificações NANDA-I, NIC e NOC. O resultado foi o desenvolvimento do sistema eletrônico PROCEnf-USP (Sistema de Documentação Eletrônica do Processo de Enfermagem da Universidade de São Paulo) que permite a documentação clínica e a geração de relatórios do processo de enfermagem, além de fornecer apoio às decisões sobre diagnósticos, resultados esperados e intervenções de enfermagem. Os fatores de êxito desse projeto de produção tecnológica compreenderam a articulação de diferentes áreas de conhecimento, bem como a valorização do contínuo aprimoramento teórico-prático do processo de enfermagem da instituição.

O processo de implementação do diagnóstico de enfermagem no Hospital Universitário da Universidade de São Paulo

More than two decades ago the Nursing Department at the University Hospital of the University of São Paulo implemented the care model called Nursing Care System (NCS), which is comprised of three phases: Background, Evaluation and Nursing Prescription. Since then, it is being developed by the Nursing Department nurses as a guiding instrument for care, teaching and research. Having in mind the automation of the NCS, the nurses began to discuss the need for changes that could speed up the work process with the proposal of implementation of the Nursing Diagnosis as another step of the NCS and with the review of nursing action/interventions. In order to do so, the adoption of a standardized system of the care process language became essential so as to make possible data capture, grouping and classification for analysis and their transformation into information. The present study aims at sharing with other nurses this experience on the implementation process of the Nursing Diagnosis as a second step of the NCS.More than two decades ago the Nursing Department at the University Hospital of the University of Sao Paulo implemented the care model called Nursing Care System (NCS), which is comprised of three phases: Background, Evaluation and Nursing Prescription. Since then, it is being developed by the Nursing Department nurses as a guiding instrument for care, teaching and research. Having in mind the automation of the NCS, the nurses began to discuss the need for changes that could speed up the work process with the proposal of implementation of the Nursing Diagnosis as another step of the NCS and with the review of nursing action/interventions. In order to do so, the adoption of a standardized system of the care process language became essential so as to make possible data capture, grouping and classification for analysis and their transformation into information. The present study aims at sharing with other nurses this experience on the implementation process of the Nursing Diagnosis as a second step of the NCS.

Indicadores de qualidade no gerenciamento de recursos humanos em enfermagem

This study will delineate with six nurses developing administrative activities, the meanings concerning quality indicators of Human Resources Management in Nursing. Data were obtained by means of interviews which allowed the construction of two categories: Administrative Activities - consisted of Meaning Units (MU) Permanent/Continuing Education; Labor Organization/ Decision-making participation; Dimensioning personnel/Time to replace vacancies and Human Resources - with the MU Absenteeism; Job Rotation Employees; Scientific Education/Title/Production; Labor Accident Reports/Occupational Diseases/Leave of Absence and Labor Satisfaction/ Dissatisfaction. The nurses reports allowed us to rescue important information to identify new constitutive elements of management quality in nursing human resources and confirmed the use of well-known indicators.Este estudo resgata junto a seis enfermeiras que desenvolvem atividades gerenciais os significados que consideram constitutivos de indicadores de qualidade no gerenciamento de Recursos Humanos em Enfermagem. Os dados obtidos por meio de entrevistas possibilitaram a construcao de duas categorias: Atividades Gerenciais - constituidas pelas Unidades de Significado (US) Educacao Permanente/Continuada; Organizacao do trabalho/Participacao na tomada de decisao; Dimensionamento de pessoal/Tempo para reposicao de vagas e Recursos Humanos - com as US Absenteismo; Rotatividade; Formacao/Titulacao/Producao Cientifica; Acidentes de Trabalho/Doencas Ocupacionais/Licencas e Satisfacao/Insatisfacao no Trabalho. As narrativas das colaboradoras possibilitaram o resgate de informacoes que permitiram a identificacao de novos elementos constitutivos de indicadores de qualidade de gerenciamento de Recursos Humanos em Enfermagem e referendaram o uso de indicadores ja consagrados.

História oral de vida: buscando o significado da hemodiálise para o paciente renal crônico

This article has the objective to show the use of life oral history as methodological framework for qualitative data collection and analysis, aimed to understand the meaning of hemodialysis and the impact of this therapeutic modality of treatment in the patients life in the Hemodialysis Unity at the University Hospital at the University of São Paulo.This article has the objective to show the use of life oral history as methodological framework for qualitative data collection and analysis, aimed to understand the meaning of hemodialysis and the impact of this therapeutic modality of treatment in the patients life in the Hemodialysis Unity at the Universitary Hospital at the University of Sao Paulo.Este articulo tiene como objetivo mostrar la utilizacion de la historia oral de vida como referencial metodologico, para la obtencion de datos cualitativos, de una investigacion realizada con la finalidad de comprender el significado de la hemodialisis y el impacto de esta modalidad terapeutica de acuerdo a la vida de pacientes del servicio de Hemodialisis del Hospital Universitario de la Universidad de Sao Paulo.

Avaliação de sistema eletrônico para documentação clínica de enfermagem

OBJETIVO: Presentar la evaluacion de un sistema electronico para la documentacion del proceso de enfermeria (PE) en la perspectiva de enfermeras usuarias. METODOS: Estudio exploratorio, descriptivo realizado con 16 enfermeras del Hospital Universitario de la Universidad de Sao Paulo. Las enfermeras evaluaron modulos y pantallas del Sistema de Documentacion Electronica del Proceso de Enfermeria de la Universidad de Sao Paulo - PROCEnf-USP, juzgando el confort visual, manipulacion, claridad y extension de la documentacion, objetividad de las informaciones y adecuacion del contenido al registro de enfermeria en unidades clinico-quirurgicas. RESULTADOS: La mayoria de las enfermeras evaluo las caracteristicas funcionales del PROCEnf-USP, como excelentes y muy buenas, destacando el soporte al raciocinio clinico al apoyar decisiones sobre diagnosticos, resultados e intervenciones de enfermeria. Todas tomaron posicion favorable respecto a la implementacion del PROCEnf-USP. CONCLUSION: Los resultados de la evaluaciones mostraron que las enfermeras estan estimuladas para adquirir nuevas habilidades tecnicas y tecnologicas, como la adopcion del PROCEnf-USP para la documentacion del PE en la realidad Institucional.Objective: To present the evaluation of an electronic system for documenting the nursing process (NP) from the perspective of nurse users. Methods: This exploratory, descriptive study was conducted with 16 nurses at the University Hospital at the University of Sao Paulo. The nurses assessed modules and system screens of the Electronic Documentation System of the Nursing Process of the University of Sao Paulo (PROCEnf –USP) judging visual comfort, handling, clarity and completeness of documentation, objectivity and adequacy of the information content of the nursing record in clinical and surgical units. Results: The majority of the nurses evaluated the functional characteristics of the PROCEnf-USP as excellent or very good, highlighting the clinical reasoning support for decisions about diagnoses, outcomes and nursing interventions. All positioned themselves favorably to the implementation of PROCEnf-USP. Conclusion: The results of the evaluations showed that the nurses are encouraged to acquire new technical skills and technology, with the adoption of PROCEnf-USP, for the documentation of the NP in the institutional reality.

Cost of nursing staffing adequacy in a neonatal unit

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.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 Sao 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.

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.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.

Meanings of the nursing diagnosis implementation process for nurses at a university hospital

This qualitative study aims to understand the meanings nurses at a university hospital attribute to the implementation process of the Nursing Diagnosis Classification System (DEn) as a phase in the Nursing Care System (NCS). Data were collected through interviews with eight nurses from the Medical Clinical Unit, who participated in the creation of an instrument to implement the DEn in the NCS. In their reports, the respondents expressed a positive change in their feelings, from initial discomfort and adverse perception of the change proposal. The stepwise appropriation of the process stages allowed them, besides the sharing of feelings, decisions and responsibilities for the results, to develop the belief that they would able to overcome the difficulties.This qualitative study aims to understand the meanings nurses at a university hospital attribute to the implementation process of the Nursing Diagnosis Classification System (DEn) as a phase in the Nursing Care System (NCS). Data were collected through interviews with eight nurses from the Medical Clinical Unit, who participated in the creation of an instrument to implement the DEn in the NCS. In their reports, the respondents expressed a positive change in their feelings, from initial discomfort and adverse perception of the change proposal. The stepwise appropriation of the process stages allowed them, besides the sharing of feelings, decisions and responsibilities for the results, to develop the belief that they would able to overcome the difficulties.

Levantamento das principais fontes de desperdício de unidades assistenciais de um hospital universitário

Este estudo teve como principais objetivos levantar os diferentes tipos de desperdicio, suas causas e sugestoes para elimina-los, segundo a opiniao de profissionais de enfermagem e medicos atuantes em unidades de Clinica Medica, Clinica Cirurgica, Pediatria, Alojamento Conjunto e Bercario; e estimar o custo da principal fonte de desperdicio nessas unidades. Trata-se de um estudo descritivo, exploratorio, com abordagem quantitativa realizado no Hospital Universitario da Universidade de Sao Paulo. A amostra foi constituida por 189 profissionais de enfermagem e medicos. O desperdicio relacionado aos materiais (36%) foi o mais apontado por todas as categorias profissionais seguido pelo desperdicio de estrutura fisica (27%). Os materiais desperdicados mais citados foram os medicamentos, pacotes de curativo, papel sulfite e dispositivos de infusao. O custo do desperdicio anual com materiais nas unidades estudadas pode girar em torno de R

Assessment of an electronic system for clinical nursing documentation

479.262,86.The objectives of this study were to survey the different types of waste, their causes and suggestions to eliminate them according to the opinion of the nursing and medical staff from the Clinical Medicine, Surgery, Pediatrics, Rooming-In, and Nursery Units; and estimate the cost of the major source of waste found in the referred units. This descriptive, explorative study was performed at the University of São Paulo Teaching Hospital using a quantitative approach. The study sample consisted of 189 medical and nursing professionals. Material waste (36%) was the most often reported by all professional categories, followed by physical structure waste (27%). The most reported wasted materials were medicines, dressing packs, stationary paper, and infusion devices The estimated annual cost of material waste in the studied units is about R