Care management: agreement between nursing prescriptions and patients' care needs

analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions.

Method:

descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed.

Results:

75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found.

Conclusion:

the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended.

Descriptors:
Patient Care Planning; Nursing Care; Nursing Process; Needs Assessment; Nursing

Authorship

Marília Silveira Faeda

RN, Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil. Master's Student, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.Faculdade de Medicina de São José do Rio PretoBrazilSão José do Rio Preto, SP, BrazilRN, Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil. Master's Student, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.

Márcia Galan Perroca

PhD, Professor, Departamento de Enfermagem Especializada, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.Faculdade de Medicina de São José do Rio PretoBrazilSão José do Rio Preto, SP, BrazilPhD, Professor, Departamento de Enfermagem Especializada, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.

Corresponding Author: Marília Silveira Faeda Faculdade de Medicina de São José do Rio Preto Av. Brigadeiro Faria Lima, 5416 Vila São Pedro CEP: 15.090-000, São José do Rio Preto , SP, Brasil E-mail: mafaeda@yahoo.com.br

SCIMAGO INSTITUTIONS RANKINGS

Tables

Tables (5)

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Table 1
Average number and absolute frequency of length of hospitalization (LH) and Care Needs (CN), according to the hospitalization unit (N=380). São José do Rio Preto, SP, Brazil, 2014

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Table 2
Comparison between the average number of nursing prescriptions and compatible items that met the patients' care needs per unit. São José do Rio Preto, SP, Brazil, 2014

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Table 3
Agreement between nursing prescriptions, patient demographic data, length of hospitalization, and PCI average score per hospitalization unit. São José do Rio Preto, SP, Brazil, 2014

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Table 4
Correlation between agreement of nursing prescriptions and nurse prescribers variables per hospitalization unit. São José do Rio Preto, SP, Brazil, 2014

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Table 5
Correlation between PCI care areas and agreement of nursing prescriptions. São José do Rio Preto, SP, Brazil, 2014

Table 1 Average number and absolute frequency of length of hospitalization (LH) and Care Needs (CN), according to the hospitalization unit (N=380). São José do Rio Preto, SP, Brazil, 2014

Units		LH (%)	CN (%)
Admission
	Emergency	-	5.8 (9.3)
	Medical clinic	-	5.9 (9.5)
	IPD*	-	5.6 (9.0)
	Palliative Care	-	6.7 (10.8)
	Cardio/hematology	-	6.7 (10.8)
	Pediatrics	-	6.2 (10.0)
	GO^‡	-	5.6 (9.0)
	Neurology/orthopedics	-	6.7 (10.8)
	Surgical clinic	-	6.2 (10.0)
	Transplantation	-	6.7 (10.8)
Discharge
	Emergency	3.3 (1.9)	5.7 (9.5)
	Medical clinic	18.7 (11.0)	5.0 (8.5)
	IPD*	40.7 (23.9)	5.2 (8.7)
	Palliative Care	17.0 (10.0)	6.3 (10.5)
	Cardio/hematology	27.4 (16.1)	6.0 (10.0)
	Pediatrics	11.1 (6.6)	5.7 (9.5)
	GO^‡	3.4 (2.0)	5.4 (9.0)
	Neurology/orthopedics	17.6 (10.3)	8.9 (14.9)
	Surgical clinics	4.7 (2.8)	5.6 (9.4)
	Transplantation	26.0 (15.4)	6.0 (10.0)

*IPD: Infectious and Parasitic Diseases; ‡GO: Gynecology and Obstetrics

Table 2 Comparison between the average number of nursing prescriptions and compatible items that met the patients' care needs per unit. São José do Rio Preto, SP, Brazil, 2014

Units		NP* M(sd)	CI† M(sd)
Admission
	Emergency	14.3 (3.5)	9.2 (3.1)‡
	Medical clinic	13.2 (3.0)	7.5 (2.6)‡
	IPD^§	13.3 (4.9)	8.3 (4.7)\|\|
	Palliative Care	14.1 (3.0)	9.6 (3.1)‡
	Cardio/hematology	16.6 (4.7)	11.0 (3.6)‡
	Pediatrics	16.2 (4.2)	12.4 (4.2)‡
	GO**	10.9 (5.4)	6.9 (3.8)\|\|
	Neurology/orthopedics	19.5 (7.0)	16.2 (6.8)††
	Surgical clinic	14.7 (3.9)	11.7 (3.6)\|\|
	Transplantation	17.3 (4.7)	14.3 (4.8)††
	Total	15.0 (4.4)	10.7 (4.0)‡
Discharge
	Emergency	15.5 (4.5)	10.1 (4.4)‡
	Medical clinic	16.0 (6.4)	11.1 (6.8)\|\|
	DIP^§	13.9 (5.2)	8.9 (5.4)††
	Palliative Care	14.9 (4.4)	10.4 (4.5)‡
	Cardio/hematology	18.5 (6.6)	13.0 (6.3)\|\|
	Pediatrics	17.0 (5.2)	13.2 (5.1)\|\|
	GO**	10.5 (5.1)	6.7 (3.6)‡
	Neurology/orthopedics	19.7 (8.2)	17.0 (8.1)††
	Surgical clinic	14.7 (4.0)	11.9 (3.8)\|\|
	Transplantation	17.2 (5.2)	14.2 (5.2)††
	Total	15.8 (5.5)	11.6 (5.3)‡

*NP: Nursing prescriptions; †CI: Compatible items; ‡p<0.01; §IPD: Infectious and Parasitic Diseases; ||p<0.05; **GO: Gynecology and Obstetrics; ††NS (Not Significant)

Table 3 Agreement between nursing prescriptions, patient demographic data, length of hospitalization, and PCI average score per hospitalization unit. São José do Rio Preto, SP, Brazil, 2014

Units	Sex	Age	LH*	PCI score^†
Emergency	0.15	0.10	0.29	0.19
Medical clinic	0.11	0.18	0.29	-0.16
IPD^‡	0.46	0.38	0.45	0.08
Palliative Care	0.22	0.16	0.19	0.23
Cardio/hematology	0.19	-0.39	0.02	-0.17
Pediatrics	0.58	-0.16	0.24	0.62
GO^\|\|	0.00	0.71	0.46	0.88
Neurology/orthopedics	0.13	0.43	0.03	0.34
Surgical clinic	0.23	-0.05	0.23	-0.22
Transplantation	0.26	-0.07	0.19	0.02
Total	0.23	0.13	0.24	0.18

*LH: Length of hospitalization; †PCI: Patient Classification Instrument; ‡IPD: Infectious and Parasitic Diseases; ||GO: Gynecology and Obstetrics.

Table 4 Correlation between agreement of nursing prescriptions and nurse prescribers variables per hospitalization unit. São José do Rio Preto, SP, Brazil, 2014

Units	Sex	Age	TPE*	TPE/HI^†	NC^‡	NP/N§
Emergency	0.38	0.27	-0.38	-0.53	-0.51	-0.53
Medical clinic	0.13	-0.03	0.02	0.01	0.04	0.16
DIP^\|\|	0.23	0.36	0.38	0.21	-0.19	-0.23
Palliative care	0.00	0.02	0.09	0.00	-0.18	-0.17
Cardio/hematology	0.00	-0.04	-0.07	-0.08	-0.09	-0.08
Pediatrics	0.00	0.09	0.09	0.09	0.00	0.09
GO**	0.00	0.09	0.07	0.18	0.02	0.07
Neurology/orthopedics	-0.07	0.29	0.29	0.29	0.10	0.27
Surgical clinic	0.00	0.22	-0.14	-0.14	-0.26	-0.22
Transplantation	0.00	0.36	0.41	-0.43	0.41	-0.02
Total	0.06	0.16	0.07	-0.04	-0.06	-0.06

*TPE: Time of professional experience; †TPE/HU: Time of professional experience in the Hospitalization Unit; ‡NC: Number of Collaborators; §NP/N: Nursing Prescriptions per Nurse; ||IPD: Infectious and Parasitic Diseases; **GO: Gynecology and Obstetrics.

Table 5 Correlation between PCI care areas and agreement of nursing prescriptions. São José do Rio Preto, SP, Brazil, 2014

Units		A1*	A2^†	A3^‡	A4^§	A5^\|\|	A6^¶	A7**	A8^††
Admission
	Emergency	0.65	-0.03	0.18	0.12	0.29	0.18	-0.14	-0.23
	Medical clinic	0.38	0.02	0.04	0.07	0.34	0.33	-0.22	-0.02
	IPD^‡‡	0.72	-0.07	0.09	0.01	0.19	0.94	0.27	0.04
	Palliative care	0.29	-0.17	0.07	-0.07	0.53	0.35	0.12	0.00
	Cardio/hematology	0.53	0.09	0.11	-0.03	0.72	0.21	0.00	0.09
	Pediatrics	0.72	0.13	-0.02	0.00	0.41	0.16	-0.02	0.00
	GO^\|\|\|\|	0.26	-0.14	0.00	0.00	0.43	0.54	-0.04	0.03
	Neurology/orthopedics	0.09	0.01	0.00	0.00	0.17	0.46	0.00	0.13
	Surgical clinic	0.36	-0.38	0.03	0.04	0.18	0.53	-0.23	0.21
	Transplantation	0.53	-0.02	0.14	0.08	0.23	0.52	-0.26	-0.06
	Total	0.45	-0.05	0.06	0.02	0.34	0.42	-0.05	0.01
Discharge
	Emergency	0.46	-0.02	0.23	0.10	0.34	0.22	-0.14	-0.23
	Medical clinic	0.52	0.07	0.00	0.09	0.71	0.31	-0.17	-0.03
	IPD^‡‡	0.81	-0.03	0.13	-0.03	0.52	0.97	0.24	0.01
	Palliative care	0.73	-0.16	0.09	-0.04	0.53	0.44	0.19	0.00
	Cardio/hematology	0.53	0.17	0.16	0.01	0.41	0.36	0.03	0.07
	Pediatrics	0.62	0.21	0.00	0.00	0.24	0.20	0.01	0.00
	GO^\|\|\|\|	0.46	-0.17	0.04	0.02	0.45	0.51	-0.02	0.11
	Neurology/orthopedics	0.34	0.06	0.00	0.00	0.17	0.42	0.00	0.18
	Surgical clinic	0.23	-0.38	0.05	0.02	0.23	0.66	-0.20	0.21
	Transplantation	0.19	0.07	0.24	0.09	0.34	0.62	-0.33	-0.05
	Total	0.49	-0.01	0.09	0.02	0.40	0.47	-0.03	0.02

A1*: Investigation/Monitoring; A2†:Body care/Eliminations; A3‡: Skin/mucosa care; A4§: Nutrition/Hydration; A5||: Mobility/Activity; A6¶: Therapeutics; A7**: Emotional support; A8††: Health Education; ‡‡IPD: Infectious and Parasitic Diseases;; ||||GO: Gynecology and Obstetrics.

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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Care management: agreement between nursing prescriptions and patients' care needs

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Mensagem

[1] Corresponding Author: Marília Silveira Faeda Faculdade de Medicina de São José do Rio Preto Av. Brigadeiro Faria Lima, 5416 Vila São Pedro CEP: 15.090-000, São José do Rio Preto , SP, Brasil E-mail: mafaeda@yahoo.com.br