Propuesta de una nueva escala de valoración de cargas de trabajo y tiempos de enfermería (VACTE ©)

Abstract

La escala Nine Equivalents of Nursing Manpower use Score (NEMS) para la valoración de las cargas asistenciales de enfermería es la más conocida y aplicada a nivel mundial. Sin embargo, le encontramos una serie de limitaciones: no refleja la actividad «propiamente enfermera», sólo cuidados derivados de la intervención médica, y está directamente relacionada con la gravedad, mientras que la atención integral del paciente implica infinidad de cuidados, no necesariamente relacionados con la gravedad. Además, entendemos que las ratio de personal planificadas pueden ser inapropiadas, con las consecuentes repercusiones para el paciente, el personal de enfermería y la institución sanitaria. Los objetivos principales fueron: elaboración de una escala representativa de todas las tareas y cuidados realizados por el personal de enfermería de nuestra unidad (VACTE © ), determinar si resulta más precisa y objetiva que NEMS para la medición de las cargas de trabajo y calcular la ratio paciente-enfermera operativa en función de la nueva escala propuesta. Realizamos un estudio descriptivo y retrospectivo sobre 91 pacientes ingresados en la Unidad de Cuidados Intermedios de la Fundación Hospital de Jove, durante el primer trimestre de 2004. Previamente creamos la escala VACTE © , realizando La escala VACTE © resultó ser representativa de la actividad enfermera y parece ser más eficaz que NEMS para determinar cargas de trabajo. La ratio planificada en la unidad duplicó a la ratio operativa calculada. The scale Nine Equivalents of nursing Manpower use Score (NEMS) for the evaluation of the nursing care loads is the most well known and applied worldwide. Nevertheless, we have found a series of limitations: it does not reflect the «proper nursing activity» but only the cares related to the medical intervention. Furthermore, it is directly related to severity while integral attention to the patient implies an infinity of cares, which are not necessarily related to the severity. In addition, we understand that the planned personnel ratios may be unsuitable, with the consequent repercussions for the patient, nurses and the sanitary institution. The primary targets were: elaboration of a representative scale of all the cares and tasks made by the nurses (VACTE © ) in our unit, to determine if it is more precise and objective than NEMS for the measurement of the service loads and to calculate the operative ratio patient-nurse based on the new proposed scale. We made a descriptive and retrospective study on 91 patients admitted to the Intermediate Care Unit of the Fundación Hospital de Jove during the first three months of 2004. Previously we created scale VACTE © , making real measurements of the time inverted in the execution of each one of the cares in 50 patients. Later, a comparison was made between the APACHE II, NEMS and VACTE © scales, taking as reference the scores obtained in the same ones during the first 24 hours of the stay. The statistical analysis was made by SPSS 11.0, assuming a confidence level of 95% (p < 0.05): lineal analysis of simple regression to compare the different scales; the force of its correlation with Spearman's coefficient and we compared the independent dichotomize variables with the Mann-Whitney test. The main results determined after the study were the following: regarding the scale to evaluate seriousness applied to the patients, an average APACHE II score of 12.1 ± 5.9 was obtained. The average value with the NEMS was 19.5 ± 5.7 and the average one with VACTE(c) was 365 ± 91.2. Significant differences were found between APACHE II and the NEMS (p = 0.008) and VACTE(c) (p < 0.001) scales. This relationship presented more force with VACTE © (r = 0.43; p < 0.001) than with NEMS (r = 0.23; p = 0.002). The operative patientnurse ratio calculated with VACTE © was 2.01. Scale VACTE © is representative of nursing activity and seems to be more effective than NEMS to determine service loads. The ratio planned in the unit duplicated the calculated operative ratio.