Nursing care systematization in maternal and child service care: an action research


Ana Paula Vieira dos Santos Esteves1, Viviane Saraiva de Almeida1, Priscilla dos Santos Vigo1, Danielle Lemos Querido1, Joffre Amim Júnior1, Rita Bernardete Ribeiro Guérios Bornia1

1Federal University of Rio de Janeiro


Aim: To implement the systematization of nursing care (SNC) in the Maternity School of the Federal University of Rio de Janeiro.
Method: This is an action research. The theory chosen was that of Basic Human Needs as proposed by Wanda Horta. The ICNP® was selected as the single classification system for the terminology with regard to diagnoses, expected outcomes and nursing interventions. Data collection will be carried out in accordance with the implementation of the SNC in each sector of the institution, consisting of the following steps: documentary research based on documents produced by the nursing staff and on the nursing diagnoses of the patients; field research through systematic observation of the team work processes; and seminars. In order to analyze the data obtained in the survey of nursing problems, the terms extracted from the medical charts will be analyzed and classified according to the model of nursing diagnoses contained in ICNP® 2.0.
Descriptors: Nursing Care; Nursing Diagnosis; Nursing Theory; Pregnant Women; Postpartum Period; Newborn.



In order to ensure full quality nursing care it is necessary to have in place protocols, routines, standardization, development and modification of the work processes. Assuming that the Systematization of Nursing Care (SNC) helps to organize care, and makes possible the implementation of the nursing process, its implementation has been chosen as a priority for the structure of nursing care procedures at the institution.

The theory chosen was the Basic Human Needs as proposed by Wanda Horta. The ICNP® was selected as the single classification system with regard to the terminology of diagnoses, expected outcomes and nursing interventions.



The study scenario and implementation of the NCS will be the Adjacent Lodging, the Obstetric Center, the Neonatal Unit, and the Obstetric Emergency Department of the Maternity Hospital, Federal University of Rio de Janeiro.

The study subjects were previously identified, and will consist of nurses working in the areas described above.

In this study, a qualitative methodological approach will be adopted, and it will be used in conjunction with descriptive data. The method used will be action research, given that there is great deal of interaction between the researcher and the people involved in the process. From this relationship it is possible to identify the highest priority problems, which are considered to be the research objective, and the concrete actions needed to deal with them(1).

In this research, we must acknowledge the nursing care provided in the unit under study, as described by the authors during the implementation of the NCS, taking into consideration its steps and nuances, in order to plan and implement interventions (actions) as part of the process(2).

The research phases will be as follows: exploratory, identification of the research theme, problem presentation, seminars, data collection and action planning, ultimately leading to the creation of the SNC Implementation Flowchart at the Maternity School of UFRJ as shown below (Figure 1):


Figure 1 - Flowchart of SAE Implementation at the Maternity School of UFRJ.

Source: Maternity School of UFRJ, 2015 - Rio de Janeiro / RJ, Brazil.


Exploratory phase
For the exploratory stage the SNC committee was created.   This was established with the following objectives:

  1. Present the project and objectives of the research for consideration by the professionals of the institution;
  2. Submit the project to the Research Ethics Committee (REC);
  3. Identify potentialities and problems related by the nursing staff with regard to their work process and the SNC;
  4. Coordinate the implementation of the SNC in the institution.

Research theme
The general theme of the research has been defined previously, with a view to encouraging the participation of the researchers with regard to the individuals under investigation, taking into account the current legislation related to the NCS.

Problem presentation
Possible questions and problems related to the nursing work process will be brought to the individuals involved in this study.

The seminars will take place as part of the meetings of the NCS committee, where the main points related to each implementation phase of the NCS in the institution will be discussed.
In the action research seminars, all the information brought to the group and possible interpretations will be discussed(1).

At this stage, the researcher, as a member of the group, will perform together with group members, possible modifications relevant to specific issues.

In addition, during the group meetings, participants can absorb knowledge through reports, articles for discussion, development of routines, protocols, and standard operating protocols (SOP) presented by permanent or temporary members of the group.

Data collection
The first stage shall consist of documentary research, involving the search for documents produced by the nursing staff. The items to be searched are the SOP, routines, protocols, communication books used by the nursing team. In addition, there will be the construction of a form for collecting data to identify the main issues related to nursing/nursing diagnoses of the patients assisted in each area/sector, obtained through medical records’ research involving diagnoses chosen at random(3) during the period from August to December 2015.

The sample size of 292 records was obtained based on the number of admissions to the institution (the total population) in 2014.

The second stage will consist of field research through systematic observation and participation in the work of the nursing team.

The third stage will be held during meetings of the SNC committee (seminars), when the group will provide data and propose solutions for the implementation of the NCS in the institution.

To analyze the data obtained in the survey of nursing problems, the terms extracted from the medical charts will be analyzed and classified according to the model of nursing diagnoses contained in ICNP® 2.0.

Action plan
- Preliminary stages for action plan implementation:

  1. Providing the nursing team with details of the NCS theme; 
  2. Training of the nursing team;
  3. Choice of the theoretical framework.

- Action plan stages:

  1.  Elaboration of the NCS-related documents;
  2.  Implementation of the nursing process.

Project data
The research was approved by the Research Ethics Committee of the institution, according to Resolution 466/2012, under Opinion No. 1,165,734, on July 31 2015.



1. Thiollent M. Metodologia da pesquisa-ação. São Paulo: Cortez; 2011.

2. Almeida VS,  Andrade M, Silva GRG, Monteiro JLS, Silva GD, Querido DL. The work process of a medication team at the neonatal intensive care unit. Journal of Nursing UPFE (online) [ internet ]. 2013 May [ cited 2015 Aug 21 ] 7 (5): 4299-303. Avaible from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/viewArticle/4470

3. Melo IDF, Menezes ANSA, Almeida VS, Silva GRG, Querido DL, Andrade M. Medication errors and medication teams: a descriptive study. Online braz j nurs [ Internet ]. 2013 October [ Cited 2015 Aug 22 ] 12 (0): 728-30. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4478.



All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf



Received: 08/28/2015
Revised: 11/12/2015
Approved: 11/12/2015