The utilization of nursing
hours in operating rooms, according to the patient’s complexity and the
surgical anesthetic procedure.
Ana Lúcia De Mattia – Escola de Enfermagem da Universidade de São Paulo
Profa. Dra. Maria Alice Fortes Gatto - Escola de Enfermagem da Universidade de São Paulo
Bibliografic reference:
De Mattia AL. The utilization of nursing hours in operating rooms,
according to the patient’s complexity and the surgical
anesthetic procedure. [thesis]. São Paulo (SP): USP - University of São Paulo
Nursing School;
2002.
Abstract. This is a
case study with exploratory character, descriptive and comparative, and a
fieldwork with a quantitative approach. It aims to classify the
surgeries in categories according to the number of nursing hours in operating
rooms, subsidizing the dimensioning of the nursing staff in operating rooms. It
was performed in a large general private Hospital in São Paulo. The
sample was constituted of 140 patients, divided into 14 groups, 10 patients on
each group. To organize the groups it was taken on account the patient’s
physical condition, according to the American Society of Anesthesiologists
(ASA), the anesthetic complexity, according to the Brazilian Medical
Association (BMA), the sort of surgical anesthetic procedure: invasive, or minimally invasive (MI) and elective surgeries.
According to the patient’s physical condition, groups were constituted with
ASA1, ASA2 and ASA3. ASA 4 was put away because there were no cases, and ASA
5 and ASA 6 were put away because they were urgency or emergency surgeries. As
to the anesthetic complexity, surgeries were classified as presenting small
complexity, mean complexity, large complexity and special complexity. Therefore
groups were symbolized as: 1S, 1M, 1L, 1S, 2S, 2M, 2L, 2S, 3M, 3L, 3S, 1SMI,
1MMI AND 2AMI. Data were collect inside the operating
rooms, by means of organized observation, according to a guide presenting items
referring to the surgery characteristics, human resources, patient’s physical
condition and surgical anesthetic procedures. Data analysis was performed
according to the surgical patient’s characteristics, hours taken by human
resources and by the patient, procedures and material resources employed. In
the comparison among groups, the characterization of the surgical patient led
to the following results: as to gender, 83 (59,29%)
female and 57 (40,71%) male, the higher age frequency was between 30 and 40
years in 34 (24,29%) of the patients. The most frequent surgical specialties
were otorhinolaryngology and traumatology
in 23 (16,43%), gynecology and obstetrics in 21 (15%)
and orthopedics and traumatology in 21 patients
(15%). General anesthesia prevailed in 75 (53,58%) of
the patients. Concerning the systemic disorders that characterize the ASA,
cardiovascular disorders prevailed in 52 (65%) of the patients, 40 (50%)
presenting systemic arterial hypertension and 16 (20%) presenting diabetes
Mellitus. As to the hours taken, the average hours taken by patients was: 3,40 hours
of nursing (NH); 0,10 hours of nurse (NeH); 3,28
hours of nursing assistant (NaH); 6,14 hours of
medical staff (MSH); 1,12 hours of surgery (SH), 1,95 hours of operating room
(ORH); 0,21 hours of anesthetic preparation (APH) and 0,16 hours of surgery
preparation (SPH). For one SH, the average hours taken for each patient was:
3,54 NH; 0,14 NeH; 3,40 NaH;
3,08 MSH and 0,54 SH. Concerning to the procedures taken, the average of
invasive procedures was 2,04 and non-invasive procedures 5,70; total procedures
7,74. The average material resources used for anesthesia was 4,19 equipment and for surgery 2,76 equipment; total 6,95
equipment. In the statistical analysis of groups referring to the ASA,
according to the anesthetic complexity, results evidenced that small and mean
anesthetic complexity presented no significant difference, and were inferior to
large and special complexity in variables NH, NaH and
MSH; as to the anesthetic complexity according to the ASA the results evidenced
that there were almost none difference among the ASA. In the group of minimally
invasive surgeries, there was difference only in the material resources, that
were superior according to the anesthetic complexity and in the analysis
comparing groups of invasive and minimally invasive surgeries with similar
anesthetic complexity and ASA the results evidenced that groups of invasive
surgeries were significantly inferior in the studied variables in relation to
groups of minimally invasive surgeries. Therefore, this study concludes that the
NH are related to the anesthetic complexity, and the
more complex the anesthetic surgical procedure, the more nursing hours are
taken. The relation of NH taken with the patient’s physical condition was not
observed. Thus a classification of surgeries in categories was done, according
to the necessary nursing hours for one hour of operating room, that is:
standard nursing cares, 1,41 hours; complex nursing
cares, 1,99 hours and differentiate nursing cares, 1,78 hours.
Main Bibliography
(1) Association
of Operating Room Nurses. Standards, recommended practices & guidelines. Denver; 1999.
(2) Conselho Federal de Enfermagem.
Resolução n. 189/96. Estabelece parâmetros para o dimensionamento do quadro de
profissionais de enfermagem nas instituições de saúde. Documentos básicos de
enfermagem. Principais leis e resoluções que regulamentam o exercício
profissional de enfermeiros, técnicos e auxiliares de enfermagem. São Paulo:
Demais editora; 2001. p. 144-50
(3) Gaidzinski RR. Dimensionamento de pessoal de enfermagem em
instituições hospitalares. [Livre docência] São
Paulo (SP): Escola de Enfermagem da USP; 1998.
(4) Gatto MAF. Análise da utilização das salas de operações.
[tese] São Paulo (SP): Escola de Enfermagem da
USP; 1995.
(5) Ide P, Kirby KK, Starck PK. Operating room productivity: an evoluation format. J Nurs Adm 1992; 22 (10):41-8.
Address for correspondence. Rua Godofredo Fraga, nº
52, apto 23, Bairro Marapé – Santos (SP), CEP. :
11070-400. E.mail: almattia@uol.com.br
Tel.: 0xx-13-3252-4507 /0xx13-8132-7460
Received
Aug 29th, 2007
Accepted:
Sep 12th , 2007