FIRST EVALUATION OF NURSE’S CARE
AT EMERGENCY ROOMS: THE APPROXIMATE OF MODEL THE CASE MANAGEMENT STRATEGY
Marcia Silva Valentim, MPEA/UFF.
Advisor: Drº Mauro Leonardo Salvador Caldeira dos Santos/ Escola de Enfermagem - Universidade Federal Fluminense (UFF)
Bibliografic reference: Valentim MRS. Avaliação primária do
enfermeiro na emergência: a aproximação da estratégia do modelo de
Gerenciamento de Caso. [Dissertação] Niterói (RJ):
Universidade Federal Fluminense;
2006.
Abstract: This paper reflects the current problem of
difficulties in attending first care cases at emergency rooms in health care
and the population difficulty to make an immediate appointment at day units,
causing an increase in the number of people who look for tertiary care
services, overloading the emergency rooms1 2. The scenario observed
at the moment is that the emergency rooms from private and public hospitals are
gradually getting more and more full, making the real emergency care patient,
whose life is in risk, wait for hours for a medical care3. The
purpose of this research is to identify the effectiveness of the nurse’s care
in the first evaluation and to describe the use of the case management4
strategy in the emergency room. The main scope of the discussions about the
case manager role was based on a Commission that focus the definition of
management as a pro-active process, which provides access to a care with
quality, safety, efficiency and in a short time, where the case manager works
with 07 elements to develop his/her activities: Punctuation, Planning,
Implementation, Coordination, Monitorizing,
Evaluation and Results5. For quantity approach research, the
statistical method was used, whereas for data collect and analysis, the EPI
INFO software was used. The collect of data was done with 1,184 medical care
reports collected in January and February of 2005 from adult patients of
medical clinic with 1, 2 and 3 clinical complexity cared by the nurse on the
first evaluation. The variables taken from the medical care reports were divided
in three categories to identify the effectiveness and describe the link of the
Case Manager on the first evaluation made by the nurse in the emergency room:
Care fragment, Clinic making decision and Care Monitorizing.
The results found in the fragment care category were: In complexity 1: 65,8% of patients did not have fragmented care, in complexity
2: 78,3% and in complexity 3: 82,6%. In making decision category the results
found were that from the patients cared by the nurse, 68,8%
had their syndromic diagnoses checked. In care monitorizing, the patients of complexity 3: 34,6% had monitorized care related
to the risk factors. We conclude that the relation to
what it is offered by the nurse care generates effectiveness, however in
relation to the ideal we face limits in the medical reports. On the other hand,
the steps described in the case management get closer to be applied to the
emergency nurse work. Based on the inconsistencies and limitations of the
research due to the data collect instrument, we suggest and recommend a
technical improvement on the medical care report, mainly in the history taking
by the nurse because of its importance in defining the kinds of complexity and syndromic diagnoses, for the nurse be able to register
his/her performance as case manager and facilitate the evaluation in each
category proposed.
Main Bibliografy
1.Toscano LNP. Uma ferramenta integrada de suporte a decisões em casos de emergências médicas hospitalares. [Tese] Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro/COPPE; 2001.
2.Rotstein Z. Management by constraints: considering patient volume when adding medical staff to the emergency departament. Int Med Australian J 2002; 4:171-174.
3.Goldim JR. Aspectos Éticos da Assistência em Situações de Emergência e Urgência. Disponível em <http://www.bioetica.ufrgs.br/emergen.htm>. Acesso em: 15 jul 2003.
4.Gonzales RIC, Casarin SNA, Caliri MHL, Sassaki CM, Monroe MA, Villa TCS. Gerenciamento de Caso: Um novo enfoque no cuidado à saúde. Rev. Latino–am Enfermagem 2003 mar/abr; 11(2): 227-31.
5.Sabbadini SF, Gonçalves AA. A Unidade de emergência no Contexto do Ambiente Hospitalar. Artigos Originais P 1-13
Adress for correspondence: Márcia Rejane
da Silva Valentim. marciarv@superig.com.br
Fellowship: Hospital de Clínicas Niterói
Received Aug 19th, 2007
Accepted: Aug 25th
, 2007