Maternal and child patient safety: a multiple criteria analysis of the decisionmaking preferences of nurse managers

Silva, Alexssandro da; Gurgel Júnior, Garibaldi Dantas; Falk, James Anthony; Pedroso, Marcel de Moraes

doi:10.1590/1806-93042018000300008

Alexssandro da Silva

Instituto Aggeu Magalhães. Fundação Oswaldo Cruz. Av. Professor Moraes Rego. s.n. Cidade Universitária. Campus UFPE. Recife, PE, Brasil. CEP: 50.670-420. E-mail: adm.alexssandro@gmail.com

Garibaldi Dantas Gurgel Júnior

Instituto Aggeu Magalhães. Fundação Oswaldo Cruz. Av. Professor Moraes Rego. s.n. Cidade Universitária. Campus UFPE. Recife, PE, Brasil. CEP: 50.670-420. E-mail: adm.alexssandro@gmail.com

James Anthony Falk

Centro Universitário UniFBV, Wyden Brasil. Recife, PE, Brasil.

Marcel de Moraes Pedroso

Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.

Professional Categories	Order	Code	CritCriteria (Nursing Assignments)
Nursing	1	TA1	Accept the woman and companion in a cordial and responsible manner.
Technicians and	2	TA2	Listen to the woman's complaint, fears and expectations.
Assistants (TA)	3	TA3	Accommodate and / or position the user appropriately so that it can be assessed in the risk classification.
	4	TA4	Gauge the woman's vital signs.
	5	TA5	Refer the client for care after risk classification.
	6	TA6	Forward / orient user regarding the location of the examination and medication, when applicable.
	7	TA7	Be alert to the woman's reclassification needs while awaiting care.
		TA8	Refer users to Social Work and Psychology when appropriate.
	8	TA9	Making the shift on a regular basis is not allowed to leave the shift without another
	9		employee taking it.
Nurses (E)	10	E1	Receive the information sheets, evaluating the women's priority in an agile and responsible manner, according to the complaint presented.
	11	E2	Call the woman by name, also requesting the presence of a companion.
	12	E3	Classify the risk quickly and efficiently, following the protocol adopted.
	13	E4	Attach the "notice of violence" form when there is suspicion or confirmation of the case.
	14	E5	Record classification data in the answer sheet, signaling the woman's classification by color.
	15	E6	Record rankings on the A & CR map.
	16	E7	Orient the woman in a clear way about her situation and the waiting time of the service.
	17	E8	Provide the technician's answer sheet to be placed in the offices.
	18	E9	Reclassify users when necessary.
	19	E10	Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the problems of the user.
	20	E11	Supervise the work of the technician / nursing assistant and trainee, guiding correctly when necessary.
	21	E12	Record the occurrences of the sector in the proper book.
Obstetric Nurses	22	EO1	To attend the women who are assigned to them, in a welcoming way, according to
(EO)			institutional protocol and with the immediate access to the obstetrician, when necessary.
	23	EO2	Communicate the nursing team about the adopted behavior: admission, observation,
	24	EO3	reassessment or discharge of the woman. Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the women's problems.
	25	EO4	Make the shift on a regular basis, not leaving it without another employee taking it.

Criteria		CE1	CE2	CE3	CE4	CE5	CE6	CE7	CE8	Means	Standard Deviation
TAE	Technical / Nursing Assistant	19.85	19.97	22.11	30.62	22.30	32.75	24.02	24.02	24.46	4.76
TAE1	Accept the woman and companion in a cordial and responsible manner.	50.47	8.35	2.88	3.52	6.26	6.63	8.08	6.33	11.57	15.84
TAE2	Listen to the woman's complaint, fears and expectations.	4.62	9.47	7.07	8.93	12.08	7.25	9.13	10.09	8.58	2.25
TAE3	Accommodate and / or position the user appropriately so that it can be assessed in the risk classification.	2.50	7.44	3.25	8.32	8.68	14.62	9.28	11.97	8.26	4.04
TAE4	Gauge the woman's vital signs.	11.51	17.98	22.92	21.67	11.07	15.79	12.22	12.98	15.77	4.65
TAE5	Refer the client for care after risk classification.	3.36	9.39	2.88	12.71	8.57	9.69	9.83	12.21	8.58	3.65
TAE6	Forward / orient user regarding the location of the examination and medication, when applicable.	5.94	10.70	3.25	12.15	9.26	8.97	12.24	12.78	9.41	3.35
TAE7	Be alert to the woman's reclassification needs while awaiting care.	6.50	12.70	37.34	16.23	17.50	11.08	12.71	13.52	15.95	9.26
TAE8	Refer users to Social Work and Psychology when appropriate.	7.93	7.78	3.25	8.05	9.08	7.75	8.08	11.04	7.87	2.17
TAE9	Making the shift on a regular basis is not allowed to leave the shift without another employee taking it.	7.19	16.19	17.16	8.43	17.50	18.21	18.42	9.09	14.02	4.87
E	Nurses	34.69	37.59	31.89	25.82	34.64	25.99	20.98	20.98	29.07	6.48
E1	Receive the information sheets, evaluating the women's priority in an agile and responsible manner, according to the complaint presented.	6.48	7.59	10.54	7.41	6.77	10.44	7.87	6.71	7.98	1.62
E2	Call the woman by name, also requesting the presence of a companion.	7.77	6.88	5.69	7.59	9.69	14.52	7.31	7.72	8.40	2.71
E3	Classify the risk quickly and efficiently, following the protocol adopted.	11.00	8.58	9.85	9.44	8.58	11.36	9.66	16.05	10.57	2.43
E4	Attach the "notice of violence" form when there is suspicion or confirmation of the case.	5.95	7.68	4.47	10.19	7.42	8.71	9.24	4.54	7.28	2.13
E5	Record classification data in the answer sheet, signaling the woman's classification by color.	12.85	9.12	7.31	11.04	6.75	9.21	9.94	11.29	9.69	2.05
E6	Record rankings on the A & CR map.	6.86	6.44	5.07	5.03	6.35	3.86	5.57	3.78	5.37	1.16
E7	Orient the woman in a clear way about her situation and the waiting time of the service.	7.86	7.36	6.23	10.78	8.58	5.26	7.08	10.40	7.94	1.92
E8	Provide the technician's answer sheet to be placed in the offices.	4.69	7.14	1.98	5.33	6.43	4.92	6.08	5.46	5.25	1.55
E9	Reclassify users when necessary.	8.67	12.16	19.15	11.77	14.86	9.24	9.75	13.82	12.43	3.48
E10	Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the problems of the user.	11.34	10.44	14.70	9.29	9.61	9.49	12.34	9.05	10.78	1.94
E11	Supervise the work of the technician / nursing assistant and trainee, guiding correctly when necessary.	12.16	10.71	10.80	6.81	8.98	9.10	10.85	7.04	9.56	1.92
E12	Record the occurrences of the sector in the proper book.	4.35	5.91	4.22	5.33	5.96	3.90	4.30	4.15	4.77	0.83
EO	Obstetric Nurses	45.46	42.44	46.00	43.56	43.06	41.26	55.00	55.00	46.47	5.48
EO1	To attend the women who are assigned to them, in a welcoming way, according to institutional protocol and with the immediate access to the obstetrician, when necessary.	43.15	22.31	29.50	24.33	28.74	24.22	20.19	36.80	28.66	7.81
EO2	Communicate the nursing team about the adopted behavior: admission, observation, reassessment or discharge of the woman.	18.44	21.10	12.94	32.03	20.47	17.59	25.89	21.25	21.21	5.72
EO3	Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the women's problems.	21.58	31.65	41.72	26.93	24.82	22.91	23.63	27.96	27.65	6.53
EO4	Make the shift on a regular basis, not leaving it without another employee taking it.	16.83	24.94	15.85	16.71	25.97	35.28	30.29	13.98	22.48	7.79

Dimensions		Criteria	CE1	CE2	CE3	CE4	CE5	CE6	CE7	CE8	Means	Standard Deviation
Reception 9,21%	TA1	Accept the woman and companion in a cordial and responsible manner.	10.02	1.67	0.64	1.08	1.40	2.17	1.94	1.52	2.55	3.05
	TA2	Listen to the woman's complaint, fears and expectations.	0.92	1.89	1.56	2.73	2.69	2.37	2.19	2.42	2.10	0.62
	TA3	Accommodate and / or position the user appropriately so that it can be assessed in the risk classification.	0.50	1.49	0.72	2.55	1.94	4.79	2.23	2.88	2.14	1.36
	E2	Call the woman by name, also requesting the presence of a companion.	2.70	2.59	1.81	1.96	3.36	3.77	1.53	1.62	2.42	0.83
Classification 14,90%	TA7	Be alert to the woman's reclassification needs while awaiting care.	1.29	2.54	8.25	4.97	3.90	3.63	3.05	3.25	3.86	2.07
	E3	Classify the risk quickly and efficiently, following the protocol adopted.	3.82	3.23	3.14	2.44	2.97	2.95	2.03	3.37	2.99	0.55
Classification 14,90%	E5	Record classification data in the answer sheet, signaling the woman's classification by color.	4.46	3.43	2.33	2.85	2.34	2.39	2.09	2.37	2.78	0.80
	E6	Record rankings on the A & CR map.	2.38	2.42	1.62	1.30	2.20	1.00	1.17	0.79	1.61	0.65
	E9	Reclassify users when necessary.	3.01	4.57	6.11	3.04	5.15	2.40	2.05	2.90	3.65	1.44
Attendance 23,30%	TA4	Gauge the woman's vital signs.	2.28	3.59	5.07	6.63	2.47	5.17	2.94	3.12	3.91	1.55
	TA5	Refer the client for care after risk classification.	0.67	1.88	0.64	3.89	1.91	3.17	2.36	2.93	2.18	1.16
	E1	Receive the information sheets, evaluating the women's priority in an agile and responsible manner, according to the complaint presented.	2.25	2.85	3.36	1.91	2.35	2.71	1.65	1.41	2.31	0.65
	E8	Provide the technician's answer sheet to be placed in the offices.	1.63	2.68	0.63	1.38	2.23	1.28	1.28	1.15	1.53	0.65
	EO1	To attend the women who compete with them, in a welcoming way, according to institutional protocol and with the immediate access to the obstetrician, when necessary.	19.62	9.47	13.57	10.60	12.38	9.99	11.10	20.24	13.37	4.25
Orientation 4,63%	TA6	Forward / orient user regarding the location of the examination and medication, when applicable.	1.18	2.14	0.72	3.72	2.06	2.94	2.94	3.07	2.35	1.02
	E7	Orient the woman in a clear way about her situation and the waiting time of the service.	2.73	2.77	1.99	2.78	2.97	1.37	1.49	2.18	2.28	0.62
Team Integration 25,89%	E10	Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the problems of the user.	3.93	3.92	4.69	2.40	3.33	2.47	2.59	1.90	3.15	0.97
	EO2	Communicate the nursing team about the adopted behavior: admission, observation, reassessment or discharge of the woman.	8.38	8.95	5.95	13.95	8.81	7.26	14.24	11.69	9.91	3.06
	EO3	Be integrated with the multiprofessional team of the obstetrical / maternity center, seeking a better solution to the women's problems.	9.81	13.43	19.19	11.73	10.69	9.45	13.00	15.38	12.83	3.24
Administrative Aspects 22,07%	TA8	Refer users to Social Work and Psychology when appropriate.	1.57	1.55	0.72	2.46	2.02	2.54	1.94	2.65	1.93	0.65
	TA9	Making the shift on a regular basis is not allowed to leave the shift without another employee taking it.	1.43	3.23	3.79	2.58	3.90	5.96	4.42	2.18	3.44	1.42
	E4	Attach the "notice of violence" form when there is suspicion or confirmation of the case.	2.06	2.89	1.43	2.63	2.57	2.26	1.94	0.95	2.09	0.65
	E11	Supervise the work of the technician / nursing assistant and trainee, guiding correctly when necessary.	4.22	4.03	3.44	1.76	3.11	2.37	2.28	1.48	2.83	1.02
	E12	Record the occurrences of the sector in the proper book.	1.51	2.22	1.35	1.38	2.07	1.01	0.90	0.87	1.41	0.51
	EO4	Make the shift on a regular basis, not leaving it without another employee taking it.	7.65	10.58	7.29	7.28	11.18	14.56	16.66	7.69	10.36	3.61
		TOTAL	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00

\begin{matrix} k & where : \\ k = Number of Criteria \\ \sum w_{j} P_{j} = (a_{i}, a_{l}) & j = Criteria \\ P = Preference \\ j = 1 & W = Weight \end{matrix}

\begin{matrix} k & where : \\ k = Number of Decision ma \ker s \\ \sum_{j} {wCP}_{j} & j = Category Criteria \\ CP = Professional Category Index \\ j = 1 & \begin{matrix} W = Weight of Professional Category \\ Criteria \end{matrix} \end{matrix}

\begin{matrix} 12 & where : \\ \sum w_{10} P_{10} = 11.34 & \begin{matrix} k = Number of Nurse {sCriteria}^{'} \\ (E = 12) \end{matrix} \\ j = Criteria \\ j = 10 & P = Preference E 10 \\ W = Weight \end{matrix}

\begin{matrix} k & where : \\ k = Number of Decisions ma \ker s \\ \sum_{j} {wCP}_{j} & j = Category Criteria \\ \begin{matrix} CP = Professional Category \\ Index \end{matrix} \\ j = 1 & \begin{matrix} W = Weight of Professional \\ Category Criteria \end{matrix} \end{matrix}

\begin{matrix} K = 8 \\ x Σ EO 1 . {wEO}_{CE 8} \\ j = EO 1 de CE 8 \\ We have : \\ K = 8 \\ x Σ 36.80 x 0 . 55_{CE 8} = 20.24 \\ j = EO 1 de CE 8 \\ where : \\ k = Number of Decisionm a \ker s = 8 \\ j = Category Criterion = EO 1 do CE 8 = \\ 36.80 % \\ CP = Professional Category Index = EO = \\ 55.00 % \\ W = Weight of Professional Category \\ Criteria = 55.00 / 100 = 0.55 \\ x Σ (EO 1_{CE} + EO 1_{CE 2} + EO 1_{CE 3} + EO 1_{CE 4} + EO 1_{CE 5} \\ + EO 1_{CE 6} + EO 1_{CE 7} + 20, 24_{CE 8}) / 8 \\ x Σ (19.62 + 9.47 + 13.57 + 10.60 + 12.38 + 9.99 + \\ 11.10 + 20.24) / 8 \\ x Σ = EO 1 = 106.97 / 8 = 13.37 \end{matrix}

Brasil

Brasil

Maternal and child patient safety: a multiple criteria analysis of the decisionmaking preferences of nurse managers

Abstract

Objectives:

Methods:

Results:

Conclusions: