Conformity of nurse prescribing to care needs: nurses' understanding

investigate the understanding of nurses on nurse prescribing conformity to the care needs of hospitalized patients and factors associated with that conformity.

Method:

a descriptive study, with a quantitative approach, was conducted at 20 in-patient units of a teaching hospital in the state of São Paulo. The participants (N=139) answered a semi-structured questionnaire.

Results:

For 43 (30.9%) nurses, nurse prescribing is always in line with patients' care needs. The fields of body care and elimination, skin and mucosa care and investigation and monitoring were the most frequently addressed.

Conclusion:

in the perception of most nurses, nurse prescribing does not conform with patients' health heeds. The establishment of strategies to improve prescribing quality is recommended, as well as the development of permanent qualification programs and the systematic use of instruments for assessment of patients' care demands regarding nursing.

Descriptors:
Nursing Care; Nursing Process; Documentation; Patient Care Planning; Nursing Assessment

UNITS	Nurses/shift M (SD)	Aides and technicians/shiftM (SD)	Patients/ nurse/shiftM (SD)
Medical clinic	2.3 (0.5)	7.5 (0.5)	33.9 (15.7)
Surgery clinic	2.3 (0.5)	7.0 (1.0)	26.7 (12.5)
Cardio/hematology	2.5 (0.8)	8.5 (0.5)	29.1 (8.2)
Palliative care	1.0 (0.0)	3.0 (0.0)	8.0 (0.0)
Infectious/parasitic diseases	1.0 (0.0)	5.0 (0.8)	18.0 (1.0)
Emergency	1.6 (0.7)	5.3 (2.6)	20.6 (8.1)
Gynecology/obstetrics	1.3 (0.5)	4.0 (0.0)	20.0 (5.6)
Neuro/orthopedics	1.3 (0.5)	5.0 (0.0)	16.7 (4.7)
Pediatrics	1.5 (0.7)	5.3 (0.5)	15.9 (6.3)
Transplantation	1.3 (0.5)	4.3 (0.5)	20.8 (5.9)
Intensive care	2.0 (0.8)	6.0 (1.0)	9.6 (0.8)
Total	1.6 (0.5)	5.5 (1.5)	19.9 (7.4)

Care needs	Nurse prescribing	Md (Q1-Q3)
Investigation and monitoring	Anthropometric measurements	5 (5-5)
	Application of measurement scales (Braden, Morse and Glasgow)	3 (3-3)
	Vital signs verification	5 (5-5)
	Effectiveness assessment of administered drugs	1 (1-2)
	Oxygen therapy	5 (5-5)
	Clearing of air ways	3 (2-4)
Care needs	Nurse prescribing	Md (Q1-Q3)
Body care and elimination	Diaper change or placement of urinals	4 (4-5)
	Probe care	4 (4-4)
	Stoma care	5 (5-5)
	Peripheral and central venous puncture care	5 (5-5)
	Hygiene needs assistance	4 (4-4)
	Oral hygiene	3 (3-4)
Skin and mucosa care	Skin/wound care	5 (5-5)
	Lying position change every two hours	3 (3-4)
Nutrition and hydration	Water balance control - intake and output	4 (4-5)
	Feeding patient warm food	1 (1-1)
	Offering food for patients to feed themselves	3 (3-4)
Locomotion and activity	Walking three times/day or as prescribed	2 (2-2)
Therapy	Drug administration in the 30-minute period before or up to one hour after prescribed time	2 (1-3)
Emotional support	Emotional support to patient/family	3 (3-4)
Health education	Patient training on diseases, clinical-laboratory exams and diagnosis exams	2 (2-2)

Variables	Morning Md (Q1-Q3)	Afternoon Md (Q1-Q3)	Night Md (Q1-Q3)	Total Md (Q1-Q3)
Characteristics
Writing clarity	4 (4-4)	3 (3-4)	4 (4-4)	4 (4-4)
Care description	4 (3-4)	3 (3-3)	4 (3-4)	4 (3-4)
Care frequency	5 (5-5)	5 (5-5)	5 (5-5)	5 (5-5)
Daily prescribing	5 (5-5)	5 (5-5)	5 (5-5)	5 (5-5)
Trustworthy data	5 (5-5)	5 (5-5)	5 (4-5)	5 (5-5)
Satisfaction
Quality	3 (3-3)	2 (1-3)	3 (2-3)	3 (3-3)
Amount of NP/shift	1 (1-3)	2 (1-3)	1 (1-1)	1 (1-3)
Time	1 (1-2)	1 (1-2)	1 (1-1)	1 (1-2)
Digitalization	5 (5-5)	5 (5-5)	5 (5-5)	5 (5-5)

Variables	In-patient units
Variables	1	2	3	4	5	6	7	8	9	10	11
Characteristics
Writing clarity	4 (0)	4 (0)	4 (0)	4 (1)	4 (0)	4 (0)	4 (0)	4 (1)	4 (0)	4 (0)	4 (0)
Care description	4 (1)	3 (0)	4 (1)	4 (0)	4 (1)	3 (0)	4 (1)	3 (0)	3 (0)	3 (0)	4 (0)
Care frequency	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)
Daily prescribing	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)
Trustworthy data	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (1)	5 (0)	5 (0)	5 (0)	5 (1)
Satisfaction
Quality	2 (0)	2(1)	3 (1)	3(0)	3 (0)	3 (1)	2(1)	3 (0)	3 (0)	3 (1)	3 (0)
Amount of NP/shift	1 (1)	1 (0)	1 (2)	1 (2)	1 (1)	1 (1)	1 (2)	1 (0)	1 (0)	1 (1)	1 (1)
Time available	1 (0)	1 (1)	1 (1)	1 (1)	1 (1)	1 (1)	1 (0)	1 (1)	1 (1)	1 (1)	1 (1)
Digitalization	5 (0)	5 (0)	5 (1)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)	5 (0)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Marília Silveira Faeda. E-mail: mafaeda@yahoo.com.br