Nursing interventions in pediatric care: a contribution to measuring workload

A descriptive, cross-sectional, and observational study was developed in the pediatric clinic of the university hospital of University of São Paulo, São Paulo, Brazil. It was organized in the following stages: identifying activities carried out by the team (from records in patient charts and from direct observation); mapping out and validating activities identified in interventions according to the Nursing Intervention Classification (NIC).

Results

The 275 identified activities were mapped out into 63 interventions, 22 NIC classes and 7 NIC domains, and 25 associated and 13 personal activities. After validation, the number of activities decreased to 244, corresponding to 53 interventions, 20 NIC classes and 6 NIC domains, and 30 associated activities and 9 personal activities.

Conclusion

Identifying the interventions/activities performed by the nursing team can help measure workload and is an important contribution to overcoming difficulties when it comes to operationalizing the process of sizing professional teams in the field of pediatrics.

Nursing staff; Pediatric nursing; Nursing; Workload; Pediatrics

Nursing Interventions in Pediatrics
Domain	Class	Intervention
1. Physiological: Basic	A Activity and Exercise Management	0221 Exercise Therapy: Ambulation

	B Elimination Management	0430 Bowel Management
		0470 Flatulence Reduction
		0580 Urinary Catheterization
		0590 Urinary Elimination Management

	C Immobility Management	0840 Positioning
	C Immobility Management	0970 Transfer

	D Nutrition Support	1100 Nutrition Management
		1052 Bottle Feeding
		1056 Enteral Tube Feeding
		1080 Gastrointestinal Intubation
		1160 Nutritional Monitoring

	E Physical Comfort Promotion	1380 Heat/Cold Application

	F Self-Care Facilitation	1630 Dressing
		1610 Bathing
		1650 Eye Care
		1720 Oral Health Promotion
		1804 Self-Care Assistance: Toileting
		1870 Tube Care

2.Physiological: Complex	H Drug Management	2300 Medication administration
	H Drug Management	2440 Venous Access Device Maintenance

	I Neurologic Management	2680 Seizure Management

	K Respiratory Management	3140 Airway Management

	L Skin/Wound Management	3584 Skin Care: Topical Treatments
	L Skin/Wound Management	3590 Skin Surveillance

	N Tissue Perfusion Management	4190 Intravenous insertion
	N Tissue Perfusion Management	4220 Peripherally Inserted Central Catheter (PICC) Care

3.Behavioral	Q Communication Enhancement	4430 Therapeutic Play
	S Patient Education	5602 Teaching: Disease Process
	T Psychological Comfort Promotion	5880 Calming Technique

4.Safety	V Risk Management	6480 Environmental Management
		6540 Infection Control
		6650 Surveillance
		6654 Surveillance: Safety
		6680 Vital Signs Monitoring

5. Family	W Childbearing Care	1054 Breastfeeding Assistance

	X Lifespan Care	7110 Family Involvement Promotion

6.Health System	Y Health System Mediation	7310 Admission Care
		7320 Case Management
		7370 Discharge Planning

	Ya Health System Management	7620 Controlled Substance Checking
		7650 Delegation
		7660 Emergency Cart Checking
		7830 Staff Supervision
		7680 Examination Assistance
		7726 Preceptor: Student
		7850 Staff Development
		7840 Supply Management
		7880 Technology Management
		7892 Transport: Interfacility

	Yb Information Management	7920 Documentation
		7960 Health Care Information Exchange
		8140 Shift Report

Personal Activities
Computer Use	Reading
Nourishment (drinking water or coffee)	Analyzing preliminary version of shift distribution
Resting	Using the toilet
Socializing	Taking medication
Personal phone calls

Associated Activities

Arranging chairs	Registering child’s chaperone in the patient system
Organizing the Kardex	Registering delivery of storeroom material into the hospital materials management system
Putting together admission kits (identification wristband, bed nameplates, vital signs form)	Searching for medication in the Intensive Care Unit
Organizing desk	Organizing patient identification labels
Organizing clipboards	Organizing computer table
Searching for earlier nursing notes/progress reports that are no longer on the clipboard	Delivering confirmation of medical reason for absence to the doctor for stamping
Removing documents from clipboard to file in patient chart	Sorting labels
Putting away materials and equipment	Changing clock battery
Reporting change in restricted diet to nutritionist	Sorting the Kardex
Searching for patient charts	Printing discharge summary
Searching the Kardex	Processing patient discharge through the system
Delivering child’s belongings to the family	Requesting X-ray
Searching for examination requests	Filling out computer forms
Transferring patients in the system	Putting together identification wristbands
Receive documents	Looking for shift supervisor’s telephone number

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence Addressed to: Fernanda Maria TogeiroFugulin. Av. Dr. Enéas de Carvalho Aguiar, 419 – Cerqueira Cesar CEP 05403-000 – São Paulo, SP, Brasil. ffugulin@usp.br

Brasil

Brasil

Nursing interventions in pediatric care: a contribution to measuring workload* * Partial data retrieved from the project “Tempo de assistência de enfermagem em unidade de pediatria, segundo o grau de dependência do paciente”.

ABSTRACT

Objective

Method

Results

Conclusion

Nursing interventions in pediatric care: a contribution to measuring workload^* * Partial data retrieved from the project “Tempo de assistência de enfermagem em unidade de pediatria, segundo o grau de dependência do paciente”.