Validation of parameters to fill in the Perroca’s patient classification system

Abstract

OBJECTIVE

To propose parameters to qualify the filling of the Patient Classification System proposed by Perroca.

METHOD

Validation study by consensus held in 2014, in a university hospital. The sample included 10 specialist nurses, four teachers and a computer science professional, all knowledgeable in the Classification System. The information was collected and analyzed through meetings registration, where strategies were discussed to enable the systematic application of the instrument in the institution. For the construction, it was considered a consensus of 100% among the experts.

RESULTS

The computerized parameter guide was elaborated with a description of what to evaluate in each item of the Perroca’s instrument, standardizing the filling by the nurses.

CONCLUSIONS

The parameter guide made it possible to minimize the subjectivity of the evaluators when applying the classification instrument, provided guiding elements to fill it in and qualified the nursing care benchmarking.

Keywords:
Nursing assessment; Resource guides; Validation studies

Resumo

OBJETIVO

Propor parâmetros para qualificar o preenchimento do Sistema de Classificação de Pacientes proposto por Perroca

MÉTODO

Estudo de validação por consenso realizado em 2014, em hospital universitário. Amostra incluiu 10 enfermeiros especialistas, quatro professores e um profissional da informática, todos com conhecimento no Sistema de Classificação. As informações foram coletadas e analisadas por meio de registro de reuniões, onde foram discutidas estratégias para viabilizar a aplicação sistemática do instrumento na instituição. Para a construção foi considerado consenso de 100% entre experts.

RESULTADOS

Elaborou-se o guia de parâmetros informatizado com descrição do que avaliar em cada item do instrumento de Perroca, padronizando o preenchimento pelos enfermeiros.

CONCLUSÕES

O guia de parâmetros possibilitou minimizar a subjetividade dos avaliadores ao aplicar o instrumento de classificação, forneceu elementos norteadores para preenchimento e qualificou a aferição dos cuidados de enfermagem.

Palavras-chave:
Avaliação em enfermagem; Guias informativos; Estudos de validação

Resumen

OBJETIVO

Proponer parámetros para calificar el llenado del Sistema de Clasificación de Pacientes propuesto por Perroca.

MÉTODO

Estudio de validación por consenso realizado en 2014, en un hospital universitario. La muestra incluyó 10 enfermeros especialistas, cuatro profesores y un profesional de la informática, todos con conocimiento en el Sistema de Clasificación. Las informaciones fueron recolectadas y analizadas por medio de registro de reuniones, donde se discutieron estrategias para viabilizar la aplicación sistemática del instrumento en la institución. Para la construcción se consideró consenso del 100% entre los expertos.

RESULTADOS

Se elaboró ​​el guía de parámetros informatizado con descripción de lo que evaluó en cada ítem del instrumento de Perroca, estandarizando el llenado por los enfermeros.

CONCLUSIONES

La guía de parámetros posibilitó minimizar la subjetividad de los evaluadores al aplicar el instrumento de clasificación, proporcionó elementos orientadores para relleno y calificó la evaluación de los cuidados de enfermería.

Palabras clave:
Evaluación en enfermería; Guías de recursos; Estudios de validación

INTRODUCTION

The changes in the care demand of hospitalized patients and the increase in the complexity in the processes of care production have been requiring some restructuring in health organizations and management models¹. Thus, nursing leaders need to commit to the use of instruments that assist in the management of human, material, technological and financial resources, in order to guarantee the achievement of a safe and comprehensive care based on the best care practices^2-3.

One of the instruments that allows to evaluate the degree of dependence of the patients in relation to the nursing care is the one elaborated by Perroca, which consists in a scale composed by nine care indicators: planning and coordination of the care process; investigation and monitoring; body care and eliminations; skin and mucous care; nutrition and hydration; locomotion and activity; therapeutics; emotional support and health education. Each indicator has increasing levels of care complexity ranging from 1 (lowest grade) to 4 (highest grade), classifying the care as minimal, intermediate, semi-intensive and intensive^4-5.

Studies have evidenced the need to standardize the evaluation criteria in order to minimize the subjectivity of each evaluator when performing the classification of critical care indicators^2,6-7. The use of a set of instructions with the application of instruments for data collection clarifies the respondents, improving the rates and the quality of the responses⁸.

The confirmation that the nurses of a university hospital had different ways of interpreting the level of complexity of each care indicator has motivated the construction and validation of a parameter guide. It is observed that the Brazilian productions regarding the use of Patient Classification Instruments are still focused on the quantitative-qualitative dimensioning of personnel in the units, indicating the need to perform new studies that can contribute to the qualified evaluation of the nursing work⁹.

Thus, this study is justified, focusing on the use of parameters to standardize the application of the Perroca's Patient Classification System. It is understood that the elaboration of a guide of parameters can help to fill in the Perroca's scale by the nurse, facilitating its application, based on a more objective interpretation. Thus, the present article aims at proposing parameters to qualify the filling of the classification of patients proposed by Perroca.

METHOD

It is a consensus validation study among experts, which describes the development of a computerized parameter guide to standardize the application of the Perroca's Patient Classification System. This method allows to reach a collective opinion or agreement between specialists regarding a specific phenomenon and has been used in nursing aiming to define practice standards^10-11.

The research was conducted in 2014, in a public university hospital in the south of Brazil, which has 842 beds and a modern structure for diagnosis and treatment of several pathologies in 60 specialties, with 6400 employees. Twelve clinical and surgical hospitalization units serving adult patients participated in the study.

The author of the Perroca's instrument^4-5) has endorsed the importance of elaborating parameters to standardize the application of its instrument and has formalized the consent, with the commitment that the original version has remained unchanged.

Ten nurses from the institution, with more than five years of experience in clinical practice; four professors from a federal university, with care and management experience in nursing; and a computer science professional were selected intentionally. All of them had knowledge in Patient Classification Systems and had publications in the area.

For the construction of the parameter guide, the following steps were followed: literature review, care mapping, survey about the frequency of the care provision, and creation of the parameter guide. Initially, the mapping of the activities and care provided to the patients was carried out, which was based on the care experience, the particularities of the areas and the care model of the institution. During the survey about the frequency of the care provided, the periodicity of the activities and the care provided was observed, according to the profile of patients attended at these units. To create the parameter guide, the researchers described the activities and the care performed in each corresponding indicator and adapted the levels of complexity according to the frequency of their accomplishment in the practice of care.

The construction of the material occurred through discussions about each indicator of the scale, seeking to clarify doubts in the light of examples of everyday care and evidence from the literature, seeking consensus among experts. Subsequently, its use required the sensitization and training of the nurses of the clinical and surgical units for its proper use.

The Directives and Norms Regulating Research Involving Human Beings, provided for by the Resolution No. 466/2012 of the National Health Council were respected, and the project was approved by the Research Ethics Committee under No. 15-0561. The authors signed the Term of Commitment for the Use of Data to have access to the minutes of the work meetings between experts, committing themselves to preserve the privacy and anonymity of those involved.

RESULTS

The result of this study was the elaboration of a parameter guide to help and qualify the filling of the Perroca's Patient Classification System. The online version in a computerized institutional platform allowed the systematic use of scale in clinical practice¹², since January 2015, effectively.

Figure 1 presents the Perroca's Classification System with the nine care indicators and the four classification levels of the original instrument (in bold). Below each classification level are the parameters validated by this study.

Figure 1
Guide of parameters constructed for the nine critical care indicators of the Perroca’s Patient Classification System of a university hospital.

DISCUSSION

An evaluation of the instrument performed by the author demonstrated the nurses' satisfaction with the use of the Classification System. However, it also pointed to a tendency to underestimate the clinical assessment to the detriment of the category of care complexity. Thus, the author raised the hypothesis that the users recognized the validity of the instrument in the categorization of patients according to the complexity of care, but sometimes they did not agree with the results regarding the categorization obtained, indicating that complementary studies to identify factors that interfere in determining the classification would be a challenge and a necessity¹³.

The construction of the parameter guide allowed the nurses detailed knowledge on how to evaluate each care indicator in the Perroca's Patient Classification System. The literature points out that the use of guides and manuals in nursing can both add benefits and serve as an objective, clear and accessible reference source for the interpretation of the guidelines. It is also capable of optimizing meetings and training, as well as harmonizes and professionalizes the work environment. On the other hand, an educational guide does not eliminate the need for verbal guidance¹⁴. Thus, researchers have been concerned with offering the guide and systematic face-to-face training in order to ensure a better use of this tool in clinical practice.

Manuals, folders and educational guides, in addition to standardizing languages, can be considered as enabling educational technologies that can be used in several scenarios for knowledge transfer, complementing or clarifying the instructions provided by experts. One of the goals is to facilitate communication. The increasing technological evolution expresses new possibilities of use of these materials in the practices of care and education¹⁵. In this sense, the parameter guide has been used as support material in the training of new nurses for the application of the Patient Classification System in a qualified manner. It is understood that the use of parameters standardizes the language, optimizes the instrument filling time, minimizes subjectivities and provides nurses with a reflection on the (re)planning of nursing care and quality of care.

In the experience of the authors, it is reiterated that the collective construction of parameters led to the formulation of a material that reflects the daily practice of the institution's professionals, making it possible to be widely used in other realities. The application of the scale requires the nurse to evaluate the patient in a comprehensive way.

The fact that the institution, the field of study, already uses the nursing process in a consolidated way in all its stages was a facilitator for the implantation of the Perroca's Patient Classification System and the parameter guide. The nursing process in the clinical practice has favored the communication based on information about the patient and their care, which provides visibility of the nurses' work¹⁶.

The information on the degree of complexity of care may favor the understanding of the behavior of institutional quality indicators and patient safety. However, scientific knowledge is constantly being renewed and, thus, there is a need for constant updating of the parameters so that it follows the evolution of nursing.

CONCLUSIONS

The parameter guide was built and validated through a rigorous process of consensus among experts. This material optimizes, qualifies and standardizes the filling of the Perroca's Patient Classification System. With the implementation of the parameter guide, the tool started to be applied in a less subjective way and presented a good receptivity from the nurses, who understood better each indicator and started to demonstrate mastery in its filling.

Studies on the theme contribute to the management of care, since the results obtained from the classification of the degree of dependence of the patients provide the analysis and assessment of the planning of the nursing staff. Consequently, the qualification of the care occurs, increasing the safety of hospitalized patients from the clinical reasoning performed by the nurses to fill in the classification instrument.

The study had as limitation the reduced sample size. However, the group of researchers has been promoting systematic training and case studies in order to discuss the application of the Patient Classification System, aiming to reduce nurses' doubts. These activities have also contributed to qualify the parameter guide presented here.

It should be highlighted the relevance of the use of this instrument to guide nurses' daily routine, being a tool capable of answering the main doubts that may arise during the use of the Perroca's Patient Classification System. It also provides subsidies for research that will use the Patient Classification System and for hospital institutions that are in the phase of implanting the Patient Classification System.

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Publication Dates

• Publication in this collection
  29 Nov 2018
• Date of issue
  2018

History

• Received
  30 Oct 2017
• Accepted
  18 May 2018