Care Perceptions in two ICU Nursing Care Delivery Models: A qualitative-comparative approach

Abstract

Objective. Analyzed in compared perspective perceptions about nursing care, nurse-patient interaction, and nursing care outcomes in two ICU nursing staff in a high-complexity hospital institution, whose Nursing are Delivery Models (NCDM) are differentiated by the proportion of nurses and nurse assistants (NA) per team and by the assigned tasks and responsibilities.
 Methods. Particularist ethnography with adaptation to virtual methodologies. It included the sociodemographic characteristics of 19 nurses and 23 NA, 14 semi-structured interviews, review of patients’ clinical records, and a focus group. Coding, categorization, inductive analysis, validation of results with participants were conducted and thematic saturation was achieved.
 Results. Four themes were identified: i) Professionalized care: a nursing of superior value; ii) senses and feelings of care; iii) nursing workload, generating factors and impacts; and iv) nursing missed care as concrete expression of the nursing workload.
 Conclusion. Compared nursing teams perceived nursing care in different ways, since it was experienced based on the assigned responsibilities and the possibilities of interaction with patients. Nursing care in the NCDM of the ICU with prevalence of direct bedside care by nurses with support from NA, it was perceived as holistic, comprehensive, and empathetic; whereas in the ICU with prevalence of delegated care to NA, it was related with administrative leadership and management of the ICU. Regarding the results, the NCDM of the ICU of direct bedside care by nurses showed better performance in patient safety and was closer to the skill level and legal responsibility of the nursing staff.

Nurses’ Work Methods Assessment Scale: A Construct Validation

“…Regarding the dimension "teamwork method," the factorial structure that emerged is in line with the theoretical component [7,9,23]. Te items highlight that this working method of nurses is based on the existence of a team leader, who designs, supervises the care provided, and promotes refection on the nursing care provided to clients [3]. On the other hand, the assignment of patients privileges the individual skills and qualifcations of the nurses on the team, making the best use of the resources available and promoting maximization and professional satisfaction [7,24].…”

“…Inherent to their professional activity and role in health institutions, nurses must contribute judiciously, rigorously, and actively to the quality of care and patient safety [3,4]. As a complex and demanding profession, nursing is always present in health institutions as the largest workforce.…”

Nurses’ perspectives on nurses’ work methods

“…Some facilitators and obstacles to the implementation of work methods were found: the scarcity of nurses; the downsizing of professionals in services and the number of patients assigned to each nurse; the characteristics of practice environments, particularly the organizational culture; the knowledge held by nurses, reflecting on autonomy in decision-making; and teamwork. Some authors point out that reflection on practice, the recognition of nurses’ competencies, and leadership style are challenges to the implementation of nursing care organization methodologies ( 5 , 11 , 19 ) .…”

“…Nursing management also influences the methods adopted by nurses, as it plays an important role in defining practices and promoting the adoption of effective methods ( 10 ) . The specific characteristics of health institutions also interfere in the configuration of work methods, such as resource availability, organizational culture, and patient profiles ( 11 ) . Given these aspects, the question arises: What are nurses’ perceptions about the work methods implemented in the hospital context?…”

“…A gestão em enfermagem também tem influência nos métodos adotados pelos enfermeiros, pois desempenha papel importante na definição das práticas e na promoção da adoção de métodos eficazes ( 10 ) . As características específicas das instituições de saúde também interferem na configuração dos métodos de trabalho, como a disponibilidade de recursos, a cultura organizacional e o perfil dos pacientes ( 11 ) . Diante desses aspectos, questiona-se: Quais as percepções dos enfermeiros acerca dos métodos de trabalho implementados no contexto hospitalar?…”