Levels of care complexity classification of patients in an oncology hospital

Abstract

Objective To classify the level of complexity of care required from Nursing by hospitalized oncology patients. Methods This is an observational, sectional, quantitative study, carried out daily with oncology patients in the Clinical and Surgical Oncology inpatient units of a cancer treatment reference hospital during a three-month period. The collection was carried out through the application of a semi-structured questionnaire and an instrument of patient classification by Fugulin et al. (2007). Results 242 patients were interviewed and 1309 evaluations were performed, with a greater number of males and those with incomplete elementary school education. There was a higher occurrence of cancer in the gastrointestinal system and female reproductive system, respectively, in the admission of Clinical and Surgical Oncology, with higher occupancy rate in the months of June and May, in that order. The behavior observed was quite similar in both admissions, corresponding, respectively, to patients who fell into minimal (33.1%; 35.1%) and intermediate care (30.2%; 37.5%). Conclusion and implications for practice The patient classification and dimensioning system in Nursing in oncology deserves further discussion and lacks validated instruments capable of representing the real situation of care.

Factors related to Nursing workload in the Oncology assistance provided to hospitalized women

“…The monitoring and control activities, administrative and managerial tasks, hygiene procedures and medications were the ones that had the highest percentage of days scored and also demanded more time from the Nursing team in the 24 care hours for each woman. Similar results were found in a Clinical Oncology unit using a patient classification instrument indicated by the National Resolution for staff sizing (17) . It is interesting to point out that the third item that most demanded Nursing time was related to administrative and managerial activities, being considered an indirect care measure.…”

“…Other studies also show that Clinical Oncology units have a higher percentage of patients with high dependency, in semi-intensive and intensive care, when compared to surgical units (17) . Undergoing clinical treatments caused a 20.54-point increase in the NAS score among the cancer patients admitted to an intensive care unit in the COVID-19 pandemic context, when compared to those undergoing surgical treatments (35) .…”

“…In Clinical and Surgical Oncology hospitalization units of a reference hospital for the Triângulo Sul macro-region that used the Patient Classification System, there was a higher percentage of patients in minimal and intermediate care, although they also include patients in semi-intensive and intensive care (17) . Despite the differences in the assessment instrument used and the participants' types of cancer when compared to this study, it is possible to point out a higher mean of Nursing hours consistent with patients in high dependence, semi-intensive or intensive care in the Clinical and Surgical Oncology hospitalization units of women in the current study.…”

“…Although the original version of NAS (15) has been used in intensive care units, the content adaptation to the Oncology context (16) was not applied to this type of scenario, and this study was pioneering. Moreover, there is scarcity of studies that help determine the workload of the Nursing team in the Hospital Oncology sector (17) , especially in Gynecological and Breast Oncology. Thus, little is known about the Nursing care demands required by hospitalized women with breast and/or gynecological cancer and undergoing clinical and/or surgical treatments, according to NAS, as well as the factors related to workload in this context.…”

Fatores relacionados à carga de trabalho da enfermagem na assistência oncológica de mulheres hospitalizadas

“…Embora a versão original do NAS (15) tenha sido utilizada em unidades de terapia intensiva, a adaptação de conteúdo para o contexto da oncologia (16) não foi aplicada a esse tipo de cenário, sendo o presente estudo pioneiro. Ainda, há escassez de estudos que auxiliem a determinação da carga de trabalho da equipe de enfermagem no setor hospitalar de oncologia (17) , especialmente na oncologia ginecológica e mamária. Assim, pouco se sabe sobre as demandas de cuidados de enfermagem requeridas…”