Mobile application for the evaluation and planning of nursing workload in the intensive care unit
Graphical abstract
Introduction
The use of nursing software in the context of health care has demonstrated perceptible improvements in the quality of life at work, in patient care and in the use of scientific evidence in clinical practice [1]. According to the nurses' perception, computer employment/utilization is associated to ease, agility and practicality in the execution of professional activities, however technical and operational aspects may limit its use [2].
During the work process, nursing constantly generates data from care, management, teaching and research activities [3]. Considering this, it is essential to apply resources to make data administration feasible, such as the adoption of scales that allow the measurement of health data, both for patient care and research purposes [4].
In this context, the Nursing Activities Score (NAS) has been used in the ICUs of several countries, including Brazil, to measure the nursing workload in the ICU, by the quantification of care as well as the degree of complexity involved in it [5]. It is an instrument capable of estimating the number of personnel providing the minimum number of nurses needed to assist patients in each shift. It has been validated in Brazil in 2009 as a highly reliable instrument [6].
However, this score has been applied using Excel or by manual completion of paper forms, mostly once a day, after 24 h of care and by professionals who often did not provide the care. Data are collected retrospectively, through the annotations of the professionals in printed records of monitoring and control, and patient records [7].
Excel can automatically calculate the punctuation and the time, as long as the calculations are manually entered in the cells. Data is stored in folders for later printing, since reports are not generated automatically. In addition, patients who have been discharged, whether by transfer to another ICU, ward or death should be registered in a specific folder. Therefore, manual calculation of the score i.e. through printing of manually filled forms makes it a slow and laborious process. Additionally, manual filling as well as manual sum of points at the end shows that the instrument is prone to calculation errors; this, together with the time wasting involved, are often limiting factors for its use [8].
In this context, the creation of a mobile application for the NAS scale would allow a practical application of the system at each working period (morning, afternoon and night shifts), allowing its prospective interpretation, that is, enabling problem anticipation and design of future care strategies. Furthermore, automatic daily and monthly reports can be generated for monitoring and planning of actions aimed at the dimensioning of nursing professionals [9].
The electronic system of the NAS scale has been described in a few studies over time. In 2009, the course of the construction of an application (software) with NAS content and its operational characteristics was described. The database was powered by PDA (Personal Digital Assistant) mobile equipment [10].
In 2010 and 2011, a NAS structure was presented in mobile technology, based on the system development lifecycle theory, built in the research modules, with access through personal computer (PC) and data collection through mobile device (smartphone). The instrument was used retrospectively, i.e. after 24 h of care [8,11]. This system created a general report, not including monthly reports with calculation of the NAS average, average of patients and total of hours spent per shift during the month.
In 2016, the NAS system was developed in cloud computing through Google Apps (Google Forms, Google Spreadsheets, Google Groups and Google sites). This system was composed of two modules (managerial and operational) and designed to run on the internet on sites hosted by Google with cloud storage [12]. However, some information about software functions and performance such as detailed daily reports, consolidated monthly reports (NAS mean, patient mean, hours / shift) and patient discharge, as well as prospective use, were not described.
However, the need to develop a device with a dynamic not previously identified in publications, that is, one that would allow scale data collection by the same professionals who provide patient assistance, in each work shift, propitiating its prospective interpretation (and not retrospective) after 24 h of assistance was evidenced [13]. In addition, this application would allow time calculation in hours, combined with the NAS score, providing the time of assistance in a practical way, with easy visualization; furthermore, reports could be generated including combined values of the score, mean NAS, inpatients, and total of hours spent per shift per month.
In this perspective, the objective of this work was to develop a mobile application for the use of the NAS scale in an electronic system, enabling its prospective interpretation and capability of generating daily and monthly reports for monitoring and action planning aimed at the dimensioning of nursing professionals.
Section snippets
Methods
This was a study of technological development, based on software engineering. The system was developed based on the NAS scale proposed by [5] and updated in [6,7] using the Java Script language in the application and Hypertext Preprocessor (PHP) in the central server and has two modules (Fig. 1).
Functional requirements: WEB module (from an internet browser) and the APP Module (from a smartphone or tablet device, Android OS or Apple IOS), issues reports for the monitoring of total NAS points and
Results
The system was developed in two modules, which allowed data management and administration through the WEB module. A central server received the data collected by the mobile device used for registration, consultation and issuance of patient reports in the ICU; access was restricted by login with username and password (Fig. 4). Data was collected by the APP module through a smartphone or tablet compatible with the Android or Apple IOS operating systems (Fig. 5). The system was done in interface
Discussion
Database has restricted access only to system administrators with login and password. Database backup on the central server is automatic at every 24 h, in the cloud, ensuring its integrity and information security. Cloud storage enables information to be accessed in a practical way from any device with internet access, contributes to network attention by integrating systems and sectors, as well as mobility in information exchange between professionals and hospitals, and portability in the
Conclusion
The developed NAS APP software presented an interface which allows prospective intervention improving the workload sizing in the ICU and was able to generate monthly/consolidated and patient discharge reports. Functional tests were successfully performed in the system. Future research is required for the implantation of the software in a hospital for a pilot study and proper evaluation by health professionals and managers.
Authorship statement
All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the International Journal of
Contributors.
All authors have contributed to and read the manuscript and approved the final copy. All authors contributed to drafting and revising the manuscript. Furthermore, the authors declare that this contribution is original, and not under consideration for publication in any other venues.
Declaration of Competing Interest
The authors declare no competing interests.
Acknowledgements
All persons who have made substantial contributions to the work reported in the manuscript (e.g., technical help, writing and editing assistance, general support), but who do not meet the criteria for authorship, are named in the Acknowledgements and have given us their written permission to be named. If we have not included an Acknowledgements, then that indicates that we have not received substantial contributions from non-authors.
The authors thank FAPESP for projects 2013/13272-9 and
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