Mobile application for the evaluation and planning of nursing workload in the intensive care unit

https://doi.org/10.1016/j.ijmedinf.2020.104120Get rights and content

Highlights

  • We present an application type software (APP NAS) which employs the Nursing Activities Score (NAS) for measuring and managing of nursing workload.

  • The software allows the use of the NAS scale prospectively.

  • APP NAS generates detailed daily reporting and consolidated daily reporting as well as general reports.

  • It allows issuance of patient discharge report.

  • APP NAS allows the query of the activities score and correlation with the time.

Abstract

Objective

In this study, we present an application type software which employs the Nursing Activities Score (NAS), a management tool for measuring nursing workload prospectively.

Method

The system was developed in two modules: WEB (controlled from an Internet browser) for data administration using Java Script; and APP (operated from a smartphone or tablet device) for data acquisition using Hypertext Preprocessor (PHP). White and black box tests were performed in the software.

Results

A software was developed with an interface that allows the calculation of the scale score by the same professional who provided assistance, generating reports to help nursing management. The functional test was successfully performed using the Android operational system.

Conclusion

The efficiency of the software was demonstrated by the functional test and the main innovations brought herein are the prospective use and the generation of management reports, which can contribute positively by improving nursing quality and safety in the intensive care unit.

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

References (23)

  • I.O. Aycan

    Bacterial colonization due to increased nurse workload in an intensive care unit

    Rev. Bras. Anestesiol.

    (2015)
  • S. Bassendowski et al.

    Integration of technology to support nursing practice: a Saskatchewan Initiative

    Online J. Nurs. Informatics (OJNI)

    (2011)
  • L.M. Matsuda et al.

    Informática em enfermagem: desvelando o uso do computador por enfermeiros

    Texto Contexto Enferm, Florianópolis

    (2015)
  • L.L. Medeiros et al.

    Protótipo de um software para registro de enfermagem em unidade de terapia intensiva neonatal

    Aquichan

    (2015)
  • M.C. Feitosa et al.

    Uso de escalas/testes como instrumentos de coleta de dados em pesquisas quantitativas em enfermagem

    S A N A R E, sobral

    (2014)
  • D.R. Miranda

    Nursing activities score

    Crit. Care Med.

    (2003)
  • K.G. Padilha et al.

    Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

    Rev. Esc. Enferm. USP

    (2015)
  • A.F. Queijo et al.

    Nursing Activities Score (NAS): adaptação transcultural e validação para a lingua portuguesa

    Rev. Esc. Enferm. USP

    (2009)
  • R. Severino et al.

    Nursing activities score: Índice de avaliação da carga de trabalho de enfermagem na UCI

    Percursos

    (2010)
  • V.M. Catalan et al.

    Sistema NAS: Nursing Activities Score em tecnologia móvel

    Rev. Esc. Enferm. USP

    (2011)
  • R. Reich et al.

    Carga de trabalho em unidade coronariana segundo o Nursing Activities Score

    Rev. Gaúcha Enferm.

    (2015)
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