Diseño, validación y aplicación multicéntrica de una escala de medición de cargas de trabajo de matronas, basada en intervenciones NIC, para unidades de paritorio

Laburpena

Introduction. The available evidence demonstrates that a shortage in the number of midwives endangers the quality of maternal-neonatal care that they provide. To plan the provision of midwives within an organization, managers find it necessary to use measurement instruments, but none of the currently validated ones include all the interventions that are carried out during their working day or take into account all the functions of the job. of the matron. The Classification of Nursing Interventions (NIC) allows us to know the work and care carried out by midwives. Therefore, the objective of this thesis was to design and validate a workload measurement scale through a multicenter application, specific for obstetric-gynecological nurses (midwives), within the delivery unit, based on NIC nursing interventions. Method. This is an analytical, descriptive, prospective and observational study, using mixed methodology (qualitative and quantitative). During the first phase of the research, a qualitative study was carried out (in-depth interviews, focus groups and a committee of experts), to understand the need to measure the workloads of midwives and list the different professional activities of this staff. To do this, a mapping of the activities of the midwives within the delivery room was carried out, and thus be able to catalog them with their corresponding NIC. Next, the research group began preparing a draft of the ad hoc scale for measuring workloads. The scale was structured in 4 dimensions, in correlation with the four functions of nursing: care function, management function, teaching function and research function. A section on supplementary interventions was also included, made up of those interventions that are carried out in an extraordinary manner in the delivery room. Once the instrument was constructed in standardized language (NIC), it was qualitatively validated in terms of content and construction by the three focus groups of midwives, carried out virtually through the Zoom platform. After obtaining the draft of the scale, we moved on to the second phase of the research, the quantitative analysis (piloting and multicenter study), carried out between the years 2020-2021, in three delivery units, in three public hospitals in the city. Region of Murcia, Spain. The data were analyzed through specific software for qualitative (Atlas.ti) and quantitative research using the SPSS statistical package version 23.0, obtaining Cronbach's alpha coefficient to determine the reliability (validity and reliability) of the ad hoc scale. Results. From the surveys, interviews, focus groups and experts, we deduce the concern and need to adapt the staff of these professionals to the current demand for care, by expressing the continued overload they experience during their professional activity. During a work shift, 96 NIC interventions can be identified in each delivery, the execution times determined during the measurement phase dictate those proposed by the NANDA group. After the meetings with the focus groups, the draft of the ad hoc designed scale is obtained; scale made up of 24 items, each item contains one or more nursing interventions (NIC) associated with the same intervention time. The application of the scale in a multicenter manner shows how the NIC interventions that entail a greater workload are those integrated into the care function, such as: fetal monitoring, support and action in emergency situations. Regarding the management function, the total time invested in managing the care of a woman in labor is 960.61 minutes (16 hours) for the day shift and 840.29 minutes (14 hours) for the night shift. Regarding the type of onset of labor, it is detected that the workload in induced labor (1035.94 minutes-17.3 hours) is higher than spontaneous labor (1032.74 minutes-17.2 hours). This represents an excess of time dedicated to the execution of her functions, with respect to the duration of her working day (12 hours). But, in addition, if we look at the ratio, the midwives in the study regularly and constantly provide care to a midwife/pregnant woman ratio of 1:3, a ratio that is not in accordance with the different obstetric guidelines for excellent care. The analysis of the data obtained corroborates the internal consistency of the tool, obtaining a Cronbach's alpha of 0.786, which indicates an acceptable value in the validity and reliability of the ad hoc scale. Conclusion. The midwives in the study are subject to an increase in their workload, with respect to the number and time dedicated to performing NIC interventions. The evidence found in this research determines that the ad hoc designed tool is valid and reliable to measure the care provided by these professionals, by establishing and predicting the staffing and proportion of personnel that is necessary according to the flow of real demand in the delivery room. Furthermore, it shows us how the midwife/pregnant mother ratio does not present the ideal proportion to establish quality care, which is why it must be redefined. This work offers us objective data that corroborates theoretical or supposed statements based on subjective experiences.