Labor and Delivery Patient Classification System Based on Direct Nursing Care Time.

摘要

This study was conducted as directed by the Army Medical Department (AMEDD) Study Board to extend the Workload Management System for Nursing (WMSN) into Labor and Delivery (L and D). The focus of the study was on nursing time spent in direct care, or that time spent performing nursing activities at the patient's bedside. By evaluating direct care time, a patient classification instrument was developed based on patient acuity. Subsquent to the AMEDD Study Board tasking, the Joint Manpower Office of the Office of the Assistant Secretary of Defense (Health Affairs) (OASD(HA)) determined that this study would be used in developing the triservice manpower staffing standard for L and D. The study was comprised of three phases, each of which involved collecting data at various Army hospitals for analysis. In Phase I, mean times were derived for each task relevant to L and D. In Phase II, a worksheet was constructed to reflect the relevant L and D tasks. Once the validity and reliability of the instrument/worksheet were established, data were collected and analyzed to: establish the acuity categories, and derive a subset of predictors that would reflect total direct care time. Phase III consisted of three parts. First, a panel of clinical nursing experts formatted the worksheet and evaluated user instructions. Second, instrument validity and reliability were verified using the smaller set of direct care indicators. Finally, L and D nursing staff members used the revised worksheets for two weeks, and provided a critique of the worksheets.... Nursing, Patient classification, Labor and delivery.