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Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: A systematic review. Nurs Health Sci 2023; 25:497-515. [PMID: 37784243 DOI: 10.1111/nhs.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bethany Howard
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Watterson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Cruz López LN, Quintero Osorio JF, Melo Roa JD, Henao Castaño ÁM. Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score. REVISTA CUIDARTE 2023. [DOI: 10.15649/cuidarte.2680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Highlights:
La NAS es una herramienta que toma relevancia al momento de evaluar la carga de trabajo de los profesionales de enfermería.
Se evidencia que el personal de enfermería está expuesto a altas cargas de trabajo que, en la mayoría de casos, supera lo sugerido por Consejos y Asociaciones de enfermería.
Algunos factores que pueden afectar la carga de trabajo son el tipo de turnos de trabajo, sexo del profesional, tipo de UCI, el número de pacientes a cargo, entre otros.
Es necesario evaluar la implementación de la NAS en distintos tipos de servicios para entender la situación y trabajo actual de los profesionales de enfermería.
Introducción: Nursing Activities Score ha sido utilizada como un instrumento principalmente en la Unidad de Cuidados Intensivos para medir las actividades de enfermería, siendo esta la unidad que maneja pacientes de mayor complejidad para el cuidado. Objetivo: establecer la carga de trabajo, evaluada por Nursing Activities Score, y factores relacionados a la misma en Unidades de Cuidado Intensivo. Metodología: Revisión cualitativa tipo scoping Review, utilizando el método PRISMA. Búsqueda en las bases de datos CINAHL, LILACS, SCOPUS, SCIENCE DIRECT, SCIELO y PUBMED. Resultados: La muestra final se compone de 87 textos, que van desde el año 2007 hasta 2021. Se clasificaron en cinco categorías: Carga de trabajo en UCI, comparación entre unidades, carga de trabajo relacionada al personal de enfermería, carga de trabajo relacionada a las características de los pacientes y consecuencias de la carga de trabajo. Discusión: La revisión revela una carga de trabajo mayor al 50% en la mayoría de los estudios, esto debido a diferentes factores: principalmente las características particulares de los pacientes, no se observó una diferencia significativa entre unidades generales y especializadas, las cargas de trabajo elevadas suponen un factor de riesgo para la ocurrencia de eventos adversos. Conclusiones: Los resultados de esta revisión permiten evidenciar que el personal de enfermería está expuesto constantemente a altas cargas de trabajo. Esta carga de trabajo puede verse influenciada o influenciar diversos factores, como lo son las características de los pacientes a quienes se brinda atención o puede afectar positiva o negativamente la calidad de la atención de enfermería.
Como citar este artículo: Cruz López Laura Nathalie, Quintero Osorio Jenny Fernanda, Melo Roa Juan David, Henao Castaño Ángela María. Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score. Revista Cuidarte. 2023;14(1):e2680. http://dx.doi.org/10.15649/cuidarte.2680
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Manthou P, Lioliousis G, Pietri I, Vasileiou P, Dainavas D, Fildisis G. Nursing Workload in Patients With Myocardial Ischemia After Non-cardiac Surgery. Cureus 2022; 14:e30737. [PMID: 36457624 PMCID: PMC9705073 DOI: 10.7759/cureus.30737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Nursing workload (NWL) in the intensive care unit (ICU) is an essential parameter of patient safety. However, little attention has been dedicated to measuring NWL in ICU about patients surgically treated with myocardial ischemia (MI). Methods: The objectives of this study are to describe and examine the NWL by applying the Nursing Activities Score in patients who underwent non-cardiac surgery and developed MI in the ICU. The statistical significance was set at 0.05. The statistical program SPSS 22.0 was used for the analysis. RESULTS The mean age was 69.1 years, whereas 32.4% of the patients had MI. Hypertension, diabetes mellitus, and dyslipidemia were the main comorbidities. On the first day in ICU, the NWL was similar in all patients (p = 0.947). In the following days, the NWL was significantly higher in patients with MI (p < 0.001). The NWL was considerably higher in patients with MI who died. CONCLUSIONS The present results are essential for planning and using nursing resources according to the care needs of postoperative patients with MI.
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Affiliation(s)
- Panagiota Manthou
- Nursing, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Lioliousis
- Intensive Care Unit, First Department of Respiratory Medicine, Thoracic Diseases General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Panagiotis Vasileiou
- Laboratory of Histology & Embryology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Emergency Department, Thoracic Diseases General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitris Dainavas
- Intensive Care Unit, General Oncology Hospital of Kifisia, Athens, GRC
| | - Georgios Fildisis
- Nursing School, National and Kapodistrian University of Athens, Athens, GRC
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Ibrahim M, Szeto WY, Gutsche J, Weiss S, Bavaria J, Ottemiller S, Williams M, Gallagher JF, Fishman N, Cunningham R, Brady L, Brennan PJ, Acker M. Transparency, Public Reporting and a Culture of Change to Quality and Safety in Cardiac Surgery. Ann Thorac Surg 2021; 114:626-635. [PMID: 34843698 DOI: 10.1016/j.athoracsur.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Academic medical centers have a duty to serve as hospitals of last resort for advanced cardiac surgical care and therefore manage patients at elevated risk of post-operative morbidity and mortality. They must also meet state and professional quality targets devised to protect the public. The tension between these imperatives can be managed by a multi-dimensional quality improvement program which aims to manage risk, optimize outcomes and exclude futile operations. We here share our approach to this process, its impact on our institution and discuss pertinent issues relevant to institutions in a similar situation.
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Affiliation(s)
- Michael Ibrahim
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Gutsche
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve Weiss
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Ottemiller
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Williams
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jo Fante Gallagher
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil Fishman
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Regina Cunningham
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luann Brady
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Survival, Quality of Life, and Functional Status Following Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review. Crit Care Med 2019; 47:e52-e63. [PMID: 30398978 DOI: 10.1097/ccm.0000000000003504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compared with noncardiac critical illness, critically ill postoperative cardiac surgical patients have different underlying pathophysiologies, are exposed to different processes of care, and thus may experience different outcome trajectories. Our objective was to systematically review the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up. DATA SOURCES MEDLINE, Embase, CINAHL, Web of Science, and Dissertations and Theses Global up to July 21, 2017. STUDY SELECTION Studies were included if they assessed hospital or long-term survival and/or patient-centered outcomes in adult patients with prolonged ICU stays following major cardiac surgery. After screening 10,159 citations, 114 articles were reviewed in full; a final 34 articles met criteria for data extraction. DATA EXTRACTION Two reviewers independently extracted data and assessed risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Studies. Extracted data included the used definition of prolonged ICU stay, number and characteristics of prolonged ICU stay patients, and any comparator short stay group, length of follow-up, hospital and long-term survival, residential status, patient-centered outcome measure used, and relevant score. DATA SYNTHESIS The definition of prolonged ICU stay varied from 2 days to greater than 14 days. Twenty-eight studies observed greater in-hospital mortality among all levels of prolonged ICU stay. Twenty-five studies observed greater long-term mortality among all levels of prolonged ICU stay. Multiple tools were used to assess patient-centered outcomes. Long-term health-related quality of life and function was equivalent or worse with prolonged ICU stay. CONCLUSIONS We found consistent evidence that patients with increases in ICU length of stay beyond 48 hours have significantly increasing risk of hospital and long-term mortality. The significant heterogeneity in exposure and outcome definitions leave us unable to precisely quantify the risk of prolonged ICU stay on mortality and patient-centered outcomes.
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Jokh Chaaya DA, de Souza Nogueira L, de Cassia Gengo E Silva Butcher R, Reboreda JZ, Silva Bonfim AK, Padilha KG. Pulse Pressure and Mortality Risk in Critically Ill Patients. AACN Adv Crit Care 2019; 29:118-125. [PMID: 29875108 DOI: 10.4037/aacnacc2018335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pulse pressure is a hemodynamic variable easily measured in the intensive care unit. OBJECTIVE To investigate whether pulse pressure is an independent risk factor for mortality in intensive care unit patients. METHODS A retrospective cohort study was carried out in Brazil. Data were collected from medical records of patients admitted to intensive care units from September to December 2012. Pulse pressure was calculated from systolic and diastolic blood pressures recorded during the first 24 hours of stay. RESULTS Records of 529 patients (mean [standard deviation] age 55.0 [17.3] years; 54.4% male, 45.6% female) were analyzed. Risk factors for mortality were age, use of vasoactive drugs, nursing workload, and length of stay in the intensive care unit. Analysis indicated that higher minimum pulse pressures were associated with lower mortality risk. CONCLUSION Pulse pressure was not found to be an independent risk factor for mortality in patients who are critically ill.
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Affiliation(s)
- Dúnia Abou Jokh Chaaya
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Lilia de Souza Nogueira
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Rita de Cassia Gengo E Silva Butcher
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Jéssica Zamora Reboreda
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Ane Karoline Silva Bonfim
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Katia Grillo Padilha
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
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Serafim CTR, Dell'Acqua MCQ, Castro MCNE, Spiri WC, Nunes HRDC. Severity and workload related to adverse events in the ICU. Rev Bras Enferm 2018; 70:942-948. [PMID: 28977219 DOI: 10.1590/0034-7167-2016-0427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 02/02/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. Method: A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). Results: A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically significant relationship with the occurrence of AEs. Conclusion: The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety. Objetivo: Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. Método: Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). Resultados: Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente significativa, na ocorrência de EAs. Conclusão: Os resultados permitem refletir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente.
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Affiliation(s)
- Clarita Terra Rodrigues Serafim
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu School of Medicine, Nursing Department. Botucatu, São Paulo, Brazil
| | - Magda Cristina Queiroz Dell'Acqua
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu School of Medicine, Nursing Department. Botucatu, São Paulo, Brazil
| | - Meire Cristina Novelli E Castro
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu School of Medicine, Nursing Department. Botucatu, São Paulo, Brazil
| | - Wilza Carla Spiri
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu School of Medicine, Nursing Department. Botucatu, São Paulo, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Universidade Estadual Paulista Júlio de Mesquita Filho, School of Medicine, Research Support Office. Botucatu, São Paulo, Brazil
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Trettene ADS, Fontes CMB, Razera APR, Prado PC, Bom GC, von Kostrisch LM. Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit. Rev Bras Ter Intensiva 2017; 29:171-179. [PMID: 28977258 PMCID: PMC5496751 DOI: 10.5935/0103-507x.20170027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/09/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit. METHODS This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared. RESULTS The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16. CONCLUSION The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.
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Affiliation(s)
- Armando dos Santos Trettene
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | | | - Ana Paula Ribeiro Razera
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Priscila Capelato Prado
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Gesiane Cristina Bom
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Lilia Maria von Kostrisch
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
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Trettene ADS, Fontes CMB, Razera APR, Gomide MR. Impact of promoting self-care in nursing workload. Rev Esc Enferm USP 2016; 50:635-641. [DOI: 10.1590/s0080-623420160000500014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVES To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. METHODS Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). RESULTS The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). CONCLUSION The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation.
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Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Eur J Cardiovasc Nurs 2016; 15:447-58. [DOI: 10.1177/1474515115602678] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/25/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antonia Kalogianni
- Faculty of Nursing, Technological Educational Institute of Athens, Greece
| | - Panagiota Almpani
- Faculty of Nursing, Technological Educational Institute of Athens, Greece
| | - Leonidas Vastardis
- Intensive Care Unit of Department of Cardiac Surgery, ‘Evangelismos’ General Hospital, Athens, Greece
| | - George Baltopoulos
- Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Christos Charitos
- Cardiothoracic Surgery Department, ‘Evangelismos’, General Hospital of Athens, Greece
| | - Hero Brokalaki
- Faculty of Nursing, National and Kapodistrian University of Athens, Greece
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Oliveira LBD, Rodrigues ARB, Püschel VADA, Silva FAD, Conceição SLD, Béda LB, Fidelis B, Santana-Santos E, Secoli SR. Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score. Rev Esc Enferm USP 2015; 49 Spec No:80-6. [DOI: 10.1590/s0080-623420150000700012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Identificar os fatores associados à carga de trabalho de enfermagem no cuidado a pacientes no pós-operatório de cirurgia cardíaca. Método Estudo de coorte prospectivo, conduzido com 187 pacientes da Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração. Os dados foram coletados nas primeiras 24 e 72 horas do paciente na UTI. A variável dependente foi a carga de trabalho calculada por meio do Nursing Activities Score (NAS) e as independentes foram de natureza demográfico-clínicas e escores de morbimortalidade. Para análise dos dados utilizou-se os testes de Wilcoxon-Mann-Whitney e de correlação de Spearman, e a regressão linear com modelo de efeitos mistos. Resultados A maioria dos pacientes era do sexo masculino (59,4%), com média de idade de 61 anos (±12,7) e 43,9% desenvolveram algum tipo de complicação no pós-operatório. Nas 24 horas, a carga de trabalho foi de 82,4% (±3,4) e foi de 58,1% (±3,4) nas 72 horas. Os fatores associados ao aumento do NAS foram: tempo de internação do paciente na UTI (p=0,036) e a presença de complicações (p<0,001). Conclusão A gravidade do paciente nas 24 horas, em oposição a inúmeros estudos, não influenciou no aumento da carga de trabalho, a qual se mostrou associada ao tempo de internação e às complicações.
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Padilha KG, Stafseth S, Solms D, Hoogendoom M, Monge FJC, Gomaa OH, Giakoumidakis K, Giannakopoulou M, Gallani MC, Cudak E, Nogueira LDS, Santoro C, Sousa RCD, Barbosa RL, Miranda DDR. Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit. Rev Esc Enferm USP 2015; 49 Spec No:131-7. [DOI: 10.1590/s0080-623420150000700019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers’ consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results.
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Affiliation(s)
| | | | | | - Marga Hoogendoom
- Isala klinieken Research Department Anesthesiologie & Intensive Care, Netherlands
| | | | | | | | | | | | - Edyta Cudak
- Poznan University of Medical Sciences, Poland
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Lachance J, Douville F, Dallaire C, Padilha KG, Gallani MC. The use of the Nursing Activities Score in clinical settings: an integrative review. Rev Esc Enferm USP 2015; 49 Spec No:147-56. [PMID: 26761705 DOI: 10.1590/s0080-623420150000700021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian's model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian's health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.
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Affiliation(s)
- Joanie Lachance
- Faculté des Sciences Infirmières, Université Laval, Quebec, Canada
| | | | | | - Katia Grillo Padilha
- Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Gouzou M, Karanikola M, Lemonidou C, Papathanassoglou E, Giannakopoulou M. Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit. Rev Esc Enferm USP 2015; 49 Spec No:15-21. [PMID: 26761687 DOI: 10.1590/s0080-6234201500000003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was "Pay", followed by "Task requirements", "Interaction", "Professional status", "Organizational policies" and "Autonomy". NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: "Autonomy", "Professional status", "Interaction" and "Task requirements". Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.
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Affiliation(s)
| | - Maria Karanikola
- School of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Chryssoula Lemonidou
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Silva JBD, Póvoa VCO, Lima MHDM, Oliveira HC, Padilha KG, Secoli SR. Nursing workload in hematopoietic stem cell transplantation: a cohort study. Rev Esc Enferm USP 2015; 49 Spec No:93-100. [PMID: 26761698 DOI: 10.1590/s0080-623420150000700014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/28/2015] [Indexed: 11/22/2022] Open
Abstract
Objective Measure nursing workload required by patients submitted to autologous and allogeneic hematopoietic stem cell transplantation (HSCT) and analyze the Nursing Activities Score (NAS) of the nursing team during the hospitalization period for HSCT. Method A prospective cohort study conducted from January 2013 to April 2014 with 62 patients hospitalized in the HSCT unit of a university hospital in Campinas, São Paulo, Brazil. The workload was measured through NAS and data analysis was through chi-square test or Fisher's exact test, Mann-Whitney test and Spearman's correlation coefficient; with 5% significance level. Results Mean nursing workload was 67.3% (SD of 8.2) in autologous HSCT patients and 72.4% (SD of 13.0) in allogeneic HSCT patients (p=0.1380).Monitoring and titration showed, in more than 50% of the time, patients demanded intensified care, requiring two hours or more in a nursing shift for reasons of safety, severity or therapy. Conclusion The nursing workload and the NAS items with the highest scores reflect the magnitude, complexity and specificity of care required by patients submitted to HSCT.
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Affiliation(s)
| | | | | | | | - Kátia Grillo Padilha
- Departamento de Enfermagem-Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Sílvia Regina Secoli
- Departamento de Enfermagem-Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
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Altafin JAM, Grion CMC, Tanita MT, Festti J, Cardoso LTQ, Veiga CFF, Kamiji D, Barbosa ÁRG, Matsubara CCT, Lara AB, Lopes CCB, Blum D, Matsuo T. Nursing Activities Score and workload in the intensive care unit of a university hospital. Rev Bras Ter Intensiva 2014; 26:292-8. [PMID: 25295824 PMCID: PMC4188466 DOI: 10.5935/0103-507x.20140041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/18/2014] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. METHODS A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. RESULTS In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients' condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). CONCLUSION We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.
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Affiliation(s)
| | | | - Marcos Toshyiuki Tanita
- Adult Intensive Care Unit, Hospital Universitário,
Universidade Estadual de Londrina - Londrina (PR), Brazil
| | - Josiane Festti
- Department of Internal Medicine, Universidade Estadual de
Londrina - Londrina (PR), Brazil
| | | | | | - Danielle Kamiji
- Scientific Initiation Program, Universidade Estadual de
Londrina - Londrina (PR), Brazil
| | | | | | - Aline Bobato Lara
- Scientific Initiation Program, Universidade Estadual de
Londrina - Londrina (PR), Brazil
| | | | - Djavani Blum
- Scientific Initiation Program, Universidade Estadual de
Londrina - Londrina (PR), Brazil
| | - Tiemi Matsuo
- Department of Statistics, Universidade Estadual de Londrina
- Londrina (PR), Brazil
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