[Analysis of the workload and the use of the nursing resources in an intensive care unit]

Instruments to measure complexity of care based on nursing workload in intensive care units: A systematic review

OBJECTIVE

To establish an evidence-based recommendation on the use of validated scoring systems that measure nursing workload in relation to the complexity of care in adult Intensive Care Units.

METHODS

A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42021251272). We searched for validation studies until July 2023 using the bibliographic databases CINAHL, Scopus, Pubmed, WOS, Cochrane Database, SCIELO, Cuiden and Cuidatge. Reference selection and data extraction was performed by two independent reviewers. The assessment of risk of bias was performed using QUADAS-2 and the overall quality according to COSMIN and GRADE approach.

RESULTS

We included 22 articles identifying 10 different scoring systems. Reliability, criterion validity and hypothesis testing were the most frequently measurement properties reported. The NAS was the only tool to demonstrate a Class A recommendation (the best performing instrument).

CONCLUSIONS

NAS is the best currently available scoring system to assess complexity of care from nursing workload in ICU. However, it barely met the criteria for a class A recommendation. Future efforts should be made to develop, evaluate, and implement new systems based on innovative approaches such as intensity or complexity of care.

IMPLICATIONS FOR CLINICAL PRACTICE

The results facilitate decision making as it establishes a ranking of which instruments are recommended, promising or not recommended to measure the nursing workload in the intensive care units.

Use of an assessment system for the allocation of human resources in the intrahospital transport of the patient admitted to an intensive care unit

INTRODUCTION

Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it.

OBJECTIVE

To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify Adverse Effects (AE).

METHODS

Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing.

STUDY PERIOD

Phase 1: pilot test 2013-2014. Phase 2: 2015-2021.

VARIABLES

Reason and duration HIT, PAST-ICU sheet, checklist, AE.

RESULTS

Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84,9% (389 IHT). The Cohen Kappa of 58,5% and p < 0,001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87,2% (2984 TIH). The Cohen Kappa of 63%and the P < 0,001. Registered 49 AE.

CONCLUSION

The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.

Info-NAS: A Computer Program for the Calculation of Intensive Care Unit Nurse Workload

The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.

Análisis de la situación de las matronas y necesidad de medir sus cargas de trabajo

RESUMEN Objetivo: Analizar la situación laboral de las matronas y detectar sus necesidades de medición de cargas de trabajo. Métodos: Estudio de metodología mixta (cuantitativo y cualitativo), observacional, descriptivo y transversal. Se realizaron dos fases: La primera fase metodológica, consistió en la realización de entrevistas individuales semiestructuradas. Y en la segunda fase metodológica, se analizaron las intervenciones de enfermería (NIC) que las matronas efectúan en paritorio durante su jornada asistencial. Resultados: El 90,3% de las matronas presentan sobrecarga en el trabajo, pues para el 80,6% el ratio matrona- gestante no se encuentra bien establecido; pues tiempo medio de ejecución de una intervención de enfermería (NIC), es de 20 minutos. Por ello, el 100% de la muestra considera de máxima utilidad el desarrollo de herramientas de medición de cargas de trabajo. Conclusiones: Se ratifica la necesidad de generar un instrumento que considere la diversidad de intervenciones de enfermería (NIC) que desarrollan dentro del paritorio.

Analysis of midwives’ situation and the need to measure their workloads

ABSTRACT Objective: to analyze midwives’ employment situation of midwives and detect their workload measurement needs. Methods: a mixed methodology (quantitative and qualitative), observational, descriptive and cross-sectional study. Two phases were carried out. The first methodological phase consisted of conducting semi-structured individual interviews. The second methodological phase analyzed the Nursing Intervention Classification (NIC) interventions that midwives perform in the labor room during daily practice. Results: 90.3% of midwives have work overload, since for 80.6% the midwife-pregnant mother ratio is not well established, since the mean execution time of a Nursing Intervention Classification (NIC) intervention is 20 minutes. For this reason, 100% of the sample considers the development of workload measurement tools to be highly useful. Conclusions: the need to generate an instrument that considers the diversity of Nursing Intervention Classification (NIC) interventions that develop within the labor room is ratified.

Factors associated with nursing workload in three intensive care units

OBJECTIVE

To determine the nursing workload in intensive care units (ICUs) and the factors associated with the Nursing Activities Score (NAS).

METHOD

An analytical cross-sectional study was carried out in three ICUs in Bucaramanga, Colombia, between February 2018 and February 2020. The nursing workload was estimated based on the NAS. A descriptive and bivariate analysis stratified by ICU was performed using a robust multiple linear regression model, and the factors associated with the nursing workload (p < 0.05) were estimated.

RESULTS

In this study, 362 records were included. The median NAS was 68.1 points (Q1:47.2-Q3:116.7). APACHE II (β = 3.13, CI: 95% 2.28; 3.98), days of stay in ICU ≥3 (β = 16.78, CI: 95% 6.15; 27.41), surgery provenance service (β = 22.31, CI: 95% 9.76; 34.86), and traumatology and emergencies diagnostic category (β = 33.72, CI 95%: 9.90; 57.53) were associated with high NAS scores.

CONCLUSION

The nursing staff spend approximately 70% of their time on a single patient, and administrative work takes up most of their time. Hospital stays of longer than 3 days, high APACHE II score, coming from the surgery department, and having a diagnosis of trauma and emergency were associated with a high workload.

Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments

OBJECTIVE

To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital.

METHOD

A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities.

RESULTS

The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations.

CONCLUSION

NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

The influence of nursing activities score on clinical alarms service

ABSTRACT Objectives: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. Methods: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. Results: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. Conclusion: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

Testing the Reliability and Validity of the Nursing Activities Score in Critical Care Nursing

BACKGROUND AND PURPOSE

The purpose of this study was to test the reliability and validity of the conceptual model of critical care nursing using the Nursing Activities Score (NAS) for intensive care unit (ICU) patients.

METHODS

An observational study conducted in 2011 using the NAS scores of 219 patients in Norway. The inter-rater reliability (IRR) was tested by parallel classifications. The validity was explored by an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) as the measurement models in the structural equation model.

RESULTS

Within the paired ratings the Spearman's correlation coefficient was 0.39. The EFA results explained 77% of the variance with six factors. The reduced CFA model resulted in a three-factor model: relationship, prevention and treatment.

CONCLUSION

The findings supported the IRR and construct validity of the conceptual model of the NAS.