1
|
Reguera-Carrasco C, Barrientos-Trigo S. Instruments to measure complexity of care based on nursing workload in intensive care units: A systematic review. Intensive Crit Care Nurs 2024; 84:103672. [PMID: 38692967 DOI: 10.1016/j.iccn.2024.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 05/03/2024]
Abstract
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.
Collapse
Affiliation(s)
- Cristina Reguera-Carrasco
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain.
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain
| |
Collapse
|
2
|
Pirret AM, Corkery MC, Gilhooly A, Devoy KL, Strickland W. The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design. Intensive Crit Care Nurs 2024; 81:103568. [PMID: 38271856 DOI: 10.1016/j.iccn.2023.103568] [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: 05/07/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. OBJECTIVES To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. METHODS Using a prospective observational design, data were collected between 9 August - 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. RESULTS Analysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5-54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. CONCLUSION TrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. IMPLICATIONS FOR CLINICAL PRACTICE TrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.
Collapse
|
3
|
Lucchini A, Villa M, Del Sorbo A, Pigato I, D'Andrea L, Greco M, Chiara C, Cesana M, Rona R, Giani M. Determinants of increased nursing workload in the COVID-era: A retrospective analysis of prospectively collected data. Nurs Crit Care 2024; 29:196-207. [PMID: 36717119 DOI: 10.1111/nicc.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required. AIM To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre. STUDY DESIGN Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload. RESULTS We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS. CONCLUSIONS The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS. RELEVANCE TO CLINICAL PRACTICE Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.
Collapse
Affiliation(s)
- Alberto Lucchini
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marta Villa
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Arianna Del Sorbo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Irene Pigato
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca D'Andrea
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Greco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Colombo Chiara
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Matteo Cesana
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rona
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Giani
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Ross P, Hodgson CL, Ilic D, Watterson J, Gowland E, Collins K, Powers T, Udy A, Pilcher D. The Impact of Nursing Skill-mix on Adverse Events in Intensive Care: A Single Centre Cohort Study. Contemp Nurse 2023:1-13. [PMID: 37096967 DOI: 10.1080/10376178.2023.2207687] [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: 04/26/2023]
Abstract
BACKGROUND The highly complex and technological environment of critical care manages the most critically unwell patients in the hospital system, as such there is a need for a highly trained nursing workforce. Intensive care is considered a high-risk area for errors and adverse events (AE) due to the severity of illness and number of procedures performed. OBJECTIVE To investigate if the percentage of Critical Care Registered Nurses (CCRN) within an Intensive Care Unit (ICU) is associated with an increased risk of patients experiencing an AE. DESIGN & SETTING We conducted a retrospective cohort study of patients admitted between January 2016 and December 2020 to a tertiary ICU in Australia. Descriptive statistics and multivariable logistic regression were used to investigate the relationship between the proportion of CCRNs each month and the occurrence of an AE defined as any one of a medication error, fall, pressure injury or unplanned removal of a central venous catheter or endotracheal tube per patient. RESULTS A total of 13,560 patients were included in the study, with 854 (6.3%) experiencing one AE. Patients with an AE were associated with higher illness severity and frailty scores. They were more commonly admitted after medical emergency team response calls and were less commonly elective ICU admissions. Those with an AE had longer ICU and in-hospital length of stay, and higher ICU and in-hospital mortality, on average. After adjusting for ICU LOS and acute severity of illness, being admitted during a month of higher critical care nursing skill-mix was associated with a statistically significant lower odds of having a subsequent AE (OR 0.966 [95% CI: 0.944-0.988], p 0.003). CONCLUSION An increasing percentage of CCRNs is independently associated with a lower risk-adjusted likelihood of an AE. Increasing the skill-mix of the ICU nursing staff may reduce the occurrence of AEs and lead to improved patient outcomes.
Collapse
Affiliation(s)
- Paul Ross
- Clinical Nurse Specialist, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840
| | - Carol L Hodgson
- Head of the Division of Clinical Trials and Cohort Studies, Deputy Director of the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 399030598,
| | - Dragan Ilic
- Director, Teaching & Learning, Head, Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840,
| | - Jason Watterson
- Clinical Nurse Manager, Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840,
| | - Emily Gowland
- Manager, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia. Tel: +61 3 9903 4840, E-mail:
| | - Kathleen Collins
- ICU Registries Manager, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia. Tel: 61 402 455 343, E-mail:
| | - Tim Powers
- Statistician, Data Science and AI Platform, 15 Innovation Way, Monash University, Clayton Campus, Victoria 3800, Tel: 61 425 873 733,
| | - Andrew Udy
- Deputy Director, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia
- Head of ICU Research, The Alfred, 55 Commercial Road, Prahran VIC 3004, Victoria, Australia, Tel: +61 438755568,
| | - David Pilcher
- Chairman, Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University
- Intensivist, Department of Intensive Care, Alfred Health, Commercial Road, Prahran VIC 3004, Tel: +61 447 264 253,
| |
Collapse
|
6
|
Sardo PMG, Macedo RPA, Alvarelhão JJM, Simões JFL, Guedes JAD, Simões CJ, Príncipe F. Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score. Nurs Crit Care 2023; 28:288-297. [PMID: 36336353 DOI: 10.1111/nicc.12854] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/28/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent. AIM To assess the nursing workload in a Portuguese ICU using the NAS. STUDY DESIGN Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June-31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines. RESULTS The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team. CONCLUSIONS The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety. RELEVANCE TO CLINICAL PRACTICE This was one of the first studies carried out with the NAS after its cross-cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the 'administrative and management activities' related to the 'patient discharge procedures', the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse-to-patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU.
Collapse
Affiliation(s)
- Pedro Miguel Garcez Sardo
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Institute of Biomedicine (iBiMED), Universidade de Aveiro (UA), Aveiro, Portugal
| | | | | | - João Filipe Lindo Simões
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Institute of Biomedicine (iBiMED), Universidade de Aveiro (UA), Aveiro, Portugal
| | | | - Carlos Jorge Simões
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Centro Hospitalar do Baixo Vouga, Hospital de Aveiro, Aveiro, Portugal
| | - Fernanda Príncipe
- Escola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Oliveira de Azeméis, Portugal
| |
Collapse
|
7
|
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
Collapse
|
8
|
Concordância entre avaliadores na aplicação do Nursing Activities Score. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao03327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
9
|
Bruyneel A, Maes J, Di Pierdomenico L, Tack J, Bogaert M, Leclercq P, Pirson M. Associations between two nursing workload scales and the cost of intensive care unit nursing staff: A retrospective study of one Belgian hospital. J Nurs Manag 2022; 30:724-732. [PMID: 34989040 DOI: 10.1111/jonm.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to assess associations between a general nursing funding scale and an intensive care unit specific nursing workload scale and the cost of nursing staff. BACKGROUND Nurse staffing represents the most important cost in the intensive care unit, so it is essential to evaluate it accurately. In addition, the assessment of nursing workload is important for the daily management of the intensive care unit and to ensure quality of care. METHODS This was a retrospective and quantitative study carried out in the intensive care unit of a Belgian hospital. The extraction of data from the Nursing Activities Score and the Minimum Hospital Summary Nursing Dataset were carried out during 2 periods of 15 days, from 1 June 2018 to 15 June 2018 and from 1 September 2018 to 15 September 2018. RESULTS A total of 234 patients were included in the study. A total of 773 Nursing Activities Score and Minimum Hospital Summary Nursing Dataset recordings were analyzed in the study per intensive care unit day. A strong correlation was observed between Nursing Activities Score and Minimum Hospital Summary Nursing Dataset for the entire intensive care unit stay with a rho (95% CI) of .88 (0.83-.93); however, the correlation was moderate per intensive care unit day with a rho of .51 (0.45-0.57). A strong association was observed between the Minimum Hospital Summary Nursing Dataset and the Nursing Activities Score with the costs of intensive care unit nurses with a rho (95% CI) of .78 (0.72-0.86) and .74 (0.65-0.84), respectively. CONCLUSIONS A general nursing funding scale in Belgium was strongly correlated with the nursing workload for the whole intensive care unit stay, but this correlation was moderate per intensive care unit day. In contrast, both scales showed a good correlation with intensive care unit nursing costs. IMPLICATIONS FOR NURSING MANAGEMENT In Belgium, a general funding scale for nurses does not allow for an assessment of the nursing workload in the intensive care unit. The Nursing Activities Score is strongly correlated with the cost of nursing staff in the intensive care unit. The authors recommend that the Belgian authorities carry out this type of study in several intensive care units in the country and eventually replace the general funding scale for nurses with the Nursing Activities Score.
Collapse
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,SIZ Nursing, A Society of Intensive Care Nurses, Belgium
| | - Julie Maes
- Simulation Laboratory for Healthcare Professions, SimLabS, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Lionel Di Pierdomenico
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,Medical Information Department, CHU-Charleroi Marie-Curie, Charleroi, Belgium
| | - Jérôme Tack
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,SIZ Nursing, A Society of Intensive Care Nurses, Belgium.,Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Bogaert
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
10
|
Hoogendoorn ME, Brinkman S, Bosman RJ, Haringman J, de Keizer NF, Spijkstra JJ. The impact of COVID-19 on nursing workload and planning of nursing staff on the Intensive Care: A prospective descriptive multicenter study. Int J Nurs Stud 2021; 121:104005. [PMID: 34273806 PMCID: PMC8215878 DOI: 10.1016/j.ijnurstu.2021.104005] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The impact of the care for COVID-19 patients on nursing workload and planning nursing staff on the Intensive Care Unit has been huge. Nurses were confronted with a high workload and an increase in the number of patients per nurse they had to take care of. OBJECTIVE The primary aim of this study is to describe differences in the planning of nursing staff on the Intensive Care in the COVID period versus a recent non-COVID period. The secondary aim was to describe differences in nursing workload in COVID-19 patients, pneumonia patients and other patients on the Intensive Care. We finally wanted to assess the cause of possible differences in Nursing Activities Scores between the different groups. METHODS We analyzed data on nursing staff and nursing workload as measured by the Nursing Activities Score of 3,994 patients and 36,827 different shifts in 6 different hospitals in the Netherlands. We compared data from the COVID-19 period, March 1st 2020 till July 1st 2020, with data in a non-COVID period, March 1st 2019 till July 1st 2019. We analyzed the Nursing Activities Score per patient, the number of patients per nurse and the Nursing Activities Score per nurse in the different cohorts and time periods. Differences were tested by a Chi-square, non-parametric Wilcoxon or Student's t-test dependent on the distribution of the data. RESULTS Our results showed both a significant higher number of patients per nurse (1.1 versus 1.0, p<0.001) and a significant higher Nursing Activities Score per Intensive Care nurse (76.5 versus 50.0, p<0.001) in the COVID-19 period compared to the non-COVID period. The Nursing Activities Score was significantly higher in COVID-19 patients compared to both the pneumonia patients (55.2 versus 50.0, p<0.001) and the non-COVID patients (55.2 versus 42.6, p<0.001), mainly due to more intense hygienic procedures, mobilization and positioning, support and care for relatives and respiratory care. CONCLUSION With this study we showed the impact of COVID-19 patients on the planning of nursing care on the Intensive Care. The COVID-19 patients caused a high nursing workload, both in number of patients per nurse and in Nursing Activities Score per nurse.
Collapse
Affiliation(s)
- M E Hoogendoorn
- Department of Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
| | - S Brinkman
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - R J Bosman
- Department of Intensive Care, OLVG, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - J Haringman
- Department of Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands; Department of Intensive Care, Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands
| | - N F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - J J Spijkstra
- Department of Intensive Care, Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Velozo KDS, Costa CAD, Tonial CT, Crestani F, Andrades GRH, Garcia PCR. Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments. Rev Esc Enferm USP 2021; 55:e00547. [PMID: 34460896 DOI: 10.1590/1980-220x-reeusp-2020-0547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Pedro Celiny Ramos Garcia
- Pontifícia Universidade Católica de Porto Alegre, Escola de Medicina, Departamento de Pediatria, Porto Alegre, RS, Brazil
| |
Collapse
|
12
|
Response from Authors. Intensive Crit Care Nurs 2021; 65:103053. [PMID: 33966927 PMCID: PMC8102210 DOI: 10.1016/j.iccn.2021.103053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
13
|
Nasirizad Moghadam K, Chehrzad MM, Reza Masouleh S, Maleki M, Mardani A, Atharyan S, Harding C. Nursing physical workload and mental workload in intensive care units: Are they related? Nurs Open 2021; 8:1625-1633. [PMID: 33596333 PMCID: PMC8186696 DOI: 10.1002/nop2.785] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
AIM In order to ensure patient safety and quality of care, it is important to consider factors which may impact on nursing workloads. This study aimed to investigate the simultaneous physical and mental workload and any relationships between these concepts on nurses working in intensive care units. DESIGN A cross-sectional design was undertaken. METHOD Participants were nurses (N = 105) recruited from six adult intensive care units which met the inclusion criteria. Nursing Activities Score (NAS) to measure physical workload and NASA Task Load Index (NASA-TLX) to measure mental workload were used. Data were collected for each participating nurse in three shifts (morning, evening and night). Data were analysed using bivariate correlation and multivariable linear regression analysis. RESULTS The mean (SD) of nurses' physical and mental workload was 72.84% (22.07%) and 70.21 (12.36), respectively. A significant relationship between physical and mental workload (p <.001) was identified.
Collapse
Affiliation(s)
| | - Minoo Mitra Chehrzad
- Department of Paediatric Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Shademan Reza Masouleh
- Social Determinants of Health Research Centre (SDHRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Maleki
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahaboddin Atharyan
- Department of Nursing, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Celia Harding
- Division of Language and Communication Science, City, University of London, London, UK
| |
Collapse
|
14
|
Fasoi G, Patsiou EC, Stavropoulou A, Kaba E, Papageorgiou D, Toylia G, Goula A, Kelesi M. Assessment of Nursing Workload as a Mortality Predictor in Intensive Care Units (ICU) Using the Nursing Activities Score (NAS) Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010079. [PMID: 33374244 PMCID: PMC7795444 DOI: 10.3390/ijerph18010079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Nursing activities score scales are valuable instruments for assessing the quality of nursing care provided in critically ill patients and easy to use in validating nurse staffing. The aim of this study was the assessment of nursing workload (NW) as a predictive factor of mortality by using the nursing activities score (NAS) scale. Materials and Methods: In this cross-sectional study of 91 days during 2019, convenience sampling was employed to recruit 82 registered nurses (RN) from three intensive care units (ICUs) of two public hospitals with 41 beds in total. Data were collected using the NAS scale, the researcher’s observation, the information given by the staff, and the nursing care reports. Descriptive and inductive statistics were used with significance level α = 0.05. The Statistical Package for Social Sciences (SPSS 25.0) was used for analyzing the data. Results: Females were the majority of the sample (84.1%), with a mean age of 38.9 (7.7) years, 87.8% had a nursing degree from a technological educational institute (T.E.I), the average working experience was 14 (8.1) years and the ICU experience was 12.9 (8.5) years. There were 3764 daily records of NAS with an average of 54.81 (2.34) and total NAS of 756.51 (150.27). The NW of the first day’s admission in the ICU was 65.15 (13.05), NW was 13.15 h/day and the NW of patients who died was 57.37 (4.06). The optimal nurse/patient ratio (NPR) was 1:1.82, while the existing NPR was 1:2.86. The mortality rate was 28.7%. Conclusion: Although the study results did not demonstrate a significant correlation between NW and mortality, the NW in ICU appeared to be relatively higher for patients who died than for those who survived. This result may serve as an indication for a positive correlation between these two variables. In addition, NW was found to be moderate, while one ICU nurse can take care of more than one patient.
Collapse
Affiliation(s)
- Georgia Fasoi
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
| | - Eirini C. Patsiou
- Intensive Care Unit, General Hospital Korgialenio-Benakio E.E.S, 11526 Athens, Greece;
| | - Areti Stavropoulou
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
| | - Evridiki Kaba
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
- Correspondence:
| | - Dimitrios Papageorgiou
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
| | - Georgia Toylia
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
| | - Aspasia Goula
- Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece;
| | - Martha Kelesi
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (G.F.); (A.S.); (D.P.); (G.T.); (M.K.)
| |
Collapse
|
15
|
Bruyneel A, Gallani MC, Tack J, d'Hondt A, Canipel S, Franck S, Reper P, Pirson M. Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs 2020; 62:102967. [PMID: 33162312 PMCID: PMC7598359 DOI: 10.1016/j.iccn.2020.102967] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.
Collapse
Affiliation(s)
- Arnaud Bruyneel
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium; SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Jérôme Tack
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Cliniques Universitaire de Bruxelles - Hôpital Erasme, Belgium
| | - Alain d'Hondt
- Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Sebastien Canipel
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Stéphane Franck
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium
| | - Pascal Reper
- Soins intensifs - Centre Hospitalier de la Haute Senne, le Tilleriau, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| |
Collapse
|
16
|
Moghadam KN, Chehrzad MM, Masouleh SR, Mardani A, Maleki M, Akhlaghi E, Harding C. Nursing workload in intensive care units and the influence of patient and nurse characteristics. Nurs Crit Care 2020; 26:425-431. [PMID: 32954619 DOI: 10.1111/nicc.12548] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding factors that can potentially influence patient care and nursing workload in intensive care units is important. Previous studies have shown contradictory outcomes about the relationships between nursing workload and patient and nurse characteristics. AIMS AND OBJECTIVES This study aimed to investigate nursing workload in intensive care units and examine the association between this in relation to patient and nurse characteristics. DESIGN A cross-sectional design was conducted. METHODS All nurses who were working in the intensive care units of five hospitals and met the study criteria were enrolled in the study. Two demographic questionnaires collected nurse and patient demographic information. The Nursing Activities Score was applied to determine nursing workload in three shifts (morning, evening, night) for each nurse. Data were analysed using the independent sample t-test, one-way analysis of variance, and multivariable linear regression analysis. RESULTS The Nursing Activities Score was calculated for 509 patients who were under the care of 105 intensive care unit nurses. The mean (SD) Nursing Activities Score was 72.84% (22.07%). Morning shifts, male patients, medical treatments, and referred patients from the emergency ward and other intensive care units imposed a higher workload for nurses. Specifically, female nurses, increased number of patients receiving care, and increased patient length of intensive care unit stay were directly associated with increased Nursing Activities Scores. Work in surgical and burn intensive care units were inversely associated with the Nursing Activities Score. CONCLUSION This study suggests that the workload of nurses in intensive care units can be affected by both nurse and patient characteristics. RELEVANCE TO CLINICAL PRACTICE The findings can be used to ensure appropriate staffing of intensive care units by nurses. However, nurse and patient characteristics should not be considered the only factors that influence nursing workload in intensive care units.
Collapse
Affiliation(s)
| | - Minoo Mitra Chehrzad
- Department of Paediatric Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Shademan Reza Masouleh
- Social Determinants of Health Research Centre (SDHRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Maleki
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Elham Akhlaghi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Celia Harding
- Division of Language and Communication Science, City, University of London, London, UK
| |
Collapse
|
17
|
Galazzi A, Bonasera Vincenti NM, Giusti GD, Brioni M, Adamini I, Laquintana D, Ristagno G, Grasselli G. The Medical Emergency Team in Italy: an overview of in-hospital emergencies response. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:9-18. [PMID: 32573502 PMCID: PMC7975838 DOI: 10.23750/abm.v91i6-s.9878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Medical Emergency Team (MET), implemented in many hospitals worldwide, aims to improve the safety of in-hospital patients whose condition is deteriorating. This study describes MET presence and organization in the Italian National Healthcare System Hospitals. METHODS A national survey with an online questionnaire was performed. The questionnaire, created ad hoc, was sent by e-mail to the nursing coordinators and MET referents of the Hospitals affiliated to the Italian National Healthcare System with an Anesthesia and Intensive Care service. RESULTS One hundred-ninety-seven hospitals were interviewed (36.2% of the whole national network). A dedicated MET, composed at least by an intensivist and a nurse, was present only in 118 cases (59.9%). The team was composed by a non-dedicated staff (67.8% of doctors, 69.5% of nurses) and a minimum shared standard of education for the nurse component was absent. One third of the estimated hospitals did not use a warning score for emergency call activation. DISCUSSION AND CONCLUSION This survey showed a heterogenous and often lacking organization of in-hospital emergency management in Italy. MET system needs to be implemented in terms of presence in the Italian hospitals, and standardized for personnel structure and training, and equipment availability. A broader study is necessary to compare our data with those of other European Countries to better identify the specific areas which need to be improved more promptly.
Collapse
|
18
|
Piredda M, Bambi S, Biagioli V, Marchetti A, Ianni A, Lusignani M, Rasero L, Matarese M, De Marinis MG. Cross-validation of the Care Dependency Scale in intensive care unit (ICU-CDS). Intensive Crit Care Nurs 2019; 57:102787. [PMID: 31883756 DOI: 10.1016/j.iccn.2019.102787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/01/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients' dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units. RESEARCH METHODOLOGY/DESIGN A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation. SETTING Adult patients admitted to intensive care units of four Italian hospitals. RESULTS The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate. CONCLUSION The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care.
Collapse
Affiliation(s)
- Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
| | - Valentina Biagioli
- Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Andrea Ianni
- Research Unit in Hygiene, Statistics and Public Health, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134 Florence, Italy.
| | - Maria Matarese
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| |
Collapse
|
19
|
Bruyneel A, Tack J, Droguet M, Maes J, Wittebole X, Miranda DR, Pierdomenico LD. Measuring the nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium. J Crit Care 2019; 54:205-211. [DOI: 10.1016/j.jcrc.2019.08.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023]
|
20
|
Lucchini A, Elli S, De Felippis C, Greco C, Mulas A, Ricucci P, Fumagalli R, Foti G. The evaluation of nursing workload within an Italian ECMO Centre: A retrospective observational study. Intensive Crit Care Nurs 2019; 55:102749. [DOI: 10.1016/j.iccn.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 01/14/2023]
|
21
|
Romano JL, Garcia PC, Silva DV, Moura BRS, de Souza Nogueira L. Type of admission and nursing workload of critical patients: a cross-sectional study. Nurs Crit Care 2019; 24:387-391. [PMID: 31294518 DOI: 10.1111/nicc.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/08/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory. AIMS AND OBJECTIVES To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU. DESIGN This was a quantitative cross-sectional study comprised of a retrospective analysis of clinical records of critical patients. METHODS Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level. RESULTS In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay. CONCLUSIONS The type of admission was not a predictive factor of the nursing workload required by critical patients. RELEVANCE TO CLINICAL PRACTICE Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU.
Collapse
Affiliation(s)
- Juliana Lemos Romano
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Paulo Carlos Garcia
- Department of Nursing, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Daniela Vieira Silva
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | - Lilia de Souza Nogueira
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
22
|
Abstract
A growing number of patients with increasingly complex or specialized diseases are being treated in hospitals worldwide. The treatment requirements of some of these patients are exceeding the capacity of standard nursing units. However, the severity of these diseases or the treatment requirements for these specific clinical pictures do not always justify admission to an intensive care unit. For this reason, an increasing number of special units (intermediate care units) are being set up to offer highly specialized treatment and close monitoring, in order to fulfil an intermediate role between the standard care unit and the intensive care unit. The recommendations of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) on the personnel, capacity, equipment and structure of these units are intended to provide the framework for the setting up and operation of intermediate care units in collaboration with experts on both an evidence-based and an expert-based basis (where scientific evidence is not available). Where only minimal or indirect evidence is available, patient safety is paramount in the formulation of the recommendation.
Collapse
|
23
|
Lucchini A, De Felippis C, Elli S, Bambi S. The burden of not-weighted factors in nursing workload: Can Nursing Activities Score be more suitable than TISS 28 and NEMS? Intensive Crit Care Nurs 2019; 51:82-83. [DOI: 10.1016/j.iccn.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022]
|
24
|
Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients. Dimens Crit Care Nurs 2019; 37:285-293. [PMID: 30273212 DOI: 10.1097/dcc.0000000000000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Oral care, using either a mouth rinse, gel, toothbrush, or combination of them, together with aspiration of secretions, may reduce the risk of ventilator-acquired pneumonia in intubated patents. Oral care procedure in patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) may cause bleeding due to the systemic anticoagulation required. PURPOSE The aim of this study was to investigate the rate of bleeding episodes during oral care in patients supported by VV-ECMO. METHODS A retrospective observational study was performed. All patients admitted to an Italian ECMO center during 2014 were included in the study. RESULTS Data from 14 patients were analyzed. The median intensive care unit length of stay was 39.0 days (interquartile range, 27.3-83.3 days), and median days on VV-ECMO was 19.5 (10.3-46.0). There were 440 ECMO days, with 1320 oral care maneuvers. In 7 patients, bleeding episodes occurred: 2 with orotracheal intubation and 5 initially managed with orotracheal intubation, thereafter via Translaryngeal tracheostomy tube (according to Fantoni's technique). In 61 oral care procedures (4.6%), bleeding was detected during or after the maneuver, whereas the total numbers of days with at least 1 bleeding episode were 35 (8%).The presence or absence of bleeding during ECMO days was statistically significant for international normalized ratio (1.01 [0.95-1.11] vs 1.13 [1.03-1.25], P < .0001), platelets (163 000 [93 500-229 000] vs 61 000 [91 00-100 000], P < .0001), and mouth care score (6 [5-7] vs 8 [7-9], P < .001). CONCLUSION Oral care can cause bleeding in patients on VV-ECMO. Implementation of protocols for daily oral care in patients on ECMO may reduce risks. As recommended by the literature, this category of patients should be treated in selected centers distinguished by a regular volume of ECMO activity and the presence of dedicated ECMO specialist nurses.
Collapse
|
25
|
Oliveira EG, Garcia PC, Citolino Filho CM, de Souza Nogueira L. The influence of delayed admission to intensive care unit on mortality and nursing workload: a cohort study. Nurs Crit Care 2018; 24:381-386. [PMID: 30478867 DOI: 10.1111/nicc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload. AIMS AND OBJECTIVES To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients. DESIGN This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED. METHODS The data were collected between 2014 and 2016 in a hospital located in São Paulo, Brazil. Nursing workload was measured by the Nursing Activities Score. Multiple linear and logistic regressions were applied, with a significance level of 5%. RESULTS Of the 534 patients analysed, the majority were men (57·49%); the mean age was 55·37 ± 19·64 years. Length of stay in the ED was not associated with nursing workload at the time of admission of patients to the ICU or during their stay in the unit. For mortality, this variable was a risk factor along with cause of admission, length of stay in the ICU and the Simplified Acute Physiology Score 3 score. For every additional hour that patients remained in the ED, their chance of dying in the ICU increased by 1%. CONCLUSION Length of stay of patients in the ED was a risk factor for mortality in the ICU; however, this variable did not have any influence on nursing workload. RELEVANCE TO CLINICAL PRACTICE Strategies need to be implemented to optimize the availability of ICU beds and reduce the length of stay of critical patients in the ED as delays in admitting such patients to the ICU have an impact on mortality.
Collapse
Affiliation(s)
- Ester Góes Oliveira
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | | | | | | |
Collapse
|
26
|
Nursing workloads and activity in critical care: A review of the evidence. Intensive Crit Care Nurs 2018; 48:10-20. [DOI: 10.1016/j.iccn.2018.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/15/2018] [Accepted: 06/03/2018] [Indexed: 11/23/2022]
|
27
|
Strazzieri-Pulido KC, S. González CV, Nogueira PC, Padilha KG, G. Santos VLC. Pressure injuries in critical patients: Incidence, patient-associated factors, and nursing workload. J Nurs Manag 2018; 27:301-310. [DOI: 10.1111/jonm.12671] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kelly C. Strazzieri-Pulido
- Independent Practitioner Enterostomal Therapy Nurse; School of Nursing (EEUSP) University of São Paulo; São Paulo Brazil
| | - Carol Viviana S. González
- Adult Health Nursing Graduate Program - PROESA; School of Nursing (EEUSP) University of São Paulo; São Paulo Brazil
| | - Paula C. Nogueira
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
- Menzies Health Institute Queensland - Griffith University, Gold Coast campus; Australia
| | - Kátia G. Padilha
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
| | - Vera L. C. G. Santos
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
| |
Collapse
|
28
|
Nieri AS, Manousaki K, Kalafati M, Padilha KG, Stafseth SK, Katsoulas T, Matziou V, Giannakopoulou M. Validation of the nursing workload scoring systems "Nursing Activities Score" (NAS), and "Therapeutic Intervention Scoring System for Critically Ill Children" (TISS-C) in a Greek Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2018; 48:3-9. [PMID: 29655596 DOI: 10.1016/j.iccn.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the reliability and validity of the Greek version of Nursing Activities Score (NAS), and Therapeutic Intervention Scoring System for Critically Ill Children (TISS-C) in a Greek Paediatric Intensive Care Unit (PICU). RESEARCH METHODOLOGY A methodological study was performed in one PICU of the largest Paediatric Hospital in Athens-Greece. The culturally adapted and validated Greek NAS version, enriched according to the Norwegian paediatric one (P-NAS), was used. TISS-C and Norwegian paediatric interventions were translated to Greek language and backwards. Therapeutic Intervention Scoring System (TISS-28) was used as a gold standard. Two independent observers simultaneously recorded 30 daily P-NAS and TISS-C records. Totally, 188 daily P-NAS, TISS-C and TISS-28 reports in a sample of 29 patients have been obtained during five weeks. Descriptive statistics, reliability and validity measures were applied using SPSS (ver 22.0) (p ≤ 0.05). RESULTS Kappa was 0.963 for P-NAS and 0.9895 for TISS-C (p < 0.001) and Intraclass Correlation Coefficient for all scale items of TISS-C was 1.00 (p < 0.001). P-NAS, TISS-28 and TISS-C measurements were significantly correlated (0.680 ≤ rho ≤ 0.743, p < 0.001). The mean score(±SD) for TISS-28, P-NAS and TISS-C was 23.05(±5.72), 58.14(±13.98) and 20.21(±9.66) respectively. CONCLUSION These results support the validity of P-NAS and TISS-C scales to be used in greek PICUs.
Collapse
Affiliation(s)
- Alexandra-Stavroula Nieri
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., Goudi, 11527 Athens, Greece
| | - Kalliopi Manousaki
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., Goudi, 11527 Athens, Greece
| | - Maria Kalafati
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., Goudi, 11527 Athens, Greece
| | - Katia Grilio Padilha
- University of São Paulo, School of Nursing, Medical-Surgical Nursing Department, São Paulo, Brazil.
| | - Siv K Stafseth
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Theodoros Katsoulas
- Department of Nursing, National and Kapodistrian University of Athens, Greece; University ICU, Ag. Anargiroi General Hospital, Kaliftaki 41, 14564 Kifissia, Greece.
| | - Vasiliki Matziou
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., Goudi, 11527 Athens, Greece.
| | - Margarita Giannakopoulou
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., Goudi, 11527 Athens, Greece.
| |
Collapse
|
29
|
Toffoletto MC, Oliveira EMD, Andolhe R, Barbosa RL, Padilha KG. COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180003780016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.
Collapse
|
30
|
Quality of Life of Adult Survivors After Extra Corporeal Membrane Oxygenation (ECMO). Dimens Crit Care Nurs 2018; 37:12-17. [DOI: 10.1097/dcc.0000000000000278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
31
|
Cyrino CMS, Dell'Acqua MCQ, Castro MCNE, Oliveira EMD, Deodato S, Almeida PMVD. Nursing Activities Score by assistance sites in Intensive Care Units. ESCOLA ANNA NERY 2017. [DOI: 10.1590/2177-9465-ean-2017-0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To compare the Nursing Activities Score (NAS) between the Assistance Sites in an Intensive Care Unit. Method: Descriptive, retrospective study, carried out in the Intensive Care Unit of a teaching hospital. The patients were organized in Assistance Sites according to their clinical characteristics and the nursing team's composition was organized in accordance with the Nursing Activities Score (NAS). The confidence interval was set at p < 0.05. Results: the majority were male surgical patients with a mean age of 56.8 years. The postoperative care Site presented the greatest patient turnover. The overall average NAS was 71.7%. There was a difference in the nursing workload between the different Assistance Sites. The shorter length of stay and the nonsurvivors contributed to increasing the workload in the ICU. Conclusion: Comparing the NAS in the different Sites made it possible to organize the work process of the nursing team according to each group, contributing to patient safety.
Collapse
|
32
|
Kraljic S, Zuvic M, Desa K, Blagaic A, Sotosek V, Antoncic D, Likic R. Evaluation of nurses’ workload in intensive care unit of a tertiary care university hospital in relation to the patients’ severity of illness: A prospective study. Int J Nurs Stud 2017; 76:100-105. [DOI: 10.1016/j.ijnurstu.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/07/2017] [Accepted: 09/09/2017] [Indexed: 11/15/2022]
|
33
|
Gil MFH, Montesinos MJL, Llor AMS, Bas MPF, Soler MLM. Adecuación de escalas para medir cargas de trabajo mediante metodología de calidad. Rev Bras Enferm 2017; 70:39-46. [DOI: 10.1590/0034-7167-2016-0246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/24/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMEN Objetivo: Determinar cuál de las escalas evaluadas (NEMS y NAS), es más adecuada para Unidades de Cuidados Intensivos aplicando metodología de calidad. Método: Tras identificar como oportunidad de mejora la no adecuación de la escala NEMS para determinar cargas de trabajo de enfermería en UCI, se aplica metodología de los ciclos de mejora a dicha escala y a la NAS, como propuesta de mejora, evaluando los criterios: medición de cargas de trabajo al día y por turno, inclusión de todas las actividades enfermeras, y análisis por paciente y unidad. Resultados: Escala NEMS no muestra diferencias significativas en el cumplimiento (67%). Comparación NEMS-NAS, todos los criterios excepto el 1º, obtienen mejora significativa. NEMS sólo valora el criterio 1 (64,22%), y NAS todos con un cumplimiento para el 1º, 2º y 4º del 64,74%, y el 3º del 100%. Conclusión: La escala NAS es más adecuada para medir cargas de trabajo de enfermería en UCI.
Collapse
Affiliation(s)
- Maria Fuensanta Hellín Gil
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, España; Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Maria José López Montesinos
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, España; Universidad de Murcia, Spain
| | - Ana Myriam Seva Llor
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, España; Universidad de Murcia, Spain
| | | | | |
Collapse
|
34
|
Goulart LL, Carrara FSA, Zanei SSV, Whitaker IY. Carga de trabalho de enfermagem relacionada ao índice de massa corporal de pacientes críticos. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Mensurar e comparar a carga de trabalho de enfermagem e a frequência dos itens pontuados no Nursing Activities Score (NAS), considerando os diferentes grupos de IMC de pacientes internados em Unidade de Terapia Intensiva (UTI). Métodos Estudo longitudinal realizado na UTI de hospital universitário em São Paulo, na qual o IMC do paciente foi calculado dividindo-se o peso pelo quadrado da altura e a carga de trabalho de enfermagem foi mensurada pelo NAS. Resultados A análise de 529 pacientes mostrou que o NAS não diferiu entre os grupos conforme o IMC. Os pacientes obesos demandaram mais tempo para o procedimento de higienização e maior número de pessoas para mobilização/posicionamento. Pacientes de baixo peso receberam mais frequentemente tratamento para melhora da função pulmonar. Conclusão Os resultados não apontaram diferença na carga de trabalho de enfermagem quando se considerou o IMC do paciente.
Collapse
|
35
|
Macedo APMDC, Mendes CMFS, Candeias ALS, Sousa MPR, Hoffmeister LV, Lage MIGS. Validação do Nursing Activities Score em unidades de cuidados intensivos portuguesas. Rev Bras Enferm 2016; 69:881-887. [DOI: 10.1590/0034-7167-2016-0147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: descrever o processo de adaptação e validação do Nursing Activities Score para o contexto português. Método: trata-se de um estudo-piloto de adaptação e validação do Nursing Activities Score, com amostra de 67 doentes internados em unidades de cuidados intensivos de três hospitais portugueses. A validade de constructo avaliou-se mediante procedimentos de análise fatorial e a consistência interna dos itens através do coeficiente Alpha de Cronbach. Resultados: obteve-se um valor médio da carga de trabalho de 63,04% (DP = 14,25; Mediana = 61,30). Os dados psicométricos revelaram um Alpha de Cronbach de 0,71, na escala total, indicando uma fidelidade aceitável. A análise fatorial confirmatória sugeriu um ajustamento adequado entre o modelo e os dados (χ2(199) = 214,5, p = 0,214; CFI = 0,95; RMSA = 0,035). Conclusão: neste estudo, a versão portuguesa do Nursing Activities Score revelou-se um instrumento válido, permitindo avaliar a carga de trabalho dos enfermeiros com segurança.
Collapse
|
36
|
Guo P, Chiew YS, Shaw GM, Shao L, Green R, Clark A, Chase JG. Clinical Activity Monitoring System (CATS): An automatic system to quantify bedside clinical activities in the intensive care unit. Intensive Crit Care Nurs 2016; 37:52-61. [PMID: 27401048 DOI: 10.1016/j.iccn.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/22/2016] [Accepted: 05/11/2016] [Indexed: 01/31/2023]
Abstract
Monitoring clinical activity at the bedside in the intensive care unit (ICU) can provide useful information to evaluate nursing care and patient recovery. However, it is labour intensive to quantify these activities and there is a need for an automated method to record and quantify these activities. This paper presents an automated system, Clinical Activity Tracking System (CATS), to monitor and evaluate clinical activity at the patient's bedside. The CATS uses four Microsoft Kinect infrared sensors to track bedside nursing interventions. The system was tested in a simulated environment where test candidates performed different motion paths in the detection area. Two metrics, 'Distance' and 'Dwell time', were developed to evaluate interventions or workload in the detection area. Results showed that the system can accurately track the intervention performed by individual or multiple subjects. The results of a 30-day, 24-hour preliminary study in an ICU bed space matched clinical expectations. It was found that the average 24-hour intervention is 22.0minutes/hour. The average intervention during the day time (7am-11pm) is 23.6minutes/hour, 1.4 times higher than 11pm-7am, 16.8minutes/hour. This system provides a unique approach to automatically collect and evaluate nursing interventions that can be used to evaluate patient acuity and workload demand.
Collapse
Affiliation(s)
- Peng Guo
- Department of Mechanical Engineering, University of Canterbury, New Zealand; Auckland Bioengineering Institute, the University of Auckland, New Zealand.
| | - Yeong Shiong Chiew
- Department of Mechanical Engineering, University of Canterbury, New Zealand; School Of Engineering, Monash University Malaysia, Malaysia.
| | - Geoffrey M Shaw
- Department of Intensive Care Medicine, Christchurch Hospital, Christchurch, New Zealand.
| | - Lei Shao
- Department of Mechanical Engineering, University of Canterbury, New Zealand; School of Electrical Engineering, Tianjin University of Technology, China.
| | - Richard Green
- Department of Computer Science and Software Engineering, University of Canterbury, New Zealand.
| | - Adrian Clark
- HIT Lab NZ, University of Canterbury, New Zealand.
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, New Zealand.
| |
Collapse
|
37
|
Armstrong E, de Waard MC, de Grooth HJS, Heymans MW, Reis Miranda D, Girbes ARJ, Spijkstra JJ. Using Nursing Activities Score to Assess Nursing Workload on a Medium Care Unit. Anesth Analg 2016; 121:1274-80. [PMID: 26484461 DOI: 10.1213/ane.0000000000000968] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The medium care unit (MCU) or "stepdown" unit is an increasingly important, but understudied care environment. With an aging population and more patients with complex multiple diseases, many patients often require a higher level of inpatient care even when full intensive care is not indicated. However, the nurse-to-patient ratio required on a MCU is neither well defined nor clear whether this ratio should be adjusted per shift. The Nursing Activities Score (NAS) is an effective instrument for measuring nursing workload in the intensive care unit (ICU) but has not been used in an MCU. The aim of this study was to measure the nursing workload per 8-hour shift on an MCU using the NAS and compare it with the NAS from an ICU in the same hospital. We also compared the NAS between groups of patients with different admission sources. METHODS The NAS was prospectively measured per patient per shift for 2 months in a 9-bed tertiary referral university hospital MCU and during a similar period in an ICU in the same hospital. RESULTS The mean NAS per patient did not differ between day (7:30 AM to 4:00 PM) and evening (3:00 PM to 11:30 PM) shifts, but the NAS was significantly lower during the night shift (11:00 PM to 8:00 AM) than during the day (P < 0.0001) and evening (P < 0.0001) shifts. The mean NASs in the ICU for day and night shifts were significantly lower than the scores in the MCU (P = 0.0056 and P < 0.0001, respectively), but NAS during the evening shift did not differ between the ICU and the MCU. The mean NAS for patients admitted to the MCU from the accident and emergency department was significantly higher than for those admitted from the ICU (P = 0.002), recovery (P = 0.002), and general ward (P < 0.0001). Patients on the MCU had a NAS comparable with that of ICU patients. CONCLUSIONS In our university hospital, NAS was higher during the day and evening hours and lower at night. We also found that patients from accident and emergency had a higher NAS than those admitted to the MCU from other locations. NAS in the MCU was not lower than the NAS in the ICU. Because of its ability to discriminate between day and evening workloads and between patients from different sources, the NAS may assist MCU managers in assessing staffing needs.
Collapse
Affiliation(s)
- Elizabeth Armstrong
- From the *Department of Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands; †Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands; and ‡Department of Intensive Care, University Hospital Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
38
|
Choi M, Lee HS. Critical Patient Severity Classification System predicts outcomes in intensive care unit patients. Nurs Crit Care 2016; 21:206-13. [PMID: 26841007 DOI: 10.1111/nicc.12223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The CPSCS was developed to assess the nursing care demands of patients in intensive care units (ICUs). AIM This study aimed to examine the Critical Patient Severity Classification System (CPSCS) score as an independent predictor of patient hospital outcomes. DESIGN This study was a secondary analysis. METHODS Data from 6380 cases were extracted from the electronic medical records in ICUs at a tertiary hospital in Korea during 2010-2012. To examine the association of the CPSCS score with 30-day ICU mortality, the Cox proportional hazards model and Kaplan-Meier survival curves were used, and generalized linear regression models of gamma distribution were developed for ICU length of stay (LOS). RESULTS More patients were admitted to surgical ICUs than medical ICUs (4664 versus 1716) during the study period. Medical ICU patients had longer ICU LOS, higher 30-day ICU mortality and a higher mean CPSCS score than surgical ICU patients. Cox analysis indicated that the mid and high CPSCS score groups had 1·687 and 2·913 times higher mortality risk, respectively, than the low CPSCS score group after adjusting for age, sex and primary diagnosis. The CPSCS score significantly predicted ICU mortality in both medical and surgical ICUs. Multivariate generalized linear regression indicated that CPSCS score was a significant predictor of ICU LOS after adjusting for other covariates. CONCLUSIONS The CPSCS score can be used to efficiently predict ICU mortality and LOS in patients admitted to the medical and surgical ICUs, although only the high CPSCS score group had significantly high mortality than the low CPSCS score group in the medical ICU. RELEVANCE TO CLINICAL PRACTICE The findings of this study contribute to valuable evidence that nursing-related factors have an impact on patient outcomes such as ICU mortality and LOS and that they have implications for hospital management, clinical practice and future research.
Collapse
Affiliation(s)
- Mona Choi
- Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | | |
Collapse
|
39
|
Palese A, Comisso I, Burra M, DiTaranto PP, Peressoni L, Mattiussi E, Lucchini A. Nursing Activity Score for estimating nursing care need in intensive care units: findings from a face and content validity study. J Nurs Manag 2016; 24:549-59. [PMID: 26806600 DOI: 10.1111/jonm.12357] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
AIM To re-evaluate the face and content validity of the Nursing Activity Score currently adopted in evaluating activities that best describe workloads in intensive care units and their weight in describing average nursing time consumption. BACKGROUND The Nursing Activity Score calculates the amount of nursing time that each patient will require over the next 24 hours. It has been widely used around the world since its first validation in 2003. However, no re-evaluation of its validity with regard to the advancements achieved in intensive care units nursing care has been documented to date. METHOD A research project was undertaken from 2012 to 2015, aimed at critically evaluating and validating this tool in the current context of Italian intensive care units nursing care. The 23 items were translated forward and backward into the Italian language, then a panel of 10 experts in critical care evaluated the face validity. Content validity was evaluated through focus groups involving seven critical care expert registered nurses. FINDINGS The Nursing Activity Score instrument has been considered as not fully adequate to measure current intensive care units nursing activities and their weightings have been considered not fully adequate to score average nursing time consumption. From the content validity process, lack of adequacy has emerged with respect to the concept of nursing care underpinning the tool, the interventions included, its capability to predict the nursing resources needed, advancements achieved in intensive care units nurses' roles and competences, and the contextual factors that may influence consumption of nursing time. CONCLUSIONS Development of the Nursing Activity Score tool both conceptually and in its structure, in view of the innovations that have occurred in the context of intensive care units, is necessary to continue to have a common tool to help clinicians and managers to capture accurately and compare nursing care required by patients in critical care settings. IMPLICATIONS FOR NURSING MANAGEMENT There is a need to revise the Nursing Activity Score tool, enabling its use in estimating nursing workloads in current Italian intensive care units practice. A taskforce of clinical nurses and nursing managers, capable of protecting the valuable original Nursing Activity Score project and to advance its further development is recommended.
Collapse
Affiliation(s)
| | - Irene Comisso
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Italy
| | - Monica Burra
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Italy
| | | | - Luca Peressoni
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Italy
| | - Elisa Mattiussi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Italy
| | - Alberto Lucchini
- Intensive Care and Emergency Department, San Gerardo, Hospital, Monza, Italy
| |
Collapse
|
40
|
Scaravilli V, Grasselli G, Castagna L, Zanella A, Isgrò S, Lucchini A, Patroniti N, Bellani G, Pesenti A. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study. J Crit Care 2015; 30:1390-4. [PMID: 26271685 DOI: 10.1016/j.jcrc.2015.07.008] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/17/2015] [Accepted: 07/13/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). MATERIAL AND METHODS We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). RESULTS Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n=18), PP improved oxygenation (Pao2/Fio2 124±50 mmHg, 187±72 mmHg, and 140±61 mmHg, during PRE, PRONE, and POST steps, respectively, P<.001), while pH and Paco2 were unchanged. CONCLUSIONS PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.
Collapse
Affiliation(s)
- Vittorio Scaravilli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Giacomo Grasselli
- Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Luigi Castagna
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Alberto Zanella
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Stefano Isgrò
- Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Alberto Lucchini
- Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Nicolò Patroniti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Giacomo Bellani
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Antonio Pesenti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy
| |
Collapse
|
41
|
Oliveira LBD, Rodrigues ARB, Püschel VADA, Silva FAD, Conceição SLD, Béda LB, Fidelis B, Santana-Santos E, Secoli SR. Assessment of workload in the postoperative period of cardiac surgery according to the Nursing Activities Score. Rev Esc Enferm USP 2015; 49 Spec No:80-6. [PMID: 26761696 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
Objective Identify factors associated with the workload of nursing care for patients in the postoperative period of cardiac surgery. Method Prospective cohort study conducted with 187 patients in the surgical intensive care unit (ICU) of the Instituto do Coração(Heart Institute) in São Paulo-Brazil. Data were collected at 24 and 72 hours of the patients' admittance in the ICU. The dependent variable was workload as calculated by the Nursing Activities Score (NAS). The independent variables were demographic and clinical, as well as mortality scores. For data analysis, the Wilcoxon-Mann-Whitney test and Spearman correlation were used, and linear regression with mixed effects model. Results The majority of patients were male (59.4%), with a mean age of 61 years (±12.7), and 43.9% developed some kind of complication in the postoperative period. In the first 24 hours, the workload was 82.4% (±3.4), and 58.1% (±3.4) in 72 hours. Factors associated with increased NAS were: patient's length of stay in the ICU (p=0.036) and the presence of complications (p<0.001). Conclusion In contrast to numerous other studies, the severity of the patient's condition in the first 24 hours of the postoperative period did not increase workload, the increase was associated with length of stay in the ICU and complications.
Collapse
Affiliation(s)
| | | | | | | | | | - Laísla Baccarin Béda
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bruna Fidelis
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Silvia Regina Secoli
- Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
42
|
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.
Collapse
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
| | | |
Collapse
|