Nursing workload in the intensive care unit - Can it be measured?

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR CLINICAL PRACTICE

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

Mapping nursing interventions using the Therapeutic Intervention Scoring System in bloodless liver transplantations

BACKGROUND

The Simplified Therapeutic Intervention Scoring System adapted to liver transplantation by King's College Hospital rank 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs.

OBJECTIVES

To evaluate nursing activities of "King's-TISS" score grouped in organ systems and nurse patient ratio in the perioperative 48 hours of blood product free liver transplantations (LT).

METHODS

The "King's-TISS" score's were analysed by nursing procedures and grouped, scored according to organ systems. The nursing workloads were studied during LT (T1), on arrival on the ICU (T2) and 12-24-48 hours after LT (T3-T4-T5).

RESULTS

The total of "King's-TISS" score points were decreased by ≥20% daily (p = 0.001). The mean score of 104 ± 3.5 points (CI:104-105) during LT decreased to 84.7 ± 12 points (CI:83-86) in 48 hours (T5). The "metabolic" and "haemostasis" points increased (p = ).01), the "immunology" points unchanged (T2-T5) postoperatively. A slight decrease was observed in case of "basic nursing care", "monitoring", "neurologic support", "renal support" and "cardiovascular support" points (T2-T5, p < .01). The "invasive intervention" and "ventilatory support" points strongly decreased (T2-T5, p < .001). One "King's-TISS" point was found to equal 7.4 minutes with a nurse patient ratio of 2:1 intraoperatively and 1:1 postoperatively.

CONCLUSION

Absence of blood product administration in LT decreases the total and organ specific workload, except the metabolic, haemostasis, immunology and basic support requirement. It was not within the scope of the King's-TISS score to analyse the application of viscoelastic haemostasis test and coagulation factor concentrate administration.