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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.
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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
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Sibilio S, Zaboli A, Parodi M, Ferretto P, Milazzo D, Trentin M, Filippi L, Carlana G, Brigo F, Marchetti M, Turcato G. Objective assessment of nursing workload in an intermediate care unit: A prospective observational study. Intensive Crit Care Nurs 2024; 86:103767. [PMID: 39255616 DOI: 10.1016/j.iccn.2024.103767] [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: 03/03/2024] [Revised: 05/22/2024] [Accepted: 07/06/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES To systematically assess the nursing workload in an Intermediate Care Unit. DESIGN Single-centre prospective observational study. The nursing activities within the initial 72 h of hospitalization were recorded on a prespecified chart and standardized as activities/5 min/patient/day. SETTING This study was conducted at the Intermediate Care Unit of the Altovicentino Hospital (Italy) from September 1 to December 31, 2022. MAIN OUTCOME MEASURE We considered working overload as an average number of nursing activities/5 min/patient/day higher than the 85th percentile and investigated independent risk factors associated with it. RESULTS A total of 183 patients were included. During their hospital stay, the average number of nursing activities per patient was 30 per 5-minute interval per day (range: 22-40). On the first day of hospitalization, the primary activities were predominantly administrative and managerial tasks. In contrast, on the second day, activities related to therapeutic management and primary care predominated. Various scores related to the patient's condition, including comorbidity, functionality, frailty, intensity, and severity, were analyzed for their association with nursing workload using multivariate analysis. However, only the National Early Warning Score was found to be an independent risk factor for nursing workload overload (OR 1.399, 95 % CI 1.205-1.624, p < 0.001). CONCLUSION The study results demonstrated a significant variation in nursing workload within the same department. Subsequent studies are necessary to confirm the ability of the National Early Warning Score in predicting nursing over workload. IMPLICATION FOR CLINICAL PRACTICE This study provides a detailed analysis of nursing workload in intermediate care settings, emphasizing the need for adequate resource allocation due to the potential for rapid deterioration in patients' conditions. By correlating nursing activities with patient severity indices, such as the National Early Warning Score, the findings support more effective organizational strategies to enhance care for patients at high risk of health decline.
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Affiliation(s)
- Serena Sibilio
- Institute of Nursing Science, University of Basel -Department of Public Health, Basel, Switzerland.
| | - Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Paolo Ferretto
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Daniela Milazzo
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Monica Trentin
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Lucia Filippi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Greta Carlana
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Massimo Marchetti
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
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Wang W, Mei Y, Vellone E, Zhang Z, Liu B, Zhou C, Zhang J. Development and psychometric testing of the Self-Care of Stroke Inventory. Disabil Rehabil 2024; 46:1178-1187. [PMID: 37078619 DOI: 10.1080/09638288.2023.2196093] [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: 10/12/2022] [Accepted: 03/22/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE To develop and evaluate the psychometric properties of the Self-Care of Stroke Inventory (SCSI). MATERIALS AND METHODS A cross-sectional, instrument development and the psychometric testing study was conducted. A 23-item self-report Self-Care of Stroke Inventory with 3 separate scales was developed. This study involved three stages: (a) Initial items generation; (b) Content and face validation; (c) Psychometric properties evaluation. The SCSI was validated by content validity, construct validity, convergent validity, internal consistency, and test-retest reliability. RESULTS From the initial 80-item pool, 24 items of 3 scales in the SCSI were retained by the expert consultation and item analysis. The scale's content validity was 0.976, 0.966, and 0.973. The EFA showed the total variance explained by the 3 scales of the SCSI were 73.417%, 74.281%, and 80.207%, respectively. The models of the 3 scales identified by EFA were all confirmed by the CFA. The SCSI scale shows evidence of good convergent validity. Cronbach's αs were 0.830, 0.930, and 0.831. Test-retest reliability of the SCSI was excellent, with an intraclass correlation coefficient of 0.945, 0.907, and 0.837. CONCLUSIONS The final 23-item SCSI presents good psychometric properties and can be used to explore the self-care of stroke in community settings.IMPLICATIONS FOR REHABILITATIONThis study developed and validated the Self-Care of Stroke Inventory (SCSI).The SCSI contains the following 3 scales: the Self-care Maintenance of Stroke scale, the Self-care Monitoring of Stroke scale, and the Self-care Management of Stroke scaleThe 23-item SCSI demonstrated strong psychometric properties.The SCSI may be used to develop future programmes to promote self-care for stroke survivors and improve their rehabilitation outcomes.
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Affiliation(s)
- Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Bowen Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chenxi Zhou
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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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.
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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
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Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: A systematic review. Nurs Health Sci 2023; 25:497-515. [PMID: 37784243 DOI: 10.1111/nhs.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bethany Howard
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Watterson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ko Y, Park B, Lee H, Kim D. Development of a patient classification system for critical care nursing based on nursing intensity. Int J Nurs Pract 2023; 29:e13128. [PMID: 36585752 DOI: 10.1111/ijn.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 01/01/2023]
Abstract
AIM This study aimed to develop a valid and reliable new intensive care unit nursing classification tool, including direct and indirect nursing activities, by measuring the nursing intensity provided to patients. BACKGROUND Prior tools primarily examine patients' medical records or disease severity/interactions, systematically failing to reflect comorbidity risk factors. DESIGN The Delphi technique was used to test the content validity of the Korean Patient Classification System on Nursing Intensity for Critical Care Nurses (KPCSNIC). METHODS Data were collected from four hospitals in two provinces from 26 December 2017 to 30 January 2018. To verify construct validity, staff nurses classified 365 patients, comparing differences by medical department and type of stay. To verify interrater reliability, data collectors and the head nurses of three intensive care units classified 87 patients. RESULTS The KPCSNIC had 8 categories, 44 nursing activities and 105 criteria. Reliability was high (r = .84). Construct validity was verified by revealing differences according to medical department and type of patient. Using total scores, four KPCSNIC groups were identified. CONCLUSION The KPCSNIC developed in this study can support staffing for nursing intensity by providing more specific evaluation criteria. Moreover, it reflects nursing intensity, including direct and indirect nursing activities.
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Affiliation(s)
- Yukyung Ko
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, South Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Changwon, South Korea
| | - Hanju Lee
- Department of Nursing, Sangmyung University, Cheonan, South Korea
| | - Donghwan Kim
- Benefits Information Analysis Department, Health Insurance Review and Assessment service (HIRA), Wonju, South Korea
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Esteban-Sepúlveda S, Giró-Formatger D, Hernández-García AF, Serratosa-Cruzado S, Moreno-Leyva M, Terradas-Robledo R, Lacueva-Pérez L. Info-NAS: A Computer Program for the Calculation of Intensive Care Unit Nurse Workload. Comput Inform Nurs 2023; 41:825-832. [PMID: 36912356 DOI: 10.1097/cin.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.
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Affiliation(s)
- Silvia Esteban-Sepúlveda
- Author Affiliations: Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona (Drs Esteban-Sepúlveda and Terradas-Robledo, Ms Giró-Formatger, Ms Hernández-García, Mr Serratosa-Cruzado, and Ms Lacueva-Pérez); and Departament d'Infermeria Fonamental i Medicoquirúrgica, Escola d'Infermeria, Universitat de Barcelona (Dr Esteban-Sepúlveda)
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Romare C, Anderberg P, Sanmartin Berglund J, Skär L. Burden of care related to monitoring patient vital signs during intensive care; a descriptive retrospective database study. Intensive Crit Care Nurs 2022; 71:103213. [DOI: 10.1016/j.iccn.2022.103213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
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Krupa S, Dorota O, Friganovic A, Mędrzycka-Dąbrowska W, Jurek K. The Polish Version of the Nursing Delirium Screening Scale (NuDESC PL)-Experience of Using in Nursing Practice in Cardiac Surgery Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910108. [PMID: 34639408 PMCID: PMC8507661 DOI: 10.3390/ijerph181910108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. Methods: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. Results: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. Conclusion: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.
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Affiliation(s)
- Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland; (S.K.); (O.D.)
| | - Ozga Dorota
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland; (S.K.); (O.D.)
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
- Correspondence:
| | - Krzysztof Jurek
- The Institute of Sociological Sciences, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland;
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Assaye AM, Wiechula R, Schultz TJ, Feo R. Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review. JBI Evid Synth 2021; 19:751-793. [PMID: 32881732 DOI: 10.11124/jbisrir-d-19-00426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this review was to determine the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings within low- and middle-income countries. INTRODUCTION Health care systems in low- and middle-income countries experience a high proportion of the global burden of disease, which is aggravated by several health care constraints. The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging in low- and middle-income countries. Health care systems in low- and middle-income countries, however, are still expected to address universal health care access and provide high-quality health care. Systematic reviews examining nurse staffing and its effect on patient and nurse workforce outcomes are largely from the perspective of high-income countries. There is a need to understand the evidence on nurse staffing and its impact in the context of low- and middle-income countries. INCLUSION CRITERIA Empirical studies that addressed acute care nurse staffing levels, such as nurse-to-patient ratio or nurses' qualifications, experience, and skill mix, and their influence on patient and nurse workforce outcomes were included in the review. Studies conducted in a low- or middle-income country were included. Outcomes must have been measured objectively using validated tools. METHODS Studies published until July 2019 were identified from CINAHL, PubMed, Scopus, Embase, PsycINFO, Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. Narrative synthesis was conducted due to high heterogeneity of included studies. The level of evidence was determined using GRADEpro. RESULTS Twenty-seven studies were included in this review and the level of evidence was low, mainly due to the design of included studies. Low nurse-to-patient ratio or high nurse workload was associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment. Findings on the effect of nurse staffing on length of hospital stay and incidence of pressure ulcers were inconsistent. Extended work hours, less experience, and working night or weekend shifts all significantly increased medication errors. Higher nurse workload was linked to higher levels of nurses' burnout, needlestick and sharps injuries, intent to leave, and absenteeism. CONCLUSIONS Lower nurse-to-patient ratios and higher nurse workload are linked to in-hospital mortality, hospital-acquired infections, and medication errors among patients, and high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave their job among nurses in low- and middle-income countries. The results of this review show similarities with the evidence from high-income countries regarding poor outcomes for patients and nurses. These findings should be considered in light of the lower nurse-to-patient ratios in most low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018119428.
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Affiliation(s)
| | - Richard Wiechula
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia.,Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia.,Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Ricci de Araújo T, Papathanassoglou E, Gonçalves Menegueti M, Grespan Bonacim CA, Lessa do Valle Dallora ME, de Carvalho Jericó M, Basile-Filho A, Laus AM. Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil. J Nurs Manag 2021; 29:1778-1784. [PMID: 33772914 DOI: 10.1111/jonm.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND Accurate data of nursing cost can contribute to reliable resource management. METHOD We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
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Affiliation(s)
- Thamiris Ricci de Araújo
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Mayra Gonçalves Menegueti
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Anibal Basile-Filho
- Department of Surgery and Anatomy of Medical School, Division of Intensive Medicine of Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Laus
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
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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.
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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.)
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Margadant CC, de Keizer NF, Hoogendoorn ME, Bosman RJ, Spijkstra JJ, Brinkman S. Nurse Operation Workload (NOW), a new nursing workload model for intensive care units based on time measurements: An observational study. Int J Nurs Stud 2020; 113:103780. [PMID: 33157431 DOI: 10.1016/j.ijnurstu.2020.103780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Several instruments have been developed to measure nursing workload. The commonly used Nursing Activities Score (NAS) and Therapeutic Intervention Scoring System (TISS) are applied to all types of ICU patients. Former research showed that NAS explained 59 to 81% of actual nursing time, whereas the Therapeutic Intervention Scoring System (TISS) described only 43% of the actual nursing time. In both models the development was not based on time measurements. OBJECTIVES The aim of this study was to develop a time-based model which can assess patient related nursing workload more accurately and to evaluate whether patient characteristics influence nursing time and therefore should be included in the model. DESIGN Observational study design. SETTING All 82 Dutch ICUs participate in the National Intensive Care Evaluation (NICE) quality registry. Fifteen of these ICUs are participating in the newly implemented voluntary nursing capacity module. Seven of these ICUs voluntarily participated in this study. PARTICIPANTS The patient(s) that were under the responsibility of a chosen nurse were followed by the observer during the entire shift. METHODS Time spent per nursing activity per patient was measured in different shifts in seven Dutch ICUs. Nursing activities were measured using an in-house developed web application. Three different models of varying complexity (1. nursing activities only; 2. nursing activities and case-mix correction; 3. complex model with case-mix correction per nursing activity) were developed to explain the total amount of nursing time per patient. The performance of the three models was assessed in 1000 bootstrap samples using the squared Pearson correlation coefficient (R2), Root Mean Squared Prediction Error (RMSPE), Mean Absolute Prediction Error (MAPE), and prediction bias. RESULTS In total 287 unique patients have been observed in 371 shifts. Model one's Pearson's R was 0.89 (95%CI 0.86-0.92), model two with case-mix correction 0.90 (95%CI 0.88-0.93), and the third complex model 0.64 (95%CI 0.56-0.72) compared with the actual patient related nursing workload. CONCLUSION The newly developed Nurse Operation Workload (NOW) model outperforms existing models in measuring nursing workload, while it includes a lower number of activities and therewith lowers the registration burden. Case-mix correction does not further improve the performance of this model. The patient related nursing workload measured by the NOW gives insight in the actual nursing time needed by patients and can therefore be used to evaluate the average workload per patient per nurse.
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Affiliation(s)
- Charlotte C Margadant
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - Marga E Hoogendoorn
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands; Department Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands
| | - Rob J Bosman
- Department of Intensive Care, OLVG, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - Jan Jaap Spijkstra
- Department of Intensive Care, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands; Department Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands
| | - Sylvia Brinkman
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
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Affiliation(s)
- Alberto Lucchini
- General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Pasquale Iozzo
- Anesthesia & Intensive Care Department, "Paolo Giaccone" University Hospital, Palermo, Italy
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital, Florence, Italy
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Decock K, Casaer MP, Guïza F, Wouters P, Florquin M, Wilmer A, Janssens S, Verelst S, Van den Berghe G, Bruyneel L. Predicting patient nurse-level intensity for a subsequent shift in the intensive care unit: A single-centre prospective observational study. Int J Nurs Stud 2020; 109:103657. [PMID: 32593881 DOI: 10.1016/j.ijnurstu.2020.103657] [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: 05/31/2019] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A dynamic optimized nurse staffing model for the Intensive Care Unit (ICU), requires a tool for monitoring nurse-level intensity with validated cut-offs to identify patients requiring 1:1, 2:1 or 3:1 patient-to-nurse ratios. OBJECTIVES We aimed to determine the Nursing Activities Score (NAS) cut-off values which can best distinguish between high, average and lower nurse-level intensity as unanimously perceived by care providers, and to evaluate whether these NAS cut-offs allow to predict nurse-level intensity in the next shift or the same shift the next day. DESIGN A prospective observational study. SETTING 9 ICUs in a Belgian tertiary care center. PARTICIPANTS All 3295 patients admitted between March 20, 2013, and September 12, 2013 were included. NAS was quantified at the end of each shift using automatically derived and manually entered care information. Additionally, 412 nurses, 24 nurse managers and 37 physicians rated perceived nurse-level intensity. METHODS We first assessed concordance between nurses', nurse managers' and physicians' perceptions of lower (3:1 patient-to-nurse ratio), average (2:1 patient-to-nurse ratio) and high (1:1 patient-to-nurse ratio) nurse-level intensity. Next, receiver operating characteristic (ROC) analysis was applied to determine the NAS cut-offs that best distinguish between different levels of perceived intensity for cases with concordant opinions. Last, logistic regression analysis was applied to estimate the ability of these NAS cut-offs to predict low and high perceived intensity during the next shift and during the same shift the next day. RESULTS Nurses', nurse managers' and physicians' perceptions were concordant in 57.1% (n = 4693) of cases, mostly concerning lower or average intensity. Optimal NAS cut-offs for lower and high intensity patients equaled 52.7% and 69.8%, respectively. The lower intensity NAS cut-off showed 74.0% accuracy to predict lower intensity in the next shift and 75.9% accuracy to predict lower intensity for the same shift the next day. The high intensity NAS cut-off showed 67.9% accuracy to predict high intensity in the next shift and 72.0% accuracy to predict high intensity for the same shift the next day. CONCLUSIONS NAS cut-offs could contribute considerably in predicting patient nurse-level intensity, and thus patient-to-nurse staffing ratios, in the next shift or day. Identification or prediction of high intensity, nevertheless, appears most complex and requires further study. Future studies need to account for the many confounding variables which complicate nurse staffing planning.
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Affiliation(s)
- Karen Decock
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Michael P Casaer
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Fabian Guïza
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Pieter Wouters
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Mieke Florquin
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Alexander Wilmer
- Medical Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Stefan Janssens
- Cardiac Intensive Care, Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Sandra Verelst
- Emergency Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Greet Van den Berghe
- Intensive Care Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Kapucijnenvoer 35, 3000 Leuven; Belgium & Quality Improvement Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Zhang S, Wu Y, Fu Z, Lu Y, Wang Q, Mingxuan L. Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL). J Nurs Manag 2020; 28:277-285. [PMID: 31789434 PMCID: PMC7161924 DOI: 10.1111/jonm.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/04/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Abstract
Aim Background Methods Results Conclusions Implications for nursing management
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Affiliation(s)
- Shan Zhang
- School of Nursing Capital Medical University Beijing China
| | - Ying Wu
- School of Nursing Capital Medical University Beijing China
| | - Ziyuan Fu
- School of Nursing Capital Medical University Beijing China
| | - Yating Lu
- School of Nursing Capital Medical University Beijing China
| | - Qingyu Wang
- School of Nursing Capital Medical University Beijing China
| | - Liu Mingxuan
- School of Nursing Capital Medical University Beijing China
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Workload scoring systems in the Intensive Care and their ability to quantify the need for nursing time: A systematic literature review. Int J Nurs Stud 2020; 101:103408. [DOI: 10.1016/j.ijnurstu.2019.103408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/29/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022]
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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]
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Stafseth SK, Tønnessen TI, My Diep L, Fagerstrøm L. Testing the Reliability and Validity of the Nursing Activities Score in Critical Care Nursing. J Nurs Meas 2019; 26:142-162. [PMID: 29724285 DOI: 10.1891/1061-3749.26.1.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the reliability and validity of the conceptual model of critical care nursing using the Nursing Activities Score (NAS) for intensive care unit (ICU) patients. METHODS An observational study conducted in 2011 using the NAS scores of 219 patients in Norway. The inter-rater reliability (IRR) was tested by parallel classifications. The validity was explored by an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) as the measurement models in the structural equation model. RESULTS Within the paired ratings the Spearman's correlation coefficient was 0.39. The EFA results explained 77% of the variance with six factors. The reduced CFA model resulted in a three-factor model: relationship, prevention and treatment. CONCLUSION The findings supported the IRR and construct validity of the conceptual model of the NAS.
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Haun de Oliveira O, Pinto R, DasGupta T, Sirtartchouck L, Rashleigh L, Cross N, Srikandarajah A, Sukumaran J, Wunsch H, Cuthbertson BH. Assessment of need for lower level acuity critical care services at a tertiary acute care hospital in Canada: A prospective cohort study. J Crit Care 2019; 53:91-97. [PMID: 31202164 DOI: 10.1016/j.jcrc.2019.06.004] [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: 12/14/2018] [Revised: 04/11/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Critical care beds are commonly described in three levels (highest level 3, lowest level 1). We aimed to describe the actual level of care for patients assigned to level 2 in a tertiary hospital with inadequate level 1 bed capacity. MATERIALS AND METHODS Prospective cohort study with daily assessment of level of care. The primary outcome was the proportion of patients who could be triaged to level 1 for the entirety of their ICU stay. Secondary outcomes included the percentage of patients who could receive level 1 care on any given day. RESULTS 289 patients originally classified as level 2 were assessed for the primary, and 335 for the secondary outcomes. 14.9% could be level 1 for their entire ICU stay. 20.6%, once appropriate for level 1, remained in that level for the rest of their ICU stay. 23.6% of the assessments were suitable for level 1 on any given day. CONCLUSION In a single centre, 14.9% of level 2 patients could have been cared for in a lower acuity bed for the entirety of their ICU stay. We believe this methodology is reproducible and can help resource allocation with regard to the high demand for critical care beds.
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Affiliation(s)
- Olivia Haun de Oliveira
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, ON M4N3M5, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, ON M4N3M5, Canada
| | - Tracey DasGupta
- Interprofessional Practice Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D404b, Toronto, ON M4N3M5, Canada
| | - Leda Sirtartchouck
- Interprofessional Practice Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D404b, Toronto, ON M4N3M5, Canada
| | - Laura Rashleigh
- Interprofessional Practice Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D404b, Toronto, ON M4N3M5, Canada
| | - Nicole Cross
- Tory Trauma Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503c, Toronto, ON M4N3M5, Canada
| | - Aruchana Srikandarajah
- Tory Trauma Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503c, Toronto, ON M4N3M5, Canada
| | - Jaya Sukumaran
- Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D408, Toronto, ON M4N3M5, Canada
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, ON M4N3M5, Canada; Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, ON M4N3M5, Canada.
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Zhu Y, Zhan YC, Zhu JM, Huang L, Zhang L, Zhang M, Li BK. The development and psychometric validation of a Chinese empathy motivation scale. J Clin Nurs 2019; 28:2599-2612. [PMID: 30830708 DOI: 10.1111/jocn.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To develop and validate an instrument to measure nurses' empathy motivation in China (See Supporting Information Appendix S1). BACKGROUND Nurses are increasingly expected to empathise with patients in clinical settings. However, research investigating nurses' empathy motivation in China is lacking, and no specific instrument exists worldwide. DESIGN Two-stage cross-sectional study, which follows the STROBE guidelines. Instrument development and psychometric evaluation were used (See Supporting Information Appendix S1). METHODS A literature review and qualitative interviews with nurses were conducted to generate the initial items. Convenience samples of 340 (for item analysis) and 640 (for psychometric evaluation) clinical nurses working at four tertiary hospitals in Anhui Province were recruited. The scale was validated by content validity, surface validity and item analysis. A total of 640 participants were randomly divided into two equal groups. Exploratory factor analysis (EFA) was used with varimax rotation, confirmatory factor analysis (CFA) and internal consistency reliability to analyse the psychometric properties of the scale (See Supporting Information Appendix S1). RESULTS From the initial 90-item pool, 27 items were retained by the item analysis. The EFA (N = 290) showed the following six factors on the scale explained 71.266% of the overall variance: amotivation, external regulation, introjected regulation, identified regulation, integrative regulation and intrinsic motivation. Furthermore, when limited to three factors, that is autonomy motivation, controlled motivation and amotivation, 56.578% of the variance was explained. The findings showed high internal consistency. The six-factor solution and three-factor solution of the scale, including 27 items, were both confirmed by the CFA, for example χ2 /df = 1.744, 2.261; RMSEA = 0.051, 0.066; GFI = 0.882, 0.847; TLI = 0.942, 0.902; and RMR = 0.039, 0.049, respectively. CONCLUSIONS The nurses' empathy motivation scale presents good psychometric properties and can be used to explore nurses' empathy motivation in China (See Supporting Information Appendix S1). RELEVANCE TO CLINICAL PRACTICE This study offers insight into nurses' complicated reasons for exhibiting empathy.
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Affiliation(s)
- Yu Zhu
- Nursing School, Anhui University of Chinese Medicine, Hefei, China
| | - Yu-Can Zhan
- School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
| | - Ji-Min Zhu
- School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
| | - Li Huang
- Nursing School, Anhui University of Chinese Medicine, Hefei, China
| | - Ling Zhang
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Miao Zhang
- Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bai-Kun Li
- School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
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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]
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Reis MASD, Gabriel CS, Zanetti ACB, Bernardes A, Laus AM, Pereira LRL. MEDICAMENTOS POTENCIALMENTE PERIGOSOS: IDENTIFICAÇÃO DE RISCOS E BARREIRAS DE PREVENÇÃO DE ERROS EM TERAPIA INTENSIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018005710016] [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
RESUMO Objetivo: investigar o conhecimento dos profissionais de enfermagem e farmacêuticos em relação à identificação de medicamentos potencialmente perigosos, bem como verificar o reconhecimento das barreiras de prevenção de erros nas instituições hospitalares. Método: estudo transversal, tipo inquérito, realizado em unidades de terapia intensiva de quatro hospitais. Um questionário construído e validado com base nas informações disponibilizadas pelo Instituto para Práticas Seguras no Uso de Medicamentos foi utilizado para coleta de dados. Para análise dos dados utilizou-se o software Statistical Package for the Social Sciences, versão 22.0 e o teste de Kruskal-Wallis para investigar diferença dos resultados entre as categorias profissionais. Adotou-se o nível significância de 0,05. Resultados: foram incluídos 126 profissionais, entre os elegíveis para participação. Dentre os 33 medicamentos potencialmente perigosos indicados no instrumento, nenhum foi identificado como tal pela totalidade de respondentes, embora 17 fossem utilizados por mais de 95% dos entrevistados. Não foi observada diferença estatisticamente significante nas respostas das diferentes categorias profissionais quanto à identificação desses medicamentos. Em relação às medidas de prevenção de erros, os enfermeiros constituíram a categoria profissional que distinguiu em maior número a existência de barreiras. Conclusão: este estudo apontou importantes lacunas no reconhecimento dos medicamentos potencialmente perigosos e adoção incipiente de barreiras para prevenção de incidentes, caracterizando situações de fragilidade nos hospitais por implicar na ruptura inicial das barreiras, especialmente quando os profissionais de saúde estão inseridos em um ambiente de alta complexidade.
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