Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score

Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study

INTRODUCTION

Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences.

OBJECTIVES

This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment.

METHODOLOGY

A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa).

SETTINGS

Intensive Care Units in Warmia and Mazury Region in Poland.

MAIN OUTCOME MEASURES

Level of Nursing Care Rationing in Intensive Care Units.

RESULTS

The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05.

CONCLUSIONS

It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care.

IMPLICATIONS FOR CLINICAL PRACTICE

Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Pressure ulcers/injuries prevention in emergency services: A scoping review

AIM OF THE STUDY

To map the available evidence on nursing care provided to prevent the development of pressure ulcers/injuries in emergency services.

MATERIAL AND METHODS

Scoping review that follows the Preferred Reporting Items for Systematic reviews and the Meta-Analyses extensions for Scoping Reviews and the Joanna Briggs Institute guidelines. The inclusion criteria were based on the PCC mnemonic. The main variables of interest were the nursing care provided to prevent the development of pressure ulcers/injuries (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The scoping review protocol was registered on the OSF platform.

RESULTS

During the selection process, 175 articles were identified in different databases. Applying the inclusion and exclusion criteria, 20 studies were included in this scoping review. The preventive measures for the development of pressure ulcers/injuries were grouped into 9 categories: "risk factors and risk assessment", "support surfaces", "dressings for pressure ulcer/injury prevention", "skin and tissue assessment", "repositioning and early mobilization", "preventive skin care", "nutrition in pressure ulcer/injury prevention", "health education" and "vital signs management". The instruments for assessing the risk of developing pressure ulcers/injuries mentioned in the studies are the Braden, Waterlow and Norton scales. The most documented tool for assessing the risk of developing pressure ulcers/injuries in hospital emergency services was the Braden Scale.

CONCLUSION

International literature identified several preventive interventions that could be implemented in emergency services to avoid pressure ulcers/injuries development. However, is crucial that those preventive interventions were systematic implemented (in combination) since hospital admission.

The effect of the intensive care unit nurse manpower on care behaviours and stress level on the nurses

BACKGROUND

Nurses working in the intensive care units (ICU) regarding the work-index-nursing work environment, the effect level ICU environment has on the nurses' care behaviors and stress levels of the nurses should be determined.

OBJECTIVE

The study aimed to investigate the effect of the nurse manpower on care behaviours and stress level of the nurses working in the ICU.

METHODS

This was a cross-sectional and correlational study. The sample of the study consisted of 123 nurses working in the ICUs. The data were collected using the survey form, Distress Thermometer (DT), The Practice Work Environment Scale of the Nursing Work Index (PES-NWI), and Caring Behaviors Scale-24 (CBS-24).

RESULTS

The mean age of nurses in the ICU was 30.2±5.6 and the mean of working time in the intensive care unit of nurses in the ICU was 3.7±3.1 years. The mean of the DT was 4.8±3.4, and the mean score of PES-NWI was 2.6±1.0 and the mean score of CBS-24 was 4.7±1.1 in nurses in the ICU. The regression model which was studied to investigate the relationship between caring behaviors and stress and nurse manpower of nurses working in intensive care unit was significant.

CONCLUSION

Care behaviors and stress levels of nurses working in intensive care units are negatively affected by insufficient nurse manpower.

Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services

AIM

To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services.

MATERIALS AND METHODS

Systematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906).

RESULTS

The pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission.

CONCLUSIONS

The prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services' characteristics.