Nursing Activities Score: nursing work load in a burns Intensive Care Unit

The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design

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.

Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score

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

Influence of Narcotrend-Assisted Anesthesia In-Depth Monitor on Cognitive Impairment of Elderly Patients under General Anesthesia

Objective

This research is designed to probe into the influence of Narcotrend- (NT-) assisted anesthesia in-depth monitor on cognitive impairment of elderly patients under general anesthesia (GA).

Methods

One hundred and forty-four elderly patients with GA in our hospital from October 2020 to April 2021 were randomized into two groups, namely, NT group (supervised anesthesia under NT monitoring) and group C (anesthesia according to doctors' experience). The heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were recorded before surgery (T0), at the beginning of surgery (T1), at the end of surgery (T2), and 1 day after surgery (T3). Serum of patients was obtained at these four time points for measurements of C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol (Cor) levels using the enzyme-linked immunosorbent assay (ELISA). The alterations in cognitive function pre- and post-anesthesia were assessed using the mini-mental state examination (MMSE), and adverse events (AEs) during anesthesia recovery, postoperative recovery, and dosage of anesthetics were recorded.

Results

At T1 and T2, MAP was higher and CVP was lower in NT group, versus group C. NT group presented higher CRP, IL-6, and Cor than group C at T1-T3. MMSE scores were higher in TN group than in group C at 12, 24, and 48 h after surgery. The incidence rates of postoperative cognitive dysfunction (POCD) and total AEs in group C were noticeably higher than those in NT group. Compared with group C, the time of anesthesia recovery, extubation, and postanesthesia care unit (PACU) residence in NT group reduced remarkably.

Conclusions

NT has little effect on the physical condition of elderly patients under GA, and can reduce the dosage of narcotic drugs and promote the recovery of patients from anesthesia, which has high clinical value.

Relationship between mental workload and hospital infection in the ICU

BACKGROUND: Nursing is among the most stressful professions. Studies that examine possible factors that influence the mental workload (MWL) of nurses are of fundamental importance, because through these results, efforts can be concentrated on improving their working conditions more efficiently. OBJECTIVE: To investigate the influence of hospital infection on the MWL of nurses in an intensive care unit (ICU). METHOD: Cross-sectional and descriptive study, with a quantitative approach. Three research instruments were used: a sociodemographic questionnaire, the NASA Task Load Index (NASA-TLX) and the Nursing Work Index-Revised Brazilian version (B-NWI-R). The sample consisted of 30 nurses from the ICU of a public hospital in João Pessoa city, Brazil, during the daytime period, and the Spearman correlation test (α= 0,05) was applied to verify associations. RESULTS: There was a high MWL among nurses, with a NASA-TLX weighted average of 66.38 (SD±15.0). Correlations were found between the levels of hospital infection in the ICU and the MWL of the nurses (r = 0.654, p <  0.01); in the nurses’ care of patients with urinary tract infection, the correlation is 0.546, p <  0.01; if care is provided to patients with lung problems, the correlation is 0.563, p <  0.01 The ICU presented a favorable environment to nursing practices, with means lower than 2.5, according to the B-NWI-R. CONCLUSION: The MWL of the nurses was associated with the hospital infection levels of the intensive care sector studied. It was found that the MWL of nurses in relation to hospital infection in the ICU increased by 42.8% . This MWL is impacted by 29.8% when nurses’ care is linked to patients with urinary infection. But if care is provided to patients with lung problems, this percentage rises to 31.7%

Assessment of Nursing Workload as a Mortality Predictor in Intensive Care Units (ICU) Using the Nursing Activities Score (NAS) Scale

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.

Model to estimate the nursing workload required by trauma victims on intensive care unit discharge

AIM

To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge.

BACKGROUND

Identifying a reliable model of nursing workload measurement that can assist professionals.

METHODS

A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R² ) were calculated to identify the reliability.

RESULTS

The original model presented high reliability (R²  = 44%) in the hospital of origin, and unsatisfactory performance (R²  < 4%) in the other institutions. An improvement in R² was observed after adjusting the coefficients for each hospital.

CONCLUSION

For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models.

IMPLICATIONS FOR NURSING MANAGEMENT

Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management.

The patient encounter index: a novel method of measuring clinical workload in a paediatric cardiology service

Technological advances have led to better patient outcomes and the expansion of clinical services in paediatric cardiology. This expansion creates an ever-growing workload for clinicians, which has led to workflow and staffing issues that need to be addressed. The objective of this study was the development of a novel tool to measure the clinical workload of a paediatric cardiology service in Cape Town, South Africa: The patient encounter index is a tool designed to quantify clinical workload. It is defined as a ratio of the measured duration of clinical work to the total time available for such work. This index was implemented as part of a prospective cross-sectional study design. Clinical workload data were collected over a 10-day period using time-and-motion sampling. Clinicians were contractually expected to spend 50% of their daily workload on patient care. The median patient encounter index for the Western Cape Paediatric Cardiac Service was 0.81 (range 0.19-1.09), reflecting that 81% of total contractual working time was spent on clinical activities. This study describes the development and implementation of a novel tool for clinical workload quantification and describes its application to a busy paediatric cardiology service in Cape Town, South Africa. This tool prospectively quantifies clinical workload which may directly influence patient outcomes. Implementation of this novel tool in the described setting clearly demonstrated the excessive workload of the clinical service and facilitated effective motivation for improved allocation of resources.

Nursing workload in burn intensive care unit

ABSTRACT Objectives: To measure the nursing workload in the Burn Intensive Care Units and evaluate its association with clinical variables, length of stay, and outcome of hospitalization. Methods: Cross-sectional study carried out in a Brazilian public large hospital. The study included 33 patients. The nursing workload was assessed using the Nursing Activities Score (NAS) every 24 hours. We performed 447 Nursing Activities Score assessments. For the statistical analysis, Student’s t-test, ANOVA, and Spearman’s correlation test were used. The considered significant difference was 5% (p ≤ 0.05). Results: The Nursing Activities Score mean was 84% (± 4.4), which corresponded to 20.2 hours. There was an association between the nursing workload and the patient’s severity (p <0.010), burned body surface (p = 0.010), and hospitalization outcome (p = 0.020). Conclusion: Burn victims, assisted in the ICU, demanded a high nursing workload, which was influenced by clinical aspects and the hospitalization outcome. These findings point to the need to reconsider the nurse staffing related to this care profile.

The Effect of Self-Care Compact Disk-Based Instruction Program on Physical Performance and Quality of Life of Patients with Burn At-Dismissal

BACKGROUND

Burn injuries still negatively influence the various aspects of life like physical performance and quality of life. This study was conducted to investigate at-dismissal self-care compact disk-based instruction program on the physical performance life quality of the patients with burns.

METHODS

One-hundred burn patients in Shahid Motahhari Burn Center, Tehran, Iran were randomly assigned to two equal groups of intervention (n=50) and control (n=50). The latter received only routine dismissal self-care program and the former an instruction compact disc plus the routine self-care program at dismissal. The demographic information and burn patients’ quality of life questionnaires were completed before and at months three and six after the intervention self-report program.

RESULTS

The physical performance of the intervention and control groups before intervention was 1.61±0.71 and 1.45±0.47, respectively (p=0.41). The physical performance of the intervention group was higher than the control group at three and six months after the intervention (p<0.001).

CONCLUSION

At-dismissal self-care compact disk-based instruction program can increase physical performance and quality of life in patients with burns. Therefore, the burn patients can be instructed based on self-care compact disk-based instruction program as an easy, available and less-costly method to take part in more satisfied treatment.

Adaptation of the Nursing Activities Score for oncologic care

OBJECTIVE

To adapt the contents of the Nursing Activities Score (NAS) tool to assist patients with cancer.

METHOD

Methodological research that according to the Delphi Technique is a method aiming at the validation of content through agreement of experts.

RESULTS

It took two rounds of opinion of experts, which added content contributions without modifying the structure and score of the original tool. The level of agreement ranged from 71 to 86%, and biological factors and assistance were more suggested: Monitoring and controls; Laboratory investigations; Support and care for family members and patients; Intravenous replacement; Renal support; Management activities.

CONCLUSION

A high level of complexity of patients with cancer, and the demand for care and biopsychosocial-spiritual care was diagnosed. This tool will enable the measurement of the workload of the Oncology Nursing team, which can contribute to the staffing dimensioning.

COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS

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.

Carga de trabalho de enfermagem relacionada ao índice de massa corporal de pacientes críticos

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.

Grau de dependência de pacientes em unidade de internação cirúrgica

RESUMOObjetivo:identificar a complexidade do cuidado de enfermagem dos pacientes em unidade de internação cirúrgica, utilizando a escala de classificação de pacientes de Perroca.Método:estudo transversal descritivo, com 546 avaliações de 187 pacientes, entre outubro e dezembro de 2012. Os dados foram analisados no programa SPSS 18.0 e teste Kappa, para medir a concordância interavaliadores.Resultados:constatou-se predomínio de pacientes nas categorias de cuidados semi-intensivo (46,5%) e intermediário (44,0%), com prevalência de banho sem auxílio (58,4%) no total da amostra e banho de leito (69,3%) entre os pacientes de cuidado semi-intensivo. O grau de concordância entre duas duplas de avaliadores foi considerado bom.Conclusão:a sistematização da aplicação do instrumento mostrou-se viável como medida de acompanhamento do grau de dependência dos pacientes, podendo contribuir para o aprimoramento do processo de trabalho, repercutindo na tomada de decisão gerencial quanto à carga de trabalho de enfermagem.

Assessment of workload in the postoperative period of cardiac surgery according to the Nursing Activities Score

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.

Pattern of nursing interventions performed on trauma victims according to the Nursing Activities Score

Objective To identify the pattern of nursing interventions performed on trauma victims in the Intensive Care Unit (ICU). Method Prospective study performed in the ICU of a hospital in São Paulo, Brazil. Nursing interventions were identified using the Nursing Activities Score (NAS). Results The sample consisted of 200 patients, most of them male, with a mean age of 40.7, victims of transport accidents. The NAS mean was 71.3%. The pattern of nursing interventions identified included monitoring and titration, laboratory investigations, medication (with the exception of vasoactive drugs), hygiene procedures, caring for drains, mobilization and positioning, support and care of relatives and patient, administrative and managerial tasks, respiratory support, care of artificial airways, treatment for improving lung function, and quantitative urine output measurement. The monitoring and mobilization interventions required care beyond what is normally required by ICU patients. Conclusion The results of this study provide important contributions to plan training activities and to size ICU nursing team.

The use of the Nursing Activities Score in clinical settings: an integrative review

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.