[Use of scores to calculate the nursing workload in a pediatric intensive care unit]

Association between nursing work conditions and adverse events in neonatal and pediatric Intensive Care Units

OBJECTIVE

To investigate the association between intensive nursing staff's work conditions and the occurrence of adverse events in patients.

METHOD

Evaluative documentary study conducted in six public neonatal and pediatric Intensive Care Units from hospitals in Paraná state, from April 2017 to January 2018. The predictive variables concerning staff sizing and work environment were measured through the instruments Nursing Activities Score and Brazilian Nursing Work Index-Revised. The thirty adverse events corresponded to the outcome variable and were detected using the instruments Pediatric and Neonatal Trigger Tool.

RESULTS

Two-hundred and three professionals participated in this research. The nursing staff sizing was verified to be appropriate. Work conditions were favorable and Cronbach's Alpha was 0.90 (IC= 0.87 - 0.92). The most frequently detected events in patients were infection and skin lesion. The statistical analysis of correlation and adverse event occurrence was not significant.

CONCLUSION

Despite the lack of evidence on statistical significance between the variables, the results reveal commitment by the public sector and professionals with patient safety and assistance quality.

Validation of the nursing workload scoring systems "Nursing Activities Score" (NAS), and "Therapeutic Intervention Scoring System for Critically Ill Children" (TISS-C) in a Greek Paediatric Intensive Care Unit

OBJECTIVES

To assess the reliability and validity of the Greek version of Nursing Activities Score (NAS), and Therapeutic Intervention Scoring System for Critically Ill Children (TISS-C) in a Greek Paediatric Intensive Care Unit (PICU).

RESEARCH METHODOLOGY

A methodological study was performed in one PICU of the largest Paediatric Hospital in Athens-Greece. The culturally adapted and validated Greek NAS version, enriched according to the Norwegian paediatric one (P-NAS), was used. TISS-C and Norwegian paediatric interventions were translated to Greek language and backwards. Therapeutic Intervention Scoring System (TISS-28) was used as a gold standard. Two independent observers simultaneously recorded 30 daily P-NAS and TISS-C records. Totally, 188 daily P-NAS, TISS-C and TISS-28 reports in a sample of 29 patients have been obtained during five weeks. Descriptive statistics, reliability and validity measures were applied using SPSS (ver 22.0) (p ≤ 0.05).

RESULTS

Kappa was 0.963 for P-NAS and 0.9895 for TISS-C (p < 0.001) and Intraclass Correlation Coefficient for all scale items of TISS-C was 1.00 (p < 0.001). P-NAS, TISS-28 and TISS-C measurements were significantly correlated (0.680 ≤ rho ≤ 0.743, p < 0.001). The mean score(±SD) for TISS-28, P-NAS and TISS-C was 23.05(±5.72), 58.14(±13.98) and 20.21(±9.66) respectively.

CONCLUSION

These results support the validity of P-NAS and TISS-C scales to be used in greek PICUs.

Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit

OBJECTIVES

To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit.

METHODS

This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared.

RESULTS

The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16.

CONCLUSION

The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.

[Nursing workload in specialized Semi-intensive Therapy unit: workforce size criteria]

OBJECTIVE

To assess the nursing workload (NW) in Semi-intensive Therapy Unit, specialized in the care of children with Craniofacial anomalies and associated syndromes; to compare the amount of workforce required according to the Nursing Activities Score (NAS) and the COFEN Resolution 293/04.

METHOD

Cross-sectional study, whose sample was composed of 72 patients. Nursing workload was assessed through retrospective application of the NAS.

RESULTS

the NAS mean was 49.5%. Nursing workload for the last day of hospitalization was lower in patients being discharged to home (p<0.001) and higher on the first compared to last day of hospitalization (p< 0.001). The number of professionals required according to NAS was superior to the COFEN Resolution 293/04, being 17 and 14, respectively.

CONCLUSION

the nursing workload corresponded to approximately 50% of the working time of nursing professional and was influenced by day and outcome of hospitalization. The amount of professionals was greater than that determined by the existing legislation.

Validation of clinical activity tracking system in Intensive Care Unit to assess nurse workload distribution

Therapeutic Intervention Score System (TISS-28) and the Nursing Activities Score (NAS) are common used to evaluate nursing workload in the Intensive Care Unit (ICU). However, they require experienced researchers to perform, are subject to user bias and experience, and are labor intensive, which all exclude regular use. A Clinical Activities Tracking System (CATS) was developed to evaluate bedside nursing activities automatically. This paper presents the validation of this system in quantifying bedside nursing activities. A total of 30 hours (1 hour/day) of nursing activities were manually recorded by trained researcher. The manually recorded total time spent on bedside nursing activities (Atime) was compared with time recorded using CATS (Ctime). A high correlation was found between Atime and Ctime with R = 0.882, and thus the actual time spent in nursing activity can be estimated using a first order polynomial function. In this study, it was found that the median Atime between 7 am-10 pm is 1.4-1.5 times higher than nursing activities at 10 pm-7 am. Results showed that CATS was able to provide unique and high information on patient bedside nursing activities.