A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 1: Analysis of the elements of activity in the nursing workload, and its variation with patient age group and pathology

Clinical and procedural predictors of nurse workload during and after invasive coronary procedures: the potential benefit of a systematic radial access

BACKGROUND

Invasive coronary procedures are increasing in number and complexity over time. This trend translates in an increased need for economical and human resources, among which is nurse staffing the most affected.

AIMS

To identify possible predictors of nurse workload, during and after diagnostic and interventional procedures.

METHODS

Two hundred and sixty consecutive patients were included: 52 and 208 patients underwent femoral and radial access, respectively. Nurse workload was calculated with a self-developed model.

RESULTS

Cathlab nurse workload was 103 [63--156] min. Independent predictors of increased Cathlab nurse workload were: femoral access, failed radial access and cross-over, interventional procedures, procedural time, urgent procedures. Cathlab nurse workload was 174 [134--218] and 86 [58--126] min, for femoral and radial access, respectively (p<0.001). Among the overall population, 174/260 patients (44 females, mean age 66+/-11 years) were hospitalised at our Center after the procedure. Fifty-six and 118 patients had femoral and radial access, respectively. Ward nurse workload was 457 [226--954] min. Independent predictors of increased Ward nurse workload were: access-site complication, length of in-hospital stay, admission to CCU, interventional procedures. Ward nurse workload was 386 [226--652] and 720 [314--1375] min, respectively for radial and femoral access (p<0.001).

CONCLUSIONS

A systematic radial access is an effective strategy for reducing nurse workload, both during, by simplifying nurse tasks in the CathLab, and after coronary invasive procedures, by preventing access-site complications, shortening in-hospital stays, and reducing admissions to CCU.

Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care?

BACKGROUND

The number of intensive care units (ICU) using a clinical information system (CIS) is increasing. It is believed that replacing manual charting with an automatic documentation system allocates nurses more time for patient care. The objective of this study was to measure changes in nurses' working time utilization after the implementation of a CIS in a polyvalent ICU of a large Finnish central hospital.

METHODS

An activity analysis-based comparison of the ICU nurses' working time utilization before and after the implementation of a CIS.

RESULTS

After the implementation of a CIS the total time the nurses spent on documentation of nursing care increased by 3.6% (NS), 15 min per shift of 8 h per nurse. The total time they spent on patient care increased by 5.5% (P < 0.05), 21 min. Intensive care nursing activities increased by 3.7% (P < 0.05), 14 min. The length of the nurses' ICU experience had some effect on these figures. The demand for nurse labor remained constant.

CONCLUSIONS

After the implementation of a CIS, an increase in the time nurses spent on documentation of care was detected, which suggests a need for further development of the system. As all the measured time changes were relatively small, any plans to reduce the ICU staff number with the aid of computers were not justified.

[Nursing records: conventional versus computerized. Critical care unit]

In these recent years, electronic clinical data systems have been incorporated into the daily nursing work for the use of records in the hospitalization units. Between 2001 and 2002, the computer program that has presently become the work tool in the Critical Unit I was designed. This project aims to know the opinion of the nursing staff on the use of the computerized record versus the previous pen and paper. The surveys designed were filled out by 90.5% of the unit staff and it was found that for nursing group, the computerized record is a better work system than the pen and paper. Further, the computerized record is characterized by being more complete, by making it possible to better gather the work and by adjusting more reliably to the nursing work. In conclusion, we would say that the perception of nursing after the initiation of the clinical record computerized system is that it has improved versus the pen-paper. The perception of the time aimed at filling out the records is greater, although paradoxically, it generates more time for the patient's care according to the staff opinion. Even so, it is considered to be a good work system.

Patient Data Management Systems in Critical Care

Abstract. Electronic patient data management systems (PDMS) were clinically used for the first time in the 1970s. Their purpose was to automatically document vital parameters sampled by monitors and to replace handwritten medical files. Because of the continuous development of computer technology, however, demands on PDMS have increased immensely. PDMS are currently expected to assist clinicians at every level of intensive care, i.e., at the strategic level of physicians' orders and prescriptions, at the operational level, and at the administrative level. In 1994, a PDMS (CareVue; Agilent Technologies) was installed and further developed in the anesthesiologic intensive care unit of the university hospital in Tübingen. The goals of this article were to describe the current demands on PDMS, to communicate our experiences in implementing a PDMS, to list the costs of purchasing and maintaining the system, and to report on the acceptance among physicians and nursing personnel. This article may assist new users in planning for, purchasing, and implementing a PDMS.

Time oriented score system (TOSS): a method for direct and quantitative assessment of nursing workload for ICU patients. Italian Multicenter Group of ICU research (GIRTI)

A method for direct quantitation of nurses' workload required by ICU patients is described. Each nursing activity has been timed in 14 different ICUs participating in the multicentre study, and the results averaged. Nursing acts were grouped in different homology lists, complied according to operative similarities. Some lists include general nursing acts, which are common to all patients admitted to ICU, others include acts peculiar to different organ system abnormalities or acts ancillary to the general group, finally one list includes emergency or occasional acts which are not encountered in every patient. The TOSS is a simple and rapid method for ICU nurses' workload assessment, can be computed both at admission and during the stay in ICU, and can provide factual information on the nurse/patient ratio necessary in a specific environment. TOSS validation was conducted with a yearly prospective study collecting 2710 patients. TOSS values varied according to diagnosis, severity of illness (SAPS) and intensity of processes (TISS), and TOSS specificity was demonstrated by the possibility of selecting a wide combination of nurse/patient ratios from 1:4 to 1:1 not possible with TISS.

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 2. The effect of time and shift on the nursing workload

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined, and the nurse's bedside activities logged at 1 min intervals throughout the 24 h immediately following the patient's return from the operating theatre. It is possible to identify three broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and the balance of the nurse's time, largely concerned with observation and liaison with other staff--learning activities (Type 3). The time devoted to technical nursing care reduces significantly over the patient's first 24 h in the ward. On the other hand the time devoted to intermittent nursing care and learning activities is shown to be shift dependent. The effect of the efficient utilisation of computer technology is estimated, and it is demonstrated that the implementation of such technology would result in the expansion of the time available for the nurse to observe the patient. The potential benefits and drawbacks of this are discussed.

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 1: Analysis of the elements of activity in the nursing workload, and its variation with patient age group and pathology

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined. It was possible to identify 3 broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and learning activities (Type 3). The latter is the balance of the nurses time which is largely concerned with observation and liaison with other staff. The 17 patients comprised 4 groups of pathologies, 2 each representative of the adult and paediatric workload. The primary bedside nurse performs virtually all of the Type 1 activities, recruiting the assistance of a secondary nurse principally to change the patients' posture (a Type 2 activity). The only practically significant period of time spent by the secondary nurse is in clinical discussion with the bedside nurse, largely at change of shift. Statistically significant differences in bedside nursing activities between age groups can be explained by the relative physical size of the patients and equipment. However the nurse maintains a higher level of awareness with shorter periods of inattention when nursing children. A greater number of significant differences between pathologies were found within the paediatric group of patients; this may indicate that a broader spectrum of such differences is to be found in this age group. An estimate was made of the impact of computer technology on the nurse's bedside workload.