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Wallet F, Bonnet A, Thiriaud V, Caillet A, Piriou V, Vacheron CH, Friggeri A, Dziadzko M. Weak Correlation Between Perceived and Measured Intensive Care Unit Nursing Workload: An Observational Study. J Nurs Care Qual 2024; 39:E39-E45. [PMID: 38780353 DOI: 10.1097/ncq.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Efficient management of nursing workload in the intensive care unit (ICU) is essential for patient safety, care quality, and nurse well-being. Current ICU-specific workload assessment scores lack comprehensive coverage of nursing activities and perceived workload. PURPOSE The purpose of this study was to assess the correlation between ICU nurses' perceived workload and the Nine Equivalents of Nursing Manpower Use Score (NEMS). METHODS In a 45-bed adult ICU at a tertiary academic hospital, nurses' perceived shift workload (measured with an 11-point Likert scale) was correlated with the NEMS, calculated manually and electronically. RESULTS The study included 1734 observations. The perceived workload was recorded for 77.6% of observations. A weak positive correlation was found between perceived and objectively measured workload. CONCLUSION Findings indicate a need to consider the multifaceted nature of nursing activities and individual workload perceptions in the ICU.
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Affiliation(s)
- Florent Wallet
- Author Affiliations: Department of Anesthesiology and Intensive Care (Dr Wallet, and Messrs Bonnet, Thiriaud, and Caillet, Dr Piriou, Dr Vacheron, and Dr Friggeri), University Hospital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; RESHAPE-INSERM U1290 (Dr Wallet and Drs Piriou and Dziadzko), Claude Bernard Lyon 1 University, Lyon, France; Department of Biostatistics, Bioinformatics and Public Health (Dr Vacheron), Hospices Civils de Lyon, Lyon, France; International Research Center in Infectiology (Dr Friggeri), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France; and Department of Anesthesiology (Dr Dziadzko), Intensive Care and Pain Management, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Bruyneel A, Lucchini A, Hoogendoorn ME. The challenge of assessing workload in intensive care units. Intensive Crit Care Nurs 2024:103722. [PMID: 38772786 DOI: 10.1016/j.iccn.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | - Alberto Lucchini
- Foundazione IRCCS San Gerardo dei Tintori, General Adult and Paediatric Intensive Care Unit, Italy
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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 2024:103672. [PMID: 38692967 DOI: 10.1016/j.iccn.2024.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Surendran A, Beccaria L, Rees S, Mcilveen P. Cognitive mental workload of emergency nursing: A scoping review. Nurs Open 2024; 11:e2111. [PMID: 38366782 PMCID: PMC10873679 DOI: 10.1002/nop2.2111] [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: 06/14/2023] [Revised: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
AIM Emergency nurses work in an environment of high cognitive mental workload. Excessive cognitive mental workload may result in patient harm and nurses' burnout. Therefore, it is necessary to understand nurses' subjective experience of cognitive workload. This scoping review aimed to curate literature about the subjective experience of cognitive mental workload reported by nurses and psychometric measures of the phenomenon. DESIGN The scoping review was conducted in accordance with JBI methodology and reported using PRISMA extension for scoping review checklist. METHODS A priori protocol was created with Peer Review of Electronic Search Strategies checklist and registered in the OSF registry. Databases including PubMed, CINAHL, ProQuest, Scopus, Science Direct, Web of Science and Google Scholar were searched. Published reports were reviewed against the eligibility criteria by performing Title and Abstract screening, followed by Full-text screening. The initial search yielded 1373 studies. Of these, 57 studies met the criteria for inclusion in this study. RESULTS The search revealed five general measures of cognitive mental workload and their variations. Only one customised measure specifically for medical-surgical nurses was found in the study. Identified measures were collated and categorised into a framework for conceptual clarity. NASA Task Load Index and its variations were the most popular subjective measure of cognitive mental workload in nursing. However, no measure or self-report scale customised for emergency nurses was identified. PATIENT OR PUBLIC CONTRIBUTION The findings of this scoping review can inform future research into the cognitive mental workload of nurses. The findings have implications for workplace health and safety for nurses and patients.
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Affiliation(s)
- Anu Surendran
- Graduate Research School, School of Nursing and MidwiferyUniversity of Southern QueenslandToowoombaQueenslandAustralia
| | - Lisa Beccaria
- School of Nursing and MidwiferyUniversity of Southern QueenslandToowoombaQueenslandAustralia
| | - Sharon Rees
- School of Nursing and MidwiferyUniversity of Southern QueenslandToowoombaQueenslandAustralia
| | - Peter Mcilveen
- School of EducationUniversity of Southern QueenslandToowoombaQueenslandAustralia
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Chen S, Wu H, Sun M, Wei Q, Zhang Q. Effects of shift work schedules, compensatory sleep, and work-family conflict on fatigue of shift-working nurses in Chinese intensive care units. Nurs Crit Care 2023; 28:948-956. [PMID: 37078518 DOI: 10.1111/nicc.12909] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Shift work is inevitable for nurses in intensive care units. Various studies explored nurses' fatigue in multiple hospital wards. However, few studies focused on fatigue among nurses in intensive care units. AIMS To determine the association between shift work schedules, compensatory sleep, work-family conflict, and fatigue of shift-working nurses in critical care units. STUDY DESIGN A descriptive cross-sectional multi-center study was conducted in March 2022 among intensive care nurses from five hospitals. METHODS Data were collected by online survey, including self-designed demographic questions, the Fatigue Scale-14, the Chinese adult daytime sleepiness scale, and the work-family scale. Pearson correlation was conducted for bivariate analysis. Independent-sample t-test, one-way ANOVA, and multiple linear regression analysis were performed to examine fatigue-related variables. RESULTS A total of 326 nurses responded to the survey with an effective response rate of 74.9%. The mean scores of physical fatigue and mental fatigue were 6.80 and 3.72, respectively. The bivariate analyses showed that work-family conflict was positively correlated with physical (r = 0.483, p < .001) and mental fatigue (r = 0.406, p < .001). Multiple linear regression results showed that work-family conflict, daytime sleepiness, and shift system were statistically significant factors influencing physical fatigue (F = 41.793, p < .001). Work-family conflict, sleep duration after the night shift, and daytime sleepiness were the main influencing factors of mental fatigue (F = 25.105, p < .001). CONCLUSIONS Nurses with higher work-family conflict, daytime sleepiness, and working 12-h shifts have higher levels of physical fatigue. Higher work-family conflict, shorter sleep duration after night shifts, and daytime sleepiness are associated with higher mental fatigue among intensive care nurses. RELEVANCE TO CLINICAL PRACTICE Nursing managers and nurses should consider work-family factors and compensatory sleep in their efforts to reduce fatigue. It is necessary to strengthen work-supporting strategies and compensatory sleep guidance for nurses to promote fatigue recovery.
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Affiliation(s)
- Shanshan Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihui Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mimi Sun
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Wei
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qixia Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Sun T, Huang XH, Zhang SE, Yin HY, Li QL, Gao L, Li Y, Li L, Cao B, Yang JH, Liu B. Fatigue as a Cause of Professional Dissatisfaction Among Chinese Nurses in Intensive Care Unit During COVID-19 Pandemic. Risk Manag Healthc Policy 2023; 16:817-831. [PMID: 37187922 PMCID: PMC10178901 DOI: 10.2147/rmhp.s391336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Aim To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic. Methods A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses. Results Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction. Conclusion Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses' fatigue and negative attitudes during times of public health emergencies.
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Affiliation(s)
- Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China
| | - Xian-Hong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China
| | - Shu-E Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, 150081, People’s Republic of China
| | - Hong-Yan Yin
- Department of Humanities and Social Sciences, Harbin Medical University (Daqing), Daqing, 163319, People’s Republic of China
| | - Qing-Lin Li
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, 150081, People’s Republic of China
| | - Lei Gao
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, 150081, People’s Republic of China
| | - Ye Li
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, 150081, People’s Republic of China
| | - Li Li
- Department of Administration, School of Law, Zhejiang University City College, Hangzhou, 310015, People’s Republic of China
| | - Bing Cao
- Department of Oncology, Weifang People’s Hospital, Weifang, 261000, People’s Republic of China
| | - Jin-Hong Yang
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, People’s Republic of China
| | - Bei Liu
- Global Center for Infectious Disease and Policy Research, Peking University, Beijing, 100191, People’s Republic of China
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Khan AR, Rosenthal CD, Ternes K, Sing RF, Sachdev G. Time Spent by Intensive Care Unit Nurses on the Electronic Health Record. Crit Care Nurse 2022; 42:44-50. [PMID: 36180057 DOI: 10.4037/ccn2022518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record. OBJECTIVE To quantify the amount of time spent by intensive care unit nurses on the electronic health record. METHODS In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated. RESULTS Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month. CONCLUSION Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.
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Affiliation(s)
- Ahsan R Khan
- Ahsan R. Khan is a medical student at the Morehouse School of Medicine in Atlanta, Georgia
| | - Courtney D Rosenthal
- Courtney D. Rosenthal is a registered surgical-trauma intensive care unit nurse and nurse educator, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Kelly Ternes
- Kelly Ternes is a registered surgical-trauma intensive care unit nurse, Carolinas Medical Center, Atrium Health
| | - Ronald F Sing
- Ronald F. Sing is an acute care surgeon, Carolinas Medical Center, Atrium Health
| | - Gaurav Sachdev
- Gaurav Sachdev is an acute care surgeon, Carolinas Medical Center, Atrium Health
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Kaya A, İşler Dalgıç A. Evaluating workload and manpower planning among pediatric emergency department nurses in Turkey during COVID-19: A cross-sectional, multicenter study. J Pediatr Nurs 2022; 65:69-74. [PMID: 35410734 PMCID: PMC8990504 DOI: 10.1016/j.pedn.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Quality nursing care in pediatric emergency departments (PEDs) can be achieved only through sustained workload-based manpower planning. The purpose of this paper to evaluate perceptions of workload and manpower planning in the PED setting in Turkey from the nurses' point of view. DESIGN AND METHODS This cross-sectional, multicenter study that was conducted among 187 nurses working in a PED setting in Turkey between June and September 2021. Data were collected using a questionnaire that measured nurses' perceptions of workload and manpower planning. The reporting of this study adhered to STROBE guidelines. RESULTS The majority of the respondents perceived the number of patients-per-nurse during a shift to be too high, the number of nurses to be insufficient in proportion to the workload, and the nursing manpower-planning to be insufficient and biased. Those with ≤1 year of nursing experience in the PED perceived an increased workload and more burnout during the COVID-19 pandemic period. CONCLUSIONS Nurses working in PED setting perceived the workload and manpower planning to be inadequate. In addition, nurses who were less experienced or felt burnout perceived their workload to be increased during the COVID-19 pandemic. PRACTICE IMPLICATIONS Further exploration of workload and manpower planning in PEDs is required. Quantifying nurses' perspectives of workload and manpower when managing emergency pediatric patients is essential for designing appropriate interventions to improve the working environment. Future studies should focus on comparing nurses' perceptions with actual workloads and manpower planning in PEDs using appropriate measurement tools.
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Affiliation(s)
- Ayla Kaya
- Pediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Ayşegül İşler Dalgıç
- Pediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
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De Groot K, De Veer AJE, Munster AM, Francke AL, Paans W. Nursing documentation and its relationship with perceived nursing workload: a mixed-methods study among community nurses. BMC Nurs 2022; 21:34. [PMID: 35090442 PMCID: PMC8795724 DOI: 10.1186/s12912-022-00811-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The time that nurses spent on documentation can be substantial and burdensome. To date it was unknown if documentation activities are related to the workload that nurses perceive. A distinction between clinical documentation and organizational documentation seems relevant. This study aims to gain insight into community nurses’ views on a potential relationship between their clinical and organizational documentation activities and their perceived nursing workload. Methods A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman’s rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed. Results The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses’ perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records. Conclusions Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.
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Hoogendoorn ME, Brinkman S, Bosman RJ, Haringman J, de Keizer NF, Spijkstra JJ. The impact of COVID-19 on nursing workload and planning of nursing staff on the Intensive Care: A prospective descriptive multicenter study. Int J Nurs Stud 2021; 121:104005. [PMID: 34273806 PMCID: PMC8215878 DOI: 10.1016/j.ijnurstu.2021.104005] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The impact of the care for COVID-19 patients on nursing workload and planning nursing staff on the Intensive Care Unit has been huge. Nurses were confronted with a high workload and an increase in the number of patients per nurse they had to take care of. OBJECTIVE The primary aim of this study is to describe differences in the planning of nursing staff on the Intensive Care in the COVID period versus a recent non-COVID period. The secondary aim was to describe differences in nursing workload in COVID-19 patients, pneumonia patients and other patients on the Intensive Care. We finally wanted to assess the cause of possible differences in Nursing Activities Scores between the different groups. METHODS We analyzed data on nursing staff and nursing workload as measured by the Nursing Activities Score of 3,994 patients and 36,827 different shifts in 6 different hospitals in the Netherlands. We compared data from the COVID-19 period, March 1st 2020 till July 1st 2020, with data in a non-COVID period, March 1st 2019 till July 1st 2019. We analyzed the Nursing Activities Score per patient, the number of patients per nurse and the Nursing Activities Score per nurse in the different cohorts and time periods. Differences were tested by a Chi-square, non-parametric Wilcoxon or Student's t-test dependent on the distribution of the data. RESULTS Our results showed both a significant higher number of patients per nurse (1.1 versus 1.0, p<0.001) and a significant higher Nursing Activities Score per Intensive Care nurse (76.5 versus 50.0, p<0.001) in the COVID-19 period compared to the non-COVID period. The Nursing Activities Score was significantly higher in COVID-19 patients compared to both the pneumonia patients (55.2 versus 50.0, p<0.001) and the non-COVID patients (55.2 versus 42.6, p<0.001), mainly due to more intense hygienic procedures, mobilization and positioning, support and care for relatives and respiratory care. CONCLUSION With this study we showed the impact of COVID-19 patients on the planning of nursing care on the Intensive Care. The COVID-19 patients caused a high nursing workload, both in number of patients per nurse and in Nursing Activities Score per nurse.
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Affiliation(s)
- M E Hoogendoorn
- Department of Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
| | - S Brinkman
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - R J Bosman
- Department of Intensive Care, OLVG, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - J Haringman
- Department of Anesthesiology and Intensive Care, Isala, Zwolle, the Netherlands; Department of Intensive Care, Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands
| | - N F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - J J Spijkstra
- Department of Intensive Care, Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
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