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Chen Y, Chan CW, Dong J, Jackson EM, Yip NH, Rossetti SC. Beyond order-based nursing workload: A retrospective cohort study in intensive care units. J Nurs Scholarsh 2024. [PMID: 38736177 DOI: 10.1111/jnu.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION In order to be positioned to address the increasing strain of burnout and worsening nurse shortage, a better understanding of factors that contribute to nursing workload is required. This study aims to examine the difference between order-based and clinically perceived nursing workloads and to quantify factors that contribute to a higher clinically perceived workload. DESIGN A retrospective cohort study was used on an observational dataset. METHODS We combined patient flow, nurse staffing and assignment, and workload intensity data and used multivariate linear regression to analyze how various shift, patient, and nurse-level factors, beyond order-based workload, affect nurses' clinically perceived workload. RESULTS Among 53% of our samples, the clinically perceived workload is higher than the order-based workload. Factors associated with a higher clinically perceived workload include weekend or night shifts, shifts with a higher census, patients within the first 24 h of admission, and male patients. CONCLUSIONS The order-based workload measures tended to underestimate nurses' clinically perceived workload. We identified and quantified factors that contribute to a higher clinically perceived workload, discussed the potential mechanisms as to how these factors affect the clinically perceived workload, and proposed targeted interventions to better manage nursing workload. CLINICAL RELEVANCE By identifying factors associated with a high clinically perceived workload, the nurse manager can provide appropriate interventions to lighten nursing workload, which may further reduce the risk of nurse burnout and shortage.
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Affiliation(s)
- Yi Chen
- Department of Industrial Engineering and Decision Analytics, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
| | - Carri W Chan
- Columbia Business School, New York City, New York, USA
| | - Jing Dong
- Columbia Business School, New York City, New York, USA
| | - Emily M Jackson
- Presbyterian/Hudson Valley Hospital, Cortlandt Manor, New York, USA
| | - Natalie H Yip
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Sarah C Rossetti
- Columbia University Irving Medical Center, New York City, New York, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Galiano MA, Moreno Fergusson ME, Guerrero WJ, Muñóz MF, Ortiz Basto GA, Cardenas Ramírez JS, Guevara Lozano M, Larraín Sundt A. Technological innovation for workload allocation in nursing care management: an integrative review. F1000Res 2024; 12:104. [PMID: 38434658 PMCID: PMC10904957 DOI: 10.12688/f1000research.125421.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.
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Kang Y, Hwang H. An exploratory study of the practical impact of the COVID-19 pandemic on nursing tasks in clinical settings. Appl Nurs Res 2024; 76:151790. [PMID: 38641385 DOI: 10.1016/j.apnr.2024.151790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/21/2024]
Abstract
AIMS To identify and compare new or increased nursing tasks in South Korea during the pandemic, categorized by hospital type and department. BACKGROUND Although COVID-19 is no longer considered a global public health emergency, the threat of novel infectious diseases remains. Reflecting on the COVID-19 pandemic is essential to prepare effectively for future outbreaks. METHODS This cross-sectional exploratory study, following the STROBE checklist, included 948 registered nurses with more than a year of clinical experience currently working in various hospitals. Questionnaires gathered demographic data, work characteristics, and the frequency of nursing task performance. Statistical analysis encompassed descriptive and inferential methods. RESULTS The most common new or increased nursing task across all hospital types was 'Access control for family caregivers.' General wards prioritized tasks related to family caregivers, while specialized units like ICU and ER focused on infection control. CONCLUSION Understanding how COVID-19 has impacted nursing tasks is crucial for gaining insights into efficient resource allocation, targeted education, and policy formulation during similar public health crises. The pandemic has given rise to new family caregiver-related tasks in the nursing profession. Consequently, continuous nursing research is essential for establishing guidelines and fostering a supportive work environment, which is crucial for the successful implementation of these tasks.
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Affiliation(s)
- Younhee Kang
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Hyeyoung Hwang
- College of Nursing, Ewha Womans University, Seoul, South Korea.
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Pirret AM, Corkery MC, Gilhooly A, Devoy KL, Strickland W. The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design. Intensive Crit Care Nurs 2024; 81:103568. [PMID: 38271856 DOI: 10.1016/j.iccn.2023.103568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 01/27/2024]
Abstract
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.
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Batassini É, Beghetto MG. Comparing nursing workload for critically ill adults with and without COVID-19: Retrospective cohort study. Nurs Crit Care 2024; 29:397-406. [PMID: 37690783 DOI: 10.1111/nicc.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Intensive care environments already required complex work, and, furthermore, the recent COVID-19 pandemic increased health care demands, disorganized work teams and limited resources. Nonetheless, the real workload of nursing workers in the care for critical patients during this period was seldom investigated. AIM To compare the workload of nursing workers, estimated using the Nursing Activities Score (NAS), in patients with and without COVID-19 who had been hospitalized in an adult intensive care unit (ICU). STUDY DESIGN This study was developed in the ICU of a public university hospital in the south of Brazil. The workload of nursing workers was estimated using the NAS, which was developed through a retrospective cohort using reports of the assistance registered in electronic records, including the first 10 days of hospitalization of all patients admitted into the ICU in 2020 and 2021, who had at least one NAS evaluation; then, the workload was compared between patients with and without COVID-19. Generalized estimating equations models were used. The project was approved by the research ethics committee of the institution where the study took place. RESULTS The follow-up of 3485 patients resulted in 20 506 days of observation during the first 10 days of ICU hospitalization. The mean NAS score for the entire patient/day sample was 85.6 ± 18.1%, with 87.8 ± 17.8% in the COVID-19 group and 82.6 ± 18.2% in the non-COVID-19 group (p < .001). The use of mechanical ventilation, noradrenaline, sedation and neuromuscular blocking drugs, extracorporeal membrane oxygenation and haemodialysis increased the value of NAS for patients with or without COVID-19. CONCLUSIONS The workload of nursing professionals was higher for COVID-19 patients than for patients who did not present the disease in the first 10 days of ICU hospitalization. RELEVANCE TO CLINICAL PRACTICE This study presents the impact of COVID-19 on the ICU nursing workload in Brazil. The high workload found can support management decisions regarding quantity and quality of workforce composition.
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Affiliation(s)
- Érica Batassini
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mariur Gomes Beghetto
- Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ahmadi N, Sasangohar F, Yang J, Yu D, Danesh V, Klahn S, Masud F. Quantifying Workload and Stress in Intensive Care Unit Nurses: Preliminary Evaluation Using Continuous Eye-Tracking. Hum Factors 2024; 66:714-728. [PMID: 35511206 DOI: 10.1177/00187208221085335] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE (1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU. BACKGROUND Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses' workload. This is the first naturalistic attempt to explore nurses' mental workload using eye movement data. METHODS Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes. RESULTS While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter. CONCLUSION Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development.
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Affiliation(s)
- Nima Ahmadi
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA and Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Jing Yang
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Valerie Danesh
- Baylor Scott & White Health, Center for Applied Health Research, Dallas, TX, USA and University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Steven Klahn
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Masud
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
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Lucchini A, Villa M, Del Sorbo A, Pigato I, D'Andrea L, Greco M, Chiara C, Cesana M, Rona R, Giani M. Determinants of increased nursing workload in the COVID-era: A retrospective analysis of prospectively collected data. Nurs Crit Care 2024; 29:196-207. [PMID: 36717119 DOI: 10.1111/nicc.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required. AIM To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre. STUDY DESIGN Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload. RESULTS We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS. CONCLUSIONS The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS. RELEVANCE TO CLINICAL PRACTICE Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.
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Affiliation(s)
- Alberto Lucchini
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marta Villa
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Arianna Del Sorbo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Irene Pigato
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca D'Andrea
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Greco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Colombo Chiara
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Matteo Cesana
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rona
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Giani
- General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: A systematic review. Nurs Health Sci 2023; 25:497-515. [PMID: 37784243 DOI: 10.1111/nhs.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bethany Howard
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Watterson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Iwaanakuchi T, Yoshida T, Fukuda Y, Uto Y. Impact of cognitive decline on medical outcomes and nursing workload: A retrospective cohort study. PLoS One 2023; 18:e0293755. [PMID: 37992023 PMCID: PMC10664958 DOI: 10.1371/journal.pone.0293755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
Few reports have quantitatively investigated the effect of dementia on medical outcomes and nurse workload. Therefore, we aimed to investigate whether cognitive decline can be identified from a nurse assessment and determined its effect on medical outcomes and nurse workload. This retrospective cohort study used electronic medical record data to investigate whether patients judged by nurses to have cognitive decline were as affected as those with a dementia diagnosis. Further, a model formula was created and validated to predict the probability of needing physical restraint, the nursing care workload, and the record volume. The subjects were 43,330 patients aged ≥40 years who were hospitalized at the study hospital during the four-year study period. Data were analyzed using the chi-square test, Welch's t-test, logistic regression analysis and linear regression analysis. The implementation of physical restraint and a discharge support conference was significantly higher in patients deemed by nurses to have cognitive decline. Nurse-deemed patients with cognitive decline were affected by the outcome and workload as much as those with dementia. The false discovery rate for the Probability model formula of physical restraint and discharge support conference were 0.198 and 0.266. The correlation coefficient of the model formula for predicting nursing care and recording volume was 0.5-0.6. Combining nurse assessment and patient attribute information in a model was useful for predicting nurse workload. These findings may serve as a foundational component for the Clinical Decision Support System, aiding in the evaluation of intervention methods from the early stages of hospital admission and improving care delivery.
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Affiliation(s)
- Takashi Iwaanakuchi
- Department of Medical Informatics, Kagoshima University Hospital, Kagoshima City, Japan
| | - Takuma Yoshida
- Graduate School of Science and Engineering, Kagoshima University, Kagoshima City, Japan
| | - Yukari Fukuda
- Department of Nursing, Kagoshima University Hospital, Kagoshima City, Japan
| | - Yumiko Uto
- Department of Medical Informatics, Kagoshima University Hospital, Kagoshima City, Japan
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Ko Y, Park B, Lee H, Kim D. Development of a patient classification system for critical care nursing based on nursing intensity. Int J Nurs Pract 2023; 29:e13128. [PMID: 36585752 DOI: 10.1111/ijn.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 01/01/2023]
Abstract
AIM This study aimed to develop a valid and reliable new intensive care unit nursing classification tool, including direct and indirect nursing activities, by measuring the nursing intensity provided to patients. BACKGROUND Prior tools primarily examine patients' medical records or disease severity/interactions, systematically failing to reflect comorbidity risk factors. DESIGN The Delphi technique was used to test the content validity of the Korean Patient Classification System on Nursing Intensity for Critical Care Nurses (KPCSNIC). METHODS Data were collected from four hospitals in two provinces from 26 December 2017 to 30 January 2018. To verify construct validity, staff nurses classified 365 patients, comparing differences by medical department and type of stay. To verify interrater reliability, data collectors and the head nurses of three intensive care units classified 87 patients. RESULTS The KPCSNIC had 8 categories, 44 nursing activities and 105 criteria. Reliability was high (r = .84). Construct validity was verified by revealing differences according to medical department and type of patient. Using total scores, four KPCSNIC groups were identified. CONCLUSION The KPCSNIC developed in this study can support staffing for nursing intensity by providing more specific evaluation criteria. Moreover, it reflects nursing intensity, including direct and indirect nursing activities.
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Affiliation(s)
- Yukyung Ko
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, South Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Changwon, South Korea
| | - Hanju Lee
- Department of Nursing, Sangmyung University, Cheonan, South Korea
| | - Donghwan Kim
- Benefits Information Analysis Department, Health Insurance Review and Assessment service (HIRA), Wonju, South Korea
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Esteban-Sepúlveda S, Giró-Formatger D, Hernández-García AF, Serratosa-Cruzado S, Moreno-Leyva M, Terradas-Robledo R, Lacueva-Pérez L. Info-NAS: A Computer Program for the Calculation of Intensive Care Unit Nurse Workload. Comput Inform Nurs 2023; 41:825-832. [PMID: 36912356 DOI: 10.1097/cin.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.
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Affiliation(s)
- Silvia Esteban-Sepúlveda
- Author Affiliations: Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona (Drs Esteban-Sepúlveda and Terradas-Robledo, Ms Giró-Formatger, Ms Hernández-García, Mr Serratosa-Cruzado, and Ms Lacueva-Pérez); and Departament d'Infermeria Fonamental i Medicoquirúrgica, Escola d'Infermeria, Universitat de Barcelona (Dr Esteban-Sepúlveda)
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Serra N, Botti S, Guillari A, Simeone S, Latina R, Iacorossi L, Torreggiani M, Guberti M, Cicolini G, Lupo R, Capuano A, Pucciarelli G, Gargiulo G, Tomietto M, Rea T. Workload, Job Satisfaction and Quality of Nursing Care in Italy: A Systematic Review of Native Language Articles. Healthcare (Basel) 2023; 11:2573. [PMID: 37761770 PMCID: PMC10531217 DOI: 10.3390/healthcare11182573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Nursing research is rapidly increasing, yet contributions from numerous countries that may interest the international nursing community are impeded because many research articles are published in authors' native language and not in English. The objectives of this work were to systematically review papers published in Italian related to job satisfaction and the quality of nursing care, and to discuss their findings in light of the international literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used. The Directory of Open Access Journals (DOAJ) and Indice della Letteretura Italiana di Scienze Infermieristiche (ILISI) databases were consulted for eligible studies published from January 2015 to November 2022. Two hundred sixteen papers were identified, 11 of which were selected for review: 8 on job satisfaction, two on workload issues, and 1 on quality of nursing care. The quality of included studies was assessed through the Effective Public Health Practice Project quality assessment tool (EPHPP). The results of our review were in line with those of international literature, and they can help to fill the knowledge gap on the quality of nursing performance in Italian care settings. In addition, the proposed method can provide further elements of discussion among literature providers and reviewers.
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Affiliation(s)
- Nicola Serra
- Biostatistics Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy;
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Assunta Guillari
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (A.G.); (T.R.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Roberto Latina
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Università degli Studi di Palermo, 90133 Palermo, Italy;
| | - Laura Iacorossi
- Nursing Research Unit IFO, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Martina Torreggiani
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42421 Reggio Emilia, Italy; (M.T.); (M.G.)
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42421 Reggio Emilia, Italy; (M.T.); (M.G.)
| | - Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Roberto Lupo
- San Giuseppe da Copertino Hospital, Local Health Authority, 73043 Copertino, Italy;
| | - Angela Capuano
- Department of Emergency, AORN Santobono-Pausilipon, 80122 Naples, Italy;
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Gianpaolo Gargiulo
- Hematology and Haematopoietic Stem Cell Transplantation Centre, University Federico II of Naples, 80138 Naples, Italy;
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Teresa Rea
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (A.G.); (T.R.)
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Rood PJT, Ramnarain D, Oldenbeuving AW, den Oudsten BL, Pouwels S, van Loon LM, Teerenstra S, Pickkers P, de Vries J, van den Boogaard M. The Impact of Non-Pharmacological Interventions on Delirium in Neurological Intensive Care Unit Patients: A Single-Center Interrupted Time Series Trial. J Clin Med 2023; 12:5820. [PMID: 37762760 PMCID: PMC10532134 DOI: 10.3390/jcm12185820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Delirium is a pathobiological brain process that is frequently observed in Intensive Care Unit (ICU) patients, and is associated with longer hospitalization as well as long-term cognitive impairment. In neurological ICU patients, delirium may be more treatment-resistant due to the initial brain injury. This study examined the effects of a multicomponent non-pharmacological nursing intervention program on delirium in neurological ICU patients. Methods: A single-center interrupted time series trial was conducted in adult neurological ICU patients at high risk for developing delirium who were non-delirious at admission. A multicomponent nursing intervention program focusing on modifiable risk factors for delirium, including the optimalization of vision, hearing, orientation and cognition, sleep and mobilization, was implemented as the standard of care, and its effects were studied. The primary outcome was the number of delirium-free and coma-free days alive at 28 days after ICU admission. The secondary outcomes included delirium incidence and duration, ICU and hospital length-of-stay and duration of mechanical ventilation. Results: Of 289 eligible patients admitted to the ICU, 130 patients were included, with a mean age of 68 ± 11 years, a mean APACHE-IV score of 79 ± 25 and a median predicted delirium risk (E-PRE-DELIRIC) score of 42 [IQR 38-50]). Of these, 73 were included in the intervention period and 57 in the control period. The median delirium- and coma-free days alive were 15 days [IQR 0-26] in the intervention group and 10 days [IQR 0-24] in the control group (level change -0.48 days, 95% confidence interval (95%CI) -7 to 6 days, p = 0.87; slope change -0.95 days, 95%CI -2.41 to 0.52 days, p = 0.18). Conclusions: In neurological ICU patients, our multicomponent non-pharmacological nursing intervention program did not change the number of delirium-free and coma-free days alive after 28 days.
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Affiliation(s)
- Paul J. T. Rood
- Department of Intensive Care Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Research Department of Emergency and Critical Care, School of Health Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg, P.O. Box 90151, 5000 LE Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Annemarie W. Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg, P.O. Box 90151, 5000 LE Tilburg, The Netherlands
| | - Brenda L. den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg, P.O. Box 90151, 5000 LE Tilburg, The Netherlands
- Department of General and Abdominal Surgery, Helios Klinikum, Lutherplatz 40, 47805 Krefeld, Germany
| | - Lex M. van Loon
- Department of Intensive Care Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- College of Health and Medicine, Australian National University, 131 Garran Rd, Acton, Canberra, ACT 2601, Australia
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- Admiraal de Ruyter Hospital (Adrz), P.O. Box 15, 4462 RA Goes, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Batterbury A, Douglas C, Coyer F. The illness severity of ward remaining patients reviewed by the medical emergency team: A retrospective cohort study. J Clin Nurs 2023; 32:6450-6459. [PMID: 36894523 DOI: 10.1111/jocn.16678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/14/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Although progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety. OBJECTIVE This study sought to quantify the illness severity of ward patients after medical emergency team review. RESEARCH DESIGN AND SETTING This retrospective cohort study examined the clinical records of 1500 randomly sampled adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies. NO PATIENT OR PUBLIC CONTRIBUTION No direct patient contact was made during the data collection and analysis phases of the study. RESULTS Patients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse-to-patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities. CONCLUSIONS Patients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements. RELEVANCE TO CLINICAL PRACTICE Profiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment.
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Affiliation(s)
- Anthony Batterbury
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Fiona Coyer
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Tack J, Bruyneel A, Bouillon Y, Taton O, Taccone F, Pirson M. Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score. Dimens Crit Care Nurs 2023; 42:286-294. [PMID: 37523728 DOI: 10.1097/dcc.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. METHODS This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. RESULTS During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. CONCLUSION A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.
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Misset B, Aegerter P, Boulkedid R, Alberti C, Baillard C, Guidet B, Beaussier M. Construction of reference criteria to admit patients to intermediate care units in France: a Delphi survey of intensivists, anaesthesiologists and emergency medicine practitioners (first part of the UNISURC project). BMJ Open 2023; 13:e072836. [PMID: 37487677 PMCID: PMC10373678 DOI: 10.1136/bmjopen-2023-072836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES No consensus criteria describe the medical eligibility of the patients to intermediate care units (IMCUs). In this first part of the UNISURC project, we aimed to develop criteria based on a consensus of physicians from the main specialties involved in IMCU admission decisions. DESIGN We selected criteria from IMCU literature, scoring systems and intensive care unit nursing workload. We submitted these criteria to a panel of experts in a Delphi survey. We used a two-round Delphi survey procedure to assess the validity and feasibility of each criterion. SETTING Medical practitioners in either public or private French institutions and proposed by the national scientific societies of anaesthesiology, emergency medicine and intensive care. The Delphi rounds took place in 2015-2016. OUTCOME MEASURES Validity and feasibility of the proposed criteria; uniformity of the judgement across the primary specialty and the hospital category of the responders. RESULTS The criteria submitted to vote were classified as one of: chronic factor (CF); acute factor (AF); specific pathway (SP); nursing activity (NA) and hospital environment (HE). Of 189 experts invited, 81 (41%) responded to the first round and 62 of them (76%) responded to the second round. A definite selection of 63 items was made, distributed across 6 CF, 18 AF, 31 SP, 3 NA and 5 HE. Validity and feasibility were influenced by the specialty or the public/private status of the institution of the responders for a few items. CONCLUSION We created a set of 63 consensus criteria with acceptable validity and feasibility to assess the medical eligibility of the patients to IMCUs. The second part of the UNISURC project will assess the distribution of each criterion in a prospective multicentre national cohort. TRIAL REGISTRATION NUMBER NCT02590172.
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Affiliation(s)
- Benoît Misset
- Department of Intensive Care, Groupe hospitalier Paris Saint-Joseph, Paris, France
- Department of Intensive Care, CHU de Liege - Hopital du Sart Tilman, Liege, Belgium
- Paris University, Paris, France
- University of Rouen Normandie, Rouen, France
- University of Liège, Liège, Belgium
| | - Philippe Aegerter
- Epidemiology and Public Health Service, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicetre, France
- University of Versailles Saint-Quentin, Versailles, France
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Rym Boulkedid
- Unité d'Epidémiologie Clinique, INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | | | - Christophe Baillard
- Paris University, Paris, France
- Department of Anesthesia and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Bertrand Guidet
- Department of Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Marc Beaussier
- Anesthesiology, Institut Mutualiste Montsouris, Paris, France
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dos Reis JD, Sa-Couto P, Mateus J, Simões CJ, Rodrigues A, Sardo P, Simões JL. Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit. Int J Environ Res Public Health 2023; 20:5284. [PMID: 37047900 PMCID: PMC10094196 DOI: 10.3390/ijerph20075284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
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.
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Affiliation(s)
- Juliana Dias dos Reis
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - Pedro Sa-Couto
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - José Mateus
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
| | - Carlos Jorge Simões
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
| | - Alexandre Rodrigues
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Centre for Innovative Biomedicine and Biotechnology (CIBB)—Center for Health Studies and Research, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Pedro Sardo
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - João Lindo Simões
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
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Sardo PMG, Macedo RPA, Alvarelhão JJM, Simões JFL, Guedes JAD, Simões CJ, Príncipe F. Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score. Nurs Crit Care 2023; 28:288-297. [PMID: 36336353 DOI: 10.1111/nicc.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/28/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent. AIM To assess the nursing workload in a Portuguese ICU using the NAS. STUDY DESIGN Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June-31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines. RESULTS The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team. CONCLUSIONS The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety. RELEVANCE TO CLINICAL PRACTICE This was one of the first studies carried out with the NAS after its cross-cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the 'administrative and management activities' related to the 'patient discharge procedures', the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse-to-patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU.
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Affiliation(s)
- Pedro Miguel Garcez Sardo
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Institute of Biomedicine (iBiMED), Universidade de Aveiro (UA), Aveiro, Portugal
| | | | | | - João Filipe Lindo Simões
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Institute of Biomedicine (iBiMED), Universidade de Aveiro (UA), Aveiro, Portugal
| | | | - Carlos Jorge Simões
- Escola Superior de Saúde da Universidade de Aveiro (ESSUA), Universidade de Aveiro (UA), Aveiro, Portugal.,Centro Hospitalar do Baixo Vouga, Hospital de Aveiro, Aveiro, Portugal
| | - Fernanda Príncipe
- Escola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Oliveira de Azeméis, Portugal
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Cruz López LN, Quintero Osorio JF, Melo Roa JD, Henao Castaño ÁM. Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score. Rev Cuid 2023. [DOI: 10.15649/cuidarte.2680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
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
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Batterbury A, Douglas C, Jones L, Coyer F. Illness severity characteristics and outcomes of patients remaining on an acute ward following medical emergency team review: a latent profile analysis. BMJ Qual Saf 2023:bmjqs-2022-015637. [PMID: 36657785 DOI: 10.1136/bmjqs-2022-015637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients requiring medical emergency team (MET) review have complex clinical needs, and most remain on the ward after review. Current detection instruments cannot identify post-MET patient requirements, meaning patients remain undistinguished, potentially resulting in missed management opportunities. We propose that deteriorating patients will cluster along dimensions of illness severity and that these clusters may be used to strengthen patient risk management practices. OBJECTIVE To identify and define the number of illness severity clusters and report outcomes among ward patients following MET review. STUDY DESIGN AND SETTING This retrospective cohort study examined the clinical records of 1500 adult ward patients following MET review at an Australian quaternary hospital. Three-step latent profile analysis methods were used to determine clusters using Sequential Organ Failure Assessment (SOFA) and Nursing Activities Score (NAS) as illness severity indicators. Study outcomes were (1) hospital mortality, (2) unplanned intensive care unit (ICU) admission and (3) subsequent MET review. RESULTS Patients were unplanned (73.9%) and medical (57.5%) admissions with at least one comorbidity (51.4%), and complex combinations of acuity (SOFA range 1-17) and dependency (NAS range 22.4%-148.5%). Five clusters are reported. Patients in cluster 1 were equivalent to clinically stable general ward patients. Organ failure and complexity increased with cluster progression-clusters 2 and 3 were equivalent to subspecialty/higher-dependency wards, and clusters 4 and 5 were equivalent to ICUs. Patients in cluster 5 had the greatest odds for death (OR 26.2, 95% CI 23.3 to 31.3), unplanned ICU admission (OR 3.1, 95% CI 3.0 to 3.1) and subsequent MET review (OR 2.4, 95% CI 2.4 to 2.6). CONCLUSION The five illness severity clusters may be used to define patients at risk of poorer outcomes who may benefit from enhanced levels of monitoring and targeted care.
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Affiliation(s)
- Anthony Batterbury
- Safety and Implementation Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia .,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Office of Nursing and Midwifery Services, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Lee Jones
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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22
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Haruna J, Masuda Y, Tatsumi H. Transitional Care Programs for Patients with High Nursing Activity Scores Reduce Unplanned Readmissions to Intensive Care Units. Medicina (Kaunas) 2022; 58:medicina58111532. [PMID: 36363489 PMCID: PMC9693432 DOI: 10.3390/medicina58111532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives: The main objective of a transitional care program (TCP) is to detect patients with early deterioration following intensive care unit (ICU) discharge in order to reduce unplanned ICU readmissions. Consensus on the effectiveness of TCPs in preventing unscheduled ICU readmissions remains lacking. In this case study assessing the effectiveness of TCP, we focused on the association of unplanned ICU readmission with high nursing activities scores (NASs), which are considered a risk factor for ICU readmission. Materials and Methods: This retrospective observational study analyzed the data of patients admitted to a single-center ICU between January 2016 and December 2019, with an NAS of >53 points at ICU discharge. The following data were extracted: patient characteristics, ICU treatment, acute physiology and chronic health evaluation II (APACHE II) score at ICU admission, Charlson comorbidity index (CCI), 28-day mortality rate, and ICU readmission rate. The primary outcome was the association between unplanned ICU readmissions and the use of a TCP. The propensity score (PS) was calculated using the following variables: age, sex, APACHE II score, and CCI. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcomes. Results: A total of 143 patients were included in this study, of which 87 (60.8%) participated in a TCP. Respiratory failure was the most common cause of unplanned ICU readmission. The unplanned ICU readmission rate was significantly lower in the TCP group. In the logistic regression model, TCP (odds ratio, 5.15; 95% confidence interval, 1.46−18.2; p = 0.01) was independently associated with unplanned ICU readmission. Conclusions: TCP intervention with a focus on patients with a high NAS (>53 points) may prevent unplanned ICU readmission.
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23
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Batassini É, Veras JC, Ferreira RR, Beghetto MG. Concordância entre avaliadores na aplicação do Nursing Activities Score. ACTA PAUL ENFERM 2022; 35. [DOI: 10.37689/acta-ape/2022ao03327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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24
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Silveira AT, Hohenreuther R, Schmidt NP, Silveira TT, Henz AC, Filho EMR, Wiltgen D, Treviso P, Marroni CA. Nursing Team Workload and the Apache Index of Gravity of Patients Post Liver Transplantation: A Cohort Study. Transplant Proc 2022. [DOI: 10.1016/j.transproceed.2022.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/27/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
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25
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Haruna J, Masuda Y, Tatsumi H, Sonoda T. Nursing Activities Score at Discharge from the Intensive Care Unit Is Associated with Unplanned Readmission to the Intensive Care Unit. J Clin Med 2022; 11:jcm11175203. [PMID: 36079134 PMCID: PMC9457354 DOI: 10.3390/jcm11175203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the accuracy of predicting unplanned the intensive care unit (ICU) readmission using the Nursing Activities Score (NAS) at ICU discharge based on nursing workloads, and compared it to the accuracy of the prediction made using the Stability and Workload Index for Transfer (SWIFT) score. Patients admitted to the ICU of Sapporo Medical University Hospital between April 2014 and December 2017 were included, and unplanned ICU readmissions were retrospectively evaluated using the SWIFT score and the NAS. Patient characteristics, such as age, sex, the Charlson Comorbidity Index, and sequential organ failure assessment score at ICU admission, were used as covariates, and logistic regression analysis was performed to calculate the odds ratios for the SWIFT score and NAS. Among 599 patients, 58 (9.7%) were unexpectedly readmitted to the ICU. The area under the receiver operating characteristic curve of NAS (0.78) was higher than that of the SWIFT score (0.68), and cutoff values were 21 for the SWIFT and 53 for the NAS. Multivariate analysis showed that the NAS was an independent predictor of unplanned ICU readmission. The NAS was superior to the SWIFT in predicting unplanned ICU readmission. NAS may be an adjunctive tool to predict unplanned ICU readmission.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
- Correspondence:
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Tomoko Sonoda
- Department of Nursing, Tensei University, Sapporo 065-0013, Japan
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26
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Connor JA, LaGrasta C, Hickey PA. Refinement of the Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes III Acuity Tool. Dimens Crit Care Nurs 2022; 41:144-50. [PMID: 36749863 DOI: 10.1097/DCC.0000000000000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Intensive Care Unit (ICU) Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool quantifies patient acuity in terms of nursing cognitive workload complexity. OBJECTIVES The aim of this study was to refine the ICU CAMEO II acuity tool. An expert panel of nursing staff from 4 pediatric ICUs convened to refine the CAMEO II across a large, freestanding children's hospital in the United States. METHOD This study used a modified Delphi technique. RESULTS Through a series of 4 Delphi rounds, the expert panel identified Domains of Care and nursing care items that were suitable to be collapsed or bundled. The number of Domains of Care decreased from 18 to 10. Each of the expert panel members then completed the ICU CAMEO II tool and the newly revised tool, ICU CAMEO III, on 5 to 10 patients. Sixty completed ICU CAMEO II tools, and ICU CAMEO III tools were available for comparison. The average difference of the 2 tools' total scores was 5 points (minimum, 4; maximum, 7). The level of agreement between the 2 tools by CAMEO Complexity Classification level (I-V) was 90%. DISCUSSION The ICU CAMEO III acuity tool is a streamlined measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure will support projection of staffing models, staffing assignments, and benchmarking across pediatric ICUs. Further research is underway to validate the CAMEO III for multisite use.
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27
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Doyen D, Morand L, Jozwiak M, Aurenche Mateu D, Saccheri C, Hyvernat H, Cremoni M, Brglez V, Bèle N, Bernardin G, Seitz-Polski B, Dellamonica J. Impact of Isolation Time of COVID-19 Patients in Intensive Care Unit on Healthcare Workers Contamination and Nursing Care Intensity. Front Med (Lausanne) 2022; 9:824563. [PMID: 35402453 PMCID: PMC8990820 DOI: 10.3389/fmed.2022.824563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background The optimal isolation time of COVID-19 patients in intensive care unit (ICU) is debated. We investigated the impact of two different COVID-19 patient isolation time strategies on healthcare workers (HCW) contamination, intensity of nursing care and potential associated adverse events. Methods We prospectively included all consecutive COVID-19 patients and HCW in our ICU in the first two pandemic waves (March to May 2020 and August to November 2020). Specific isolation measures for COVID-19 patients were released after two negative RT-PCR assays in the first wave and 14 days after the onset of symptoms in the second wave. Contamination of HCW was assessed at the end of each pandemic wave by combining both a RT-PCR assay and a serological test. Results Overall, 117 COVID-19 patients and 73 HCW were included. Despite an earlier release from isolation after ICU admission in the second than in the first wave [6 (4–8) vs. 15 (11–19) days, p < 0.01], the proportion of HCW with a positive serological test (16 vs. 17%, p = 0.94) or with a positive RT-PCR assay (3 vs. 5%, p = 0.58) was not different between the two waves. Although a lower nurse-to-bed ratio, the intensity of nursing care was higher in the second than in the first wave. A longer isolation time was associated with accidental extubation (OR = 1.18, 95%CI:1.07–1.35, p = 0.005) but neither with ventilator-associated pneumonia nor with dysglycemia. Conclusion A shorter isolation time of COVID-19 patients in ICU was not associated with higher HCW contamination, while a longer isolation time seemed to be associated with higher accidental extubation.
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Affiliation(s)
- Denis Doyen
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France.,LP2M - CNRS Laboratoire de Physiomédecine Moléculaire, Université Côte d'Azur (UCA), Nice, France
| | - Lucas Morand
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Didac Aurenche Mateu
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Clément Saccheri
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Hervé Hyvernat
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Marion Cremoni
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France
| | - Vesna Brglez
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France
| | - Nicolas Bèle
- Centre Hospitalier Intercommunal de Fréjus Saint-Raphaël, Réanimation Polyvalente, Fréjus, France
| | - Gilles Bernardin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
| | - Barbara Seitz-Polski
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 1, Nice, France.,UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur (UCA), Nice, France
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Romare C, Anderberg P, Sanmartin Berglund J, Skär L. Burden of care related to monitoring patient vital signs during intensive care; a descriptive retrospective database study. Intensive Crit Care Nurs 2022; 71:103213. [DOI: 10.1016/j.iccn.2022.103213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
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29
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Chen YT, Chiu YC, Teng ML, Liao PH. The effect of medical material management system app on nursing workload and stress. BMC Nurs 2022; 21:19. [PMID: 35039036 PMCID: PMC8761961 DOI: 10.1186/s12912-022-00806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Aims To develop a clinical medical material management App for nurses, in order to reduce their workload and improve the efficacy of medical material management. Design The single-group pre- and post-test experimental design was adopted. Methods The subjects were nurses in the intensive care units of a regional hospital in Hsinchu City enrolled by purposive sampling. Single-group pre-tests and post-tests were conducted. The research period was from November 2019 to March 2020. The workload, stress, and information acceptance of 57 nurses before and after the intervention of the Medical Equipment App were collected. The research tools included a structured questionnaire, which includes open questions that cover the aspects of workload, stress, and information acceptance intention of nurses, as well as a demographic questionnaire, which collects the basic personal data, including gender, age, years of service, educational level, nursing ability level, use ability of IT products, and unit type. The results were analyzed and compared using SPSS, APP Inventor, and data mining modeling to determine the effects of the App. Results After employing the Shift Check App, the average workload of nurses was effectively reduced, in particular, the workload reduction of the N1 level nursing ability was greater than that of N2. In addition to satisfaction, the scores of information acceptance intention in all aspects, including behavioral intention, technology use intention, and contributing factors, all increased. Conclusion The use of information technology products to assist medical material management in clinical practice has a significant effect on the load reduction of nurses and improvement of satisfaction. Clinical relevance The App developed in this study can improve nurses’ work satisfaction, quality of care and workload reduction.
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Affiliation(s)
- Yi-Tsao Chen
- College of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.,Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, 300, Taiwan
| | - Yi-Cheng Chiu
- Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, 300, Taiwan
| | - Meng-Lan Teng
- Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, 300, Taiwan
| | - Pei-Hung Liao
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.
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30
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Bruyneel A, Maes J, Di Pierdomenico L, Tack J, Bogaert M, Leclercq P, Pirson M. Associations between two nursing workload scales and the cost of intensive care unit nursing staff: A retrospective study of one Belgian hospital. J Nurs Manag 2022; 30:724-732. [PMID: 34989040 DOI: 10.1111/jonm.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to assess associations between a general nursing funding scale and an intensive care unit specific nursing workload scale and the cost of nursing staff. BACKGROUND Nurse staffing represents the most important cost in the intensive care unit, so it is essential to evaluate it accurately. In addition, the assessment of nursing workload is important for the daily management of the intensive care unit and to ensure quality of care. METHODS This was a retrospective and quantitative study carried out in the intensive care unit of a Belgian hospital. The extraction of data from the Nursing Activities Score and the Minimum Hospital Summary Nursing Dataset were carried out during 2 periods of 15 days, from 1 June 2018 to 15 June 2018 and from 1 September 2018 to 15 September 2018. RESULTS A total of 234 patients were included in the study. A total of 773 Nursing Activities Score and Minimum Hospital Summary Nursing Dataset recordings were analyzed in the study per intensive care unit day. A strong correlation was observed between Nursing Activities Score and Minimum Hospital Summary Nursing Dataset for the entire intensive care unit stay with a rho (95% CI) of .88 (0.83-.93); however, the correlation was moderate per intensive care unit day with a rho of .51 (0.45-0.57). A strong association was observed between the Minimum Hospital Summary Nursing Dataset and the Nursing Activities Score with the costs of intensive care unit nurses with a rho (95% CI) of .78 (0.72-0.86) and .74 (0.65-0.84), respectively. CONCLUSIONS A general nursing funding scale in Belgium was strongly correlated with the nursing workload for the whole intensive care unit stay, but this correlation was moderate per intensive care unit day. In contrast, both scales showed a good correlation with intensive care unit nursing costs. IMPLICATIONS FOR NURSING MANAGEMENT In Belgium, a general funding scale for nurses does not allow for an assessment of the nursing workload in the intensive care unit. The Nursing Activities Score is strongly correlated with the cost of nursing staff in the intensive care unit. The authors recommend that the Belgian authorities carry out this type of study in several intensive care units in the country and eventually replace the general funding scale for nurses with the Nursing Activities Score.
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,SIZ Nursing, A Society of Intensive Care Nurses, Belgium
| | - Julie Maes
- Simulation Laboratory for Healthcare Professions, SimLabS, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Lionel Di Pierdomenico
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,Medical Information Department, CHU-Charleroi Marie-Curie, Charleroi, Belgium
| | - Jérôme Tack
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,SIZ Nursing, A Society of Intensive Care Nurses, Belgium.,Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Bogaert
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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31
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Soomann M, Wendel-Garcia PD, Kaufmann M, Grazioli S, Perez MH, Hilty MP, André MC, Brotschi B. The SARS-CoV-2 Pandemic Impacts the Management of Swiss Pediatric Intensive Care Units. Front Pediatr 2022; 10:761815. [PMID: 35155302 PMCID: PMC8832059 DOI: 10.3389/fped.2022.761815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
The impact of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic on pediatric intensive care units (PICUs) is difficult to quantify. We conducted an observational study in all eight Swiss PICUs between 02/24/2020 and 06/15/2020 to characterize the logistical and medical aspects of the pandemic and their impact on the management of the Swiss PICUs. The nine patients admitted to Swiss PICUs during the study period suffering from pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and constituting 14% (9/63) of all SARS-CoV-2 positive hospitalized patients in Swiss children's hospitals caused a higher workload [total Nine Equivalents of nursing Manpower use Score (NEMS) points, p = 0.0008] and were classified to higher workload categories (p < 0.0001) than regular PICU patients (n = 4,881) admitted in 2019. The comparison of the characteristics of the eight Swiss PICUs shows that they were confronted by different organizational issues arising from temporary regulations put in place by the federal council. These general regulations had different consequences for the eight individual PICUs due to the differences between the PICUs. In addition, the temporal relationship of these different regulations influenced the available PICU resources, dependent on the characteristics of the individual PICUs. As pandemic continues, reflecting and learning from experience is essential to reduce workload, optimize bed occupancy and manage resources in each individual PICU. In a small country as Switzerland, with a relatively decentralized health care local differences between PICUs are considerable and should be taken into account when making policy decisions.
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Affiliation(s)
- Maarja Soomann
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Pedro D Wendel-Garcia
- University of Zurich, Zurich, Switzerland.,Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Mark Kaufmann
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias P Hilty
- University of Zurich, Zurich, Switzerland.,Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Maya C André
- Division of Respiratory and Critical Care Medicine, University of Basel Children's Hospital, Basel, Switzerland.,Department of Pediatric Hematology and Oncology, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Barbara Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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32
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Silveira RRPD, Serafim CTR, Castro MCNE, Rodrigues GM, Corrente JE, Lima SAM. Nursing workload associated with neonatal mortality risk: a cross-sectional study. Rev Bras Enferm 2022; 75:e20200965. [DOI: 10.1590/0034-7167-2020-0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT Objectives: to analyze the association between nursing workload and neonatal mortality risk in newborns admitted to the Neonatal Intensive Care Unit. Methods: this is an observational, cross-sectional study conducted from January 2019 to January 2020. Results: the sample consisted of 399 newborns, 55.4% male, Nursing Activities Score mean of 67.5%, and Score for Neonatal Acute Physiology Perinatal Extension mean of 17.7, revealed itself as a predictor of the risk of death, while gestational age, length of hospitalization, and the first-minute Apgar established a protective relationship. The correlation between workload and neonatal mortality was low (r= 0.23, p=0.0009). Conclusions: the workload of the nursing team is not associated with the risk of mortality in the Neonatal Intensive Care Unit, as measured by the Nursing Activities Score.
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Azevedo AV, Tonietto TA, Boniatti MM. Nursing workload on the day of discharge from the intensive care unit is associated with readmission. Intensive Crit Care Nurs 2021; 69:103162. [PMID: 34895796 DOI: 10.1016/j.iccn.2021.103162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To verify whether there is an association between the Nursing Activities Score (NAS) on the day of discharge from the intensive care unit and readmission.. MATERIALS AND METHODS A retrospective cohort study of all patients admitted to the intensive care unit of Hospital Ernesto Dornelles, Porto Alegre, Brazil, who were discharged to the ward from October 2018 to December 2019. We collected demographic and clinical variables of the patients and the Nursing Activities Scoreon the day of discharge. Patients were followed up until the day of hospital discharge or death. RESULTS We included 1045 patients in the final sample. One hundred eighty-eight (18.0%) patients were readmitted, in addition there were two (0.2%) unexpected deaths that occurred in the ward. The median NAS was 59.9 (50.9-67.3), which was higher in the bivariate analysis in patients who were readmitted (64.0, 55.7-71.4) than in patients who were not readmitted (58.7, 49.7-66.1) (p < 0.001). Patients with a Nursing Activities Score ≥ 60.0 and < 60.0 had rates of readmission of 23.4% and 12.7%, respectively (p < 0.001). After multivariable adjustment, the Nursing Activities Score at discharge maintained an association with readmission. In addition, in the Cox regression, the Nursing Activities Score as a dichotomous variable was independently associated with readmission (adjusted HR 1.560; CI 1.146-2.125; p = 0.005). CONCLUSIONS We found that the nursing workload, assessed by the Nursing Activities Score at the time of discharge from the intensive care unit, was associated with risk of readmission..
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Affiliation(s)
| | - Tiago A Tonietto
- Critical Care Department, Hospital de Clínicas de Porto Alegre, Brazil
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Gershengorn HB, Pilcher DV, Litton E, Anstey M, Garland A, Wunsch H. Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand. Intensive Care Med 2021. [PMID: 34854939 DOI: 10.1007/s00134-021-06575-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
Purpose The impact of intensivist workload on intensive care unit (ICU) outcomes is incompletely described and assessed across healthcare systems and countries. We sought to examine the association of patient-to-intensivist ratio (PIR) with hospital mortality in Australia/New Zealand (ANZ) ICUs. Methods We conducted a retrospective study of adult admissions to ANZ ICUs (August 2016–June 2018) using two cohorts: “narrow”, based on previously used criteria including restriction to ICUs with a single daytime intensivist; and “broad”, refined by individual ICU daytime staffing information. The exposure was average daily PIR and the outcome was hospital mortality. We used summary statistics to describe both cohorts and multilevel multivariable logistic regression models to assess the association of PIR with mortality. In each, PIR was modeled using restricted cubic splines to allow for non-linear associations. The broad cohort model included non-PIR physician and non-physician staffing covariables. Results The narrow cohort of 27,380 patients across 67 ICUs (predicted mortality: median 1.2% [IQR 0.4–1.4%]; mean 5.9% [sd 13.2%]) had a median PIR of 10.1 (IQR 7–14). The broad cohort of 91,206 patients across 73 ICUs (predicted mortality: 1.9% [0.6–6.5%]; 7.6% [14.9%]) had a median PIR of 7.8 (IQR 5.8–10.2). We found no association of PIR with mortality in either the narrow (PIR 1st spline term odds ratio [95% CI]: 1 [0.94, 1.06], Wald testing of spline terms p = 0.61) or the broad (1.02 [0.97, 1.07], p = 0.4) cohort. Conclusion We found no association of PIR with hospital mortality across ANZ ICUs. The low cohort predicted mortality may limit external validity. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06575-z.
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Maddox LJ. Nurse-to-Patient Ratios in Tele-Critical Care. Crit Care Nurse 2021; 41:74-75. [PMID: 34851380 DOI: 10.4037/ccn2021135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lory J Maddox
- Lory J. Maddox is a senior clinical outcomes researcher, Connect Care Services, Intermountain Healthcare, Salt Lake City, Utah
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Affiliation(s)
- Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lyvonne N Tume
- School of Health & Society, University of Salford, Salford, UK
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Bruyneel A, Lucchini A, Hoogendoorn M. Impact of COVID-19 on nursing workload as measured with the Nursing Activities Score in intensive care. Intensive Crit Care Nurs 2021; 69:103170. [PMID: 34893395 PMCID: PMC8580832 DOI: 10.1016/j.iccn.2021.103170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | - Alberto Lucchini
- General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, Via Pergolesi 33, Monza (MB), Italy - University of Milano-Bicocca, Italy
| | - Marga Hoogendoorn
- Department Anesthesiology and Intensive Care, Isala, Zwolle, The Netherlands
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Bonfim AKS, Passos ICMDO, Saleh CMR, Padilha KG, Nogueira LDS. Nursing workload of trauma patients in the emergency room: A prospective cohort study. Int Emerg Nurs 2021; 59:101071. [PMID: 34571452 DOI: 10.1016/j.ienj.2021.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Ane Karoline Silva Bonfim
- Medical-Surgical Nursing Department, School of Nursing, University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419 São Paulo, 05403-000, Brazil.
| | | | - Carmen Mohamad Rida Saleh
- Nursing Division, Central Institute of Clinical Hospital, Faculty of Medicine, University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 255 São Paulo, 05403-000, Brazil.
| | - Katia Grillo Padilha
- Medical-Surgical Nursing Department, School of Nursing, University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419 São Paulo, 05403-000, Brazil.
| | - Lilia de Souza Nogueira
- Medical-Surgical Nursing Department, School of Nursing, University of São Paulo. Avenida Doutor Enéas de Carvalho Aguiar, 419 São Paulo, 05403-000, Brazil.
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Ohbe H, Sasabuchi Y, Yamana H, Matsui H, Yasunaga H. Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study. Lancet Reg Health West Pac 2021; 13:100185. [PMID: 34527980 DOI: 10.1016/j.lanwpc.2021.100185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
Background Many mechanically ventilated patients in Japan are treated in high-dependency care units (HDUs) rather than intensive care units (ICUs). HDUs can provide intermediate-level care with reduced costs; however, there is limited evidence on whether mechanically ventilated patients should be treated in the ICU or HDU. Methods This was a comparative effectiveness study using a nationwide administrative database in Japan. We identified mechanically ventilated patients with pneumonia in ICU or HDU on the day of admission in the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019. The primary outcome was 30-day in-hospital mortality. Propensity score matching analysis was performed to compare this outcome between patients treated in the ICU and HDU. The robustness of the analyses was evaluated with multivariable regression, overlap weighting, and instrumental variable analyses. Findings Of 14,859 mechanically ventilated patients with pneumonia, 7,528 (51%) were treated in the ICU and 7,331 (49%) were treated in the HDU. After propensity score matching, patients treated in the ICU had significantly lower 30-day in-hospital mortality than did those treated in the HDU (24.0% vs. 31.2%; difference, −7.2%; 95% confidence interval, −10.0% to −4.4%). The multivariable regression, overlap weighting, and instrumental variable analyses showed a similar direction and magnitude of association. Interpretation Critical care for mechanically ventilated patients with pneumonia in the ICU was associated with a 7.2% decrease in 30-day in-hospital mortality vs. care in the HDU. Residual confounding may still play a role in the effect estimates. Funding This study received funding from Ministry of Health, Labour and Welfare, Japan, and Ministry of Education, Culture, Sports, Science and Technology, Japan.
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Padilla Fortunatti C, Munro CL. Factors associated with family satisfaction in the adult intensive care unit: A literature review. Aust Crit Care 2021; 35:604-611. [PMID: 34535370 DOI: 10.1016/j.aucc.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients. REVIEW METHODS/DATA SOURCES A search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related. RESULTS The search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member-related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies. CONCLUSIONS A broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.
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Affiliation(s)
- Cristóbal Padilla Fortunatti
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA; Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile.
| | - Cindy L Munro
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA
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Camargo MDD, Silveira DT, Lazzari DD, Rodrigues AFV, Moraes KB, Duarte ERM. Nursing Activities Score: trajectory of the instrument from paper to cloud in a university hospital. Rev Esc Enferm USP 2021; 55:e20200233. [PMID: 34498660 DOI: 10.1590/1980-220x-reeusp-2020-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/15/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the process of organization and construction of an information technology structure named Nursing Activities Score (NAS) Cloud Technology®. METHOD This project was based on the life cycle theory and has enabled the development of technological production through software engineering. RESULTS The NAS Cloud Technology® was developed for remote and collaborative access on a website hosted by Google Sites® and protected in a business environment by the certified security and data protection devices Health Insurance Portability and Accountability Act (HIPPA). In 2015, this system received more than 10.000 submissions/month, totaling 12 care units for critical patients covered by the information technology structure, circa 200 nurses per day involved in the collection and hundreds of daily submissions, integrating the complete transition from paper to cloud. CONCLUSION The development of NAS Cloud Technology® system has enabled the use of technology as a facilitating means for the use of Nursing care data, providing tools for decision-making on the nursing personnel sizing required for the care demands in the inpatient care units. The potential of cloud structures stands out due to their possibility of innovation, as well as low-cost access and high replicability of the information system.
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Affiliation(s)
| | - Denise Tolfo Silveira
- Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Médico Cirúrgico, Porto Alegre, RS, Brazil
| | - Daniele Delacanal Lazzari
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Enfermagem, Florianópolis, SC, Brazil
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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: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Andre JH, Zachary SE, Elhoff JJ. Workload in the Cardiac ICU: You Down With APPs? Pediatr Crit Care Med 2021; 22:753-5. [PMID: 34397990 DOI: 10.1097/PCC.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rood PJ, Zegers M, Ramnarain D, Koopmans M, Klarenbeek T, Ewalds E, van der Steen MS, Oldenbeuving AW, Kuiper MA, Teerenstra S, Adang E, van Loon LM, Wassenaar A, Vermeulen H, Pickkers P, van den Boogaard M. The Impact of Nursing Delirium Preventive Interventions in the Intensive Care Unit: A Multicenter Cluster Randomized Controlled Trial. Am J Respir Crit Care Med 2021; 204:682-691. [PMID: 34170798 DOI: 10.1164/rccm.202101-0082oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Delirium is common in critically ill patients and associated with deleterious outcomes. Non-pharmacologic interventions are recommended in current delirium guidelines, but their effects have not been unequivocally established. Objective To determine the effects of a multicomponent nursing intervention program on delirium in the Intensive Care Unit. Methods Stepped wedge cluster randomized controlled trial, conducted in Intensive care units of 10 centers. Adult critically ill surgical, medical or trauma patients at high risk to develop delirium were included. A multicomponent nursing intervention program focusing on modifiable risk factors was implemented as standard of care. Primary outcome was the number of delirium-free and coma-free days alive in 28 days after Intensive Care Unit admission. Measurements and main results A total of 1749 patients were included. Time spent per 8 hours shift on interventions was median [IQR] 38 [14-116] in the intervention period and median 32 [13-73] minutes in the control period (p=0.44). Patients in the intervention period had median 23 [4-27] delirium-free and coma-free days alive, compared to median 23 [5-27] days for patients in the control group (mean difference -1.21 days, 95%CI -2.84 to 0.42 days; p=0.15). Also, the number of delirium days was similar: median 2 [1-4] days (ratio of medians 0.90, 95%CI 0.75 to 1.09; p=0.27). Conclusion In this large randomized controlled trial in adult ICU patients, a limited increase was achieved of the use of nursing interventions, and no change in the number of delirium-free and coma-free days alive in 28 days could be determined. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT03002701.
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Affiliation(s)
- Paul Jt Rood
- Radboudumc, 6034, Department of Intensive Care Medicine, Nijmegen, Netherlands.,Radboudumc, 6034, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | | | | | - Matty Koopmans
- Medical Centre Leeuwarden, 4480, Department of Intensive Care Medicine, Leeuwarden, Netherlands
| | - Toine Klarenbeek
- Maxima Medical Centre Location Veldhoven, 89569, Department of Intensive Care Medicine, Veldhoven, Netherlands
| | - Esther Ewalds
- Bernhoven Hospital Location Uden, 97772, Uden, Netherlands
| | | | | | - Michael A Kuiper
- Medical Centre Leeuwarden, 4480, Department of Intensive Care Medicine, Leeuwarden, Netherlands
| | - Steven Teerenstra
- Radboudumc, 6034, Department for Health Evidence, Nijmegen, Netherlands
| | - Eddy Adang
- Radboudumc, 6034, Department for Health Evidence, Nijmegen, Netherlands
| | - Lex M van Loon
- University of Twente, 3230, Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, Enschede, Netherlands
| | - Annelies Wassenaar
- Radboudumc, 6034, Department of Intensive Care Medicine, Nijmegen, Netherlands
| | | | - Peter Pickkers
- Radboudumc, 6034, Department of Intensive Care Medicine, Nijmegen, Netherlands
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Cuadrado D, Riaño D, Gómez J, Rodríguez A, Bodí M. Methods and measures to quantify ICU patient heterogeneity. J Biomed Inform 2021; 117:103768. [PMID: 33839305 DOI: 10.1016/j.jbi.2021.103768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
Patients in intensive care units are heterogeneous and the daily prediction of their days to discharge (DTD) a complex task that practitioners and computers are not always able to solve satisfactorily. In order to make more precise DTD predictors, it is necessary to have tools for the analysis of the heterogeneity of the patients. Unfortunately, the number of publications in this field is almost non-existent. In order to alleviate this lack of tools, we propose four methods and their corresponding measures to quantify the heterogeneity of intensive patients in the process of determining the DTD. These new methods and measures have been tested with patients admitted over four years to a tertiary hospital in Spain. The results deepen the understanding of the intensive patient and can serve as a basis for the construction of better DTD predictors.
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Ricci de Araújo T, Papathanassoglou E, Gonçalves Menegueti M, Grespan Bonacim CA, Lessa do Valle Dallora ME, de Carvalho Jericó M, Basile-Filho A, Laus AM. Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil. J Nurs Manag 2021; 29:1778-1784. [PMID: 33772914 DOI: 10.1111/jonm.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND Accurate data of nursing cost can contribute to reliable resource management. METHOD We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
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Affiliation(s)
- Thamiris Ricci de Araújo
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Mayra Gonçalves Menegueti
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Anibal Basile-Filho
- Department of Surgery and Anatomy of Medical School, Division of Intensive Medicine of Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Laus
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
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Huang SL, Cheng H, Duffield C, Denney-Wilson E. The relationship between patient obesity and nursing workload: An integrative review. J Clin Nurs 2021; 30:1810-1825. [PMID: 33529423 DOI: 10.1111/jocn.15679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/03/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the relationship between patient obesity and nursing workload, and discuss the nursing activities most affected by patient obesity. BACKGROUND The increasing number of patients with obesity, and the severity of obesity, impacts the healthcare workforce, particularly to nurses who provide most direct care to patients. There is growing evidence to suggest that patient obesity may increase nursing workload and time taken for clinical care. DESIGN Integrative review. METHODS A comprehensive search of academic databases for primary research related to patient obesity and nursing workload, published since 2000, was conducted. References of relevant articles were hand-searched. RESULTS 27 articles were analysed. Analysis was undertaken at the levels of patient characteristics, nursing work and the healthcare system. The increasing number of patients with obesity, and the severity of patient obesity, increases nursing workload by affecting nursing time needed to deliver care. An increased number of nurses, particularly with increased clinical skill, are needed to deliver care meeting these increased needs. Organisational change is required to provide infrastructure and bariatric equipment that enables effective nursing care of patients with obesity. Organisations must consider additional time and staff needs when delivering care for patients with obesity. CONCLUSIONS The current health system is not established to address the challenge of providing nursing care to the increasing numbers of patients with obesity. Further research on accurately and objectively quantifying the impact and severity of patient obesity on nursing clinical activities is required. RELEVANCE TO CLINICAL PRACTICE When determining staffing, healthcare organisations must consider the increased nursing staff, time and clinical skill required to provide care for patients with obesity. Healthcare organisations should implement policies that ensure sufficient staffing in areas where care of patients with obesity is prevalent, and provide training for and workplace availability of bariatric equipment.
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Affiliation(s)
- Sizhao L Huang
- Gastroenterology and Neurology, Westmead Hospital, Westmead, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, Australia
| | - Christine Duffield
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, Australia.,Sydney Local Health District, NSW Health, Sydney, Australia
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Henzi A, Kleger GR, Hilty MP, Wendel Garcia PD, Ziegel JF. Probabilistic analysis of COVID-19 patients' individual length of stay in Swiss intensive care units. PLoS One 2021; 16:e0247265. [PMID: 33606773 PMCID: PMC7894868 DOI: 10.1371/journal.pone.0247265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Rationale The COVID-19 pandemic induces considerable strain on intensive care unit resources. Objectives We aim to provide early predictions of individual patients’ intensive care unit length of stay, which might improve resource allocation and patient care during the on-going pandemic. Methods We developed a new semiparametric distributional index model depending on covariates which are available within 24h after intensive care unit admission. The model was trained on a large cohort of acute respiratory distress syndrome patients out of the Minimal Dataset of the Swiss Society of Intensive Care Medicine. Then, we predict individual length of stay of patients in the RISC-19-ICU registry. Measurements The RISC-19-ICU Investigators for Switzerland collected data of 557 critically ill patients with COVID-19. Main results The model gives probabilistically and marginally calibrated predictions which are more informative than the empirical length of stay distribution of the training data. However, marginal calibration was worse after approximately 20 days in the whole cohort and in different subgroups. Long staying COVID-19 patients have shorter length of stay than regular acute respiratory distress syndrome patients. We found differences in LoS with respect to age categories and gender but not in regions of Switzerland with different stress of intensive care unit resources. Conclusion A new probabilistic model permits calibrated and informative probabilistic prediction of LoS of individual patients with COVID-19. Long staying patients could be discovered early. The model may be the basis to simulate stochastic models for bed occupation in intensive care units under different casemix scenarios.
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Affiliation(s)
- Alexander Henzi
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Gian-Reto Kleger
- Division of Intensive Care Medicine, Cantonal Hospital, St.Gallen, Switzerland
| | - Matthias P. Hilty
- The RISC-19-ICU Registry Board, University of Zurich, Zürich, Switzerland
- Institute of Intensive Care Medicine, University Hospital of Zürich, Zürich, Switzerland
| | - Pedro D. Wendel Garcia
- The RISC-19-ICU Registry Board, University of Zurich, Zürich, Switzerland
- Institute of Intensive Care Medicine, University Hospital of Zürich, Zürich, Switzerland
| | - Johanna F. Ziegel
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
- * E-mail:
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Nasirizad Moghadam K, Chehrzad MM, Reza Masouleh S, Maleki M, Mardani A, Atharyan S, Harding C. Nursing physical workload and mental workload in intensive care units: Are they related? Nurs Open 2021; 8:1625-1633. [PMID: 33596333 PMCID: PMC8186696 DOI: 10.1002/nop2.785] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
AIM In order to ensure patient safety and quality of care, it is important to consider factors which may impact on nursing workloads. This study aimed to investigate the simultaneous physical and mental workload and any relationships between these concepts on nurses working in intensive care units. DESIGN A cross-sectional design was undertaken. METHOD Participants were nurses (N = 105) recruited from six adult intensive care units which met the inclusion criteria. Nursing Activities Score (NAS) to measure physical workload and NASA Task Load Index (NASA-TLX) to measure mental workload were used. Data were collected for each participating nurse in three shifts (morning, evening and night). Data were analysed using bivariate correlation and multivariable linear regression analysis. RESULTS The mean (SD) of nurses' physical and mental workload was 72.84% (22.07%) and 70.21 (12.36), respectively. A significant relationship between physical and mental workload (p <.001) was identified.
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Affiliation(s)
| | - Minoo Mitra Chehrzad
- Department of Paediatric Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Shademan Reza Masouleh
- Social Determinants of Health Research Centre (SDHRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Maleki
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahaboddin Atharyan
- Department of Nursing, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Celia Harding
- Division of Language and Communication Science, City, University of London, London, UK
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Racy S, Davidson PM, Peeler A, Hager DN, Street L, Koirala B. A review of inpatient nursing workload measures. J Clin Nurs 2021; 30:1799-1809. [PMID: 33503306 DOI: 10.1111/jocn.15676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload. OBJECTIVES To compare measures of nursing workload in adult inpatient settings. DESIGN, DATA SOURCES AND REVIEW METHOD A review of published studies characterising nursing workload measures was undertaken. Databases-PubMed and CINHAL-were used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide and report the review. RESULTS Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties. CONCLUSION Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice. RELEVANCE TO CLINICAL PRACTICE Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well-being, as well as enhancing patient health outcomes in inpatient settings.
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Affiliation(s)
- Stepney Racy
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - David N Hager
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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