Nursing Activities Score and Workload in the Intensive Care Unit of a University Hospital

Overview

Journal Rev Bras Ter Intensiva

Specialties Critical Care
General Medicine

Date 2014 Oct 9

PMID 25295824

Citations 14

Authors

Juliana Aparecida Morini Altafin

Cintia Magalhaes Carvalho Grion

Marcos Toshyiuki Tanita

Josiane Festti

Lucienne Tibery Queiroz Cardoso

Caio Fabricio Fonseca Veiga

Danielle Kamiji

Alan Roger Gomes Barbosa

Caio Cesar Takeshi Matsubara

Aline Bobato Lara

Cesar Castello Branco Lopes

Djavani Blum

Tiemi Matsuo

Affiliations

Soon will be listed here.

Abstract

Objective: The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument.

Methods: A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%.

Results: In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients' condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600).

Conclusion: We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.

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References

Panunto M, Guirardello E . Nursing workload at a gastroenterology unit. Rev Lat Am Enfermagem. 2010; 17(6):1009-14. DOI: 10.1590/s0104-11692009000600013. View

Kiekkas P, Brokalaki H, Manolis E, Samios A, Skartsani C, Baltopoulos G . Patient severity as an indicator of nursing workload in the intensive care unit. Nurs Crit Care. 2007; 12(1):34-41. DOI: 10.1111/j.1478-5153.2006.00193.x. View

Goncalves L, Padilha K . [Factors associated with nursing workload in adult intensive care units]. Rev Esc Enferm USP. 2008; 41(4):645-52. DOI: 10.1590/s0080-62342007000400015. View

Sousa C, Goncalves L, Toffoleto M, Leao K, Padilha K . Predictors of nursing workload in elderly patients admitted to intensive care units. Rev Lat Am Enfermagem. 2008; 16(2):218-23. DOI: 10.1590/s0104-11692008000200008. View

Conishi R, Gaidzinski R . [Evaluation of the Nursing Activities Score (NAS) as a nursing workload measurement tool in an adult ICU]. Rev Esc Enferm USP. 2007; 41(3):346-54. DOI: 10.1590/s0080-62342007000300002. View

Lobo S, Rezende E, Knibel M, Silva N, Paramo J, Nacul F . Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg. 2010; 112(4):877-83. DOI: 10.1213/ANE.0b013e3181e2bf8e. View

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

Oliveira A, Meira Dias O, Mello M, Araujo S, Dragosavac D, Nucci A . Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit. Rev Bras Ter Intensiva. 2014; 22(3):250-6. View

Cudak E, Dyk D . [Nursing demand in intensive therapy units]. Anestezjol Intens Ter. 2011; 42(2):70-4. View

10.

Vincent J, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P . Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26(11):1793-800. DOI: 10.1097/00003246-199811000-00016. View

11.

Giakoumidakis K, Baltopoulos G, Charitos C, Patelarou E, Galanis P, Brokalaki H . Risk factors for prolonged stay in cardiac surgery intensive care units. Nurs Crit Care. 2011; 16(5):243-51. DOI: 10.1111/j.1478-5153.2010.00443.x. View

12.

de Souza Nogueira L, Koike K, Sardinha D, Padilha K, de Sousa R . Nursing workload in public and private intensive care units. Rev Bras Ter Intensiva. 2013; 25(3):225-32. PMC: 4031844. DOI: 10.5935/0103-507X.20130039. View

13.

Miranda D, de Rijk A, Schaufeli W . Simplified Therapeutic Intervention Scoring System: the TISS-28 items--results from a multicenter study. Crit Care Med. 1996; 24(1):64-73. DOI: 10.1097/00003246-199601000-00012. View

14.

Miranda D, Nap R, de Rijk A, Schaufeli W, Iapichino G . Nursing activities score. Crit Care Med. 2003; 31(2):374-82. DOI: 10.1097/01.CCM.0000045567.78801.CC. View

15.

Morris R, MacNeela P, Scott A, Treacy P, Hyde A . Reconsidering the conceptualization of nursing workload: literature review. J Adv Nurs. 2007; 57(5):463-71. DOI: 10.1111/j.1365-2648.2006.04134.x. View

16.

Giakoumidakis K, Baltopoulos G, Charitos C, Patelarou E, Fotos N, Brokalaki-Pananoudaki H . Risk factors for increased in-hospital mortality: a cohort study among cardiac surgery patients. Eur J Cardiovasc Nurs. 2010; 11(1):23-33. DOI: 10.1016/j.ejcnurse.2010.09.005. View

17.

Padilha K, de Sousa R, Queijo A, Mendes A, Miranda D . Nursing Activities Score in the intensive care unit: analysis of the related factors. Intensive Crit Care Nurs. 2007; 24(3):197-204. DOI: 10.1016/j.iccn.2007.09.004. View

18.

Janzantte Ducci A, Zanei S, Whitaker I . [Nursing workload to verify nurse/patient ratio in a cardiology ICU]. Rev Esc Enferm USP. 2009; 42(4):673-80. DOI: 10.1590/s0080-62342008000400009. View

19.

de Souza Nogueira L, Santos M, Mataloun S, Moock M . [Nursing Activities Score: comparison among the Index APACHE II and the mortality in patients admitted in intensive care unit]. Rev Bras Ter Intensiva. 2014; 19(3):327-30. View

20.

Miranda D, Jegers M . Monitoring costs in the ICU: a search for a pertinent methodology. Acta Anaesthesiol Scand. 2012; 56(9):1104-13. DOI: 10.1111/j.1399-6576.2012.02735.x. View