Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

Abstract

Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers’ consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results.

Nursing Activities Score by assistance sites in Intensive Care Units

“…4,7,8,13,15 The mean age was 56.8 years old, and this is also consistent with other studies undertaken in Brazil. 4,7,16 and abroad 10,11,17 In relation to the outcome of survival or nonsurvival of the patients, it may be observed that 27.1% of the patients did not, ultimately, survive. In other studies undertaken in Brazilian ICUs, the mortality rate was 41.0% 2 and 21.6%, 4 while in studies undertaken in ICUs abroad, this value is close to 10.0%.…”

“…Recently, one multicentric study 11 carried out in seven countries, with the aim of describing the workload in ICU using the NAS, identified variation in the scores, with means ranging from 44.5% in Spain through to 101.8% in Norway. The characteristics of the patients, the structure of the unit and the work process used in the different countries may explain the difference in mean NAS between these ICUs.…”

“…The characteristics of the patients, the structure of the unit and the work process used in the different countries may explain the difference in mean NAS between these ICUs. 10,11,19 In this regard, it can be said that the nursing workload is complex and nonlinear, and may be influenced by characteristics both of the nurses and of the patients, as well as the unit's organizational characteristics and by the time and effort necessary for carrying out the care provided. 19 In relation to the clinical variables and the nursing workload in this sample, one can say that the shorter the length of stay, the higher the NAS.…”

“…At the time of writing, this instrument is being used in 12 different countries and studies have related its use to variables such as patient mortality, length of stay, and the occurrence of adverse events. 3,9,11,12 Using this instrument to measure the nursing workload promotes the practicing of safe care and reduces costs for the institution. 7,10,11 Accordingly, the nurses must analyze the dynamics and specific characteristics of the ICU where they work, as well as the characteristics of the patients, in order to apply the tools and strategies for organizing the activities and the nursing work process.…”

Correlação entre o tempo de assistência de enfermagem e indicadores de qualidade assistencial em Unidades de Terapia Intensiva

“…Pesquisa desenvolvida por Nogueira (2015), com o objetivo de correlacionar o tempo médio de assistência dispensado pelos profissionais de enfermagem em uma UTI de um hospital privado no interior do Estado de São Paulo com indicadores de qualidade assistencial, encontrou uma média de 12,21 horas de assistência dispensadas aos pacientes internados no período do estudo.…”