Scores TISS-28 versus NEMS to size the nursing team in a pediatric intensive care unit

Abstract

ObjectiveTo estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit.MethodsAn observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments.ResultsA total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement.ConclusionTime spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study

“…The Therapeutic Intervention Scoring System-28 (TISS-28) was used to identify the patient›s severity and demand for care. This instrument was built to establish the Nursing workload in the ICU based on the determination of the therapeutic interventions, complexity of the Nursing care required and time spent in performing Nursing procedures in the care of critically-ill patients ( 19 ) .…”

Workload in the Care of a Patient with Congenital Diaphragmatic Hernia and the Patient’s Need for Nursing Care

“…In the following years, research tools were developed, such as: Therapeutic Intervention Scoring System 57 (TISS-57) followed by TISS-28, OMEGA, Time Oriented Score System (TOSS), Nine Equivalents of Nursing Manpower Use Score (NEMS), Nursing Activities Score (NAS), which were validated in subsequent studies [12,13]. They have many limitations and focus mainly on measuring the intensity of work or actions performed in a certain period of time [14]. Without exhausting the problem of the workload in the intensive care unit [12,15,16].…”

“…These patients undergo the following procedures, which for the purpose of research are marked with numbers from (1) to (14). These are: (1) invasive mechanical ventilation or non-invasive mechanical ventilation (1.1), central intravenous access (2), arterial access (3), continuous heparin infusion (3.1), parenteral nutrition (4), continuous infusion pharmacotherapy (5), antibiotic and fractionated pharmacotherapy (6), additional fluid therapy (7), monitoring of bladder catheter diuresis (8) or monitoring diuresis with a scale (8.1), intragastric tube feeding ( 9), monitoring and control of pain (10), monitoring and control of vital signs (11), patient care management (12), patient comfort (13), specialist procedures (14). Nurse-to-patient ratio 1:1* means that one nurse takes care of one patient who is undergoing procedures as above.…”

“…For the NEMS tool, the average (expressed in points) of day and night duty was multiplied by 10.6'. The result in minutes was multiplied by 3, followed by the result being divided by 60' [14,[29][30].…”

Relación entre carga laboral y calidad del cuidado en pacientes críticos de 3 ciudades - Colombia 2021

“…Existe otra derivación del TISS-28 denominada Nine Equivalents of Nursing Manpower Use Score (NEMS), la cual reduce la propuesta de actividades solamente a 9 variables, con las que se valora el trabajo enfermero, procedente del esfuerzo terapéutico mediante el cálculo de las horas de cuidados directos al paciente. Sin embargo, pese a sintetizar y facilitar la aplicación de la misma se documenta la desventaja de no tener en cuenta las actividades inherentes al trabajo de Enfermería (79), ya que le da prioridad a las intervenciones asistenciales, a pesar de que, en el estudio propuesto por Canabarro et al (80), afirma una adecuada correlación y concordancia en los resultados de NEMS frente a TISS-28, también reportaron que el número de profesionales estimados y el tiempo dedicado a las actividades de Enfermería reflejados por la NEMS fueron significativamente mayores en comparación con TISS-28, no obstante, tampoco se encuentra validada en el contexto colombiano.…”