Nursing workload assessment in an intensive care unit: A 5‐year retrospective analysis

Abstract

Aims To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5‐year period. Background Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload. Design Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between 1 January 2015–31 December 2019. Methods Simplified Therapeutic Intervention Scoring System (TISS‐28) scores of 730 adult patients. Three TISS‐28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study. Results The TISS‐28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS‐28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years. Conclusions Lower workloads were found for age ≤44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively). Relevance to clinical practice Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score

“…The implementation of the (Portuguese version of) NAS was suggested after a 5‐year retrospective study conducted in this Portuguese ICU with TISS 28 5 …”

“…The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide 1,2 . Nursing activities in ICUs are dynamic and variable over the 24‐h period 3 and the management of nursing workload is becoming a challenge 1,4–9 . In fact, increased nursing workload is associated with increased incidence of adverse events 10,11 that could compromise the patient safety culture 12–14 and the quality of care 6,15,16 …”

“…Furthermore, a 5‐year retrospective study conducted in a Portuguese ICU concluded that the systematic nursing workload assessment in critical care contexts could be an important strategy to manage the nursing team (and the nursing care process) and suggested the implementation of the Nursing Activities Score (NAS) 5 …”

Nursing Workload in Patients With Myocardial Ischemia After Non-cardiac Surgery

“…Also, no study was observed correlating the length of hospital stay with the mortality of patients who have undergone major surgery. However, several studies have crosslinked the length of hospital stay in the ICU with patient mortality, concluding that prolonged hospital stay in the postoperative ICU is associated with increased mortality [ 9 , 10 ]. A study of 735 control patients who underwent coronary artery bypass graft surgery concluded that patients who died were hospitalized in the ICU for longer than the others [ 11 ].…”

Do frail elderly people affect the nursing workload in intensive care units?

“…In another study, conducted at a university hospital in Londrina, Paraná, no significant difference was observed in the NAS presented by elderly patients (73.99 to 74.3%) and non-elderly patients (74.08 to 75.18%) (9) , that is, the scores indicated high nursing workload in both groups. The analysis of the nursing workload in an ICU in Portugal using the Simplified Therapeutic Intervention Scoring System (TISS-28) also showed that aging was directly proportional to workload increase, with higher scores observed in the elderly when compared to other age groups of adulthood (p < 0.001) (10) . Although the workload was measured with another tool in our study, it is important to emphasize the TISS-28 was the precursor of the NAS (7) , whose measurement is based on items related to care complexity, comprised of categories of therapeutic intervention that remained in the NAS.…”