Clinical Severity as a Predictor of Nursing Workload in Pediatric Intensive Care Units: A Cross-Sectional Study

Abstract

BackgroundIncreased nursing workload (NW) is associated with increased incidence of adverse events. In adult ICUs, one of the factors that increase NW is the severity of illness; however, this has not been adequately investigated in pediatric intensive care unit (PICU).AimTo explore potential association between clinical severity of critically ill children and NW in PICU.MethodsA descriptive, correlational, cross-sectional study design was employed. Data were collected from three PICUs of Athens, Greece, during November 2015 to March 2016, using a sample of 58 pediatric patients. The Pediatric-Nursing Activities Score (P-NAS) and the Therapeutic Intervention Scoring System 28 (TISS-28) were used to measure NW and the Pediatric Logistic Organ Dysfunction (PELOD) to assess clinical severity. Demographic and clinical variables of the children were also investigated. Multiple linear regressions were used to identify NW predictive factors, at 5% significance level.ResultsParticipants' median age (interquartile range [IQR]) was 38.5 (7.0–127.0) months and 50% of them were male. PELOD score was significantly correlated with NW scores on the first day of hospitalization in PICU (P-NAS: ρ = .319, p = .020, TISS-28: ρ = .547, p < .0001) and with NW during total PICU stay (TISS-28: ρ = .483, p < .001). The PELOD (β = .694, p = .052) and the elective surgery (β = −13.12, p = .01) were predictors of the P-NAS on the first day of hospitalization, and the PELOD (β = .563, p = .029) and the emergency surgery (β = 16.09, p = .01) were predictors of the P-NAS during total PICU stay. The PELOD (β = .509, p = .001) was a predictor factor of the TISS-28 score on the first day of PICU hospitalization and the PELOD (β = .371, p = .003) and the age (β = .036, p = .005) were predictors of the TISS-28 score during total PICU stay.ConclusionsThe clinical severity is a predictive factor of NW required in PICUs.