Abstract
Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian's model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian's health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.
Highlights
Intensive care units (ICUs) are constantly evolving and in recent decades have had to deal with an increasing number of old patients and comorbidities
The use of tools for nursing workload measurement serves as a starting point for the analysis, comparison, and processing of data related to nursing activities and can provide important inputs to promote the optimization of the use of resources and establish a more adequate nurse-patient ratio[3]
A large majority of the articles reviewed by this study were published in nursing journals (86.1%), while 9.3% were published in multidisciplinary journals[14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49] (Chart 1)
Summary
Intensive care units (ICUs) are constantly evolving and in recent decades have had to deal with an increasing number of old patients and comorbidities. This in turn leads to a greater number of complex procedures[1], which calls for closer monitoring and a greater need for nursing interventions, resulting in increased nurse workload and higher costs. The use of more objective strategies to evaluate nursing activities is essential to optimize the use of ICU resources and ensure appropriateness, efficacy and cost-effectiveness[3]. The use of tools for nursing workload measurement serves as a starting point for the analysis, comparison, and processing of data related to nursing activities and can provide important inputs to promote the optimization of the use of resources and establish a more adequate nurse-patient ratio[3]
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