Mean Nursing Activities Score Research Articles

The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design

IntroductionIntensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. ObjectivesTo determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. MethodsUsing a prospective observational design, data were collected between 9 August – 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. ResultsAnalysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5–54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. ConclusionTrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. Implications for clinical practiceTrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.

Comparing nursing workload for critically ill adults with and without COVID-19: Retrospective cohort study.

Intensive care environments already required complex work, and, furthermore, the recent COVID-19 pandemic increased health care demands, disorganized work teams and limited resources. Nonetheless, the real workload of nursing workers in the care for critical patients during this period was seldom investigated. To compare the workload of nursing workers, estimated using the Nursing Activities Score (NAS), in patients with and without COVID-19 who had been hospitalized in an adult intensive care unit (ICU). This study was developed in the ICU of a public university hospital in the south of Brazil. The workload of nursing workers was estimated using the NAS, which was developed through a retrospective cohort using reports of the assistance registered in electronic records, including the first 10 days of hospitalization of all patients admitted into the ICU in 2020 and 2021, who had at least one NAS evaluation; then, the workload was compared between patients with and without COVID-19. Generalized estimating equations models were used. The project was approved by the research ethics committee of the institution where the study took place. The follow-up of 3485 patients resulted in 20 506 days of observation during the first 10 days of ICU hospitalization. The mean NAS score for the entire patient/day sample was 85.6 ± 18.1%, with 87.8 ± 17.8% in the COVID-19 group and 82.6 ± 18.2% in the non-COVID-19 group (p < .001). The use of mechanical ventilation, noradrenaline, sedation and neuromuscular blocking drugs, extracorporeal membrane oxygenation and haemodialysis increased the value of NAS for patients with or without COVID-19. The workload of nursing professionals was higher for COVID-19 patients than for patients who did not present the disease in the first 10 days of ICU hospitalization. This study presents the impact of COVID-19 on the ICU nursing workload in Brazil. The high workload found can support management decisions regarding quantity and quality of workforce composition.

Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score.

During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.

The Nursing Activities Score and its association with healthcare-associated infections in a Brazilian adult intensive care unit

The intensive care unit (ICU) requires a specialized team with adequate human resources, including nursing. For an adequate measurement of the workload of nursing professionals of Brazilian ICUs, the Nursing Activities Score (NAS) has been used to promote better adequacy of work scales. Work overload can increase the incidence of adverse events, including healthcare-associated infections (HAI). Objective: To associate the nursing workload measured by the NAS with the rates of HAI in an Adult ICU of a university hospital, in addition to evaluating the impact of the separation of ICUs by unit, or type of specialization. Method: Data collection was performed at Brazil, in the Adult ICU: stratified by the Surgical, Neurological and Medical specialties; including the calculation of the means of NAS and the monthly rates of HAI of each ICU unit, from 2016 to April 2019. NAS data were collected from secondary spreadsheets, without identification of the patient, and the rates of HAIs were collected from information from the Hospital Infection Control Service. Results: The mean NAS was different for each unit, with Neurological unit with the highest mean. In relation to HAIs, neurological unit patients had a higher incidence of HAIs and patients with HAIs. Pneumonia associated with mechanical ventilation (VAP) was higher in Surgical and Neurological units. Bloodstream and urinary tract infection were higher in the Medical unit. There was a positive correlation for NAS and VAP in the Medical unit and with urinary tract infection in the Surgical unit. In the Neurological unit there was a negative correlation with the rate of HAI and rate of patients with HAI. Conclusion: The mean NAS observed by us was lower when compared to other ICUs and variations may be associated with the type of hospital and clinical profile of patients. It was possible to observe that each unit has its particularity regarding the incidence of HAIs and the association between NAS (nursing workload) and rates, reinforcing the need for stratification and association of indicators per unit.

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

Compare the nursing workload according to the condition of frailty in elderly people in an intensive care unit (ICU). A cross-sectional study whose sample included patients aged ≥60 years who were hospitalized for ≥24 hours in the ICU of a university hospital in São Paulo, Brazil. The Tilburg Frailty Indicator (TFI) was used to identify frailty in elderly people and the Nursing Activities Score (NAS) was used to measure the nursing workload. In a sample of 204 elderly people, frailty was found in 156 (76.5%). The elderly people contributed to high nursing workload (mean NAS 75.9) on the first day in the ICU, but frailty did not significantly change the NAS (p = 0.606) (frail 75.7 versus non-frail 76.5), either based on the mean value or the proportion of patients in each category. The condition of frailty in elderly people did not increase the nursing workload in the ICU.

Adverse events in critically ill patients: a cross-sectional study.

To identify the prevalence of adverse events and the critically ill patient's need for care in an intensive care unit. This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.

Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil.

To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. Accurate data of nursing cost can contribute to reliable resource management. We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). The total mean cost by the top-down approach was US$1,640.4±1,484.2/patient. The bottom-up approach based on a total mean NAS of 833±776 points (equivalent to 200±86hr of nursing care) yielded a mean cost of US$1,487.2±1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.

Avaliação da demanda de intervenções de enfermagem em terapia intensiva segundo o Nursing Activities Score (NAS)

Objective: To identify the frequency of the most prevalent nursing interventions in the ICU and to identify the possibility of planning the care more realistically and objectively with the Nursing Activities Score (NAS) assessment of the time spent and adequate design. To verify the influence of variables on the NAS and analyze the mortality by the correlation of the NAS with the Simplified Acute Physiology Score 3 (SAPS 3). Correlate the NAS with the Therapeutic intervention scoring system-28 (TISS-28). Method: Prospective study using manual data collection and chart analysis, with an n of 179 patients. Data were compiled and analyzed from the point of view of descriptive statistics. Results: The mean NAS was 71.43. There was no influence of the variables age, length of stay and origin, the post-discharge destination variable presented a positive correlation considering the death outcome. Positive correlation of TISS-28 with the exception of the domain of basic activities. SAPS 3 showed a positive correlation where NAS rises in patients who died. Inadequacy in the dimensioning of the studied units. Conclusion: The NAS is an instrument that covers what is required to assess the demand for care, translating into a valid management tool.

VALIDACIÓN DEL NURSING ACTIVITIES SCORE EN UNIDADES DE CUIDADOS INTENSIVOS CHILENAS

Objective: Analyse the degree to which psychometric properties are preserved in the Nursing Activities Score through assessments of instrument reliability and validity. Method: Assessments of instrument adaptation and validation that measures the workload of nursing in Intensive Care Units and that covers more than 80% of nursing activities, estimating the daily allocation of patients to the nursing staff according to the patients’ care needs. The instrument’s reliability was assessed in six intensive care units located in two hospitals in Santiago, Chile. Results: The mean nursing activities score was 70.86%. For exploratory factor analysis, items without variability were excluded (2, 3, 15, 16 and 18). The least squares factor extraction method was used, executed inthe Factor software, and it resulted in one factor explaining 12.8% of total instrument variance. The proposed factor structure grouped items in one factor; however, items 1, 5, 6, 7, 8, 13, 14, 19, 20, 22 and 23 did not present adequate communality. The calculated value for the Kuder-Richardson formula was 0.886. The Nursing Activities Score instrument was highly and positively correlated with the Therapeutic Intervention Scoring System (r= 0.601), used as an external validation criterion. Conclusion: Due to theoretical and practical relevancy, as well as conceptual connections of the items selected during the content validation process, we recommend that these items are not eliminated from the Nursing Activities Score instrument. Additional validation studies should beconducted in other populations.

CARGA DE TRABALHO DE ENFERMAGEM E A MORTALIDADE DOS PACIENTES EM UNIDADE DE TERAPIA INTENSIVA

RESUMO Objetivo: verificar se a carga de trabalho de enfermagem é em preditor de mortalidade em Unidade de Terapia Intensiva. Método: estudo documental, retrospectivo, corte transversal, desenvolvido na Unidade de Terapia Intensiva de um hospital universitário terciário. Utilizou-se a curva Receiver Operator Characteristic Curve composta pelo Nursing Activities Score e índice de gravidade APACHE e regressão logística para análise da predição de mortalidade. Resultados: compuseram a amostra 324 pacientes, sendo 214 (66%) sobreviventes. A média Nursing Activities Score das primeiras 24 horas de internação foi de 79,3 pontos, variando de 34,8 a 134,2 pontos e o APACHE II mediano foi 24,5 (2-42). Na análise da curva Receiver Operator Characteristic Curve o Nursing Activities Score evidenciou uma área sobre a curva de 0,626; IC 0,570 a 0,678 e o APACHE II de 0,721 com intervalo de confiança IC 95% de 0,669 a 0,769. Conclusão: a carga de trabalho de enfermagem não foi um preditor de mortalidade em Unidade de Terapia Intensiva, pois os pacientes que demandam a maior carga de trabalho de enfermagem não necessariamente são aqueles que evoluem para óbito.

Carga de trabalho de enfermagem em unidade de internação de onco-hematologia

Objetivo: Identificar los factores relacionados con la carga de trabajo de enfermería generada por pacientes onco-hematológicos hospitalizados. &lt;br /&gt;Método: Cohorte prospectivo realizado con 151 pacientes ingresados en unidad de Onco-Hematología de un hospital universitario, en el Estado de São Paulo, Brasil. Se utilizó para la colecta de datos una ficha con informaciones demográfico-clínicas y el Nursing Activities Score (NAS). En el análisis de los datos se utilizo estadística descriptiva, inferencial y modelos de regresión linear.&lt;br /&gt;Resultados: La media del NAS en la unidad fue del 47,8% (11,5 horas). Pacientes con enfermedades oncológicas y hematológicas malignas demandaron mayor carga de trabajo de enfermería, comparados a aquellos con enfermedades no malignas (p=0,0034); los pacientes que murieron presentaron mayor puntuación de NAS, comparada con la de los supervivientes (p&amp;lt;0,0001); en la regresión linear, las variables, diagnóstico y condición de salida, determinaron un R2 de 0,26. Conclusión: Pacientes onco-hematológicos demandan asistencia semi-intensiva, información que ofrece subsidios al enfermero para planear recursos humanos en esta especialidad.&lt;br /&gt;&lt;br /&gt;

Evaluation of Nursing Workload and Efficiency of Staff Allocation in a Trauma Intensive Care Unit

Background: Heavy workload is one of the main problems of nurses working in intensive care units (ICUs). It not only decreases the quality and safety of patient care, but also increases human errors in health care, rate of hospitalization, and risk of mortality in patients. Workload evaluation and surveillance of patients enable authorities to allocate adequate staff to ICUs, leading to improved quality of patient care and treatment. Objectives: The present study aimed to evaluate nurses’ workload and efficiency of nursing staff allocation in a trauma ICU of Shahid Rajaee hospital, affiliated to Shiraz University of Medical Sciences. Methods: In this cross sectional study, we evaluated nurses’ workload in a trauma ICU. The evaluation was based on the nursing activities score (NAS) system and was performed in the morning, evening, and night shifts for 1 month. In this period, all nursing care activities provided for 36 patients in this unit were monitored and recorded. Additionally, the number of nurses required per shift was estimated, based on the required and available time for care. Efficiency of nursing staff allocation was evaluated accordingly. Results: The mean age of the patients was 40.17 ± 22.30 years, and the length of ICU stay was 9.79 days on average. Based on the findings, the mean NAS score was 65.3 ± 23.19%. Moreover, the number of nurses in the morning and evening shifts was less than the required number, except for days 3 and 7. On the other hand, the number of nurses in the night shifts was proportional to the required number. Conclusions: The results indicated a heavy nursing workload in the ICU. Our findings also suggest that the quality of patient care can be improved by balanced distribution of workforce relative to workload in different shifts.

Nursing workload for cancer patients under palliative care.

To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload. This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care. Analysis of 197 measures of the Nursing Activities Score (NAS) revealed a mean score of 43.09% and an association between the performance status of patients undergoing palliative care and the mean NAS scores. The results of the study point to the need to resize the team of the unit. The NAS has proven to be a useful tool in oncologic clinical units for patients undergoing palliative care. Verificar a carga de trabalho de enfermagem requerida por pacientes com câncer sob cuidados paliativos e possíveis associações entre as características demográficas e clínicas dos pacientes e a carga de trabalho de enfermagem. Trata-se de um estudo de abordagem quantitativa, transversal, prospectivo, desenvolvido na clínica de Tecido Ósseo Conectivo (TOC) da Unidade II do Instituto Nacional de Câncer José Alencar Gomes da Silva, com pacientes em cuidados paliativos. A análise de 197 medidas do Nursing Activities Score (NAS) revelou um escore médio de 43,09% e uma associação entre a performance status de pacientes em cuidados paliativos com os valores médios do NAS. Os resultados do estudo apontam para a necessidade de redimensionamento da equipe da Unidade. O NAS mostrou-se um instrumento passível de utilização em unidades clínicas oncológicas, com pacientes em cuidados paliativos.

Impact of promoting self-care in nursing workload

To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation. Verificar o impacto da promoção do autocuidado na carga de trabalho de enfermagem e associá-la às variáveis: idade, gênero, classificação socioeconômica, escolaridade, estado civil e número de filhos dos cuidadores. Estudo prospectivo, onde participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos, 1ª e 2ª internação, quanto à carga de trabalho de enfermagem mensurada por meio do Nursing Activities Score (NAS). A média NAS na 1ª internação foi de 60,9%, e na 2ª internação foi de 41,6%, ou seja, 14,6 e 9,9 horas de enfermagem, respectivamente. A carga de trabalho de enfermagem no primeiro dia de internação foi maior quando comparada ao último dia, tanto na 1ª (p<0,001) como na 2ª internação (p<0,001), e maior no primeiro (p<0,001) e último dia (p=0,025) na 1ª internação. Ainda, na 1ª internação, foi maior quando comparada à 2ª internação (p<0,001), e os itens NAS referentes à capacitação do autocuidado a influenciaram (p<0,001). A carga de trabalho de enfermagem referente à promoção do autocuidado correspondeu a 14,6 horas e foi superior ao determinado pela legislação existente.

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

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.

Using Nursing Activities Score to Assess Nursing Workload on a Medium Care Unit.

The medium care unit (MCU) or "stepdown" unit is an increasingly important, but understudied care environment. With an aging population and more patients with complex multiple diseases, many patients often require a higher level of inpatient care even when full intensive care is not indicated. However, the nurse-to-patient ratio required on a MCU is neither well defined nor clear whether this ratio should be adjusted per shift. The Nursing Activities Score (NAS) is an effective instrument for measuring nursing workload in the intensive care unit (ICU) but has not been used in an MCU. The aim of this study was to measure the nursing workload per 8-hour shift on an MCU using the NAS and compare it with the NAS from an ICU in the same hospital. We also compared the NAS between groups of patients with different admission sources. The NAS was prospectively measured per patient per shift for 2 months in a 9-bed tertiary referral university hospital MCU and during a similar period in an ICU in the same hospital. The mean NAS per patient did not differ between day (7:30 AM to 4:00 PM) and evening (3:00 PM to 11:30 PM) shifts, but the NAS was significantly lower during the night shift (11:00 PM to 8:00 AM) than during the day (P < 0.0001) and evening (P < 0.0001) shifts. The mean NASs in the ICU for day and night shifts were significantly lower than the scores in the MCU (P = 0.0056 and P < 0.0001, respectively), but NAS during the evening shift did not differ between the ICU and the MCU. The mean NAS for patients admitted to the MCU from the accident and emergency department was significantly higher than for those admitted from the ICU (P = 0.002), recovery (P = 0.002), and general ward (P < 0.0001). Patients on the MCU had a NAS comparable with that of ICU patients. In our university hospital, NAS was higher during the day and evening hours and lower at night. We also found that patients from accident and emergency had a higher NAS than those admitted to the MCU from other locations. NAS in the MCU was not lower than the NAS in the ICU. Because of its ability to discriminate between day and evening workloads and between patients from different sources, the NAS may assist MCU managers in assessing staffing needs.

Nursing activities score: differences in nursing workload in three intensive care units

The activities that impact on the nursing workload in an intensive care unit have not been described. To retrospectively analyze the nursing workload in the three intensive care units-ICU (general, neurosurgery and cardiac surgery) of the same department with the Nursing Activities Score (NAS) to describe the nursing interventions that mostly impact on the workload. Retrospective observational study. Patients admitted from January 2006 to December 2012 were included in the study. The NAS was completed every 24 hours around 6 am. Patients included in the study were 7588; their mean NAS score was 61.7 ± 19.02%; 75.9 ± 1.44 in General ICU, 61.6 ± 2.46 Neuro ICU, 62.5 ± 3.06 in the Cardiosurgical ICU. The items that mostly impacted on the nursing workload were the need of monitoring and titration, the hygiene procedures, and the Mobilization and positioning. The three procedures were performed with different frequencies in the three ICUs. The results confirm that the minimum required care in ICUs is around 950 minutes/day. The differences observed in the three ICUs were determined by the different clinical severity and caring complexity of the patients.

Nursing workload in intensive care unit trauma patients: analysis of associated factors.

BackgroundFrom the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU.MethodsThis is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fisher's exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses.FindingsThe majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (±18.6) and the mean NAS was 71.3% (±16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU.ConclusionWorkload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

Nursing Activities Score and workload in the intensive care unit of a university hospital.

ObjectiveThe nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument.MethodsA longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%.ResultsIn total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients’ condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600).ConclusionWe observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.

Nursing Activities Score (NAS): 5 Years of experience in the intensive care units of an Italian University hospital

To retrospectively analyse the application of the Nursing Activities Score (NAS) in an intensive care department from January 2006 to December 2011. The sample consists of 5856 patients in three intensive care units (GICU: General Intensive Care Unit, NeuroICU: Neurosurgical Intensive Care Unit, CICU: Cardiothoracic Intensive Care Unit) of an Italian University hospital. The NAS was calculated for each patient every 24 hours. In patients admitted to general ICU, the following scores: SAPS 2 and SAPS 3 (Simplified Acute Physiology Score), RASS (Richmond Agitation Sedation Scale) and Braden were also recorded along with the NAS. The mean NAS for all patients was 65.97% (Standard Deviation ± 2.53), GICU 72.55% (± 16.28), NeuroICU 59.33% (± 16.54), CICU 63.51% (SD ± 14.69). The average length of hospital stay (LOS) was 4.82 (SD ± 8.68). The NAS was high in patients with increasing LOS (p<0.003) whilst there were no significant differences for age groups except for children 0-10 years (p<0.002). The correlation of NAS and SAPS 2 was r=0.24 (p=0.001), NAS and SAPS 3 r=-0.26 (p=0.77), NAS and RASS r=-0.23 (p=0.001), NAS and Braden r=0.22 (p=0.001). This study described the daily use of the NAS for the determination of nursing workload and defines the staff required.