Dinis Reis Miranda

Nursing activities score

ObjectivesThe instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness. Many nursing activities are not necessarily related to severity of illness, and cost-effectiveness studies require the accurate evaluation of nursing activities. The aim of the study was to determine the nursing activities that best describe workload in the intensive care unit and to attribute weights to these activities so that the score describes average time consumption instead of severity of illness. DesignTo define by consensus a list of nursing activities, to determine the average time consumption of these activities by use of a 1-wk observational cross-sectional study, and to compare these results with those of the Therapeutic Intervention Scoring System-28. SettingA total of 99 intensive care units in 15 countries. PatientsConsecutive admissions to the intensive care units. InterventionDaily recording of nursing activities at a patient level and random multimoment recording of these activities. ResultsA total of five new items and 14 subitems describing nursing activities in the intensive care unit (e.g., monitoring, care of relatives, administrative tasks) were added to the list of therapeutic interventions in Therapeutic Intervention Scoring System-28. Data from 2,041 patients (6,451 nursing days and 127,951 multimoment recordings) were analyzed. The new activities accounted for 60% of the average nursing time; the new scoring system (Nursing Activities Score) explained 81% of the nursing time (vs. 43% in Therapeutic Intervention Scoring System-28). The weights in the Therapeutic Intervention Scoring System-28 are not derived from the use of nursing time. ConclusionsOur study suggests that the Nursing Activities Score measures the consumption of nursing time in the intensive care unit. These results should be validated in independent databases.

Pandemic influenza and excess intensive-care workload

Even during the peak of a pandemic, all patients requiring hospital and ICU admission can be served, including those who have non–influenza-related conditions.

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

Objetivo Describir la carga de trabajo de enfermeria en Unidades de Cuidados Intensivos (UCI) de diferentes paises segun el Nursing Activities Score (NAS) y establecer una guia estandarizada para su utilizacion en UCI. Metodo estudio observacional en 19 UCIs de siete paises (Noruega, Paises Bajos, Espana, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuacion media total en la escala NAS fue de 72.81% com valores entre 44.46% (Espana) y 101.8% (Noruega). Las medias NAS en Polonia, Grecia y Egipto fue de 83.0%, 64.59% y 57.11% respectivamente. El NAS medio fue similar en Brasil (53.98%) y los Paises Bajos (50.96%). De los 23 items de la escala hubo problemas en la interpretacion de 5 de ellos (21.74%). Este problema se resolvio mediante el consenso entre los investigadores. Conclusion El presente estudio demuestra variacion en la carga de trabajo en UCI de diferentes paises. La guia estandarizada de puntuacion del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.

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

BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.

Integration of Substudies

The integration of the substudies followed two strategies: (1) formal statistical hypothesis testing; (2) explorative integration of the substudies.

Nursing activities score: manual atualizado para aplicação em Unidade de Terapia Intensiva

Objetivo Describir la carga de trabajo de enfermeria en Unidades de Cuidados Intensivos (UCI) de diferentes paises segun el Nursing Activities Score (NAS) y establecer una guia estandarizada para su utilizacion en UCI. Metodo estudio observacional en 19 UCIs de siete paises (Noruega, Paises Bajos, Espana, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuacion media total en la escala NAS fue de 72.81% com valores entre 44.46% (Espana) y 101.8% (Noruega). Las medias NAS en Polonia, Grecia y Egipto fue de 83.0%, 64.59% y 57.11% respectivamente. El NAS medio fue similar en Brasil (53.98%) y los Paises Bajos (50.96%). De los 23 items de la escala hubo problemas en la interpretacion de 5 de ellos (21.74%). Este problema se resolvio mediante el consenso entre los investigadores. Conclusion El presente estudio demuestra variacion en la carga de trabajo en UCI de diferentes paises. La guia estandarizada de puntuacion del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.

Nursing activities score: manual actualizado para su aplicación en la Unidade de Cuidados Críticos

Objetivo Describir la carga de trabajo de enfermeria en Unidades de Cuidados Intensivos (UCI) de diferentes paises segun el Nursing Activities Score (NAS) y establecer una guia estandarizada para su utilizacion en UCI. Metodo estudio observacional en 19 UCIs de siete paises (Noruega, Paises Bajos, Espana, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuacion media total en la escala NAS fue de 72.81% com valores entre 44.46% (Espana) y 101.8% (Noruega). Las medias NAS en Polonia, Grecia y Egipto fue de 83.0%, 64.59% y 57.11% respectivamente. El NAS medio fue similar en Brasil (53.98%) y los Paises Bajos (50.96%). De los 23 items de la escala hubo problemas en la interpretacion de 5 de ellos (21.74%). Este problema se resolvio mediante el consenso entre los investigadores. Conclusion El presente estudio demuestra variacion en la carga de trabajo en UCI de diferentes paises. La guia estandarizada de puntuacion del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.

EURICUS-I: Introduction

Intensive care is a development of modern medical practice, with the goal of providing for and treating life threatening illness. Caring for such patients is a most demanding job with unremitting hard work, the skilled use of high technology equipment and, literally, life and death dramas occurring every day.