Katia Grillo Padilha

Nursing Workload as a Risk Factor for Healthcare Associated Infections in ICU: A Prospective Study

Introduction Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS). Methods This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses’ patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. Results 195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient’s clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI. Conclusions Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Nursing Activities Score (NAS): cross-cultural adaptation and validation to Portuguese language

El estudio tuvo como objetivos adaptar al portugues y evaluar las propiedades psicometricas de el Nursing Activities Score (NAS), un instrumento para medir la carga de trabajo de enfermeria en UCI. Tras el proceso de adaptacion cultural, el NAS se aplico a una muestra de 200 pacientes adultos ingresados en las UCIs. El analisis de consistencia interna por el coeficiente alfa de Cronbach revelo que el NAS cuenta con 23 medidas independientes que no permiten consolidacion o reduccion. La evaluacion de la fiabilidad interobservador mostro alta concordancia (99,8%) y el indice Kappa media de 0,99. La validez concurrente se demostro por la correlacion estadisticamente significativa entre el TISS-28 y NAS (r=0,67, p<0,0001), y por analisis de regresion multivariante (R2=94,4%, p<0,0001). Al evaluar la validez convergente, la regresion multivariante mostro asociacion estadisticamente significativa entre el NAS y el SAPS II, cuando ajustada por la edad (R2=99,8%, p<0,0001). Los resultados obtenidos indican que el NAS es un instrumento valido y fiable para medir la carga de trabajo de enfermeria de UCIs brasilenas.The study aimed to adapt to the Portuguese language and to evaluate the psychometric properties of the Nursing Activities Score (NAS), an instrument for measuring the nursing workload in ICUs. After the process of cross-cultural adaptation, the NAS was applied to a sample of 200 adult ICU patients. The analysis of internal consistency by Cronbachs alpha coefficient revealed that the NAS has 23 independent measures that do not allow for either consolidation or reduction. Assessment of inter-rater reliability showed high concordance level (99.8%) and a Kappa index average of 0.99. The concurrent validity was demonstrated by statistically significant correlation between the TISS-28 and NAS (r=0.67, p<0.0001), and by multivariate regression analysis (R²=94.4%, p<0.0001). The convergent validity was supported by the statistically significant association between the NAS and the SAPS II, when adjusted for age (R²=99.8%, p<0.0001). These results indicate that the NAS is a valid and reliable instrument to measure nursing workload of Brazilian ICUs.

Carga de trabalho de enfermagem em unidades de terapia intensiva publicas e privadas

Objective This study sought to compare patients at public and private intensive care units according to the nursing workload and interventions provided. Methods This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in São Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patients stay at the intensive care unit. Pearsons chi-square test, Fishers exact test, the Mann-Whitney test, and Students t test were used to compare the patient groups. Results The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the care of drains, mobilization and positioning, and intravenous hyperalimentation. The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit. Conclusion Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning.OBJECTIVE: This study sought to compare patients at public and private intensive care units according to the nursing workload and interventions provided. METHODS: This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in Sao Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patients stay at the intensive care unit. Pearsons chi-square test, Fishers exact test, the Mann-Whitney test, and Students t test were used to compare the patient groups. RESULTS: The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the care of drains, mobilization and positioning, and intravenous hyperalimentation. The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit. CONCLUSION: Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning.

Nursing Activities Score e demanda de trabalho de enfermagem em terapia intensiva

ABSTRACT Objective: To measure and characterize the workload of nurses in the Intensive Care Unit (ICU) by applying the Nursing Activities Score (NAS). Methods: A descriptive, quantitative, retrospective study, conducted in one ICU of a Philanthropic Hospital in Teresina x96 PI (Brazil), from September to October 2010, with a sample of 66 patients. There were 285 measurements of the NAS performed. Results: With regards to nursing workload, there was a mean total score of 68.1% for the NAS (51.5% and 108.3%), corresponding to the percentage of time spent by nursing professionals in direct assistance to the patient within 24 hours. A statistical correlation was found between NAS and clinical outcome S x13x11x13x13x14 x11

Nursing allocation and adverse events/incidents in intensive care units

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Carga de trabalho de enfermagem em unidade de terapia intensiva de cardiologia e fatores clínicos associados

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The use of the Nursing Activities Score in clinical settings: an integrative review

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Nursing workload among adults, elderly and very elderly patients in the Intensive Care Unit

6x11Keywords: Workload; Work hours; Intensive Care Units RESUMO Objetivo: Medir e caracterizar a carga de trabalho de enfermagem em Unidade de Terapia Intensiva (UTI) por meio da aplicacao do Nursing Activities Score (NAS). Metodos: Estudo descritivo quantitativo, retrospectivo, realizado em uma das UTIs de um Hospital Filantropico de Teresina-PI, de setembro a outubro de 2010, com amostra de 66 pacientes. Foram realizadas 285 medidas do escore NAS. Resultados: Quanto a carga GHWUDEDOKRGHHQIHUPDJHPx0fIRLYHULAFDGDXPDPpGLDGRHVFRUHWRWDOGR1

Nursing workload in hematopoietic stem cell transplantation: a cohort study.

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Pattern of nursing interventions performed on trauma victims according to the Nursing Activities Score.

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