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

Abstract

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.

Análise de eventos adversos em pacientes internados em unidade de terapia intensiva

“…(4,13) A lower mean in the NAS was found, compared to other Brazilian studies, which found results ranging from 73.4 to 87.5%. (15) However, other studies showed similar NAS means, ranging from 52.7% to 66.1%. These results probably reflect a profile of the patients similar to the ICU in this study.…”

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

“…In the literature, there is great variation of NAS score relative to patients admitted to ICU of public hospitals (19)(20) . Considering critical patients that developed infection during stay in ICU, some authors obtained a mean NAS of 81.2+16.2% (6) .…”

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

“…Although the NAS is widely used in intensive care units (ICU) of different specialties (7)(8)(9) , its application in specific settings, such as postoperative care of cardiac surgery, is still limited (10)(11) . The NAS findings have indicated that sociodemographic (6)(7) and clinical variables, (7) length of stay in the ICU (11) , mortality (8) and severity of the patient's conditions (8,10,12) are factors associated with the high workload of the nursing staff. Studies conducted with patients in the postoperative period of cardiac surgery showed that, in the first 24 hours, the nursing workload ranged from 61.6% to 96.8% (10)(11)(12)(13) .…”

“…The NAS findings have indicated that sociodemographic (6)(7) and clinical variables, (7) length of stay in the ICU (11) , mortality (8) and severity of the patient's conditions (8,10,12) are factors associated with the high workload of the nursing staff. Studies conducted with patients in the postoperative period of cardiac surgery showed that, in the first 24 hours, the nursing workload ranged from 61.6% to 96.8% (10)(11)(12)(13) . In addition, the authors observed that, in this population, the NAS was associated with adverse outcomes such as increased length of stay in the ICU, complications and mortality (13)(14)(15) .…”