Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study

Jam, R.; Mesquida, J.; Hernández, O.; Sandalinas, I.; Turégano, C.; Carrillo, E.; Pedragosa, R.; Valls, Josefa; Parera, Ana; Ateca, Begoña; Salamero, M.; Jane, Roser; Oliva, Joan Carles; Delgado‐Hito, Pilar

doi:10.1111/nicc.12380

Cited by 17 publications

(20 citation statements)

References 48 publications

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“…The compliance with preventive VAP actions in patients with low nursing workload measured by the Nursing Activites Score was lower compared to patients with higher levels of nursing workload. [34] The results of this research are in line with results verified in other studies. [30,[34][35][36] In one of these studies, carried out with 195 patients, 43 (22%) developed HAI and, as in the present study, an excessive nursing workload was identified as a risk factor for HAI (OR: 11.41; p .019).…”

Section: Discussionsupporting

confidence: 92%

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Gomes¹,

Röder²,

Cunha³

et al. 2019

JNEP

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Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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Section: Discussionsupporting

confidence: 92%

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Gomes¹,

Röder²,

Cunha³

et al. 2019

JNEP

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“…Nurses have multiple roles and central responsibility to keep patients safe in the complex healthcare environment [57,58]. The effect of personal and professional values and attitudes on the consistency of adherence to patient safety by nurses has been shown to be more important than the effect of their workloads [22]. It is believed that individual factors such as nurses' attitudes, perceptions, knowledge, and information seeking can facilitate or hinder the use of clinical practice guidelines by nurses and consequently endanger patient safety [11,26] through inconsistent adherence to patient-safety principles [59].…”

Section: Discussionmentioning

confidence: 99%

“…Institutional systemic factors influencing nurses' adherence to and compliance with patient-safety principles are as follows: the organizational patient-safety climate [21], workload, time pressure, encouragement by leaders and colleagues [22][23][24], level of ward performance [25], provision of education for the improvement of knowledge and skills [11,18], institutional procedures or protocols, and also communication between healthcare staff and patients [11]. In addition, personal motivation, resistance to change, feelings of autonomy, attitude toward innovation, and empowerment are personal factors that impact on the nurses' adherence to patient-safety principles [26].…”

Section: Introductionmentioning

confidence: 99%

Nurses’ Adherence to Patient Safety Principles: A Systematic Review

Vaismoradi

Tella

Logan

et al. 2020

IJERPH

168

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Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses' adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses' adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010-2019. Using the theoretical domains of the Vincent's framework for analysing risk and safety in clinical practice, we synthesized our findings according to 'patient', 'healthcare provider', 'task', 'work environment', and 'organisation and management'. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients' participation, healthcare providers' knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses' adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse' adherence to patient-safety principles and their effects on patient-safety outcomes.

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“…Ventilator acquired pneumonia (VAP) is another iatrogenic disease that compromises the patient's recovery and well‐being. Jam et al () report on a cross‐sectional observational study conducted in two adult general ICUs in Spain, to examine compliance with non‐pharmacological procedure to reduce VAP. A one‐hour lecture on non‐pharmacological technique was delivered prior to the observational study and this lecture supplemented a national quality initiative to reduce VAP across Spain the year before.…”

mentioning

confidence: 99%

“…The authors conclude that knowledge of preventive measures did not guarantee compliance nor did the nurse to patient ratio. Jam et al () suggest compliance requires interventions associated with work climate and professionals' attitude and that requires a deeper understanding of the contextual factors affecting clinical practice. Indeed, such insight might illuminate beyond the statistics derived from observational schedules whether there is a gap between ‘adequate’ performance and exacting criteria to determine ‘compliance’.…”

mentioning

confidence: 99%