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

Objetivo Describir la carga de trabajo de enfermería en Unidades de Cuidados Intensivos (UCI) de diferentes países según el Nursing Activities Score (NAS) y establecer una guía estandarizada para su utilización en UCI. Método estudio observacional en 19 UCIs de siete países (Noruega, Países Bajos, España, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuación media total en la escala NAS fue de 72.81% com valores entre 44.46% (España) 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 Países Bajos (50.96%). De los 23 ítems de la escala hubo problemas en la interpretación de 5 de ellos (21.74%). Este problema se resolvió mediante el consenso entre los investigadores. Conclusión El presente estudio demuestra variación en la carga de trabajo en UCI de diferentes países. La guía estandarizada de puntuación del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.Objetivo Descrever a carga de trabalho de enfermagem em Unidades de Terapia Intensiva (UTI) de diferentes países, segundo o Nursing Activities Score (NAS), e padronizar o manual do NAS para uso nessas Unidades. Método Estudo transversal realizado em 19 UTI de sete países (Noruega, Holanda, Espanha, Polônia, Egito, Grécia e Brasil) com um total de 758 pacientes adultos, em novembro de 2012. Resultados A média do NAS total da amostra foi 72.81%, com variação entre 44.46% (Espanha) e101.81% (Noruega). Nas UTI da Polônia, Grécia e Egito, as médias foram de 83.00%, 64.59% e 57.11%, respectivamente. As médias NAS no Brasil (53.98%) e na Holanda (50,96%) foram similares. Dos 23 itens da escala, houve dúvidas no entendimento de 5(21.74%), que foram solucionados por consenso entre os pesquisadores. Conclusão O estudo mostrou diferentes cargas de trabalho de enfermagem nas UTI estudadas. Um manual padronizado do NAS para uso nessas unidades contribuirá para sanar dúvidas em futuras aplicações.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

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

ABSTRACT Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian’s model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian’s health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach

Impact of promoting self-care in nursing workload

Abstract OBJECTIVES 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. METHODS 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). RESULTS 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). CONCLUSION The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation

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

ABSTRACT 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

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

RESUMO Objetivo Analisar a influência da carga de trabalho de enfermagem na ocorrência de infecção relacionada à assistência à saúde (IRAS) em pacientes na Unidade de Terapia Intensiva (UTI), segundo o tipo de tratamento. Método Estudo de coorte retrospectivo desenvolvido em nove UTI em São Paulo, Brasil, de setembro a dezembro de 2012. A carga de trabalho de enfermagem foi mensurada pelo Nursing Activities Score (NAS). Os testes T-Student, Exato de Fisher e regressões logísticas foram utilizados nas análises. Resultados A casuística foi composta por 835 pacientes (54,3±17,3 anos; 57,5% do sexo masculino), dentre os quais 12,5% adquiriram IRAS na UTI. O NAS dos pacientes admitidos para tratamento clínico foi de 71,3±10,9 e para cirúrgico, 71,6±9,2. O tempo de permanência na unidade e a gravidade foram fatores preditivos para ocorrência de IRAS em pacientes admitidos nas UTI para tratamento clínico ou cirúrgico e o sexo masculino apenas para pacientes cirúrgicos. Ao considerar as admissões independentes do tipo de tratamento, além das variáveis citadas, o índice de comorbidades também permaneceu no modelo de regressão. O NAS não foi fator preditivo de IRAS. Conclusão A carga de trabalho de enfermagem não exerceu influência na ocorrência de IRAS nos pacientes deste estudo

Carga de trabalho de enfermagem em transplante de células-tronco hematopoiéticas: estudo de coorte

RESUMO Objetivo Mensurar a carga de trabalho de enfermagem requerida por pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH), autólogo e alogênico e analisar as atividades do Nursing Activities Score (NAS) executadas pela equipe de enfermagem durante a internação para o TCTH. Método Coorte prospectiva realizada de janeiro/2013 a abril/2014 com 62 pacientes internados na unidade de TCTH de um hospital universitário de Campinas/SP, Brasil. Mediu-se a carga de trabalho por meio do NAS e analisaram-se os dados utilizando os testes Qui-quadrado ou Exato de Fisher, Mann-Whitney e o coeficiente de correlação de Spearman; considerou-se nível de significância de 5%. Resultados A média da carga de trabalho de enfermagem foi de 67,3% (DP 8,2) em pacientes de TCTH autólogo e de 72,4% (DP 13,0) no TCTH alogênico (p=0,1380). O item Monitorização e controles apontou, em mais de 50% das observações, que os pacientes demandaram intensificação deste cuidado, exigindo duas horas ou mais em algum turno de trabalho por motivos de segurança, gravidade ou terapia. Conclusão A carga de trabalho de enfermagem e os itens do NAS mais pontuados refletem a magnitude, complexidade e especificidade dos cuidados demandados pelos pacientes submetidos ao TCTH

Nursing workload as a prognostic factor of the hospitalization length and patients' mortality

Introduction: The nursing staff shortage, the high cost of care for cardiac surgery patients and the necessity for high quality nursing care necessitate the monitoring of nursing workload (NWL) and its correlation with outcomes, such as in hospital mortality, ιntensive care unit length of stay (ICU-LOS) and in hospital length of stay (Hospital LOS). The aim of this study was to test the hypothesis that the NWL can be correlated and predict the patients’ ICU-LOS, Hospital LOS and in hospital mortality. Material and Methods: An observational cohort study was carried out. The sample of our study consisted of 313 consecutive patients who were admitted to the cardiac surgery ICU of one general hospital of Attica region from November 2007 to December 2008. Data collection was performed by two instruments: a) The Nursing Activities Score (NAS) for measuring NWL and b) the logistic EuroSCORE for predicting the perioperative mortality. Additionally, a specifically designed form was used for the collection of demographic and clinical patient’s data. The correlation of ICU-LOS, Hospital-LOS and mortality with NWL and other variables were studied. Statistical analysis was performed with SPSS version 14.0 using X2 test and multivariate logistic regression. P - value was ? 0.05. Results: Our study sample consisted of 313 patients. The mean patients’ age was 66.2 (±11.5 SD) years old and the mean BMI 27.2 kg/m2 (±4.2). The 214 were males (68.4%). The mean ICU-LOS was 6.1 days (±20.6), with median 2 days and the mean Hospital LOS was 12.8 days, with median 9 days. According to the clinical patients’ features, the mean first day NAS was 63.1% (±4.9), with median 61.6%, while the mean NAS of the first days hospitalization in the cardiac surgery ICU was 57.7% (±6.1), with median 55.6%. The mean logistic EuroSCORE was 10.8% (±14.4), with median 5.6%, while the mean duration of the surgery procedure and the cardio-pulmonary bypass were 275.1 min (±77.6), with median 260 min and 133.8 min (±55.5), with median 120 min respectively. The in hospital mortality was 11.8%. The patients’ exposure to high NWL levels during the first day of their hospitalization in the ICU was associated with statistically significant increase of their ICU-LOS (p<0.001), Hospital LOS (p=0.004) and mortality (p=0.009). In parallel, the patients’ exposure to high NWL levels during the first two days of their hospitalization was associated with statistically significant increase of their ICU-LOS (p<0.001), Hospital LOS (p<0.001) and mortality (p=0.01). In addition, when the measure of NWL was the NAS of the first day of hospitalization, the variables that had been positively associated with mortality were high EuroSCORE (p=0.008) and the increase of ICU-LOS (p<0.001). The same variables had positive association with mortality, when the measure of NWL was the NAS of the first two days of hospitalization (EuroSCORE, p=0.004 & ICU-LOS, p=0.004). ........................................................................................................................................Εισαγωγή: Η υποστελέχωση των νοσηλευτικών υπηρεσιών, το υψηλό κόστος νοσηλείας των ασθενών που υποβάλλονται σε χειρουργική επέμβαση καρδιάς, αλλά και η ανάγκη για παροχή ποιοτικής φροντίδας επιβάλλουν την παρακολούθηση του φόρτου νοσηλευτικής εργασίας (ΦΝΕ) και τη συσχέτισή του με αποτελέσματα, όπως η θνησιμότητα, η διάρκεια νοσηλείας (ΔΝ) στη μονάδα εντατικής θεραπείας (ΜΕΘ) και η συνολική διάρκεια νοσηλείας (ΣΔΝ) των ασθενών αυτών. Σκοπός της παρούσας μελέτης ήταν ο έλεγχος της υπόθεσης ότι «Ο ΦΝΕ μπορεί να συσχετιστεί και να προβλέψει τη ΔΝ και την ενδονοσοκομειακή θνησιμότητα ασθενών μετά από χειρουργική επέμβαση καρδιάς». Υλικό και Μέθοδος: Επρόκειτο για μη πειραματική μελέτη παρακολούθησης. Το δείγμα της μελέτης αποτέλεσαν 313 ασθενείς, οι οποίοι εισήχθησαν με τυχαία χρονολογική σειρά, από το Νοέμβριο του 2007 μέχρι και το Δεκέμβριο του 2008, στην καρδιοχειρουργική ΜΕΘ ενός γενικού νοσοκομείου της Αττικής, μετά από χειρουργική επέμβαση ανοικτής καρδιάς. Για τη συλλογή των δεδομένων χρησιμοποιήθηκαν δύο εργαλεία: α) Το Nursing Activities Score (NAS) για τον προσδιορισμό του ΦΝΕ και β) το λογιστικό EuroSCORE για την εκτίμηση του περιεγχειρητικού κινδύνου. Επιπλέον, χρησιμοποιήθηκε ειδικά σχεδιασμένο έντυπο συλλογής δημογραφικών και κλινικών χαρακτηριστικών. Μελετήθηκε η συσχέτιση της ΔΝ στη ΜΕΘ, της ΣΔΝ, αλλά και της θνησιμότητας των ασθενών με το ΦΝΕ και με άλλες μεταβλητές. Για τη στατιστική επεξεργασία χρησιμοποιήθηκε το πρόγραμμα SPSS 14.0 και συγκεκριμένα η δοκιμασία Χ2 για τη διμεταβλητή ανάλυση και η μέθοδος της πολυπαραγοντικής λογιστικής παλινδρόμησης για την πολυμεταβλητή ανάλυση των δεδομένων. Ως επίπεδο στατιστικής σημαντικότητας ορίστηκε το p - value = 0,05. Αποτελέσματα: Οι ασθενείς που συμπεριελήφθηκαν στην μελέτη ήταν 313, μέσης ηλίκιας 66,2 έτη (±11,5 ΤΑ) και με μέσο ΔΜΣ 27,2 kg/m2 (±4,2). Εξ αυτών οι 214 ήταν άνδρες (68,4%). H μέση ΔΝ στη ΜΕΘ ήταν 6,1 ημέρες (±20,6), με διάμεσο τιμή 2 ημέρες, ενώ η μέση μετεγχειρητική ΣΔΝ ήταν 12,8 ημέρες (±20,3) με διάμεσο τιμή 9 ημέρες. Σχετικά με τα κλινικά χαρακτηριστικά των ασθενών, η μέση τιμή του NAS της πρώτης ημέρας νοσηλείας στη ΜΕΘ ήταν 63,1% (±4,9), με διάμεσο τιμή 61,6%, ενώ η μέση τιμή του μέσου NAS των δύο πρώτων ημερών νοσηλείας ήταν 57,7% (±6,1), με διάμεσο τιμή 55,6%. Η μέση τιμή του λογιστικού EuroSCORE των ασθενών ήταν 10,8% (±14,4), με διάμεσο τιμή 5,6%, ενώ η μέση διάρκεια της χειρουργικής επέμβασης και της εξωσωματικής κυκλοφορίας ήταν 275,1 λεπτά (± 77,6), με διάμεσο τιμή 260 λεπτά και 133,8 λεπτά (±55,5), με διάμεσο τιμή 120 λεπτά, αντίστοιχα. Η ενδονοσοκομειακή θνησιμότητα άγγιξε το 11,8%. Η έκθεση των ασθενών σε υψηλά επίπεδα ΦΝΕ κατά την πρώτη ημέρα νοσηλείας συσχετίστηκε με στατιστικώς σημαντική αύξηση της ΔΝ στη ΜΕΘ (p<0,001), της ΣΔΝ (p=0,004) και της θνησιμότητας (p=0,009). Η έκθεση των ασθενών σε υψηλά επίπεδα ΦΝΕ κατά τις δύο πρώτες ημέρες νοσηλείας συσχετίστηκε με στατιστικώς σημαντική αύξηση της ΔΝ στη ΜΕΘ (p<0,001), της ΣΔΝ (p<0,001), αλλά και της θνησιμότητας (p=0,01). .............................................................................................................