Confiabilidad inter-observador del Nursing Activities Score entre profesionales de la salud en una Unidad de Cuidado Intensivo

Objetivo : Analizar la confiabilidad inter-observador del NAS entre administradores y enfermeras clínicas en la UCI. Método : Estudio metodológico desarrollado en una UCI general en Noruega. En una muestra seleccionada el NAS fue aplicado en 101 pacientes críticos por tres clases de evaluadores: Enfermeras asistenciales, médicos intensivistas y enfermeras gestoras. La confiabilidad inter-observador fue analizada mediante el test de Kappa. Resultados : Los promedios del NAS fueron 88,4(DE=16,2) y 88,7(DE=24,5) respectivamente para las enfermeras asistenciales y gestoras. Los médicos obtuvieron un promedio NAS inferior 83,7;DE=21,1). Las 18 intervenciones médicas tuvierón mayor concordancia entre las enfermeras asistenciales y los médicos (85,6), en comparación con las enfermeras asistenciales y gestoras (78,7). En las cinco actividades de enfermería, los coeficientes Kappa fueron bajos entodas las actividades y entre todos los grupos. Conclusión : El estudio mostró confiabilidad inter-observador satisfactorias para el NAS entre las enfermeras asistenciales y gestoras.Objetivo Analisar a confiabilidade interobservadores do NAS entre enfermeiros intensivistas e administradores em UTI. Método Estudo metodológico desenvolvido em UTI geral, de adultos, na Noruega. Em uma amostra selecionada, o NAS foi aplicado em 101 pacientes por três avaliadores: enfermeira assistencial, médico intensivista e enfermeira gestora. A confiabilidade interobservadores foi analisada por meio do teste Kappa. Resultados As médias NAS foram 88,4(SD=16,2) e 88,7(SD=24,5) respectivamente para enfermeiros assistenciais e gestores. Os médicos obtiveram média NAS inferior (83,7; SD=21,1). As 18 intervenções médicas tiveram maior concordância entre enfermeiros assistenciais e médicos (85,6), comparativamente aos enfermeiros assistenciais e gestores (78,7). Nas cinco atividades de enfermagem, os coeficientes Kappa foram baixos em todas as atividades e entre todos os grupos. Conclusão O estudo mostrou confiabilidade interobservadores satisfatória para o NAS entre enfermeiros assistenciais e gestores.Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers

The Value of Nursing Competence and Staffing for Patients in Critical Care: A Scoping Review

Background: Nurse competence and staffing in critical care are of interest to hospital managers and politicians, especially if a relationship exists between educated nurses and patient outcomes. Observational data can describe and measure the impact of critical care nursing practices in intensive care units and may be linked to outcomes. Objective: The aim of this study was to provide an understanding of how levels of nursing competence and staffing in intensive care units are described and associated with nurse-sensitive outcomes. Methods: A scoping review was conducted. Electronic databases, including CINAHL, Medline, Embase, the British Nursing Index, and SweMed+, were searched for English language studies from 2006 to 2023. The inclusion criteria were nurses working in critical care, nurse staffing ratio or assessment, and nurse-sensitive outcomes for intensive care patients. Results: Twenty-one studies were included. As only few studies mentioned the educational level of nurses and the studies used several job titles, it was difficult to interpret nursing competence. Studies that used valid tools for workloads often reported significant results of nursing staffing related to nurse-sensitive outcomes. Adverse events increased with higher levels of nurse workload, and some events were also affected by the level of competence. Lower mortality rate was linked to more nursing hours per patient. Conclusion: We found associations between education, nurse staffing, and nurse-sensitive outcomes in intensive and critical care units. To highlight its effects, advanced nursing competence in critical care and research must be better described. Patients’ need for nursing competence must be assessed using validated tools.publishedVersio

«Lite visste vi hvordan vårsemesteret 2020 ville bli» – en tverrsnittstudie om pandemiens innvirkning på intensivsykepleiestudentenes opplevelser i vårsemesteret 2020

Bakgrunn: Midt i vårsemesteret 2020 ble SARS-CoV-2 erklært som pandemi. Studiehverdagen til landets intensivsykepleiestudenter ble brått snudd på hodet. All undervisning ble digital, og det var stor usikkerhet rundt gjennomføringen av praksisstudier. Mangelen på intensivsykepleiere ble tydeliggjort, og utdanning av flere intensivsykepleiere mer kritisk. Hensikt: Hensikten med studien var å kartlegge hvilke erfaringer intensivsykepleiestudentene i masterprogram hadde i vårsemesteret 2020 under covid-19-pandemien i Norge. Metode: Studien er en beskrivende tverrsnittstudie med bruk av spørreskjema. Spørreskjemaet ble testet gjennom en pilotstudie, og sendt ut til alle landets intensivsykepleiestudenter som var i en videreutdanning som tilbød mastergrad. Resultat: Svarprosenten i studien var 29,2 prosent (n = 56). I teoretiske emner oppnådde 75 prosent av studentene sine læringsmål, og i kliniske emner oppnådde 76,8 prosent sine læringsmål. Digital undervisning medførte at 60,7 prosent (n = 34) opplevde svekket studiemotivasjon. Halvparten av studentene opplevde redusert mulighet for veiledning i klinisk praksis, og 64,3 prosent erfarte at de ble brukt som arbeidskraft på praksisstedet. Kun 34 prosent opplevde å få beholde sin studentrolle, og 23,3 prosent tviler på om de vil fortsette i yrket. Konklusjon: Våre resultater viser at første fase av pandemien medførte endringer i undervisning, praksisstudier og veiledning, som medførte lavere læringsutbytte og motivasjon. Flertallet av respondentene oppnådde likevel sine læringsmål i både teoretiske og kliniske emner. Funnene viser at opplevelse av å bli brukt som arbeidskraft i praksis, og tap av studentrolle, er faktorer som reduserer motivasjon til å både gjennomføre studiet og å fortsette i yrket. Studien viser at det å være student i en pandemi er utfordrende fordi pandemien medførte endringer i studenthverdagen.publishedVersio

Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project

Objectives: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units. Setting: Four intensive care units in a Norwegian University Hospital. Research methodology: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals. Results: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pres- sure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]). Conclusion: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable. Implications for clinical practice: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement projectpublishedVersio

Assessment of Nursing intensity with Nursing Activities Score in Norwegian Intensive Care Units

The aim was to test: the reliability and validity of the Nursing Activities Score (NAS) in relation to nursing intensity (NI) and nurse staffing costs and to examine: how the use of the NAS by critical care nurses can provide a tool for hospital administrators in Norwegian Intensive Care Units (ICUs). The instrument NAS assess nursing activities, including patients’ critical care needs and quantifies workload. The study method was a quantitative observational design and used in three studies and data were collected from internal quality registers, patients’ records and the Norwegian Intensive Care Registry. The study samples were 235/219/ 6,390 patients. The NAS tool was found to be reliable and valid in relation to the assessment of NI and emerging from the confirmatory factor analysis, a reduced three-factor model based on ICU patients’ NAS scores, with the latent factors “relationship”, “prevention” and “treatment”, confirmed the conceptual model of critical care nursing. The NAS is an applicable tool in identification of patients’ care needs in critical care and can be used to describe nurse staffing costs in Norwegian ICUs. Hospital administrators can use the NAS to make budgetary decisions for ICU contexts

Nursing of Criticall Ill Patients in Prone Position in an Intensive Care Unit, 2001

The purpose of the survey is to describe and evaluate the condition in prone positions, with perspective taken from Dorothe Orems eight universal self care requisites

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

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

Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

ABSTRACT Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers

Testing the reliability and validity of the Nursing Activities Score in critical care nursing

Background and Purpose: The purpose of this study was to test the reliability and validity of the conceptual model of critical care nursing using the Nursing Activities Score (NAS) for intensive care unit (ICU) patients. Methods: An observational study conducted in 2011 using the NAS scores of 219 patients in Norway. The inter-rater reliability (IRR) was tested by parallel classifications. The validity was explored by an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) as the measurement models in the structural equation model. Results: Within the paired ratings the Spearman's correlation coefficient was 0.39. The EFA results explained 77% of the variance with six factors. The reduced CFA model resulted in a three-factor model: relationship, prevention and treatment. Conclusion: The findings supported the IRR and construct validity of the conceptual model of the NAS

Correction: Stafseth et al. Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. <i>Int. J. Environ. Res. Public Health</i> 2022, <i>19</i>, 7010

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