Department of Anesthesiology and Intensive Care, Isala, Zwolle, The Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
Int J Nurs Stud. 2021 Feb;114:103852. doi: 10.1016/j.ijnurstu.2020.103852. Epub 2020 Dec 8.
A range of classification systems are in use for the measurement of nursing workload in Intensive Care Units. However, it is unknown to what extent the measured (objective) nursing workload, usually in terms of the amount of nursing activities, is related to the workload actually experienced (perceived) by nurses.
The aim of this study was to assess the association between the objective nursing workload and the perceived nursing workload and to identify other factors associated with the perceived nursing workload.
We measured the objective nursing workload with the Nursing Activities Score and the perceived nursing workload with the NASA-Task Load Index during 228 shifts in eight different Intensive Care Units. We used linear mixed-effect regression models to analyze the association between the objective and perceived nursing workload. Furthermore, we investigated the association of patient characteristics (severity of illness, comorbidities, age, body mass index, and planned or unplanned admission), education level of the nurse, and contextual factors (numbers of patients per nurse, the type of shift (day, evening, night) and day of admission or discharge) with perceived nursing workload. We adjusted for confounders.
We did not find a significant association between the observed workload per nurse and perceived nursing workload (p=0.06). The APACHE-IV Acute Physiology Score of a patient was significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.02). None of the other patient characteristics was significantly associated with perceived nursing workload. Being a certified nurse or a student nurse was the only nursing or contextual factor significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.03).
Workload is perceived differently by nurses compared to the objectively measured workload by the Nursing Activities Score. Both the severity of illness of the patient and being a student nurse are factors that increase the perceived nursing workload. To keep the workload of nurses in balance, planning nursing capacity should be based on the Nursing Activities Score, on the severity of patient illness and the graduation level of the nurse.
有一系列的分类系统被用于测量重症监护病房的护理工作量。然而，目前尚不清楚测量的（客观）护理工作量（通常以护理活动的数量来衡量）与护士实际感受到的（主观）护理工作量之间的关系程度。
本研究旨在评估客观护理工作量与主观护理工作量之间的关联，并确定与主观护理工作量相关的其他因素。
我们在 8 个不同的重症监护病房的 228 个班次中，使用护理活动评分（Nursing Activities Score）来测量客观护理工作量，使用 NASA 任务负荷指数（NASA-Task Load Index）来测量主观护理工作量。我们使用线性混合效应回归模型来分析客观护理工作量和主观护理工作量之间的关联。此外，我们还调查了患者特征（疾病严重程度、合并症、年龄、体重指数以及计划内或计划外入院）、护士的教育水平以及环境因素（每名护士的患者人数、班次类型（白天、晚上、夜间）和入院或出院日）与主观护理工作量的关联。我们对混杂因素进行了调整。
我们没有发现护士观察到的每个班次的工作量与主观护理工作量之间存在显著关联（p=0.06）。患者的急性生理学和慢性健康评估 IV 评分（APACHE-IV Acute Physiology Score）与主观护理工作量显著相关，即使在调整了混杂因素后也是如此（p=0.02）。其他患者特征与主观护理工作量均无显著关联。注册护士或实习护士是唯一与主观护理工作量显著相关的护理或环境因素，即使在调整了混杂因素后也是如此（p=0.03）。
与护理活动评分测量的客观工作量相比，护士对工作量的感知存在差异。患者的疾病严重程度和实习护士身份是增加主观护理工作量的因素。为了使护士的工作量保持平衡，护理能力规划应基于护理活动评分、患者的疾病严重程度和护士的毕业水平。
