General Intensive Care Unit, Emergency Department - ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Nurs Crit Care. 2024 Jan;29(1):196-207. doi: 10.1111/nicc.12888. Epub 2023 Jan 30.
COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required.
To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre.
Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload.
We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS.
The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS.
Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.
COVID-19 与护理工作量增加有关，因此需要较高的护士与患者比例。
分析意大利体外膜肺氧合 (ECMO) 中心 COVID-19 患者与无 COVID-19 疾病的对照患者 (NCOVID-19 组) 的护理工作量差异，以护理活动评分 (NAS) 表示。
回顾性分析前瞻性收集的数据，纳入 2019 年 5 月 1 日至 2021 年 2 月 28 日期间入住普通重症监护病房的连续患者。然后进行多变量分析，以评估 COVID-19 疾病是否是 NAS 升高的独立预测因素，并评估哪些其他因素和程序与工作量增加独立相关。
我们共纳入 574 例患者，其中 COVID-19 组 135 例 (24%)，NCOVID-19 组 439 例 (76%)。COVID-19 组的平均 NAS 较高 (79±11 与 65±15，T=-10.026;p<0.001)。COVID-19 组更频繁地使用俯卧位、连续肾脏替代治疗 (CRRT) 和 ECMO。COVID-19 组中更多的患者存在多药耐药菌定植。COVID-19 组机械通气时间和 ICU 住院时间较长。COVID-19 诊断与更高的 NAS 独立相关。更高 NAS 的其他独立预测因素是俯卧位和连续肾脏替代治疗 (CRRT) 的使用。多药耐药菌定植和 ECMO 支持与更高的 NAS 无关。
COVID-19 患者的护理工作量较高主要是由于治疗严重低氧血症患者所需的特定程序，如俯卧位。多药耐药菌定植和 ECMO 支持与更高的 NAS 无关。
COVID-19 患者的工作量增加主要是由于特定干预措施，如俯卧位和 CRRT，以及相关的护理活动，如持续在患者床边、移动、定位和复杂的卫生程序。
