Cassiano Carolina, Nogueira Lilia de Souza, Araújo Ana Carolina Unger, Lima Fernanda Rodrigues, Hanifi Nasrin
Faculty of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil.
Medical Surgical Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil.
Nurs Crit Care. 2025 Jul;30(4):e13221. doi: 10.1111/nicc.13221. Epub 2025 Jan 14.
The safety of patients in the intensive care unit (ICU) is significantly impacted by inadequate staffing of nursing professionals to meet the demand for care of critically ill patients. COVID-19 patients increased nurses' workload, particularly in high-intensity care settings like the ICU.
To evaluate the association of workload and number of patients per nursing professional with the occurrence of adverse events and death in critically ill patients with COVID-19 in the ICU.
This is a retrospective cohort study. This study analysed patients with COVID-19, aged 12 years or older, admitted between 1 April 2020 and 31 May 2021 in the ICU of a hospital in Brazil. Nursing workload was measured by the Nursing Activities Score (NAS). The independent variables were the ratio of the NAS score per nursing professional (NNR) and the ratio of the number of patients per nursing professional (PNR). Dependent variables included adverse events (pressure injuries and health care-associated infections-HAIs) and death in the ICU.
Of the 386 included patients, 59.59% were male and the median age was 60.5 years. The median NAS, NNR and PNR values were 72.81%, 128% and 1.64, respectively. The frequency of pressure injuries (31.09%) exceeded that of HAIs (16.06%), and 218 patients (56.48%) died. The NNR was associated with HAIs (OR 1.006; CI95% 1.001-1.012; p = .012), pressure injury (OR 1.005; CI95% 1.000-1.010; p = .033) and death (OR 1.010; CI95% 1.005-1.015; p < .001) in the ICU. There was no association between PNR values and the study's dependent variables.
A high workload per nursing professional was associated with the occurrence of adverse events and deaths of patients with COVID-19 in the ICU, while the nursing staff sizing was not.
The results reinforce the importance of evaluating the workload of nursing professionals to establish safety measures for the care of patients with infectious diseases.
重症监护病房（ICU）中护理专业人员配备不足，无法满足重症患者的护理需求，这对患者安全产生了重大影响。新型冠状病毒肺炎（COVID-19）患者增加了护士的工作量，尤其是在ICU等高强度护理环境中。
评估ICU中COVID-19重症患者的工作量及每名护理专业人员护理的患者数量与不良事件发生及死亡之间的关联。
这是一项回顾性队列研究。本研究分析了2020年4月1日至2021年5月31日期间入住巴西一家医院ICU的12岁及以上的COVID-19患者。护理工作量通过护理活动评分（NAS）来衡量。自变量为每名护理专业人员的NAS评分比值（NNR）和每名护理专业人员护理的患者数量比值（PNR）。因变量包括ICU中的不良事件（压力性损伤和医疗保健相关感染-HAIs）及死亡。
在纳入的386例患者中，59.59%为男性，中位年龄为60.5岁。NAS、NNR和PNR的中位值分别为72.81%、128%和1.64。压力性损伤的发生率（31.09%）超过了HAIs的发生率（16.06%），218例患者（56.48%）死亡。NNR与ICU中的HAIs（比值比1.006；95%置信区间1.001-1.012；p = 0.012）、压力性损伤（比值比1.005；95%置信区间1.000-1.010；p = 0.033）及死亡（比值比1.010；95%置信区间1.005-1.015；p < 0.001）相关。PNR值与研究的因变量之间无关联。
每名护理专业人员的高工作量与ICU中COVID-19患者的不良事件发生及死亡相关，而护理人员规模与不良事件发生及死亡无关。
研究结果强化了评估护理专业人员工作量以制定传染病患者护理安全措施的重要性。
