Workload assessment using the nursing activities score in intensive care units: Nationwide prospective observational study in France.

Jérôme E Dauvergne, Arnaud Bruyneel, Anaëlle Caillet, Pascal Caillet, Brigitte Keriven-Dessomme, Jérôme Tack, Bertrand Rozec, Laurent Poiroux
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Abstract

Background: Within French intensive care units (ICUs), patients are treated with two levels of care (intensive or intermediate) with different nurse-to-patient ratios legally defined.

Objectives: We aimed to compare the nursing workload associated with these two levels of care.

Research methodology: A nationwide prospective observational study was conducted in France between April and July 2023. Each ICU was allowed to choose its own two-week period of data collection during which the Nursing Activities Score was collected by nurses at patients' bedside, during each shift. The Nursing Activities Score ranges from 20 to 177% and a 100% score represents a nurse per shift. The number of patients per nurse was collected and the Nursing Activities Score per nurse was assessed.

Results: One hundred and five ICUs participated. Overall, 21,665 measurements of Nursing Activities Score per patient and 9,885 Nursing Activities Score per nurse were collected. ICUs were composed by 2083 beds distributed into 1520 (73 %) intensive care beds and 563 (27 %) intermediate care beds. Among the participating units, 93 (89 %) of the teams worked in 2 shifts. Median [p25-p75] Nursing Activities Score per adult patient was 61 % [49-80] for intensive care patients and 47 % [38-61] for intermediate care patients (p < 0.001). Median Nursing Activities Score per nurse for adult population was 127 % [92-167], 143 % [92-198], and 164 % [126-213] for nurses only providing intensive care, only intermediate care or both levels of care, respectively (p < 0.001). A Nursing Activities Score per nurse value >100 % was observed in 71.4 %.

Conclusions: Nurses' workload was high in the ICU, especially when providing intermediate or mixed levels of care.

Implications for practice: In order to reduce nurses' workload, a review of the nurse-to-patient ratios is expected. Physically separating the two levels of care may be a valuable option.

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在重症监护病房使用护理活动评分进行工作量评估:法国全国性前瞻性观察研究。
背景:在法国的重症监护病房(ICU)中,患者接受两种级别(重症或中级)的护理,法律规定了不同的护士与患者比例:我们旨在比较与这两种护理级别相关的护理工作量:研究方法:2023 年 4 月至 7 月期间,我们在法国开展了一项全国性的前瞻性观察研究。每个重症监护病房可自行选择两周的数据收集期,在此期间,护士每班在患者床旁收集护理活动评分。护理活动评分范围为 20% 至 177%,100% 的评分代表每班护士的护理活动。收集每位护士护理的病人数量,并评估每位护士的护理活动得分:结果:有 15 个重症监护病房参与了该项目。总共收集了 21,665 次每位患者护理活动评分和 9,885 次每位护士护理活动评分。重症监护病房共有 2083 张病床,其中重症监护病床 1520 张(73%),中级监护病床 563 张(27%)。在参与调查的病房中,93 个小组(89%)实行两班倒工作制。重症监护患者每名成人患者的护理活动评分中位数[p25-p75]为61%[49-80],中级护理患者为47%[38-61](71.4%的患者护理活动评分为100%):结论:重症监护室护士的工作量很大,尤其是在提供中级或混合护理时:对实践的启示:为了减轻护士的工作量,应重新考虑护士与病人的比例。将两级护理实际分开可能是一个有价值的选择。
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