Nursing workload on the day of discharge from the intensive care unit is associated with readmission

PurposeTo verify whether there is an association between the Nursing Activities Score (NAS) on the day of discharge from the intensive care unit and readmission..Materials and methodsA retrospective cohort study of all patients admitted to the intensive care unit of Hospital Ernesto Dornelles, Porto Alegre, Brazil, who were discharged to the ward from October 2018 to December 2019. We collected demographic and clinical variables of the patients and the Nursing Activities Scoreon the day of discharge. Patients were followed up until the day of hospital discharge or death.ResultsWe included 1045 patients in the final sample. One hundred eighty-eight (18.0%) patients were readmitted, in addition there were two (0.2%) unexpected deaths that occurred in the ward. The median NAS was 59.9 (50.9–67.3), which was higher in the bivariate analysis in patients who were readmitted (64.0, 55.7–71.4) than in patients who were not readmitted (58.7, 49.7–66.1) (p < 0.001). Patients with a Nursing Activities Score  ≥ 60.0 and < 60.0 had rates of readmission of 23.4% and 12.7%, respectively (p < 0.001). After multivariable adjustment, the Nursing Activities Score at discharge maintained an association with readmission. In addition, in the Cox regression, the Nursing Activities Score as a dichotomous variable was independently associated with readmission (adjusted HR 1.560; CI 1.146–2.125; p = 0.005).ConclusionsWe found that the nursing workload, assessed by the Nursing Activities Score at the time of discharge from the intensive care unit, was associated with risk of readmission..     

监护病房中高血钠发生的危险因素及护理对策

目的 分析监护病房中高血钠发生的危险因素及护理对策。方法 用急性生理功能与慢性健康状况评分Ⅱ评分系统评估疾病严重程度，采用单因素x^2检验和多因素Logistic回归分析判定发生高血钠的危险因素。结果 监护病房中高血钠患者的发生率为16．55％，高血钠发生与患者不同程度的意识水平，尿量，高热，基础疾病较严重，经口饮水受限及使用脱水剂不当等因素显著相关。结论 高血钠是监护病房中常见并发症，应重视其危险因素，加强护理，减少发生率。     

重症监护室护理记录单的优化设计与应用

目的 设计ICU护理记录单,并研究其在提高护士工作效率中的作用。 方法 根据科室实际情况优化设计了文字、表格书写相结合的记录单,并与原ICU记录单比较。 结果 优化前、后的护理记录单记录字数和记录用时均少于优化前的护理记录单。 结论 优化后的护理记录单显著提高了书写质量和护理工作效率。     

Evaluation of nurses’ workload in intensive care unit of a tertiary care university hospital in relation to the patients’ severity of illness: A prospective study

BackgroundsCosts of intensive care reach up to 30% of the hospital budget with workforce expenses being substantial. Determining proper nurse—patient ratio is necessary for optimizing patients’ health related outcomes and hospitals’ cost effective functioning.ObjectivesTo evaluate nurses’ workload using Nine Equivalents of Nursing Manpower Use Score and Nursing Activities Score scoring systems while assessing correlation between both scores and the severity of illness measured by Simplified Acute Physiology Score II.DesignA Prospective studySettingsCardiac Surgery Intensive Care Unit of the Clinical Hospital Centre Rijeka, Croatia, from October 2014 to February 2015. This Intensive Care Unit has 3 beds that can be expanded upon need.ParticipantsThe study included 99 patients treated at this Unit during the study’s period. The scores were obtained by 6 nurses, working in 12 h shifts.MethodsMeasurements were obtained for each patient 24 h after admission and subsequently twice a day, at the end of the day shift (7 pm) and at the end of the night shift (7 am). The necessary data were obtained from the patient’s medical records.ResultsNursing Activities Score showed significantly higher number of nurses are required for one 12 h shift (Z = 3.76, p < 0.001). Higher scores were obtained on day shifts vs. night shifts. (Nursing Manpower Use Score, z = 3.25, p < 0.001; Nursing Activities Score, z = 4.16, p < 0.001). When comparing Nursing Activities Score and Nursing Manpower Use Score during the week, we calculated higher required number of nurses on weekdays than on weekends and holidays, (Nursing Manpower Use Score, p < 0.001; Nursing Activities Score, p < 0.001). Correlation analysis of Nursing Activities Score and Nursing Manpower Use Score with Simplified Acute Physiology Score II has shown that Nursing Manpower Use Score positively associated with severity of disease, while Nursing Activities Score shows no association.ConclusionBoth scores can be used to estimate required number of nurses in 12-h shifts, although Nursing Activities Score seems more suitable for units with prolonged length of stay, while Nursing Manpower Use Score appears better for units with shorter duration of stay (up to four days). Higher workload measured by Nursing Manpower Use Score scale can be predicted with higher Simplified Acute Physiology Score II. However, with low Simplified Acute Physiology Score II scores it cannot be assumed that the nursing workload will also be low. Further research is needed to determine the best tool to asses nursing workload in intensive care units.     

优化人员管理对提高重症监护室护理质量的作用

目的 探讨优化人员管理对提高重症监护室(ICU)护理质量的作用.方法 2007年6月起对我院ICU护理人员实施分层分级管理,2008年和2010年分别对ICU护理人员和患者进行问卷调查,比较优化管理后护理质量的达标情况和患者满意度.结果 实施优化管理后,护理质量达标率及患者满意度均较以前显著提高,差异有统计学意义(P＜...     

哈尔滨市ICU护士护理软技能现状的调查

目的调查哈尔滨市重症监护室（ICU）护士护理软技能现状及其影响因素。方法2011年4—7月采用整群随机抽样方法,在哈尔滨市抽取3家三甲医院ICU的护士为调查对象,采用护理软技能测评量表对300名ICU护士进行调查,评价其护理软技能情况并分析影响因素。结果共发放问卷300份,回收275份,有效问卷245份,有效回收率为89．09％。哈尔滨市ICU护士护理软技能的总均分为（145．40±15．43）分,低于全国常模。得分最高的项目为自我管理技能（43．76±4．32）分,最低得分为职业情操（26．17±2．54）分。对影响ICU护士护理软技能得分的因素进行单因素分析,发现不同年龄、性别、学历、婚姻状态、聘用形式及职称的护士软技能得分不同,差异具有统计学意义（F／t分别为13．28,6．14,4．22,6．85,2．34,5．24;P〈0．05）。以护理软技能总分为因变量,以年龄、性别、婚姻状况、学历、聘用形式、职称为自变量,进行多元线性回归分析,结果表明,护士护理软技能水平受学历、年龄、婚姻状况的影响（R。=0．202）。结论哈尔滨市ICU护士护理软技能还需进一步提高,需要对低学历、已婚及护龄长的护士进行重点干预和培训,从而改善护患关系,提高护理质量。     

重症监护室患者侵袭性导管相关感染分析与护理

目的探讨重症监护室（ICU）内各种侵袭性导管监护治疗与导管相关性感染的关系及其护理干预对策。方法对我院2005年1月-2006年10月ICU收治的739例患者进行回顾性调查,了解ICU内侵袭性导管相关感染发生情况。结果739例患者在ICU住院期间发生医院感染129例,医院感染发病率17．45％;患者日医院感染发生率13．04‰;与尿道插管相关的泌尿道感染发生率11．57‰;与动静脉插管相关的血液感染发病率0．46‰;与使用呼吸机相关的肺部感染发病率9．78‰。侵袭性操作越多感染率相应增高。结论加强环境治理、避免交叉感染、严格洗手制度、严格管理侵袭性操作及合理使用抗生素等综合治理措施是预防和控制侵袭性导管相关感染的有效途径。     

ICU患者在机械通气中应用异丙酚镇静的观察与护理

目的观察异丙酚在ICU机械通气患者的镇静效果及护理.方法选择40例在ICU接受气管插管、机械通气患者按住院号单双分成2组,观察组20例在上机后使用异丙酚,对照组20例给与其它镇静剂,观察2组机械通气时间、在ICU住院的时间.结果观察组的机械通气时间、在ICU住院时间,明显少于对照组（P＜0.01,P＜0.05）.结论异丙酚用于ICU机械通气患者的镇静不仅能安全有效镇静,而且能减少机械通气时间和在ICU住院时间,使用异丙酚应严格无菌技术操作以防止发生医源性感染.     

卒中单元重症监护对急性重症脑卒中的护理效果观察

目的探讨卒中单元建立重症监护病房对急性重症脑卒中的护理效果。方法将符合监护标准的61例急性重症脑卒中患者置卒中单元重症监护病房实施重症监护作为观察组（A组）,将2006年1月之前在本院神经内科及神经外科住院的急性重症脑卒中患者60例的常规护理作为对照组（B组）。对比两组患者的意识障碍程度评分、神经功能缺损程度评分、病残程度评分和并发症的发生率、病死率等指标,分析卒中单元对急性重症脑卒中患者实施重症监护的优越性。结果A组在改善神经功能缺损程度评分、意识障碍程度评分方面,均明显优于B组（P〈0.01）,并发症的发生率亦显著低于对照组（P〈0.01）。结论卒中单元建立重症监护病房对急性重症脑卒中患者实施重症监护,能有效提高急性重症脑卒中的疗效,显著提高护理质量,改善护患关系。     

Developing a minimum dataset for nursing team leader handover in the intensive care unit: A focus group study

Background

Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit.

Nursing activities score (NAS): A proposal for practical application in intensive care units

For over 30 years in an attempt to demonstrate the cost-benefit ratio of the intensive care unit (ICU) a variety of tools have been developed to measure not only the severity of illness of the patient but also to capture the true cost of nursing workload. In this context, the nursing activities score (NAS) was developed as a result of modifications to the therapeutic interventions scoring system-28 (TISS-28). The NAS is a tool to measure nursing workload ICU and it has been shown to be twice as effective in measuring how nurses spend their time caring for critically ill patients than the TISS-28. This paper discuss the introduction of the NAS into everyday use in an intensive care unit in Brazil and highlights the challenges of standardisation of operational definitions, training requirements and accurate completion of the documentation when using such a tool. The rationale and steps undertaken to achieve this are outlined and the benefits of such a process are highlighted.     

TISS在SICU护理工作量评定与分析中的应用

目的：应用治疗干预计分系统（TISS）评定、分析外科重症监护病房（SICU）的护理工作量,为临床管理提供客观参考依据。方法：观察北京某三级甲等医院SICU半年内每天的护理记录并收集366例患者每天的TISS计分,统计SICU病房每天所有患者的TISS总分。结果：根据TISS给定的分级方法,826例次SICU患者的TISS计分均数为39.52,约需要1：1的护患比。其中有46.97%例次的TISS计分在40～87分之间,属于TISS分类Ⅳ级的重患者,需要1名或者1名以上的护士直接护理。SICU每天护理工作总量的TISS计分均数为195.74,每天满足患者直接护理需要的护士岗位职数为15人。TISS的76个护理干预项目中,心电图监护、每24小时的常规摄入及排出、留置导尿管的操作频次占前3位。结论：SICU护士处于超负荷工作状态。TISS为SICU护理工作量的评估和人力资源的合理使用提供了有力的依据;护患比例失调,护士编制不足,是监护病房亟待解决的问题。     

综合重症监护病房医院感染分析

目的了解本院综合ICU医院感染的现状,为医院感染监测与控制提供依据。方法采用前瞻性与回顾性调查相结合的方法,以我国卫生部2001年颁布的《医院感染诊断标准(试行)》进行判定分析。结果共调查329例住院病例,其中感染病例47例(77例次),感染率14.29%(例次感染率23.40%),感染部位以呼吸道为主,其次为泌尿道。感染的危险因素主要为泌尿插管、中心静脉插管和应用人工呼吸机,医院感染病例的病原菌分布以革兰氏阴性杆菌为主。结论 ICU医院感染是多因素共同作用的结果,切实做好医院感染监测和控制,对提高医疗质量,保障医疗、医患安全均具有重要意义。     

Triggers and nursing influences on delirium in intensive care units

Among care providers, nurses have the most influence on the occurrence of delirium in patients. To identify and investigate the risk factors associated with delirium and analyse the nurse's influence on delirium, a secondary data analysis approach was used with clinical data from the electronic medical record and health care provider data from the management information systems of a university hospital. Data of 3284 patients (delirium = 688, non‐delirium = 2596) hospitalized in the medical and surgical intensive care units containing 2178 variables were analysed. Donabedian's structure‐process‐outcome model was applied to categorize the factors for multilevel hierarchical logistic regression analysis. Sixteen factors (10 patient factors, 1 provider factor, 1 environmental factor, 2 nursing intervention factors and 2 medical intervention factors) were identified as significant in the final model. Longer intensive care unit experience of nurses did not decrease the risk of delirium. Greater number of nursing intervention needs and greater use of restraints were associated with an increased risk of delirium. The duration of nursing career did not affect the reduction of the risk of delirium. Nurses should therefore endeavour to acquire nursing experience specific for delirium care and attend training courses for delirium management.     

Measuring nursing workload in neonatal intensive care

AIM: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). BACKGROUND: Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses. METHODS: A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. KEY ISSUES: The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload. CONCLUSIONS: It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.     

综合ICU多重耐药鲍曼不动杆菌的预防及护理

目的:探讨ICU多重耐药鲍曼不动杆菌的预防及护理方法。方法:对我科收治的15例多重耐药鲍曼不动杆菌感染患者采取综合预防和护理措施,观察其疗效及死亡率。结果:10例患者拔除气管套管后恢复良好,3例患者长期带管生存,2例死亡。结论:通过鲍曼不动杆菌耐药监测系统的检测、抗菌药物合理应用及监管,重视手卫生和病房的消毒隔离;对高度耐药菌株感染患者进行主动隔离,防止交叉感染;合理的营养支持,以增强抵抗力;气道湿化要适度,注重翻身扣背后的及时吸痰;进行吞咽功能的训练以促进其功能恢复,尽早拔除气管套管等,可降低多重耐药细菌感染发生率,多重耐药鲍曼不动杆菌感染后患者能够得到有效的恢复,降低死亡率。