护理活动评分表的信度和效度研究

[目的]翻译“护理活动评估量表”(NAS),评价其信度、效度及文化相关性,提供一种有效方便的护理工作量评估的中文版问卷。[方法]应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对126例重症监护病房(ICU)病人应用问卷对其结构效度进行评价,对其中30例病人进行重测信度评价。[结果]中文版NAS问卷中所有条目均具有较好的文化相关性,其中1个条目重新修订,且具有较好的信度和效度。因子分析显示中文版NAS具有与原英文版量表一致的结构效度。[结论]中文版护理工作量评估表是一种具有较高信度、效度的ICU专用护理工作量评估量表,可以为广大护理管理者提供可靠的理论依据和数据支持。     

护理活动评分表的信度和效度研究

[目的]翻译“护理活动评估量表”（NAS），评价其信度、效度及文化相关性，提供一种有效方便的护理工作量评估的中文版问卷。[方法]应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对126例重症监护病房（ICU）病人应用问卷对其结构效度进行评价，对其中30例病人进行重测信度评价。[结果]中文版NAS问卷中所有条目均具有较好的文化相关性，其中1个条目重新修订，且具有较好的信度和效度。因子分析显示中文版NAS具有与原英文版量表一致的结构效度。[结论]中文版护理工作量评估表是一种具有较高信度、效度的ICU专用护理工作量评估量表，可以为广大护理管理者提供可靠的理论依据和数据支持。     

护理活动评估量表在ICU护理工作量调查中的应用

[目的]应用护理活动评估量表评估ICU护理工作量,为护理管理者合理安排护士人力提供理论依据。[方法]翻译英文版护理活动评估量表,评价其信度及效度;并应用此表对2006年1月—4月入住中国医科大学附属第一医院ICU病人进行护理工作量评价。[结果]ICU病人不同住院时期、不同转归对护理工作量有影响,而不同疾病种类间护理工作量差异无统计学意义。[结论]护理活动评估量表在ICU的应用可以反映ICU的护理工作量情况,并能为合理地调配ICU护士人力提供有价值的数据支持。     

护理活动评估量表在ICU护理工作量调查中的应用

[目的]应用护理活动评估量表评估ICU护理工作量,为护理管理者合理安排护士人力提供理论依据.[方法]翻译英文版护理活动评估量表,评价其信度及效度;并应用此表对2006年1月-4月入住中国医科大学附属第一医院ICU病人进行护理工作量评价.[结果]ICU病人不同住院时期、不同转归对护理工作量有影响,而不同疾病种类间护理工作量差异无统计学意义.[结论]护理活动评估量表在ICU的应用可以反映ICU的护理工作量情况,并能为合理地调配ICU护士人力提供有价值的数据支持.     

ICU护理工作量的研究

我国护理人力资源短缺以及因此引起的护理质量问题正受到国家卫生管理部门和医院管理者的关注[1],护理工作量的测量及护理人力资源的配置方法应运而生[2～3],但关于ICU的护理工作量计算和人力配置尚缺乏一个有效具有公信力的工具提供适当的测量。为了尽可能客观地评估ICU的护理工作量,引进了国外测量ICU护理工作量的ICNSS(the in-tensive critical nursingscore system,ICNSS)量表,本量表的形成来自多种成人重症护理单位,并有很好的信、效度[4～5]。在取得此量表后,先后对其进行了翻译、修订和信、效度评价,形成适合我国国情的中文版量表。本研究应用此量表对一综合ICU的护理工作量做调查,现报道如下。     

ICU护理工作量的研究

我国护理人力资源短缺以及因此引起的护理质量问题正受到国家卫生管理部门和医院管理者的关注，护理工作量的测量及护理人力资源的配置方法应运而生，但关于ICU的护理工作量计算和人力配置尚缺乏一个有效具有公信力的工具提供适当的测量。为了尽可能客观地评估ICU的护理工作量，引进了国外测量ICU护理工作量的ICNSS（the intensive critical nursing score system，ICNSS）量表，本量表的形成来自多种成人重症护理单位，并有很好的信、效度。在取得此量表后，先后对其进行了翻译、修订和信、效度评价，形成适合我国国情的中文版量表。本研究应用此量表对一综合ICU的护理工作量做调查，现报道如下。     

重症监护病房成人护理工时评估体系的构建

[目的]建立重症监护病房(ICU)成人护理工时评估体系,评估ICU护理工作量,为ICU专科护理特点分析提供依据。[方法]选取某三级甲等医院4个ICU注册护士92名及病人200例,利用观察法和工时测量法,形成ICU成人护理项目框架并进行实时测量。采用负荷权重法和专家咨询法确定各项ICU护理项目难度系数,形成ICU成人护理工时评估体系,并完成信效度检验。[结果]ICU成人护理工时评估体系包含19个基础护理项目、9个ICU专科护理项目及6个护理业务管理项目,Cronbach's α系数为0.63,重测信度为0.86。应用Kaiser-Meyer-Olkin(KMO)检验及Bartlett's检验测量因子分析的可行性,结果提示资料适合因子分析,最终提取出9个因子,累计贡献率为65.65%。[结论]构建的ICU成人护理工时评估体系具有较好的信效度,可全面、系统地评估ICU护理工作量,为护理管理者提供可靠的理论依据和数据支持。     

护理活动评分系统在心脏外科ICU护理人力需求中的应用

目的探讨护理活动评分(NAS)在心脏外科ICU护理人力需求中的应用效果,为合理配置护理人力资源提供参考。方法采用NAS对成人心脏外科ICU 385个班次的护理工作量进行评分,分析NAS测定的护理人力需求与实际护理人力配置的差异,并比较不同班次,入住ICU不同时期、不同通气方式、不同疾病严重程度患者NAS得分差异,预测护理人力需求。结果 NAS预测护患比高于实际护患比,差异有统计学意义(P0.05),NAS预测护患比在不同班次、入住ICU不同时期、不同通气方式、不同疾病严重程度患者间均存在统计学差异(P0.05)。结论心脏外科ICU的护理工作量大,需根据护理活动评分系统酌情增加护理人力的配置,进行护理人力配置时需综合考虑不同班次、入住ICU不同时期、不同通气状态、不同病情严重程度护理工作量的差异,科学合理配置护理人力资源。     

不同量表在测量ICU护理工作量中的应用

目的 了解应用护理活动评估量表(nursing activities score,NAS)和治疗干预评分系统28版(simplified therapeutic intervention scoring system,TISS-28)测量ICU护理工作量情况,分析两种量表间的一致性.方法 选择在自贡市两所医院ICU住院治疗的305例患者,同时应用TISS-28量表和NAS量表测量ICU护理工作量,分析两种量表间的一致性及测算两所医院ICU护患比.结果 两所医院应用TISS-28量表和NAS量表测量ICU的护理工作量比较,r=0.808,P＜0.001;r=0.925,P＜0.001,两种量表具有一定的相关性.其所测得两所医院的护患比比较,均P＞ 0.05,差异无统计学意义.结论 TISS-28量表和NAS量表内在一致性较好,具有简单、快速、有效的优势,可选择任何一种量表测量ICU护理工作量,为ICU护理人力资源的有效管理提供数据支持.     

透析病人主要照顾者照顾性行为评估表的信效度研究

[目的]翻译"透析病人主要照顾者照顾性行为评估量表"(caregiving to adults on dialysis,LC-GADs),评价其信度、效度及文化相关性,提供一种有效方便的透析病人照顾性行为评估的中文版问卷.[方法] 应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价.对136例透析病人的主要照顾者应用问卷调查对其结构效度进行评价.对其中30例主要照顾者进行重测,进行重测信度评价.[结果]问卷中所有条目均具有较好的文化相关性,其中1个条目被重新修订.中文版LC-GADs有较好的信度和效度,内容效度指数(CVI)为0.975.问卷的信度和效度Cronbach's α分别为0.93和0.86,重测信度为0.80和0.76.因子分析显示中文版LC GADs具有与原英文版量表一致的结构效度.[结论]中文版LC-GADs是一种具有较高信度和效度的评估透析病人照顾者专用行为评估量表,可以为以后广大护理同仁在研究透析病人照顾者行为相关方面提供可靠的数据支持.     

护理活动评分系统在ICU人力资源管理中的应用

目的探讨护理活动评分系统在ICU人力资源管理中的应用效果。方法采用护理活动评估量表（nursing activities scale,NAS）测量在本院ICU住院的149例病人的护理工作量,根据工作量计算护士人数,并预见性地合理安排每班护士人数。结果 ICU病人当天需要的护理工作量得分最低为30.50分,最高为129.70分,平均（53.23±18.12）分。所需护患比为1～2∶1的占了68.73%。实施护理活动评分系统后护理不良事件总发生率为18.12%,明显少于实施前33.12%,实施前后比较,χ2=8.909,P〈0.001,差异具有统计学意义。结论 ICU护士人力应以所收治病人实际需要的护理工作量进行动态合理分配。采用护理活动评分系统进行人力资源管理可提高ICU护理质量。     

Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score

Background

Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent.

Aim

To assess the nursing workload in a Portuguese ICU using the NAS.

Study Design

Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June–31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines.

Results

The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team.

Conclusions

The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety.

Relevance to Clinical Practice

This was one of the first studies carried out with the NAS after its cross-cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the ‘administrative and management activities’ related to the ‘patient discharge procedures’, the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse-to-patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU.     

Measuring the nursing workload per shift in the ICU

Purpose

In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24?h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of this study was to evaluate if differences in nursing workload between consecutive shifts can be identified by a nursing workload measurement tool.

Methods

The nursing activities score (NAS) was registered per patient for every shift during a 4-week period in a prospective, observational research project in the surgical-pediatric ICU (SICU-PICU) and medical ICU (MICU) of an academic hospital.

Results

The NAS was influenced by the patient characteristics and the type of shift. Furthermore, the scores were lower during night shifts, in weekends and in MICU patients. Overall, the mean NAS per nurse per shift was 85.5?%, and the NAS per 24?h was 54.7?%.

Conclusion

This study has shown that the nursing workload can be measured per working shift. In the ICU, the NAS differentiates the nursing workload between shifts, patients and units.     

Nursing Activities Score in the intensive care unit: analysis of the related factors.

BACKGROUND: High costs of intensive care as well as quality of care and patient safety demand measurement of nursing workload in order to determine nursing staff requirements. It is also important to be aware of the factors related to high patient care demands in order to help forecast staff requirements in intensive care units (ICUs). OBJECTIVES: To describe nursing workload using the Nursing Activities Score (NAS); to explore the association between NAS and patients variables, i.e. gender, age, length of stay (LOS), ICU discharge, treatment in the ICU, Simplified Acute Physiology Score II (SAPS II) and Therapeutic Interventions Scoring System-28 (TISS-28). METHODS: NAS, demographic data, SAPS II and TISS-28 were analysed among 200 patients from four different ICUs in a private hospital in S?o Paulo, Brazil. RESULTS: NAS median were 66.4%. High NAS scores (> 66.4%) were associated with death (p-value 0.006) and LOS (p-value 0.015). Logistic regression analysis demonstrated that TISS-28 scores above 23 and SAPS II scores above 46.5 points, classified as high, increased 5.45 and 2.78 times, respectively, the possibility of a high workload as compared to lower values of the same indexes. CONCLUSION: This study shows that the highest NAS scores were associated with increased mortality, LOS, severity of the patient illness (SAPS II), and particularly to TISS-28 in the ICU.     

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.     

Factors associated with nursing workload in adult intensive care units

This study was aimed both at analyzing the nursing workload on the first day of admission of patients in Intensive Care Units (ICUs) and the factors associated with it. This is a qualitative, retrospective, cross-section study that was carried out in April of 2002 and October of 2004. The data were taken from a database that gathered information from 5 ICUs from two private hospitals and the sample was comprised of 214 adult patients that remained in the ICU for at least 24 hours. The total Nursing Activities Score (NAS) average was 69.9%, and the median 68.0%. According to the median, it was verified that 109 (50.9%) individuals required heavy nursing attention and the remaining 105 (49.1%) required less attention. The severity of the illness, the patient's age and the kind of treatment were not factors associated with nursing workload in the first 24 hours at the ICU.     

运用两种评分法对神经内科ICU急性期患者护理工作量的研究

目的通过两种评分方法评价神经内科重症患者的护理工作量。方法根据重症监护护理评分系统修订量表的内容与计时法,对入住神经内科ICU急性期的25例患者进行护理工作量和护理时间的评价。结果神经内科ICU患者不同班次的护理工作量差异具有统计学意义(P0.01);机械通气与非机械通气患者护理评分差异无统计学意义(P0.05),而每例患者护理所消耗的时间差异具有统计学意义(P0.01)。结论重症监护护理评分系统修订量表与计时法反映了神经内科不同班次、不同危重程度患者的护理工作量,为动态调配护士人力资源提供了有价值的数据支持。