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Identifier 000454754
Title Σύγκριση εργαλείων φόρτου νοσηλευτικής φροντίδας και συσχέτιση με δείκτες βαρύτητας νόσου και έκβασης παιδιατρικών ασθενών σε πανεπιστημιακή ΜΕΘ
Alternative Title Comparison of nursing workload tools and relation to severity of illness and outcome indices in an academic pediatric intensive care unit
Author Σινάνη, Γεωργία
Thesis advisor Ηλία, Σταυρούλα
Reviewer Μπριασούλης, Γεώργιος
Ακουμιανάκη, Ευαγγελία
Abstract Background: Children hospitalized in the Pediatric ICUs are in critical condition and need quality care from specialized staff that aims to treat, reduce the complications of disease, pain, anxiety and support young patients and their families. The increased time required to care for ICU children translates into a nursing workload (NW) and is greater than in other nursing departments. Nursing workload can affect both the quality of care provided and patient safety. Staff burnout due to this has a direct impact on adverse patient outcomes. The use of tools to assess the nursing workload that can contribute to the proper utilization of logistical and human resources expressed by the ratio of patients per nurse in pediatric ICUs is important. Correlating nursing workload with severity and risk scales of pediatric ICU patients is also important because are particularly susceptible to experiencing adverse events when NW is high. Objective: The present study aims to measure and quantify the burden of nursing workload (NW) with reliable scales, to compare them and to correlate NW with indicators of clinical severity and outcome of pediatric patients hospitalized in the PICU of Crete and in the calculation of optimal staffing. Methods: The study is a prospective cohort study conducted in the Children’s ICU of the University General Hospital of Heraklion, Crete. The sample of the study was all the pediatric patients of the ICU, aged 29 days to 18 years, who were hospitalized between June and December 2021. The pediatric scales NAS (Nursing Activities Score), TISS-28 (Therapeutic Intervention Scoring System 28) and NEMS (Nine Equivalents of nursing Manpower use Score) were used to measure the nursing workload. The tools used to assess the clinical severity of the patients were the Glasgow Pediatric Scale, the Multiple Organ Dysfunction Index (PELOD-2) the Pediatric Mortality Index III (PIM III) and PRISM III/IV. Also, the Humpty Dumpty Fales Score (HDFS) and Braden Q scales were used for patient’s risk of falls and pressure ulcer risk, respectively. Demographic and clinical laboratory data were recorded from the electronic (CRITIS, a Med Web) and physical records of the patients. Data were collected and recorded in an excel worksheet. The statistical analysis of the data was done with the statistical application package SPSS 28.0. The level of significance was set as a=0.05. Results: In the total population studied, 60% were boys, the median age was 5 years, emergency admissions were 69.1%, the children's hospitalization days in the Children's ICU were 5 (median value), the children with comorbidities were 41.8% of hospitalized patients, the clinical severity of patients with the PELOD-2 scale showed that the risk of death was 4.91% and mortality was 7.3% (on the children studied) and 3.7 % (of all children who were hospitalized in the same time period). The mean NAS score was 76.75 (±15.18) corresponding to a mean care time of 1105.27 (±218.64) minutes, the TISS-28 score was 26.78 (±6.84) that is 851.67 (±217.61) minutes of nursing care and NEMS was 27.41 (±7.01) which is equivalent to 871.66 (±222.76) minutes of care provided. The TISS-28 scale was found to have a moderate positive statistically significant linear correlation with the NAS scale (r=0.543, p<0.001) and a strong positive statistically significant linear correlation with the NEMS scale (r=0.764). Also, the NAS scale was found to have a moderately positive statistically significant linear correlation with the NEMS (r=0.388, p<0.001). The Bland-Altman concordance test showed that 5.4% of the total recordings differed from the upper and lower limits of agreement of the P-NAS and TISS-28 scales. The corresponding percentages for the P-NAS and NEMS scales and for the NEMS and TISS-28 scales were 5.8% and 3.5%, respectively. Patients admitted to the Children's ICU from the ED had a significantly higher daily NAS nursing workload patients admitted from the OR [76.64 (±10.29) vs. 67.82 (±10.67), p =0.003]. NAS nursing workload was found to have a positive linear statistically significant correlation with the length of stay of patients in the Children's ICU (r=0.562, p<0.001), that is, patients with a higher NAS score tended to have a longer length of stay. The discriminative ability of the severity and outcome prognostic scale scores and nursing workload scales between patients who survived and those who died was high. The Braden Q scale score (pressure ulcers) was found to have a statistically significant negative linear correlation with TISS-28 (r=-0.469, p<0.001), NAS (r=-0.257, p<0.001) and NEMS ( r=-0.627, p<0.001) and the HDFS (falls) scale score was found to have a statistically significant positive linear correlation with the TISS-28 (r=0.336, p<0.001) and NEMS (r=0.487 p<0.001 ). The optimal nurse-patient ratio in the Children's ICU was 1:1,2. Conclusions: The 3 nursing workload assessment scales NAS, TISS-28 and NEMS proved to be reliable and valid tools in pediatric ICUs. The NAS scale is superior to others in assessing nursing workload. Nursing workload and patient clinical severity scales predict outcome in ICU children with high discrimination. It was also found that an increased risk of developing pressure ulcers and an increased risk of falls is proportional to the increased NW of patients. Finally, optimal staffing in the Children's ICU requires additional nurses.
Language Greek
Issue date 2023-04-05
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/c/6/f/metadata-dlib-1682489209-456172-23340.tkl Bookmark and Share
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