Association between nursing workload and staff size with the occurrence of adverse events and deaths of patients with COVID-19: A retrospective cohort study.

IF 3 3区医学 Q1 NURSING

Nursing in Critical Care Pub Date : 2025-01-14 DOI:10.1111/nicc.13221

Carolina Cassiano, Lilia de Souza Nogueira, Ana Carolina Unger Araújo, Fernanda Rodrigues Lima, Nasrin Hanifi

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引用次数: 0

Abstract

Background: 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.

Aim: 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.

Study design: 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.

Results: 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.

Conclusion: 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.

Relevance to clinical practice: The results reinforce the importance of evaluating the workload of nursing professionals to establish safety measures for the care of patients with infectious diseases.

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护理工作量和人员规模与COVID-19患者不良事件发生和死亡之间的关系：一项回顾性队列研究

背景：重症监护病房（ICU）患者的安全受到护理专业人员配备不足的严重影响，以满足重症患者的护理需求。COVID-19患者增加了护士的工作量，特别是在ICU等高强度护理环境中。目的：探讨重症监护病房重症COVID-19患者的护理工作量和护理人数与不良事件发生和死亡的关系。研究设计：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日期间在巴西一家医院ICU住院的12岁或以上的COVID-19患者。采用护理活动评分（NAS）测量护理工作量。自变量为每个护理专业人员的NAS评分（NNR）和每个护理专业人员的患者数（PNR）之比。因变量包括ICU的不良事件（压力损伤和卫生保健相关感染- hais）和死亡。结果：386例患者中，男性占59.59%，中位年龄60.5岁。NAS、NNR和PNR中位数分别为72.81%、128%和1.64。压伤发生率（31.09%）高于急性呼吸道感染（16.06%），死亡218例（56.48%）。NNR与HAIs相关(OR 1.006；CI95% 1.001 - -1.012;p = 0.012)，压伤(OR 1.005；CI95% 1.000 - -1.010;p = 0.033)和死亡(OR 1.010；CI95% 1.005 - -1.015;p结论：护理人员的高工作量与ICU中COVID-19患者不良事件和死亡的发生有关，而护理人员的规模与此无关。与临床实践的相关性：结果强调了评估护理专业人员工作量对建立传染病患者护理安全措施的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nursing in Critical Care NURSING-

CiteScore

6.00

自引率

13.30%

发文量

109

审稿时长

>12 weeks

期刊介绍： Nursing in Critical Care is an international peer-reviewed journal covering any aspect of critical care nursing practice, research, education or management. Critical care nursing is defined as the whole spectrum of skills, knowledge and attitudes utilised by practitioners in any setting where adults or children, and their families, are experiencing acute and critical illness. Such settings encompass general and specialist hospitals, and the community. Nursing in Critical Care covers the diverse specialities of critical care nursing including surgery, medicine, cardiac, renal, neurosciences, haematology, obstetrics, accident and emergency, neonatal nursing and paediatrics. Papers published in the journal normally fall into one of the following categories: -research reports -literature reviews -developments in practice, education or management -reflections on practice