RESUMEN
INTRODUCTION: Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. OBJECTIVES: To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. METHODS: Using a prospective observational design, data were collected between 9 August - 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. RESULTS: Analysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5-54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. CONCLUSION: TrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. IMPLICATIONS FOR CLINICAL PRACTICE: TrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.
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Enfermería de Cuidados Críticos , Atención de Enfermería , Personal de Enfermería en Hospital , Humanos , Carga de Trabajo , Estudios Prospectivos , Unidades de Cuidados IntensivosRESUMEN
BACKGROUND: Patient and/or family activated escalation may improve care to deteriorating patients. However, limited literature describes patients' and families' experience of deterioration and what barriers might restrict call activation. OBJECTIVE: This study explored patients' and families' experiences of acute ward deterioration, their perception of a need for a patient and/or family activated escalation service and barriers that may prevent them from using it. DESIGN: Using a qualitative cross sectional research design and a co-design approach, data were collected using face-to-face semi-structured interviews, field notes and reflective journaling. Between December 2015 and February 2016, purposeful sampling recruited 41 adult ward patients and family who either experienced a recent Medical Emergency team (MET) or Patient at Risk team (PART) escalation, or no recent MET or PART escalation. FINDINGS: Themes included: (1) patient awareness of their illness and deterioration, 2) the importance of returning to their normal lives, (3) reassurance on arrival of the PART and MET, (4) beliefs held to prevent use of such a service, and (5) support for a patient and/or family activated escalation service. CONCLUSION: Most participants supported a patient and/or family activated escalation service, however barriers may prevent some patients from using it.
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Equipo Hospitalario de Respuesta Rápida/normas , Satisfacción del Paciente , Pacientes/psicología , Percepción , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Factores de TiempoRESUMEN
BACKGROUND: Whilst research demonstrates the benefits of nasal high flow oxygen in the intensive care setting, limited literature exists on its benefits in ward patients. OBJECTIVES: This study evaluated the use of nasal high flow oxygen in adult ward patients with respiratory failure or at risk of respiratory deterioration. Primary outcome was an improvement in pulmonary function as indicated by decreases in respiratory and heart rates and an increase in arterial oxygen saturation via pulse oximetry. RESEARCH METHODOLOGY: Using a prospective observational research design, purposeful sampling recruited 67 adult ward patients receiving nasal high flow oxygen between May and July 2015 (inclusive). All recruited patients were included in the data analysis. RESULTS: The median age was 71.0 years (q25, q75=58.0, 78.0) and most patients were medical specialty patients (n=46, 68.7%). After commencing nasal high flow oxygen, respiratory rate (t=2.79, p=<0.01) and heart rate (t=2.23, p=0.03) decreased and arterial oxygen saturation via pulse oximetry increased (t=4.08, p=<0.001). CONCLUSION: Nasal high flow oxygen appears effective in a selective group of ward patients with respiratory failure, or at risk of respiratory deterioration, and may reduce demand on critical care beds; this warrants further research.