Abstrakt
Factors associated with increased nursing workload in a pediatric ICU: A prospective observational cohort study.
Alexandra Stavroula Nieri, Georgia Sinani, Evaggelia Asimina, Eleni Spithouraki, Stavrina Ilia, Margarita Giannakopoulou
Introduction: NW is related to the quality of care provided in the ICUs, as it was found that increased NW affects negatively both patient safety and nursing outcomes. The identification of the factors that influence the NW is particularly important, as it helps to improve care. However, it has not been investigated which factors influence the NW in Pediatric Intensives Care Units (PICU).
Aim: To assess the NW in the PICU, as well as to investigate the factors with increased NW.
Methods: A prospective and observational study was performed in one PICU (6-bed PICU and 1-bed for short-term care) in Greece from the 1st of July to the 31st of December 2021. NW was assessed daily for each patient with the P-NAS scale, while clinical severity was assessed on the 1 st day of patients' hospitalization using the Pediatric Risk of Mortality IV (PRISM IV) score and Paediatric Logistic Organ Dysfunction 2 (PELOD-2) score. Descriptive analyses, correlation study with parametric and Area under the Receiver Operating Characteristic Curve (AUC-ROC) were performed, with statistical significance α=0.05.
Results: The study sample consisted of 55 patients (60% boys; median age: 3.72 (0.69-11.78) years) and 684 NW records were performed. Four (7.3%) children died. The mean scores of P-NAS on admission, on discharge, and in total records were 83.87 (± 22.42), 72.87 (± 22.93) and 27.41 (± 7.01), respectively. The NW on admission had statistically significant correlation the PRISM IV score IV (rho=0.371, p=0.007) and PELOD-2 (rho=0.631, p<0.001). The AUC-ROC of NAS for predicting death of critically ill children was 0.929 (0.849, 1.008). The admission from another hospital (p<0.001), the emergency admission (p<0.001), and the diagnostic category of trauma (p=0.028) were associated with increased NW on admission. Moreover, department (p<0.001) and type of admission (p<0.001) and the existing of comorbidities (p<0.001) were associated with increased daily NW in PICU.
Conclusion: The P-NAS are reliable and valid tool for the assessment of NW in PICU. The P-NAS had good discrimination in predicting mortality in critically ill children. Prognostic factors of high workload were the severity scores, the coming from another hospital, the trauma diagnosis, and the emergency admission.