Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments

Velozo, Kelly Dayane Stochero; Costa, Caroline Abud Drumond; Tonial, Cristian Tedesco; Crestani, Francielly; Andrades, Gabriela Rupp Hanzen; Garcia, Pedro Celiny Ramos

doi:10.1590/1980-220X-REEUSP-2020-0547

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0547 copy

Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments

Comparação da carga de trabalho de enfermagem em Unidade de Terapia Intensiva Pediátrica estimada por três instrumentos

Comparación de la carga de trabajo de enfermería en Unidad de Cuidados Intensivos Pediátrica estimada por tres instrumentos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital.

Method:

A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities.

Results:

The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations.

Conclusion:

NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

DESCRIPTORS
Pediatric Nursing; Workload; Intensive Care Units, Pediatric; Nursing, Team

Instruments	Minimum score	Maximum score	Median score	Mean score	Mean hours of work in 24 hours
NAS Mean	25.30	142.9	55	56.7 ± 12.5	13.6 ± 3.0
NAS Admission	33.6	142.9	60.1	62.6 ± 17.3	15.0 ± 4.2
NAS Maximum	33.6	142.9	65.6	67.7 ± 19.7	16.3 ± 4.7
TISS-28 Mean	7	55	21	22.1 ± 7.1	11.7 ± 3.8
TISS-28 Admission	10	48	19	20.6 ± 7.9	10.9 ± 4.2
TISS-28 Maximum	10	55	22	23.7 ± 9.3	12.6 ± 5.0
NEMS Mean	9	51	27	24.4 ± 7.7	12.9 ± 4.1
NEMS Admission	9	51	18	23.2 ± 8.6	12.3 ± 4.5
NEMS Maximum	15	51	24	25.9 ± 9.8	13.8 ± 5.2

Classification	NAS^§ NAS = Nursing Activities Score; TISS-28 = Therapeutic Intervention Scoring System-28; NEMS = Nine Equivalents of Nursing Manpower Use Score. §Values expressed as mean and standard deviation. *ANOVA and Tukey’s post hoc test, paired evaluation.	TISS-28^§ NAS = Nursing Activities Score; TISS-28 = Therapeutic Intervention Scoring System-28; NEMS = Nine Equivalents of Nursing Manpower Use Score. §Values expressed as mean and standard deviation. *ANOVA and Tukey’s post hoc test, paired evaluation.	NEMS^§ NAS = Nursing Activities Score; TISS-28 = Therapeutic Intervention Scoring System-28; NEMS = Nine Equivalents of Nursing Manpower Use Score. §Values expressed as mean and standard deviation. *ANOVA and Tukey’s post hoc test, paired evaluation.	p^* NAS = Nursing Activities Score; TISS-28 = Therapeutic Intervention Scoring System-28; NEMS = Nine Equivalents of Nursing Manpower Use Score. §Values expressed as mean and standard deviation. *ANOVA and Tukey’s post hoc test, paired evaluation.
Group 1	10.2 ± 2.5^a a, b, c The same symbol indicates that no difference was found among the instruments.	5.5 ±1.1 ^b a, b, c The same symbol indicates that no difference was found among the instruments.	7.9 ± 0.2^c a, b, c The same symbol indicates that no difference was found among the instruments.	<0.001
Group 2	3.4 ± 0.9^a	6.3 ± 3.1^b a, b, c The same symbol indicates that no difference was found among the instruments.	5.0 ± 4.1^c a, b, c The same symbol indicates that no difference was found among the instruments.	<0.001
Total	13.6 ± 3.0^a	11.8 ± 3.8^b a, b, c The same symbol indicates that no difference was found among the instruments.	12.9 ± 4.1^c a, b, c The same symbol indicates that no difference was found among the instruments.	<0.001

Correlations	r^* NAS = Nursing Activities Score; TISS-28 = Therapeutic Intervention Scoring System-28; NEMS = Nine Equivalents of Nursing Manpower Use Score. p < 0.01 for all the observations. *Pearson’s correlation coefficient.
NAS and TISS-28	0.716
NAS(1) and TISS-28(1)	0.536
NAS(2)and TISS-28(2)	0.807
NAS and NEMS	0.670
NAS(1) and NEMS(1)	0.077
NAS(2) and NEMS(2)	0.787
NEMS and TISS-28	0.862
NEMS(1) and TISS-28(1)	0.138
NEMS(2) and TISS-28(2)	0.888

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Cristian Tedesco Tonial, Av. Ipiranga, 6690, Petrópolis, 90610-000 – Porto Alegre, RS, Brazil, cristiantonial@gmail.com