Comparison of workloads in two nursing care delivery models in adult intensive care units

TL;DR

This study compares nursing workloads in two intensive care units in Colombia, finding that nurses are overburdened and care is often missed due to high patient demands and mismatched staffing.

Contribution

The study provides empirical evidence on nursing workload and missed care in Colombian ICUs, highlighting the impact of staffing models and patient complexity.

Findings

Nurses in both ICUs had higher patient assignments than recommended by TISS-28.

Surgical and high-risk patients required more care time, increasing the risk of adverse events.

Nursing assistants in one unit performed tasks beyond their training and legal scope.

Abstract

Work overload is associated with missed care and a higher prevalence of adverse events. The study aims to generate empirical evidence on nursing workload in intensive care units in Colombia, considering differences in team composition based on qualifications, skills, and competencies (Skill Mix).

To compare the workload and distribution of nursing activities in two intensives cares units with different Nursing Care Models based on the application of the TISS-28.

Quantitative and retrospective study with data from medical records of patients treated between 2018 and 2020 in Medellín. The TISS-28 was calculated upon admission and SAPS-3 was used to control for confounding variables. Mean and proportion comparison tests were used according to the type of variable and data distribution pattern.

The nurses in both ICUs had a patient assignment higher than indicated by the TISS-28. Surgical patients, those with vasoactive drugs, transfusions, adverse events, or those who died, had longer care times. The adverse events increased proportionally with the TISS-28 level.

Key elements include the relationship between care safety and staff qualification, experience and workload; the missed nursing care; and the undervaluation of care as a public good.

It was identified that in both ICUs there is a higher workload for nurses regarding the time available for activities and patients. The majority of care provided by the nursing assistants in the ICU2-Assistants do not correspond with their level of training and legal responsibility.

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