Miia M Jansson1, Hannu P Syrjälä2, Tero I Ala-Kokko3. 1. Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland. Electronic address: miia.jansson@oulu.fi. 2. Department of Infection Control, Oulu University Hospital, Oulu, Finland. 3. Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland; Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
Abstract
BACKGROUND: Nurse understaffing and increased nursing workload have been associated with increased risk of adverse patient outcomes and even mortality. AIM: To determine whether nurse staffing and nursing workload are associated with ventilator-associated pneumonia and mortality. METHODS: This prospective, observational cohort study was conducted in a single tertiary-level teaching hospital in Finland during 2014-2015. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System and Intensive Care Nursing Scoring System scores, and Intensive Care Nursing Scoring System indices. Ventilator-associated pneumonia was defined according to the Centers for Disease Control and Prevention criteria. FINDINGS: Evaluable data was available for 85 patients. The overall ventilator-associated pneumonia and 28-day mortality rates were 23.5% and 35.3%, respectively. Nurse staffing, measured as the daily lowest nurse-to-patient ratio (P = 0.006) and median Intensive Care Nursing Scoring System index (P = 0.046), were significantly lower in patients with ventilator-associated pneumonia. In addition, nursing workload, measured as median scores obtained by the Therapeutic Intervention Scoring System (P = 0.009) and Intensive Care Nursing Scoring System (P = 0.03), was significantly higher in infected patients. The median (P = 0.02) and daily highest (P = 0.03) Intensive Care Nursing Scoring System scores were significantly higher in non-survivors. CONCLUSIONS: Lower nurse staffing and increased nursing workload are associated with ventilator-associated pneumonia and mortality, demonstrating that adequate staffing is a prerequisite for the availability and quality of critical care services.
BACKGROUND: Nurse understaffing and increased nursing workload have been associated with increased risk of adverse patient outcomes and even mortality. AIM: To determine whether nurse staffing and nursing workload are associated with ventilator-associated pneumonia and mortality. METHODS: This prospective, observational cohort study was conducted in a single tertiary-level teaching hospital in Finland during 2014-2015. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System and Intensive Care Nursing Scoring System scores, and Intensive Care Nursing Scoring System indices. Ventilator-associated pneumonia was defined according to the Centers for Disease Control and Prevention criteria. FINDINGS: Evaluable data was available for 85 patients. The overall ventilator-associated pneumonia and 28-day mortality rates were 23.5% and 35.3%, respectively. Nurse staffing, measured as the daily lowest nurse-to-patient ratio (P = 0.006) and median Intensive Care Nursing Scoring System index (P = 0.046), were significantly lower in patients with ventilator-associated pneumonia. In addition, nursing workload, measured as median scores obtained by the Therapeutic Intervention Scoring System (P = 0.009) and Intensive Care Nursing Scoring System (P = 0.03), was significantly higher in infectedpatients. The median (P = 0.02) and daily highest (P = 0.03) Intensive Care Nursing Scoring System scores were significantly higher in non-survivors. CONCLUSIONS: Lower nurse staffing and increased nursing workload are associated with ventilator-associated pneumonia and mortality, demonstrating that adequate staffing is a prerequisite for the availability and quality of critical care services.
Authors: Diana Kushemererwa; Jenny Davis; Nompilo Moyo; Sue Gilbert; Richard Gray Journal: Int J Environ Res Public Health Date: 2020-11-19 Impact factor: 3.390