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Factors Related to Workload of Intensive Care Unit Nurses: Systematic Review and Meta-Analysis

중환자실 간호사의 업무부담 관련 요인: 체계적 문헌고찰 및 메타분석

  • Jeong, Ah In (College of Nursing, Ewha Womans University) ;
  • Shin, Sujin (College of Nursing, Ewha Womans University) ;
  • Hong, Eunmin (College of Nursing, Ewha Womans University)
  • 정아인 (이화여자대학교 간호대학) ;
  • 신수진 (이화여자대학교 간호대학) ;
  • 홍은민 (이화여자대학교 간호대학)
  • Received : 2023.09.29
  • Accepted : 2023.10.25
  • Published : 2023.12.31

Abstract

Purpose: This study aimed to identify factors related to the workload of intensive care unit nurses through a systematic literature review and meta-analysis to provide basic data to explore the direction of development of nursing staffing standards. Methods: This study involved quantitative studies about nurses working in intensive care units related to nursing workload published in English or Korean since 2000. Search terms included 'intensive care unit', 'nursing workload', and their variations. Databases such as RISS, DBpia, MEDLINE(PubMed), CINAHL, PsycINFO, and Web of Science were utilized. Quality assessment was conducted using the Joanna Briggs Institute's Critical Appraisal Checklist for Analytical Cross-Sectional Studies. JAMOVI software facilitated the analysis of effect sizes, employing a meta-analysis approach for 7 studies with correlational or regression data. Results: From 16 studies on the workload of intensive care unit nurses, a total of 20 patient and nurse-related factors were identified. Patient-related factors included severity of illness, length of stay, and age. Meta-analysis was conducted for three patient-related factors: age, severity of illness measured by SAPS 3, and length of stay. Only severity of illness measured by SAPS 3 was significantly associated with nurse workload (Zr=0.16, p<.001, 95% CI=0.09-0.24). Conclusion: In previous studies, the characteristics of intensive care units and patients varied across studies, and a variety of scales for measuring workload and severity of illness were also used. Sustained research reflecting domestic intensive care unit work environments and assessing the workload of intensive care unit nurses should be imperative.

Keywords

References

  1. 2020 domestic intensive care unit status survey report: White paper of Korean Society of Critical Care Medicine [Internet]. Seoul: Korean Society of Critical Care Medicine; 2020 Jun 25 [cited 2023 Aug 10]. Available from: http://plan.medone.co.kr/67_ksccm/data/ksccm_report_book_2020.pdf.
  2. Sousa CR, Goncalves LA, Toffoleto MC, Leao K, Padilha KG. Predictors of nursing workload in elderly patients admitted to intensive care units. Revista Latino-Americana de Enfermagem. 2008;16(2):218-223. https://doi.org/10.1590/s0104-11692008000200008
  3. Lee JM, Lee KO, Hong JH, Park HH. Analysis of factors related to mortality in adult ICU patients: Focusing on nurse staffing level. Journal of Muscle and Joint Health. 2022;29(1):41-49. https://doi.org/10.5953/JMJH.2022.29.1.41
  4. Bae SH. Intensive care nurse staffing and nurse outcomes: A systematic review. Nursing in Critical Care. 2021;26(6):457-466. https://doi.org/10.1111/nicc.12588
  5. Abbey M, Chaboyer W, Mitchell M. Understanding the work of intensive care nurses: A time and motion study. Australian Critical Care. 2012;25(1):13-22. https://doi.org/10.1016/j.aucc.2011.08.002
  6. Park MO, Yang EJ, Lee MM, Cho SH, Shim MY, Lee SH. The nurse staffing in intensive care units based on nursing care needs: A multicenter study. Journal of Korean Critical Care Nursing. 2021;14(2):1-11. https://doi.org/10.34250/jkccn.2021.14.2.1
  7. Driscoll A, Grant MJ, Carroll D, Dalton S, Deaton C, Jones I, et al. The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2018;17(1):6-22. https://doi.org/10.1177/1474515117721561
  8. Lee JM, Han CH, Lee SM, Lee SC, Hong JH, Park HY, et al. Analysis of current status of adult intensive care unit use and treatment status by nursing institution according to severity. Goyang: National Health Insurance Service, Ilsan Hospital; 2020 Oct. Report No: NHIMC 2020-20-011.
  9. Oliveira AC, Garcia PC, Nogueira LS. Nursing workload and occurrence of adverse events in intensive care: A systematic review. Revista da Escola de Enfermagem da USP. 2016;50(4):683-694. https://doi.org/10.1590/S0080-623420160000500020
  10. Harkanen M, Vehvilainen-Julkunen K, Murrells T, Paananen J, Franklin, BD, Rafferty AM. The contribution of staffing to medication administration errors: A text mining analysis of incident report data. Journal of Nursing Scholarship. 2020;52(1):113-123. https://doi.org/10.1111/jnu.12531
  11. Kiekkas P, Brokalaki H, Manolis E, Samios A, Skartsani C, Baltopoulos G. Patient severity as an indicator of nursing workload in the intensive care unit. Nursing in Critical Care. 2007;12(1):34-41. https://doi.org/10.1111/j.1478-5153.2006.00193.x
  12. Park YS, Song RY. Estimation of nurse staffing based on nursing workload with reference to a patient classification system for a intensive care unit. Journal of Korean Critical Care Nursing. 2017;10(1):1-12.
  13. Kiekkas P, Sakellaropoulos GC, Brokalaki H, Manolis E, Samios A, Skartsani C, et al. Association between nursing workload and mortality of intensive care unit patients. Journal of Nursing Scholarship. 2008;40(4):385-390. https://doi.org/10.1111/j.1547-5069.2008.00254.x
  14. Hoogendoorn ME, Brinkman S, Spijkstra JJ, Bosman RJ, Margadant CC, Haringman J, de Keizer NF. The objective nursing workload and perceived nursing workload in Intensive Care Units: Analysis of association. Int J Nurs Stud. 2021 Feb;114:103852. https://doi.org/10.1016/j.ijnurstu.2020.103852
  15. Padilha KG, de Sousa RM, Queijo AF, Mendes AM, Reis Miranda D. Nursing activities score in the intensive care unit: Analysis of the related factors. Intensive and Critical Care Nursing. 2008;24(3):197-204. https://doi.org/10.1016/j.iccn.2007.09.004
  16. Huang SL, Cheng H, Duffield C, Denney-Wilson E. The relationship between patient obesity and nursing workload: An integrative review. Journal of Clinical Nursing. 2021;30(13-14):1810-1825. https://doi.org/10.1111/jocn.15679s
  17. Ozturk Birge A, Beduk T. The relationship of delirium and risk factors for cardiology intensive care unit patients with the nursing workload. Journal of Clinical Nursing. 2018;27(9-10):2109-2119. https://doi.org/10.1111/jocn.14365
  18. Reis JDD, Sa-Couto P, Mateus J, Simoes CJ, Rodrigues A, Sardo P, et al. Impact of wound dressing changes on nursing workload in an intensive care unit. International Journal of Environmental Research and Public Health. 2023;20(7):5284. https://doi.org/10.3390/ijerph20075284
  19. Cho SH, Song KJ, Park IS, Kim YH, Kim MS, Gong DH, et al. Development of staffing levels for nursing personnel to provide inpatients with integrated nursing care. Journal of Korean Academy of Nursing Administration. 2017;23(2):211-222. https://doi.org/10.11111/jkana.2017.23.2.211
  20. Lucchini A, De Felippis C, Elli S, Schifano L, Rolla F, Pegoraro F, et al. Nursing Activities Score (NAS): 5 years of experience in the intensive care units of an Italian University hospital. Intensive and Critical Care Nursing. 2014;30(3):152-158. https://doi.org/10.1016/j.iccn.2013.10.004
  21. Yoo HS, Kim JH. Measurement of relative value scales of nursing activities in wards of general hospitals. Journal of the Korean Data Analysis Society. 2011;13(1):91-106.
  22. Yim MY, Hwang WJ. Workload and job satisfaction of home health care nurses in Korea. Journal of Korean Academic Society of Home Health Care Nursing, 2017;24(1):5-13. https://doi.org/10.22705/jkashcn.2017.24.1.005
  23. Lee YY. Comparison of nursing workload associated with patient and anesthetic factors in the post-anesthesia care unit. Journal of Korean Nursing Administration Academic Society. 2008;14(4):432-439. http://www.riss.kr/link?id=A76516818
  24. An HN, Ahn SH. Evaluating nursing needs in neonatal intensive care unit with the Korean patient classification system for neonatal intensive care nurses. Journal of Korean Critical Care Nursing. 2020;13(2):24-35. https://doi.org/10.34250/jkccn.2020.13.2.24
  25. Chang LY, Yu HH, Chao YC. The relationship between nursing workload, quality of care, and nursing payment in intensive care units. Journal of Nursing Research. 2019;27(1):1-9. https://doi.org/10.1097/jnr.0000000000000265
  26. Jeon EK. Nursing workload measurement of neonatal intensive care unit nurses. Korean Nurse. 2001;40(4):69-71.
  27. Yuan Z, Wang J, Feng F, Jin M, Xie W, He H, et al. The levels and related factors of mental workload among nurses: A systematic review and meta-analysis. International Journal of Nursing Practice. 2023;29(5):e13148. https://doi.org/10.1111/ijn.13148
  28. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Journal of Clinical Epidemiology. 2021;134:178-189. https://doi.org/10.1016/j.jclinepi.2021.03.001
  29. Checklist for systematic reviews and research syntheses: The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews [Internet]. Adelaide(AU): Joanna Briggs Institute; c2017 [cited 2023 Aug 25]. Available from: https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Systematic_Reviews2017_0.pdf.
  30. Mahmood K, Eldeirawi K, Wahidi MM. Association of gender with outcomes in critically ill patients. Critcal Care. 2012;16(3):R92. https://doi.org/10.1186/cc11355