Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality : a prospective, single-center cohort study
Jansson, Miia M.; Syrjälä, Hannu P.; Ala-Kokko, Tero I. (2018-12-07)
Miia M. Jansson, Hannu P. Syrjälä, Tero I. Ala-Kokko, Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective, single-center cohort study, Journal of Hospital Infection, Volume 101, Issue 3, 2019, Pages 257-263, ISSN 0195-6701, https://doi.org/10.1016/j.jhin.2018.12.001
© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe2019042913592
Tiivistelmä
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.
Kokoelmat
- Avoin saatavuus [34547]
