# Comparison of the Nursing Workload of Hospitalized Patients in Pediatric ICU among the P-NAS, TISS-28 and NEMS Scales

**Introduction: **Nursing workload (NW) measurement scales are valuable tools for assessing the quality of care provided and nursing staffing. Several tools have been developed to measure NW, such as the Pediatric Nursing Activity Score (P-NAS), Nine Equivalents of Nursing Manpower (NEMS) and Therapeutic Intervention Scoring System (TISS-28) scales. However, the relationship of all three scales in Pediatric Intensive Care Units (PICU) in Greece has not been investigated.

**Aim: **To measure and compare NW among the P-NAS, NEMS and TISS-28 scales in patients hospitalized in the PICU, as well as to investigate potential correlation of the measured NW with the average length of stay (LOS), clinical severity and patients’ outcome.

**Method: **A prospective, cross-sectional, observational study with repeated measures was performed in one PICU in Greece. The study sample consisted of patients (age < 18 years) who were hospitalized in the ICU for at least 8 hours from 1/1/2021 to 31/3/2021. NW was assessed daily for each patient with the P-NAS, NEMS and TISS-28 scales, while clinical severity was assessed on the 1st day of patients’ hospitalization using the Pediatric Risk of Mortality (PRISM) score. Descriptive analyses, correlation study with parametric and non-parametric methods, and multiple linear regression were performed, with statistical significance α=0.05 (SPSS v.28).

**Results: **The study sample consisted of 61 patients (49.2% boys; median age: 41.00 months) and 330 NW records were performed. The median PRISM score was 8.00 and the median ICU LOS was 4.00 days. Four (6.6%) children died. The mean NW with the NAS scale was equal to 66,33 (±16,44), for the NEMS was 27.40 (±8.65), and for the TISS-28 was 26.60 (±8.28). All scales correlated statistically significantly (0.747≤r≤0.869, p<0.001). In the Bland-Altman concordance test, the percentage of observations that were outside the limits of agreement was 6.7% between the P-NAS and TISS-28 scales, 5.2% between the P-NAS and NEMS, and 3.6% between NEMS and TISS-28 5.2%. The NW on admission had statistically significant correlation with the LOS (rho=0.507, p<0.001) and the PRISM score (rho=0.464, p<0.001). Patients who died had a statistically significantly greater NW on admission than those who survived (p<0.001). In multiple linear regression, PRISM score and department of origin were found to be predictors of admission NW score.

**Conclusions: **The P-NAS, NEMS and TISS-28 scales are reliable and valid tools for the assessment of NW in PICU. NW is associated with patient outcome, length of stay, and patient severity.

Category: | Volume 61, Issue 4 |

Hits: | 347 Hits |

Created Date: |
08-03-2023 |

Authors: | Alexandra – Stavroula Nieri , Paraskevi Feizidou , Eleni Panagou , Alkisti Kotsia , Daphne Kaitelidou , Vasiliki Matziou , Margarita Giannakopoulou |