Marga Hoogendoorn

129 7. 1 I NTRODUCT I ON In this thesis on ICU nursing workload, we addressed three research questions. This chapter first describes and discusses the main findings per research question after which the implications of those findings are discussed. 1. Which scoring systems to measure the amount of ICU nursing workload do exist and can they be applied to measure workload in the Dutch ICU setting? Chapter 2, a systematic literature review, shows a large attention in the literature to nursing workload in Intensive Care over the last decades. We identified 34 different scoring systems of which 27 described a translation of workload into the needed nursing time, and of which the first scoring system dates from 1974. Only a minor part of the scoring systems was validated with time measurements (26%). Most scoring systems were evaluated by comparing them with another system (59%). The Nursing Activities Score (NAS) performed best, it is developed by nurses for measuring nursing workload and validated with time measurements. The review also shows that the most common way to translate the workload score into nursing time needed was by categorizing the results into a patient per nurse ratio. Validation of this translation was mostly evaluated by comparing the results with other systems or with the actual planning, not with objective time measurements. We concluded that due to this poor methodology the translation from a score into a patient per nurse ratio weakens the value of nursing workload scoring systems. Chapter 3 shows the results of a validation study of the NAS with time and motion techniques in the Dutch ICU setting. This study showed significant differences between the literature based converted NAS-times and the observed times for all items. For most of the nursing activities the converted NAS overestimated the observed time (86%). This chapter shows that after more than 15 years of use the NAS needs a revision with further validation of the translation of assigned points into the nursing time needed. 2. To what extent are the objective nursing workload and the perceived nursing workload correlated and are they associated with the satisfaction of nurses with their workload? Chapter 4 showed that, in contrast to what we expected, workload is perceived differently by nurses than measured with NAS. We found that the severity of illness of the patient, expressed by the APACHE-IVAcute Physiology Score, was significantly associatedwith the perceived nursing workload. Being a student nurse was also associated with a significant