Marga Hoogendoorn

141 SUMMARY Critical ill patients in the Intensive Care Unit (ICU) require a high amount of care. Due to their critical illness, they are in need for monitoring and use of modalities for organ support, and therefore specialized nursing care. Due this complex and specific care the nursing staff consists mainly of certified ICU nurses, and they can take care for only a limited number of patients per shift. The high need for specialized nursing care is the main reason that the costs for nursing staff are the largest part of the ICU budget. In a situation of shortage of certified ICU nurses in most West European countries it is important to deploy the nursing staff as efficiently as possible. Due to budget constraints overstaffing must be avoided, but understaffing should also be avoided because of the increased risk of burn-out or bore-out. It is therefore important to quantify the amount of nursing work, i.e., the nursing workload and the need for nursing staff. In this thesis we focus on two aspects of nursing workload; the amount of time needed for patient care (the objective nursing workload) and the impact of this patient care on the nurse (the subjective or perceived nursing workload). Furthermore, we describe the importance of nursing workload for the planning of nursing staff and the impact of COVID on both the workload and planning of nursing staff. Chapter 2 describes the results of a systematic review on available workload scoring systems and evaluation of the content validity, reliability and validity of those systems. We searched the bibliographic databases MEDLINE, Embase and Cinahl on English, Dutch and German articles about systems measuring nursing workload in Intensive Care that includes a translation into the amount of nursing time needed. From 71 included articles we identified 34 different scoring systems of which 27 systems were included for further analysis as they described a translation of workload into nursing time needed. We identified the Nursing Activities Score (NAS) as the best performing model although there is room for improvement. The NAS is validated with a work sampling method obtained by Multi Moment Recordings and explains 81% of the time spent by nurses. Although originally developed to measure the nursing workload per day it has also been validated for a use per shift. The results of the interrater and intra-rater reliability vary from low to good, with low results for the items that estimate time by nurses and good results for the other items. Due to the important role of workload scoring systems, we concluded that it is necessary to improve the reliability and accuracy of the NAS for a translation into the needed nursing time. Chapter 3 describes the results of a validation study with the most used ICU workload scoring system to find out if the NAS is in need for a revision after more than fifteen years