Marga Hoogendoorn

15 1 . 5 OBJ ECT I VES The aim of this thesis was to evaluate existing scoring systems to quantify ICU nursing workload and to relate this objective nursing workload to the perceived nursing workload. To fulfil this aim we addressed the following research questions: 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? 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? 3. What is the impact of COVID-19 on the ICU nursing workload? 1 . 6 THES I S OUTL I NE Research question one is answered in chapter 2 and 3. Chapter 2 of this thesis describes the results of a systematic literature review on scoring systems used to measure the amount of nursing care needed for ICU patients. We evaluated the validity and reliability of those systems and evaluated which system is most useful in daily practice in terms of quantification of the required nursing capacity. Chapter 3 describes a validation study of the Nursing Activities Score in the Dutch ICU setting, according to the literature review in chapter 2 the most used and best performing system, to measure nursing workload. We performed this validation study with time-motion techniques to find out if this system needs a revision after 15 years of use. Research question two is answered in chapter 4 and 5. In chapter 4 we describe the association between the objective nursing workload, based on the NAS, and the perceived nursing workload, based on the NASA-TLX. In chapter 5 we describe the association of both the objective nursing workload and the perceived workload with the satisfaction of nurses on their nursing workload. In chapter 6 we assessed our third research question. In this chapter we describe the impact of the COVID-19 pandemic on the nursing workload and compared it to a recent non-COVID period. Finally, chapter 7 contains the overall findings and discussion of our findings, the strengths and limitations of this research project, the implications for practice and suggestions for further research.