The objective nursing workload and perceived nursing workload in Intensive Care Units: Analysis of association.

BACKGROUND: A range of classification systems are in use for the measurement of nursing workload in Intensive Care Units. However, it is unknown to what extent the measured (objective) nursing workload, usually in terms of the amount of nursing activities, is related to the workload actually experienced (perceived) by nurses. OBJECTIVES: The aim of this study was to assess the association between the objective nursing workload and the perceived nursing workload and to identify other factors associated with the perceived nursing workload. METHODS: We measured the objective nursing workload with the Nursing Activities Score and the perceived nursing workload with the NASA-Task Load Index during 228 shifts in eight different Intensive Care Units. We used linear mixed-effect regression models to analyze the association between the objective and perceived nursing workload. Furthermore, we investigated the association of patient characteristics (severity of illness, comorbidities, age, body mass index, and planned or unplanned admission), education level of the nurse, and contextual factors (numbers of patients per nurse, the type of shift (day, evening, night) and day of admission or discharge) with perceived nursing workload. We adjusted for confounders. RESULTS: We did not find a significant association between the observed workload per nurse and perceived nursing workload (p=0.06). The APACHE-IV Acute Physiology Score of a patient was significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.02). None of the other patient characteristics was significantly associated with perceived nursing workload. Being a certified nurse or a student nurse was the only nursing or contextual factor significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.03). CONCLUSION: Workload is perceived differently by nurses compared to the objectively measured workload by the Nursing Activities Score. Both the severity of illness of the patient and being a student nurse are factors that increase the perceived nursing workload. To keep the workload of nurses in balance, planning nursing capacity should be based on the Nursing Activities Score, on the severity of patient illness and the graduation level of the nurse.

Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer.

BACKGROUND: Reduced muscle density is associated with an increased risk of postoperative complications. We examined the prognostic value of muscle density as a predictor of postoperative complications in elderly patients undergoing surgery for colorectal cancer. METHODS: Patients (≥70 years) who underwent surgery for colorectal cancer between 2006 and 2013 were selected from a prospective single centre database. The Hounsfield Unit Average (HUA or HU/mm2) of the psoas muscles at the level of the third lumbar vertebra was calculated on the scan. High and low muscle density groups were identified based on the lowest gender specific HUAC quartile. Major postoperative complications (Clavien-Dindo (CD) ≥3) within 30 days after surgery were retrospectively documented. Logistic regression analysis was used to identify risk factors for postoperative complications. RESULTS: A total of 373 patients (median age = 78 years) were included in this study. The mean muscle density score was 24.5 ± 4.3 HU/mm2 for males and 26.3 ± 5.0 HU/mm2 for females. The cut-off point for the lowest gender specific quartile was ≤22.0 HU/mm2 for males and ≤23.5 HU/mm2 for females. After multivariable regression, there was a statistically significant association between muscle density and CD ≥ 3 (OR = 1.84 (95% CI 1.11-3.06), p = 0.019). Anastomotic leakage in patients with a primary anastomosis (n = 287) occurred more often in patients with low muscle density (11.7% vs 23.3%, p = 0.016). The associations remained significant after correction for confounders. CONCLUSION: Low muscle density is associated with major postoperative complications in older patients who undergo surgery for colorectal cancer.