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Real requirements of nursing activities and patient-related factors related to nursing overload in an internal medicine department

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Abstract

Adequate nursing care can be decisive for the outcome of a patient admitted to an internal medicine ward. Individual prediction of nursing activity at the time of a patient’s admission could improve the work process. This study aimed to assess the objectively assessed nursing requirements of patients admitted to a medical setting and to identify clinical factors that correlate with high demands. This is a prospective and pragmatic observational study that enrolled patients admitted to the Internal Medicine ward at the Altovicentino Civil Hospital (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first 3 days of hospitalization and standardized as performance/5 min/patient. Patients requiring more than the 75th percentile of performance/5 min/patient were considered nursing over-activities. Multivariable models were used to assess patient-related risk factors associated with nursing over-activity. This study enrolled 333 patients (mean age: 74.2; 55.6% male). Their mean Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), Chronic Barthel Index, and Sistema Informtativo della Performance Infermieristica (SIPI) scores were 5.3, 4.2, 62.4, and 53.7, respectively. Mean National Early Warning System (NEWS) on admission was 3.9 (standard deviation: 2.8). A median of 73 (interquartile range [IQR]: 54–109) nursing care activities/5 min/patient were performed. NEWS score (odds ratio [OR]: 1.372, 95% confidence interval [95%CI]: 1.216–1.547, p < 0.001) and Acute Barthel Index (OR: 0.983, 95%CI: 0.967–0.999, p = 0.041) were independent risk factors for nursing over-activities. NEWS and the Acute Barthel Index could help reorganize nursing resources within internal medicine wards, allowing for an equal distribution between patients who require more resources and those who require less.

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Authors and Affiliations

  1. Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy

    Gianni Turcato, Marta Parodi, Francesca Fulghesu, Lidia Bertorelle, Paolo Ferretto, Daniela Milazzo, Monica Trentin & Massimo Marchetti

  2. Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

    Arian Zaboli, Francesco Brigo & Michael Mian

  3. Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy

    Serena Sibilio

  4. Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria

    Serena Sibilio

  5. College of Health Care-Professions Claudiana, Bozen, Italy

    Michael Mian

Authors
  1. Gianni Turcato
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  2. Arian Zaboli
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Contributions

GT: Conceptualization, Methodology, Investigation, Formal analysis, Data curation, Writing—Original draft preparation, Writing—Review and Editing; AZ: Conceptualization, Methodology, Formal analysis, Data curation, Writing—Original draft preparation, Writing—Review and Editing; FB: Writing—Original draft preparation, Writing—Review and Editing; MP: Investigation; FF: Investigation; LB: Investigation; SS: Writing—Original draft preparation, Writing—Review and Editing; MM: Supervision; PF: Investigation; DM: Investigation; MT: Investigation; MM: Supervision.

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Correspondence to Gianni Turcato.

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The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the local ethics committee (Comitato etico sperimentazioni cliniche ULSS 8, Berica-Vicenza, Italia; approval number: 0028977/23) and was conducted according to the Declaration of Helsinki regarding the Ethical Principles for Medical Research Involving Human Subjects.

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Each patient was asked to participate by signing a special consent document to participate in the study.

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Turcato, G., Zaboli, A., Brigo, F. et al. Real requirements of nursing activities and patient-related factors related to nursing overload in an internal medicine department. Intern Emerg Med 19, 429–443 (2024). https://doi.org/10.1007/s11739-023-03499-y

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