Simplified Therapeutic Intervention Scoring System: The TISS-28 items - Results from a multicenter study
Simplified Therapeutic Intervention Scoring System: The TISS-28 items - Results from a multicenter study
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DOI：
10.1097/00003246-199601000-00012
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发表时间：
1996-01-01
影响因子：
8.8
通讯作者：
Schaufeli, W
中科院分区：
文献类型：
--
作者：
Miranda, DR;deRijk, A;Schaufeli, W
目的：为了验证简化版的治疗干预评分系统TISS-28，并确定TISS-28与评分和未评分的护理活动所花费的时间之间的关联。设计：前瞻性多中心研究。设置：22个成人内科、外科和普通荷兰重症监护室（ICU）。患者：共有903名连续入住ICU的患者。干预：TISS-28是从TISS-76项目的10，000个记录的随机样本中构建的。通过原点使用多变量回归分析计算相应的权重; TISS-76评分用作预测值。在另一个随机抽样的10，000条记录中进行交叉验证，并将TISS-76的得分与TISS-28的得分进行比较将ICU的护理活动分为6类：a）TISS-28中的护理活动，B）TISS-28中未包括的护理活动，b）TISS-28中未包括的护理活动，c）TISS-28中未包括的护理活动，d）TISS-28中未包括的护理活动。c）间接患者护理（与患者相关但不直接接触患者的活动，例如与家人接触，维持供应）; d）组织活动（例如，会议、实习生监督、研究）; e）个人活动（对于护士他/她自己，例如休息、上厕所）; f）其他。在1个月的时间内，由独立评分员每天从患者的记录中确定TISS-76和TISS-28评分。在一周的时间里，所有值班护士都使用一种称为“工作抽样”的方法对他们的活动进行评分。测量和主要结果：验证分析包括1,820对有效的TISS-76和TISS-28记录。TISS-28的平均值（28.8 +/- 11.1）高于（p < .00）TISS-76的值（24.2 +/- 10.2）。TISS-28解释了TISS-76中86%的变异（r = 0.93，r（2）= 0.86）。“工作抽样”产生了10 079份护理活动登记，其中5 530份可与TISS-28记录相匹配。样本取自内科（19.3%）、外科（19.1%）和普通（61.6%）ICU。在这些样本中，51.1%来自大学医院，35.8%来自床位超过500张的医院，7.1%来自300至500张床位的医院，5.8%来自60分的医院）。在TISS分数的连续组中，用TISS-28评分的活动所花费的时间比例显著增加。在较低的TISS评分组（0至20分），有一个显着较大的比例的时间分配给病人的护理活动，而不是在TISS-28。有没有显着差异的比例时，花费的时间将间接的病人护理和组织活动与TISS评分的水平。在TISS评分的连续组中，用于个人活动的时间比例显着下降。每个班次的个人活动平均时间在1小时至40分钟（0至20分TISS组）和1小时至16分钟（>60分TISS组）之间变化。在夜班期间，患者护理活动所用的时间明显多于白天或夜班。相反，护士在夜班期间花在个人护理活动上的时间显着减少。三个班次的间接护理活动所消耗的时间没有显著差异，一个典型的护士能够提供相当于46.35 TISS-28分/班次的工作（一个TISS-28点等于每班护士的10.6分钟）。简化的TISS-28解释了TISS-76中86%的变化，因此可以在ICU的临床实践中取代原始版本。典型的护士能够提供等于46个TISS-28分的护理活动。该信息，连同关于TISS评分与ICU内的各种护理活动中花费的时间的关联的信息，与ICU中的护理人力的管理相关。
Objectives: To validate a simplified version of the Therapeutic Intervention Scoring System, the TISS-28, and to determine the association of TISS-28 with the time spent on scored and nonscored nursing activities.Design: Prospective, multicenter study.Setting: Twenty-two adult medical, surgical, and general Dutch intensive care units (ICUs).Patients: A total of 903 patients consecutively admitted to the ICUs.Interventions: TISS-28 was constructed from a random sample of 10,000 records of TISS-76 items. The respective weights were calculated using multivariable regression analysis through the origin; TISS-76 scores were used as predicted values. Cross validation was performed in another random sample of 10,000 records and the scores of TISS-76 were compared with those scores obtained with TISS-28 (r = .96, r(2) = .93).Nursing activities in the ICU were inventoried and divided into six categories: a) activities in TISS-28; b) patient care activities not in TISS-28; c) indirect patient care (activities related to but not in direct contact with the patient, such as contact with family, maintaining supplies); d) organizational activities (e.g., meetings, trainee supervision, research); e) personal activities (for the nurse him/herself, such as taking a break, going to the bathroom); f) other.During a 1-month period, TISS-76 and TISS-28 scores were determined daily from the patient's records by independent raters. During a 1-wk period, all of the nurses on duty scored their activities using a method called ''work sampling.''Measurements and Main Results: The analysis of validation included 1,820 valid pairs of TISS-76 and TISS-28 records. The mean value of TISS-28 (28.8 +/- 11.1) was higher (p < .00) than that value of TISS-76 (24.2 +/- 10.2). TISS-28 explained 86% of the variation in TISS-76 (r = .93, r(2) = .86).''Work sampling'' generated 10,079 registrations of nursing activities, of which 5,530 could be matched with TISS-28 records. Samples were taken from medical (19.3%), surgical (19.1%), and general (61.6%) ICUs. Of these samples, 51.1% originated from university hospitals, 35.8% from hospitals with >500 beds, 7.1% from hospitals with 300 to 500 beds, and 5.8% from hospitals with 60 points). In the successive groups of TISS scores, there was a significant increase in the proportion of time spent on the activities scored with TISS-28. In the lower TISS score group (0 to 20 points), there was a significantly larger proportion of time allocated to patient care activities not in TISS-28. There was no significant difference in the proportion of time spent when associating indirect patient care and organizational activities with the level of TISS score. There was a significant decrease in the proportion of time spent on personal activities in the successive groups of TISS scores. The mean time spent per shift with personal activities varied between 1 hr and 40 mins (group 0 to 20 points TISS), and 1 hr and 16 mins (group >60 points TISS). Significantly more time was used for patient care activities during the evening shift than during the day or the night shift. Conversely, nurses spent significantly less time on activities regarding their personal care during the evening shift. The time consumed for the activities of indirect patient care did not differ significantly among the three shifts.A typical nurse was capable of delivering work equal to 46.35 TISS-28 points per shift (one TISS-28 point equals 10.6 mins of each nurse's shift).Conclusions: The simplified TISS-28 explains 86% of the variation in TISS-76 and can therefore replace the original version in the clinical practice in the ICU.Per shift, a typical nurse is capable of delivering nursing activities equal to 46 TISS-28 points. This information, together with the information concerning the association of TISS score with the time spent in the various nursing activities within the ICU, is relevant to the management of nursing manpower in the ICU.