Development of a Comprehensive Scoring System to Measure Multi-faceted Nursing Workloads in ICU and Apply to ICU medical evaluation

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Objective To develop a Comprehensive Nursing Intervention Score (CNIS) that includes the functions of nursing itself, in an effort to quantify nursing workload in.. the intensive care unit (ICU) of Japanese hospitals. Design= Investigation for ICU nurses and retrospective statistical analysis of ICU patients admitted to university hospital. Setting ICUs in 3 university hospitals, (investigation for nurses) and 1 university hospital (retrospective analysis). Measurements and Main Result With reference to the TISS, a list of 88 items in 8 categories was prepared for nursing activities undertaken within the ICU. For each individual item, 5 aspects were scored in a range of 0-3 using a Delphi process number of nurses, workload, physical fatigue, psychological stress, and special skills. To determine the validity of items, the parent ratio was statistically tested by investigation for 118 ICU nurses. The mean matching ratio was 73% overall (p < 0.001). To determine the reliability of items, 44 nurses were surveyed twice using the same questionnaire, with an interval of 1 week between first and second tests. The mean value of the matching ratio was 0.65 overall (p < 0.01). To examine external validation, CNIS and Nine Equivalents of Nursing Manpower Use Score (NEMS) were calculated for 107 patients who stayed in the ICU for at least 24 hours. Regression analysis was calculated for CNIS and NEMS for a total of 1160 days, and the correlation coefficient was 0.55 (p < 0.001). The correlation coefficient when nursing care items were excluded from the CNIS was 0.75 (p< 0.001). Conclusion= A final total of 73 items in 8 categories, scored for 6 aspects was designated as the CNIS and was found to be valid and reliable