[Care work load in critical patients. Comparative study NEMS versus NAS]

Abstract

Introduction: The systems of calculating care load have not yet reached the levels of generalized use which the systems of prognostic estimation of survival have. The reason for this is their potential defects of design (medical and not nursing conceptualization) and the sometimes confusing completion (TISS 76). The simplest ("nine equivalents of nurse manpower use score" [NEMS], care levels) add the difficulty of not being useful for the calculation of staff, because the design is not oriented towards nursing. The development of NAS (nursing activity score) by FRICE tries to solve all these problems. Our objective has been to verify to what degree the NEMS and NAS are correlated as systems of expression and calculation of care load.

Patients and method: During the last quarter of 2004, NEMS and NAS have been used simultaneously by the nursing staff. During this period, 150 pairs of daily calculation values of NEMS-NAS and 150 pairs of calculation values by shift of NEMS-NAS have been collected. Comparison of means and linear correlation of values obtained and the analysis of the histograms of values of each series, their value ranges and analysis of their bias coefficients have been done. The analysis was done with the SPSS/PC 11.

Results: During the period indicated, it has been verified that NEMS has a much narrower value range than NAS, both in regards to daily values (18-45 versus 29.70-84.50) and in regards to values by shift (18-45 versus 22.40-84.50). The bias analysis shows a deviation to the left of both series of values. Linear correlation between NEMS-NAS by shift shows a R2 of 0.1634 and becomes even poorer in the NEMS-NAS correlation per day with R2 of 0.2012. It should also be stressed that NEMS expresses its results in points while NAS does so in percentage of time occupied in the attention and care of the patient.

Conclusions: In this preliminary study, the better adaptation of NAS versus NEMS to real work loads of patients hospitalized in the ICU and the non-possible correlation between the values of both systems is affirmed.