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Observational Study
. 2021 Feb:62:102967.
doi: 10.1016/j.iccn.2020.102967. Epub 2020 Oct 28.

Impact of COVID-19 on nursing time in intensive care units in Belgium

Arnaud Bruyneel  1 , Maria-Cécillia Gallani  2 , Jérôme Tack  3 , Alain d'Hondt  4 , Sebastien Canipel  5 , Stéphane Franck  6 , Pascal Reper  7 , Magali Pirson  8
Affiliations
Observational Study

Impact of COVID-19 on nursing time in intensive care units in Belgium

Arnaud Bruyneel et al. Intensive Crit Care Nurs. 2021 Feb.

Abstract

Introduction: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload.

Objective: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context.

Design: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS).

Setting: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients.

Measurements and main results: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4).

Conclusions: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

Keywords: Coronavirus; Intensive care unit; Nursing activities score; Workload.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Box plots representing the median NAS according to shift and hospital. Black: no-COVID-19 patients. Grey: COVID-19 patients; NAS d = NAS day; NAS n = NAS night. All comparisons are significant (H: 4613,77, p value < 0.001).
See this image and copyright information in PMC

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