الفهرس 
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Abstract
Summary
The recently increasing demand in healthcare resources is influenced by many factors such as aging population, epidemiological changes, technological advances, and emerging epidemics. This may have led to many changes being applied recently in the healthcare management system leading to a better quality of care and decreased costs. Workload is the major characteristic of the critical or intensive care units (ICUs) work environment which may have negative consequences for nurses and the patients they care for. Workload can be defined as the time spent on patient care by health care worker during a specific period of time. Also, workload can be defined as the amount of care allocated to patients based on an assessment of their nursing needs and the care they require (Borzuchowska et al., 2023).
Health-care systems are encountering an increased demand for high-quality care while the resources they can command from the society are decreasing. Quality of care is the responsibility of everyone involved in health care. It is described in as the process for the attainment of the highest degree of excellence in the delivery of patient care. Quality of health care is an important component of long-term socioeconomic development by ensuring the well-being and recovery of critically ill patients through competence of nurses, patient advocacy, multidisciplinary collaboration, patient safety measures, continuous monitoring, compassionate care, and evidence-based practice. These elements collectively contribute to the provision of exceptional care to critically ill patients, aiming for their recovery, improved outcomes, increased satisfaction, improved quality of life and a supportive work environment (Mainz et al., 2023).
Aim of the study:
This study aimed to assess relation between nursing workload and quality of care for patients in critical care units through the following:
- Assess nursing workload among the nurses in critical care units.
- Assess quality of care for the patients in critical care units.
- Assess relation between nursing workload and quality of care for the patients in critical care units.
Research questions:
- What is nursing workload among the nurses in critical care units?
- What is quality of care for the patients in critical care units?
- Is there relation between nursing workload and quality of care for the patients in critical care units?
Research design:
A descriptive exploratory design was conducted to achieve the aim of this study. The used design is a powerful tool used to gather information about a particular group or phenomenon by observing and collecting data on a given topic without attempting to infer cause-and-effect relationships to provide a comprehensive and accurate picture of the population or phenomenon being studied and to describe the relationships, patterns, and trends that exist within the data (Sirisilla, 2023).
Setting:
The current study was conducted at three CCUs; medical, surgical and cardiac units at El-Mahalla El-Kubra General Hospital in Gharbia Governorate. where it provides health care services in various medical fields to the residents of El-Mahalla El-Kubra city and 54 of its neighboring villages, at a rate of one million people, it consists of 10 departments with different medical surgical specialists distributed in the five floors hospital. In addition, emergency department on the ground floor and three ICUs in the third floor.
Subjects:
- A convenient sample of all available nurses at CCUs of the previous mentioned setting which including 60 nurses divided into 20 nurses in each selected unit.
- 180 patients involved in this study from both genders (60 patients from each selected unit) by using power analysis equation. They were a representative of total patients admitted to critical/ICUs (N=2000) at El-Mahalla El-Kubra General hospital. Ratio of nurses to patients was 1:1 or 1:2.
Tools of data collection:
Tool (I): Nursing Activities Score –Task Load Index (NASA-TLX)
It was self-administered questionnaire adopted from Hart (2006) and translated into Arabic by investigator. It was used to assess nursing workload demands with variety of activities for caring of patients in CCUs. It was divided into 2 parts as follows:
• Part 1: It was concerned with demographic characteristics of the nurses such as, (gender, age, marital status, and educational level) it includes 4 items.
• Part 2: It consisted of six dimensions including (Mental, physical, temporal demands, frustration, efforts and performance satisfaction levels) for assessing workload for 14 main nursing tasks in CCUs which developed by investigator based on recent relevant literature review (Webb et al., 2019; Zeraati & Alavi, 2014). Total questions were 84 questions. Score of each question ranged from (low = 0 to very high =100). While, score was reversed in performance level dimension where as it ranged from (perfect = 0 to failure =100).
Tool (II): Quality of Nursing Care Scale in Intensive Care Units (QNCS-ICU)
It used for measuring the quality of care through many nursing tasks/activities that were given to the patients in CCUs. It included main 14 nursing tasks in ICU distributed as; Taking nursing assessment (10 activities), administering respiratory airways management (14 activities), carrying out pain management (7 activities), following drug administration protocol (7 activities), caring of patient`s lines (12 activities), caring of patient`s drains (8 activities), caring of patient`s urinary catheter (4 activities), caring of patients’ wounds (4 activities), providing nutritional support (6 activities), maintaining the patient’s activity & mobility (5 activities), promoting patient’s hygiene procedures (3 activities), providing psychological support & health education (4 activities), applying infection control precautions (8 activities) and keeping patient safety and security standards in the correct manner (6 activities). Total activities of 14 nursing tasks were 98.
Each activity done correctly was given (one) grade and activity not done correctly was given (zero).
So, the total score was classified as follows:
- Competent level was considered if score ≥ 85% ≥ 83.3 grades.
- Incompetent level was considered if score < 85% < 83.3 grades.
Tool (III): Quality of care indices
It included two parts; part one included demographic characteristics of patients as age, sex, marital status, educational level, length of stay, and causes of discharge from the unit. Part two covered the key indicators of quality of nursing care among the studied patients in CCUs including falls incidence, pressure sore density, restraint use, tube self-extraction, infection density and mortality rate (Chang et al., 2019).
Scoring system:
The response for this index included two options, either present took (1) or absent took (zero).
The result of the current study can be summarized as the following:
• Concerning the studied nurses’ demographic data; 70% of them aged from 20 to 30 years, 83.3% were females, 73.3% were married, 30% of them had nursing diploma; while 23.3℅ had bachelor degree.
• Regarding the studied nurses’ total NWL level; the present study finding indicated that the mean total NWL level was 61.28, ranged from 40.4 to 82; while 80% of them showed high NWL level, 16.7% showed moderate level and 3.3% showed very high level. Highest score 76% was attributed to promoting patient`s hygiene procedures, while the lowest score 47.1% was attributed to taking nursing assessment.
• Regarding the studied nurses’ total QNC level; the present study finding indicated that the mean total QNC level among all studied nurses was 79, ranged from 54.4 to 96.7; while 80% of them had in competent QNC level and only 20% of them had competent level.
• Concerning the studied patients’ demographic data; age of studied patients ranged between 20 to 65 years with Mean 58.28 ± 11.1, 54.4% of them were females. Regarding marital status, 61.1% of them were married while 33.3% were widow. Regarding education level, 37.8% had secondary school, while 23.3% were illiterate and 6.7% had university.
• Regarding the studied patients’ length of stay and causes of discharge; 63.3% of them stayed in hospital from 2 to 7 days, 52.2% achieved recovery while 3.30% were transferred.
• Regarding the quality of care indices; the present study finding indicated that, mortality rate occurred in 44.4% of the studied patients, restraint used in 26.7%, pressure sore density occurred in 11.1% of them, infection density in 7.8%, while tube self-extraction in 1.1% among the studied patients.
• Regarding the relation between the studied nurses’ workload total mean scores and their demographic characteristics; the current study revealed that, there was no significant association found between nursing workload total mean scores and demographic characteristics of the studied nurses.
• Regarding the relation between the studied nurses’ QNC total means score and their demographic characteristics; the current study revealed that, there was no significant association was found between QNC total means score, gender, age & marital status. However, there was highly statistical significant relation found between quality of nursing care for all nursing tasks total mean scores and educational level among the studied nurses.
• Regarding the relation between quality of care indices and the studied patients’ demographic characteristics; the current study revealed that, a higher mortality rate was significantly associated with older age, being married or widow, lower education level, shorter length of stay except the gender. Higher percentage of pressure sore density was significantly associated with higher length of stay, death. However, no significant association was found between tube self-extraction with patients’ demographic data. Otherwise, a higher percentage of infection density was significantly associated with longer length of stay.
• Regarding the correlation between total nursing workload level and total quality of nursing care level, the study found a highly statistically significant negative correlation.
Conclusion:
In In the light of the present study findings, the following can be concluded;
The majority of the studied nurses had a high total nursing workload level in ICU. As well as, the majority of them had total incompetent quality of nursing care level for the patients in critical care units. Also, the study results indicated that low total level of quality of care indices among the patients in critical care units.
Additionally, the study results revealed that there was a highly statistically significant negative correlation between total score of nursing workload level and quality of care for the patients in critical care units which answered the research questions.
Recommendations:
Based on the present study findings, the following recommendations are suggested;
Periodical continuous evaluation program for nurses regarding activities of all tasks demand for caring of patients in critical care units.
Availability of procedure book for the activities of all tasks should be performed by the nurses for caring of patients in CCUs for enhancing quality of care for such group of patients.
Replication of this study on large number of the patients in different critical care units in different hospitals is recommended to generalize the study results.
Further research is recommended to address multi factors affecting quality of care for patients in CCUs to suggest evidence-based guidelines according to studied factors to enhance quality of care for patients in CCUs.
Further study is needed to assess nursing workload in CCUs accurately (direct and indirect activities) for developing strategies to manage it effectively.