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Scores TISS-28 versus NEMS to size the nursing team in a pediatric intensive care unit
Kelly Dayane Stochero Velozo1, Pedro Celiny Ramos Garcia1, Jefferson Pedro Piva2
1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Insights
The Nursing Activities Score (NEMS) indicated higher nursing workload and team size needs in pediatric intensive care compared to the Therapeutic Intervention Scoring System (TISS-28). Both scales showed good agreement for workload assessment.
Area of Science:
- Pediatric Intensive Care Nursing
- Healthcare Management
- Nursing Workload Measurement
Background:
- Accurate estimation of nursing workload and appropriate team sizing are critical for patient safety and quality of care in pediatric intensive care units (PICUs).
- Existing tools require validation for specific clinical settings to ensure optimal resource allocation.
- The Therapeutic Intervention Scoring System-28 (TISS-28) and the Nine Equivalents of Nursing Manpower (NEMS) are commonly used but their comparative performance in PICUs needs further investigation.
Purpose of the Study:
- To estimate nursing workload and determine optimal nursing team size in a PICU setting.
- To compare the efficacy of the TISS-28 and NEMS scoring systems in assessing nursing workload and team sizing.
- To evaluate the correlation and agreement between TISS-28 and NEMS in a pediatric intensive care environment.
Main Methods:
- An observational prospective quantitative study conducted in a university hospital's PICU over one year (2009).
- Inclusion criteria: children hospitalized for >8 hours (or >4 hours if deceased).
- Data collected included clinical information, Paediatric Index of Mortality 2, TISS-28, and NEMS scores, which were converted to nursing working hours and team size recommendations.
Main Results:
- A total of 459 children and 3,409 observations were analyzed.
- Average TISS-28 score was 20.8±8, and NEMS score was 25.2±8.7.
- NEMS estimated a higher nursing workload (13.3 hours) and required a larger team (35.8 professionals) compared to TISS-28 (11 hours, 29.6 professionals), with adequate correlation and agreement between the instruments.
Conclusions:
- The NEMS provides a significantly higher estimation of nursing time spent on activities and required team size compared to the TISS-28 in a PICU.
- These findings suggest NEMS may offer a more comprehensive assessment for nursing resource allocation in pediatric intensive care.
- Both TISS-28 and NEMS demonstrated acceptable correlation and agreement, supporting their utility in workload assessment.
Objective:
To estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit.
Methods:
An observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments.
Results:
A total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement.
Conclusion:
Time spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.
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