Original articleQuality of patient care in the critical care unit in relation to nurse patient ratio: A descriptive study
Introduction
Intensive care is one of the most resource-intensive forms of medical care. This is due to patients’ severity of illness, who typically have several life-threatening conditions and are cared for in units with high staffing levels (both in amount and competence) within a high-tech environment. Critical care units in Sweden care for approximately 50,000 patients each year and in addition approximately 45,000 patients are cared for in close proximity to the ICU (post-operative recovery room and cardiac-intensive care). Critical care consumes about 1/10 of the cost of somatic care with a daily cost 35–50,000 Skr depending on the degree of specialisation (Swedish Society of Anesthesia and Intensive care, SFAI). In order to reduce the lack of knowledge of intensive care long-term outcomes and the impact on patients, a national quality register has collected data since 2001 (www.icuregswe.org). The goal of the registry is to collect and publish optimal medical and nursing-related outcomes as measured by indicators such as mortality, complications, quality of life and functional status after intensive care. Among these indicators, only the frequency of ventilator associated pneumonia (VAP) and catheter-related sepsis coincides for intensive care patients with scientifically approved nursing indicators for nursing care (Kurtzman and Corrigan, 2007, Montalvo, 2007). To date, there is a lack of data that describes how these indicators are a useful measure of Swedish intensive care from the nursing perspective. However, there are quality reports from SFAI suggesting that Sweden has a standardised mortality rate that is low compared to international reports. One possible explanation is that Sweden has a greater amount of staff with higher levels of competence among both physicians and nurses compared to other countries. In Sweden, nursing studies is part of higher education. For nurses there are three years of education (bachelor degree) to become a registered nurse (180 ECTS credits) plus an additional one-year (60 ECTS) for advanced level (Master degree) to become a specialist nurse in critical care. Swedish intensive care units employ both registered nurses with or without specialisation in intensive care to provide basic nursing care, pharmacological, medical and ventilator support alongside nursing assistants. Nursing's impact on the health of patients by hospital has been debated in the scientific literature (Aiken et al., 2013, Aiken et al., 2014b, Neuraz et al., 2015). Aiken et al. (2013) have shown that the number of nurses per patient and nurse education to bachelor level, affect the frequency of complications measured by mortality, infections and higher patient satisfaction with more nurses (Kendall-Gallagher et al., 2011). In a related study regarding intensive care, McGahan et al. (2012) concluded that the education level of basic level nurses did not affect mortality and morbidity in ICU patients (McGahan et al., 2012). However, there is a scarcity of literature that discusses how the number and level of higher education among specialised nurses per patient affect quality of intensive care nursing. Therefore, we aimed to investigate in a national study if the number of specialist nurses plays a role in relation to direct patient care. Specifically this study will identify and discuss the direct result of care such as patient time on non invasive and invasive breathing support during intensive care in order to evaluate the specialist nurse role for the quality of patient care in general critical care units.
Section snippets
Objectives and setting
This is a retrospective survey of critical care from registry data of all patients (>15 years) receiving care in general critical care units at University hospitals and is included in SIR during the years 2010–2014. Comparisons between seven general ICU University Hospitals will be performed.
In Sweden there are three hospital types; university hospitals (teaching hospitals that provide highly specialised care), County hospitals (provide general and to some extent specialised care) and local
Discussion
The hospitals included in the study all reported that they employed nurses with specialist training at masters level in critical care. However, there were differences in ratio ranging from 1:1 to 0:5 specialist nurse per patient with complements of 0.5 nursing assistants per patient. Whether or not this difference is due to local organisations of management or just the fact that there is a lack of nurses with specialisation in critical care was not investigated here but should be a focus for
Acknowledgements
We are grateful to the heads of each critical care unit for giving us access to the study locations.
Funding
The authors have no sources of funding to declare.
Conflict of interest
The authors have no conflict of interest to declare.
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