title: Preliminary results on nursing workload in a dedicated weaning center.
abstract: OBJECTIVE
  To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center (WC) and to examine the correlation of the nursing time with nursing workload (NW) scores and with clinical severity and dependency.
  
  
  METHODS
  Four-bed WC of a pulmonary rehabilitation department.
  
  
  METHODS
  None.
  
  
  METHODS
  Prospective, observational study of 46 consecutive patients admitted to a long-term WC. Time required by items of the Time Oriented Score System (TOSS) and other tasks specific to respiratory intermediate intensive care units were evaluated for all the activities performed on each patient in the first 2 days after admission. Patient dependency and level of nursing care at admission were measured using the Dependence Nursing Scale (DNS) and the Intermediate Therapeutic Intervention Score System (TISS-int). The Acute Physiology and Chronic Health Evaluation (APACHE) II score was also recorded at admission.
  
  
  RESULTS
  On the first day each patient needed 45 +/- 15% (63 +/- 23%, 45 +/- 22%, and 29 +/- 14% for the three nursing shifts) of allocated single nursing time. On the TOSS on the first day patients required a daily mean 28 +/- 10% of total available nursing time; on the second day the results did not change. Time of care in the first 24 h was only weakly related to DNS, APACHE II score, and TISS-int; only DNS was able (although weakly; r = 0.45) to predict minutes of nursing care.
  
  
  CONCLUSIONS
  In difficult-to-wean patients from mechanical ventilation the nursing time in the first 2 days after admission is high. The use of TOSS may underestimate NW by about 38%. Although only DNS showed the ability to predict minutes of care, the weak relationship limits its value in clinical practice.
authors.affiliation: Lung Function and Respiratory Intermediate Intensive Care Unit, S. Maugeri Foundation IRCCS, Medical Center of Gussago, Italy. nambrosino@fsm.it
authors.forename: M
authors.initials: M
authors.lastname: Vitacca
authors.forename: E
authors.initials: E
authors.lastname: Clini
authors.forename: R
authors.initials: R
authors.lastname: Porta
authors.forename: N
authors.initials: N
authors.lastname: Ambrosino
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007558:Italy; D008297:Male; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013996:Time and Motion Studies; D015300:Ventilator Weaning / Q000451:nursing*; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*