title: Factors determining the patients' care intensity for surgeons and surgical nurses: a conjoint analysis.
abstract: BACKGROUND
  Surgeons and nurses sometimes perceive a high workload on the surgical wards, which may influence admission decisions and staffing policy. This study aimed to explore the relative contribution of various patient and care characteristics to the perceived patients' care intensity and whether differences exist in the perception of surgeons and nurses.
  
  
  METHODS
  We invited surgeons and surgical nurses in the Netherlands for a conjoint analysis study through internet and e-mail invitations. They rated 20 virtual clinical scenarios regarding patient care intensity on a 10-point Likert scale. The scenarios described patients with 5 different surgical conditions: cholelithiasis, a colon tumor, a pancreas tumor, critical leg ischemia, and an unstable vertebral fracture. Each scenario presented a mix of 13 different attributes, referring to the patients' condition, physical symptoms, and admission and discharge circumstances.
  
  
  RESULTS
  A total of 82 surgeons and 146 surgical nurses completed the questionnaire, resulting in 4560 rated scenarios, 912 per condition. For surgeons, 6 out of the 13 attributes contributed significantly to care intensity: age, polypharmacy, medical diagnosis, complication level, ICU-stay and ASA-classification, but not multidisciplinary care. For nurses, the same six attributes contributed significantly, but also BMI, nutrition status, admission type, patient dependency, anxiety or delirium during hospitalization, and discharge type. Both professionals ranked 'complication level' as having the highest impact.
  
  
  CONCLUSIONS
  The differences between surgeons and nurses on attributes contributing to care intensity may be explained by differences in professional roles and daily work activities. Surgeons have a medical background, including technical aspects of their work and primary focus on patient curation. However, nurses are focused on direct patient care, i.e., checking vital functions, stimulating self-care and providing woundcare.
  
  
  CONCLUSIONS
  Surgeons and nurses differ in their perception of patients' care intensity. Appreciation of each other's differing interpretations might improve collaboration between doctors and nurses and may help managers to match hospital resources and personnel.
authors.affiliation: Department of Surgery, Academic Medical Center, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. c.j.vanoostveen@amc.nl.
authors.forename: Catharina J
authors.initials: CJ
authors.lastname: van Oostveen
authors.affiliation: Department of Surgery, Academic Medical Center, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. h.vermeulen@amc.nl.|Amsterdam School of Health Professions, University of Amsterdam, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. h.vermeulen@amc.nl.
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
authors.affiliation: Department of Surgery, Academic Medical Center, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. e.j.nieveenvandijkum@amc.nl.
authors.forename: Els J M
authors.initials: EJ
authors.lastname: Nieveen van Dijkum
authors.affiliation: Department of Surgery, Academic Medical Center, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. d.j.gouma@amc.nl.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of Surgery, Academic Medical Center, P.O box 22700, 1100 DE, Amsterdam, The Netherlands. d.ubbink@amc.nl.
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
mesh_terms: D000328:Adult; D000368:Aged; D034742:Electronic Mail; D005260:Female; D006295:Health Resources; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009741:Nursing Staff, Hospital / Q000523:psychology; D010351:Patient Discharge; D011787:Quality of Health Care; D012648:Self Care; D066231:Surgeons / Q000523:psychology; D011795:Surveys and Questionnaires; D016526:Workload