Nursing Workload

In the intensive care unit, patients' care and secure drugs administration require a central venous catheter. These invasive devices can lead to complications, particularly infections. Most preventive recommendations focus on catheter insertion, line handling, and dressings. Few recommendations adress catheter dwell time, which is certainly the main source of infection. Part of the prevention strategy is the regular and systematic replacement of infusion sets , as they may become contaminated during use, mainly through the hands of healthcare professionals. Prolonged use increases the risk of infection. Infusion lines changes involve disconnecting the old sets, discarding infusion devices containing drug residues, and replacing them with new sterile devices. Current international guidelines recommend replacing these sets every 4 days, and the Center for Disease Control and Prevention recommends not exceeding 7 days. Replacing these devices requires the time of qualified nurses, numerous sterile medical devices, and medications. In addition to the intended effect on infection prevention, the procedure has impacts on workload and costs. The objective of the study is to demonstrate that changing infusion set every 7 days does not increase the rate of central venous catheters related infections compared with changing infusion set every 4 days.

Increasing patient complexity, staffing shortages, and administrative burdens have intensified nurses' workloads, contributing to burnout and reduced job satisfaction. These challenges were particularly evident in the intensive care units (ICU) during the COVID-19 outbreak. With the growing healthcare demand in front of us, it is essential to understand and manage perceived workload effectively to maintain high-quality care and promote staff well-being. A real-time overview of nursing workload may facilitate the identification of patients requiring additional support and enable more effective distribution of workload among nurses during shifts. A dashboard has therefore been developed for use in the ICU to provide an overview of the patients at the unit and their corresponding nursing workload. To assess whether this dashboard is fit for purpose, this study aims to evaluate nurses' perspectives on its implementation, focusing on acceptance, adoptability, appropriateness, and fidelity. Additionally, the model for the calculation of the nursing workload will be assessed in terms of its alignment with ICU nurses' perceived workload and its potential for automation with artificial intelligence (AI).

Pressure injuries are common in intensive care unit (ICU) patients who cannot reposition themselves. International guidelines recommend using support surfaces to redistribute pressure and regular turning to prevent these injuries. In Taiwan, high-specification foam mattresses (HSFM) with manual turning remain the standard, but frequent repositioning is labor-intensive and challenging in settings with limited nursing staff. The Turn-Assist Alternating Pressure Air Mattress (TAPAM) integrates pressure redistribution with automated lateral turning, potentially reducing nursing workload while maintaining preventive effectiveness. This study will compare TAPAM with HSFM plus manual turning in ICU patients, evaluating manpower requirements, time spent, perceived effort, and clinical outcomes. A cost-effectiveness and cost-benefit analysis will be conducted to assess the overall value of TAPAM for pressure injury prevention in high-risk ICU populations.