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Abstract
Purpose
This study aimed to identify the type and frequency of nursing activities targeting emergency department patients by analyzing electronic nursing records.
Methods
This retrospective study identified the characteristics of and nursing activities for adult patients who visited a university hospital emergency department for 6 months from January to June 2018 by analyzing the hospital's electronic nursing records. Descriptive statistics and one-way analysis of variance were used to analyze the characteristics of patients and the nursing records.
Results
A total of 36,435 patients, with an average age of 52.82±19.91 years and a male-to-female ratio of 1:1.16, participated in the study. The number of patients with Korean Triage and Acuity Scale levels 4 (less urgent) and 5 (non-urgent) were 24,403 (67% of the total number). Referrals were requested 1.21±0.54 times per patient. The most frequent NANDA diagnosis and Nursing Intervention Classification intervention were “ Risk for unstable blood glucose level” (858, 28.4%), and “ Surveillance” (83,131, 23.9%). The most frequent Clinical Care Classification action type was “ Assess or Monitor” (313,729, 38.5%). The higher the severity level and the number of referrals, the more the recorded numbers of nursing diagnoses, interventions, and care activities.
Conclusion
This study demonstrated the possibility of nursing task analysis by identifying the type and frequency of nursing activities based on the data from electronic nursing records. Further research on electronic nursing records would contribute to the usefulness of these records for nursing workload analysis and effective workforce management.
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Table 1.
General and Clinical Characteristics of Patients whose Nursing Records were Analyzed (N=36,435)
| Characteristics | Categories | n (%) or M± SD |
|---|---|---|
| Age (year) | 19~39 | 11,489 (31.5) |
| 40~59 | 9,802 (26.9) | |
| 60~79 | 11,672 (32.1) | |
| ≥80 | 3,472 (9.5) | |
| 52.82±19.91 | ||
| Gender | Men | 16,837 (46.2) |
| Women | 19,598 (53.8) | |
| Chief complaint† | Abdominal pain | 3,656 (8.2) |
| Fever | 2,281 (5.1) | |
| Dyspnea | 2,224 (5.0) | |
| Headache | 2,207 (4.9) | |
| Dizziness | 1,958 (4.4) | |
| Chest pain | 1,029 (2.3) | |
| Vomiting | 1,013 (2.3) | |
| Fever and chilling | 890 (2.0) | |
| General weakness | 832 (1.9) | |
| Diarrhea | 806 (1.8) | |
| Severity (KTAS level) | 1: Resuscitation | 633 (1.7) |
| 2: Emergent | 2,952 (8.1) | |
| 3: Urgent | 8,447 (23.2) | |
| 4: Less urgent | 19,628 (53.9) | |
| 5: Non-urgent | 4,775 (13.1) | |
| Admission routes | Direct visit | 31,006 (85.1) |
| Outpatient departments | 939 (2.6) | |
| Transfer from other | 4,490 (12.3) | |
| institutions | ||
| Disposition | Discharged | 26,454 (72.6) |
| Admitted | 8,780 (24.1) | |
| Transferred | 684 (1.9) | |
| Dead | 254 (0.7) | |
| Others‖ | 263 (0.7) | |
| Number of referral | None | 15,037 (41.3) |
| 1 | 17,749 (48.7) | |
| 2 | 2,962 (8.1) | |
| ≥3 | 687 (1.9) | |
| 1.21±0.54‡ | ||
| Referred department§(n=21,398) | Medical department | 10,417 (40.1) |
| Surgical department | 6,433 (24.7) | |
| Neurological department | 3,481 (13.4) | |
| Other departments | 5,659 (21.8) | |
| Length of ED stay (hour) | 6 | 24,629 (67.6) |
| 6~＜24 | 10,185 (28.0) | |
| ≥24 | 1,621 (4.5) | |
| 6.57±8.97 | ||
| ED=emergency department; KTAS=Korean triage and acuity scale; | ||
Table 2.
Nursing Diagnosis of Patients whose Nursing Records were Analyzed (N=3,019)
Table 3.
Top 30 Nursing Interventions of Patients whose Nursing Records were Analyzed (N=347,303
| Domain | NIC domain and class | Nursing interventions | n (%) | Rank |
|---|---|---|---|---|
| Physiological: basic | B. Elimination management | Tube care: urinary | 10,574 (2.7) | 8 |
| Urinary catheterization | 4,589 (1.2) | 14 | ||
| Enema administration | 1,668 (0.4) | 21 | ||
| C. Immobility management | Transfer | 8,889 (2.2) | 10 | |
| Physical restraint† | 1,210 (0.3) | 24 | ||
| D. Nutrition support | Tube care: gastrointestinal | 5,638 (1.4) | 13 | |
| E. Physical comfort promotion | Pain management: acute | 1,250 (0.3) | 23 | |
| F. Self-care facilitation | Tube care | 1,651 (0.4) | 22 | |
| Physiological: complex | G. Electrolyte and acid-base | Hyperglycemia management | 2,048 (0.5) | 17 |
| management | Hypoglycemia management | 848 (0.2) | 27 | |
| H. Drug management | Medication administration | 16,480 (4.1) | 7 | |
| Central venous access device management‡ | 8,829 (2.2) | 11 | ||
| J. Perioperative care | Surgical preparation | 669 (0.2) | 29 | |
| K. Respiratory management | Oxygen therapy | 10,053 (2.5) | 9 | |
| Artificial airway management | 2,027 (0.5) | 18 | ||
| K. Respiratory management | Mechanical ventilation: invasive/noninvasive | 1,137 (0.3) | 25 | |
| Airway insertion and stabilization | 860 (0.2) | 26 | ||
| Tube care: chest | 533 (0.1) | 30 | ||
| L. Skin/wound management | Wound care | 2,254 (0.6) | 16 | |
| Wound irrigation | 1,859 (0.5) | 19 | ||
| Suturing | 1,673 (0.4) | 20 | ||
| M. Thermoregulation | Fever treatment | 709 (0.2) | 28 | |
| N. Tissue perfusion management | Intravenous insertion | 41,456 (10.4) | 2 | |
| Intravenous therapy | 33,423 (8.4) | 4 | ||
| Blood products administration | 5,874 (1.5) | 12 | ||
| Safety | U. Crisis management | Code management | 3,060 (0.8) | 15 |
| V. Risk management | Surveillance | 83,131 (20.9) | 1 | |
| Vital signs monitoring | 22,645 (5.7) | 6 | ||
| Health system | Y. Health system mediation | Discharge planning | 29,192 (7.3) | 5 |
| a. Health system management | Examination assistance | 40,424 (10.2) | 3 |
Table 4.
Top 30 Nursing Care Activities Provided to Patients whose Nursing Records were Analyzed (N=815,090)
Table 5.
Nursing Records by KTAS Levels and Number of Referrals
| Variables | Categories | NANDA† | NIC | Nursing care activity | |||
|---|---|---|---|---|---|---|---|
| M± SD | F (p) Scheffé | M± SD | F (p) Scheffé | M± SD | F (p) Scheffé | ||
| KTAS level | 1: Resuscitation a | 1.58±0.97(n‡=190) | 44.74 (＜.001) a＞ b＞ c＞ d, a＞ b＞ e | 37.21±41.15(n=633) | 1,435.97 (＜.001) a＞ b＞ c＞ d＞ e | 67.78±70.69(n=633) | 1,363.00 (＜.001) a＞ b＞ c＞ d＞ e |
| 2: Emergent b | 1.28±0.62(n=583) | 18.70±26.91(n=2,952) | 39.97±48.03(n=2,952) | ||||
| 3: Urgent c | 1.16±0.48(n=867) | 13.40±17.34(n=8,447) | 30.63±33.60(n=8,447) | ||||
| 4: Less urgent d | 1.08±0.28(n=810) | 6.78±7.77(n=19,629) | 17.05±16.14(n=19,629) | ||||
| 5: Non-urgent e | 1.05±0.23(n=91) | 4.66±6.05(n=4,775) | 12.74±12.41(n=4,775) | ||||
| Number of referrals | ≥3 a | 1.37±0.71(n=169) | 15.65 (＜.001) a＞ c＞ d, b＞ c＞ d | 28.04±34.25(n=687) | 1,343.06 (＜.001) a＞ b＞ c＞ d | 55.46±58.58(n=687) | 1,351.47 (＜.001) a＞ b＞ c＞ d |
| 2 b | 1.26±0.59(n=504) | 18.00±21.93(n=2,962) | 38.08±39.69(n=2,962) | ||||
| 1 c | 1.17±0.52(n=1,535) | 11.29±15.84(n=17,749) | 26.04±30.35(n=17,749) | ||||
| None d | 1.07±0.28(n=333) | 4.94±6.95(n=15,037) | 13.44±13.80(n=15,037) | ||||
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