Workload and the quality of nursing care in critically ill patients: a systematic review
Abstract
Introduction: The Intensive Care Unit (ICU) is a highly
complex environment that requires continuous and
specialized care, exposing nursing staff to a high workload.
This overload may affect both the physical and mental health
of professionals, as well as the quality and safety of care
provided to critically ill patients.Objective: To evaluate
whether workload overload among nursing staff affects the
quality of care for critically ill patients in intensive care
units.Methodology: A systematic literature review was
conducted following PRISMA guidelines. The search was
carried out between March and May 2022 in the PubMed,
Google Scholar, SCIELO, LILACS, and ScienceDirect
databases. Studies published between 2010 and 2022 in
Spanish, English, and Portuguese, related to nursing
workload in adult ICUs, were included. After applying
inclusion and exclusion criteria, 16 articles were selected for
the final analysis. Methodological quality was assessed
according to the hierarchy of evidence proposed by Stetler et
al.Results: The analyzed studies show a significant
association between nursing workload overload and
deterioration in the quality of care. A high workload was
associated with increased healthcare-associated infections,
eficiencia y calidad de las mismas, dado que por cada
paciente que sea asignado por una enfermera aumente el
riesgo de mortalidad (Isabel et al., 2021; Mol et al., 2017).
Por esta razón, el ámbito psicosocial influye de manera
positiva como negativa hacia la salud, el bienestar y
rendimiento del enfermero(a), en los cuales se presentan
como exigencias psicológicas; ajuste entre las tareas y los
tiempos laborales, familiares y sociales; control sobre el
trabajo; apoyo social e instrumental de compañeros y
superiores; calidad de liderazgo; compensaciones del trabajo;
y seguridad en el empleo. En cuanto a las demandas mentales
son una de las principales fuentes de carga mental, teniendo
efectos perjudiciales para la salud de los trabajadores y para
el logro de los objetivos de la organización (Ceballos-
Vásquez et al., 2015).
ventilator-associated
pneumonia,
pressure
injuries,
medication errors, and higher mortality. Instruments such as
the Nursing Activities Score (NAS) and the Therapeutic
Intervention Scoring System (TISS) were the most frequently
used to measure workload, demonstrating that higher scores
are associated with poorer clinical outcomes and reduced
patient safety.Conclusions: The available evidence confirms
that excessive nursing workload negatively impacts the
quality of care for critically ill patients. Insufficient staffing
levels and inadequate personnel distribution in the ICU are
key factors contributing to adverse events and increased
mortality. Adequate human resource planning and
continuous workload monitoring are essential to ensure safe,
effective, and high-quality care in the intensive care setting.
