Functioning and nursing workload in patients undergoing acute rehabilitation

Background: Patients with an acute illness or injury have a high chance to survive if appropriate medical and surgical care is provided. Many of them, however, experience a significant loss of functioning. Nurses have an important part in preventing disability in the acute hospital. Consequently, nursing interventions are triggered by patients' functioning. However, rather than being based on functioning current hospital payment systems are based on medical diagnoses. To date there is no evidence on the association between distinct aspects of functioning and nursing workload. The International Classification of Functioning, Disability and Health (ICF) is a way to classify and describe functioning. Aim of this study was to examine if functioning, described by the newly developed ICF Core Sets for the acute hospital, predicts nursing workload.

Methods: Cohort study on patients undergoing acute rehabilitation in the acute hospital. Patients' functioning was assessed with the ICF at admission and discharge. Nursing workload was defined as time spent with standardized nursing interventions. Linear models were used to analyse the association between ICF categories and nursing workload.

Results: We included 200 patients (mean age 70, 60% female), 25% with neurological, 25% with cardiopulmonary, and 50% with musculoskeletal conditions. Patients had an average of 4148 minutes nursing time (median=2090). ICF categories explained considerably more of the total variance of nursing time than Barthel Index. Conclusion: Categories of the acute ICF Core Sets are potentially useful to predict nursing workload in the acute hospital. Aspects of functioning relevant for nursing could be distinguished. Further studies are needed to validate these findings.