Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study

Background: Management decisions regarding quality and quantity of
nurse staffing have important consequences for hospital budgets.
Furthermore, these management decisions must address the nursing
care requirements of the particular patients within an
organizational unit. In order to determine optimal nurse staffing
needs, the extent of nursing workload must first be known. Nursing
workload is largely a function of the composite of the patients'
individual health status, particularly with respect to functioning
status, individual need for nursing care, and severity of symptoms.
The International Classification of Functioning, Disability and
Health (ICF) and the derived subsets, the so-called ICF Core Sets,
are a standardized approach to describe patients' functioning
status. The objectives of this study were to (1) examine the
association between patients' functioning, as encoded by categories
of the Acute ICF Core Sets, and nursing workload in patients in the
acute care situation, (2) compare the variance in nursing workload
explained by the ICF Core Set categories and with the Barthel
Index, and (3) validate the Acute ICF Core Sets by their ability to
predict nursing workload. Methods: Patients' functioning at
admission was assessed using the respective Acute ICF Core Set and
the Barthel Index, whereas nursing workload data was collected
using an established instrument. Associations between dependent and
independent variables were modelled using linear regression.
Variable selection was carried out using penalized regression.
Results: In patients with neurological and cardiopulmonary
conditions, selected ICF categories and the Barthel Index Score
explained the same variance in nursing workload (44% in
neurological conditions, 35% in cardiopulmonary conditions),
whereas ICF was slightly superior to Barthel Index Score for
musculoskeletal conditions (20% versus 16%). Conclusions: A
substantial fraction of the variance in nursing workload in
patients with rehabilitation needs in the acute hospital could be
predicted by selected categories of the Acute ICF Core Sets, or by
the Barthel Index score. Incorporating ICF Core Set-based data in
nursing management decisions, particularly staffing decisions, may
be beneficial.