{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:21:21Z","timestamp":1787595681339,"version":"build-2736575974"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Nursing workload in intensive care units (ICUs) is a key determinant of patient outcomes, quality of care, and efficient resource utilization. The Nursing Activities Score (NAS) is a validated instrument for quantifying nursing workload; however, evidence regarding its use in low- and middle-income countries remains limited. This observational study assessed nursing workload using the NAS and evaluated its ability to predict patient outcomes among 501 adult patients admitted to the ICU of a teaching hospital between 7 March 2022 and 27 February 2023. NAS was recorded for each patient, and outcomes were classified as survivors and non-survivors. The predictive performance of NAS was evaluated using receiver operating characteristic (ROC) curve analysis, model calibration was assessed with the Hosmer\u2013Lemeshow goodness-of-fit test, and logistic regression was used to examine the association between NAS and mortality. Differences in NAS scores between survivors and non-survivors were compared using the Mann\u2013Whitney U test. The median NAS was 83.40 (IQR: 68.30\u2013101.10; range: 39.2\u2013134.4), indicating a high nursing workload. NAS demonstrated good discriminative ability for predicting patient outcomes (AUROC\u2009=\u20090.838, p\u2009&lt;\u20090.001), with an optimal cut-off value of 90.40, yielding 73.5% sensitivity and 73.1% specificity. The model showed good calibration (Hosmer\u2013Lemeshow p\u2009=\u20090.422). Higher NAS scores were significantly associated with mortality (Exp(B) = 0.937, p\u2009&lt;\u20090.001), and non-survivors had significantly higher NAS scores than survivors (110.70 vs. 76.20, p\u2009&lt;\u20090.001). These findings demonstrate that the NAS is a reliable tool for measuring ICU nursing workload and predicting patient outcomes, supporting its use to optimize nurse staffing, workload allocation, and critical care resource planning in resource-limited settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006169","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:22:25Z","timestamp":1787592145000},"page":"e0006169","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance of Nursing Activities Score in intensive care units of a teaching hospital in a low-middle-income country: An observational study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1241-8119","authenticated-orcid":true,"given":"Raj Kumar","family":"Mehta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafizah Che","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6077-0046","authenticated-orcid":true,"given":"Bishnu","family":"Bista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamata Sharma","family":"Neupane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"9931","key":"pgph.0006169.ref001","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/S0140-6736(13)62631-8","article-title":"Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study","volume":"383","author":"LH Aiken","year":"2014","journal-title":"Lancet"},{"issue":"1","key":"pgph.0006169.ref002","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12871-021-01548-7","article-title":"Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach","volume":"22","author":"J Park","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"pgph.0006169.ref003","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.apergo.2013.04.023","article-title":"Human factors systems approach to healthcare quality and patient safety","volume":"45","author":"P Carayon","year":"2014","journal-title":"Appl Ergon"},{"issue":"12","key":"pgph.0006169.ref004","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1097\/MLR.0b013e3181468ca3","article-title":"The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis","volume":"45","author":"RL Kane","year":"2007","journal-title":"Med Care"},{"issue":"4","key":"pgph.0006169.ref005","doi-asserted-by":"crossref","first-page":"187","DOI":"10.4103\/ijccm.IJCCM_164_15","article-title":"Quality indicators compliance survey in indian intensive care units","volume":"21","author":"M Kartik","year":"2017","journal-title":"Indian J Crit Care Med"},{"issue":"3","key":"pgph.0006169.ref006","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5005\/jp-journals-10071-24415","article-title":"Patient safety in intensive care unit: what can we do better?","volume":"27","author":"SJ Patil","year":"2023","journal-title":"Indian J Crit Care Med"},{"key":"pgph.0006169.ref007","volume-title":"State of the world\u2019s nursing: Investing in education, jobs, and leadership","author":"WHO","year":"2021"},{"issue":"1","key":"pgph.0006169.ref008","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12912-022-01003-z","article-title":"Facilitators for and barriers to nurses\u2019 work-related health-a qualitative study","volume":"21","author":"DR Thapa","year":"2022","journal-title":"BMC Nurs"},{"issue":"5","key":"pgph.0006169.ref009","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.ijnurstu.2014.02.007","article-title":"Nurse staffing, medical staffing and mortality in intensive care: an observational study","volume":"51","author":"E West","year":"2014","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"pgph.0006169.ref010","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/j.1365-2648.2006.03941.x","article-title":"Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis","volume":"55","author":"Y Numata","year":"2006","journal-title":"J Adv Nurs"},{"issue":"2","key":"pgph.0006169.ref011","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1097\/01.CCM.0000045567.78801.CC","article-title":"Nursing activities score","volume":"31","author":"TISS Working Group. 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