Investigating the Application of a Nine Equivalents of Nursing Manpower Use Score to Identify Patients at the End Stages of Life

Nine equivalents of nursing manpower use score (NEMS) is one of the scoring systems used in some studies to determine the severity of the status of patients in the ICU. The present study was conducted to investigate the application of NEMS to identify patients at the end stages of life.

This study was a prospective design where 420 patients were selected from the intensive care unit (ICU) of a referral hospital. Data collection tools were demographic, disease-related, and NEMS questionnaires. The last calculated NEMS score for patients was used to detect their need for end-of-life care. After completing the sampling, the data were analyzed by descriptive statistics and Cox regression at 95% confidence interval.

The relative risk of death in the ICU was 1.027 (95% CI = 1.015 - 1.042). All patients with NEMS ≥ 38 died, however, all patients who had a NEMS score ≤ 15 were discharged from the ICU with a satisfactory general health. The death rate was 22.1% in the 15 ≤ NEMS ≥ 34 scores. Finally, the patients admitted to the ICU were divided into three groups. The first group was the patients with a mortality risk < 41%, the second group had a mortality risk between 41% and 99%, and the third group were the patients with the mortality risk of 100%.

The present study presented a numerical criterion (NEMS > 34) for identifying the patients in need of end-of-life care instead of life-saving measures. However, further studies should be carried out in this area to argue the exact NEMS score requiring life-saving measures in ICU patients.