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Kim HJ, Lee SH, Lee JJ, Seong SS, Yang H, Lee HY. [Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design]. J Korean Acad Nurs 2024; 54:237-249. [PMID: 38863191 DOI: 10.4040/jkan.22142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 06/13/2024]
Abstract
PURPOSE This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. METHODS The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. RESULTS The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. CONCLUSION These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.
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Affiliation(s)
- Hyun-Joo Kim
- Seoul St. Mary's Hospital Nursing Department, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hee Lee
- Seoul St. Mary's Hospital Nursing Department, The Catholic University of Korea, Seoul, Korea
| | - Jai-Jung Lee
- Seoul St. Mary's Hospital Nursing Department, The Catholic University of Korea, Seoul, Korea
| | - Sun-Suk Seong
- Seoul St. Mary's Hospital Nursing Department, The Catholic University of Korea, Seoul, Korea
| | - Hee Yang
- Seoul St. Mary's Hospital Nursing Department, The Catholic University of Korea, Seoul, Korea
| | - Hyang-Yuol Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea.
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Kim Y, Lee MJ, Choi M, Cho E, Ryu GW. Exploring nurses' multitasking in clinical settings using a multimethod study. Sci Rep 2023; 13:5704. [PMID: 37029189 PMCID: PMC10082008 DOI: 10.1038/s41598-023-32350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open
Abstract
Nurses often multitask in the process of managing patient care and communicating with healthcare providers simultaneously within a limited time, which can negatively affect patient care and safety. In this multimethod research, we conducted a time and motion study to record nursing activities using eye trackers for 23 participants (9 nurses and 14 patients). The frequency and duration of single and multitasking activities were analyzed. Additionally, we conducted focus group interviews (FGIs) with 12 nurses (2-5 nurses per group) to further investigate their multitasking experience. The total duration of the eye tracker recordings was 3,399 min. Daily nursing activities comprised 23.7%, 21.1%, and 12.5% of scheduled medication, documentation, and monitoring and measurement, respectively. Among these activities, nurses mostly carry out scheduled medication, monitoring, and measurement together. Three themes emerged in the FGIs: "Being involved in every little task regarding patient care," "Getting swamped by the complexity of symptoms and problems of the patients at a given time," and "Getting interrupted at work too often." Nurses performed multiple activities while cooperating with other healthcare providers and providing care to patients. It is important to create an environment where nurses can focus on essential nursing activities to improve patient safety.
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Affiliation(s)
- Yoojin Kim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Mi Ja Lee
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Gi Wook Ryu
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea.
- Department of Nursing, Hansei University, 30 Hanse-Ro, Gunpo-Si, Gyeonggi-Do, 15852, South Korea.
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Grealish L, Ranse K, Todd JA, Armit L, Billett S, Collier L, Bail K, Moyle W. Barriers and enablers to embedding fundamental nursing care for older patients-Implications of a mixed methods study for nursing leadership. J Adv Nurs 2023; 79:1162-1173. [PMID: 35285976 DOI: 10.1111/jan.15194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/04/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
AIMS To understand the enablers and barriers for delivering fundamental care to hospitalized older patients. DESIGN Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results. METHODS Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations. RESULTS There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs. CONCLUSION The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions. IMPACT Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.
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Affiliation(s)
- Laurie Grealish
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia.,Gold Coast Health, Australia
| | - Kristen Ranse
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
| | | | | | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Australia
| | | | | | - Wendy Moyle
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
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Snowdon DA, King OA, Dennett A, Pinson JA, Shannon MM, Collyer TA, Davis A, Williams CM. Delegation of patient related tasks to allied health assistants: a time motion study. BMC Health Serv Res 2022; 22:1280. [PMID: 36280846 PMCID: PMC9590386 DOI: 10.1186/s12913-022-08642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task. Methods A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks. Results Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02). Conclusion AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs’ role in providing patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08642-7.
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Affiliation(s)
- David A Snowdon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Olivia A King
- grid.1002.30000 0004 1936 7857Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC Australia ,grid.414257.10000 0004 0540 0062Allied Health Department, Barwon Health, Geelong, VIC Australia
| | - Amy Dennett
- grid.414366.20000 0004 0379 3501Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC Australia ,grid.1018.80000 0001 2342 0938School of Allied Health Human Services and Sport, La Trobe University, Bundoora, VIC Australia
| | - Jo-Anne Pinson
- grid.419789.a0000 0000 9295 3933Medical Imaging Department, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC Australia ,grid.466993.70000 0004 0436 2893Medical Imaging Department, Peninsula Health, Frankston, VIC Australia
| | - Michelle M Shannon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Taya A Collyer
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Annette Davis
- grid.419789.a0000 0000 9295 3933Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC Australia
| | - Cylie M Williams
- grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,grid.1002.30000 0004 1936 7857School of Primary and Allied Health Care, Monash University, Frankston, VIC Australia
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Mustaffa KH, Shafie AA, Ngu LH. A comparison of self-evaluated survey and work sampling approach for estimating patient-care unit cost multiplier in genetic nursing activities. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:170-179. [PMID: 35714898 DOI: 10.1016/j.anr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare patient care multipliers estimated from subjective evaluation against work sampling techniques in genetic nursing activities. METHODS An observational work sampling technique was conducted from November to December 2019 with nine genetic nurses in a tertiary referral centre in Malaysia. The work sampling activity instrument was devised, validated, and pilot tested. All care and noncare-related activities were sampled at 10-minute intervals within 8 hours of working over 14 days, followed by a subjective evaluation of activities survey over the same period. Bonferroni correction was undertaken for multiple testing with a p value of 0.0025. RESULTS The two techniques produced significant differences in genetic nurses' activities categorization. The work sampling showed that compared with subjective evaluation, direct care (19.3% versus 45.0%; p < .001) was estimated to be significantly lower, and indirect care (40.4% versus 25.6%; p < .001) and unit-related care (28.5% versus 16.9%; p < .001) were higher. Both techniques produced a similar proportion of time spent in other noncare activities (12.0%) but differed in genetic meetings and information-gathering activities. While the multipliers for patient face-to-face contact were significantly larger between work sampling (4.57) and the survey (1.94), the multipliers for patient care time were smaller between work sampling (1.47) and the survey (1.24), indicating that caution should be taken when multiplying for patient contact time compared to patient care activity to determine the cost of care provision. CONCLUSION A considerable proportion of time spent away from the patient needs to be allocated to patient-related care time. Thus, estimating the paid cost solely based on direct time with patients considerably underestimates the cost per hour of nurses' care. It is recommended to employ 'patient-related activity' instead of the 'face-to-face contact' multiplier because the former did not significantly differ from the one estimated using work sampling.
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Affiliation(s)
- Khairu Hazwan Mustaffa
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia; Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia.
| | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Larsson IM, Aronsson A, Norén K, Wallin E. Healthcare workers' structured daily reflection on patient safety, workload and work environment in intensive care. A descriptive retrospective study. Intensive Crit Care Nurs 2021; 68:103122. [PMID: 34362657 DOI: 10.1016/j.iccn.2021.103122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the results of use of structured daily reflection assessments among healthcare workers at an intensive care unit over the course of one year. METHODS In this descriptive retrospective study, data were analysed both quantitatively and qualitatively. The data encompassed 1095 work shifts, evaluated by healthcare workers at an intensive care unit using a structured daily reflection instrument. The areas evaluated were patient safety, workload and work environment, and free-text comments were possible. FINDINGS The results showed that 36% (n = 395) of work shifts, most of them daytime shifts (44%; n = 161), were affected. Workload was the area that affected most work shifts (29%; n = 309). Missed nursing care, complex care and inaccurate communication impacted patient safety, while patient care, multitasking and working conditions affected workload. Work environment was impacted by organisational factors, environment, lack of control and moral stress. CONCLUSION Using daily reflection among healthcare workers in the intensive care unit illuminated areas that affect patient safety, workload, and work environment. The importance of communication and collaboration and how they can impact patient safety, workload, and the work environment were highlighted by the team.
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Affiliation(s)
- Ing-Marie Larsson
- Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, SE-751 85 Uppsala, Sweden; Department of Intensive Care, University Hospital, Uppsala, Sweden.
| | - Anna Aronsson
- Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, SE-751 85 Uppsala, Sweden; Department of Intensive Care, University Hospital, Uppsala, Sweden
| | - Karin Norén
- Department of Intensive Care, University Hospital, Uppsala, Sweden
| | - Ewa Wallin
- Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, SE-751 85 Uppsala, Sweden; Department of Intensive Care, University Hospital, Uppsala, Sweden
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Craswell A, Bennett K, Dalgliesh B, Morris-Smith B, Hanson J, Flynn T, Wallis M. The impact of automated medicine dispensing units on nursing workflow: A cross-sectional study. Int J Nurs Stud 2020; 111:103773. [DOI: 10.1016/j.ijnurstu.2020.103773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
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Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls? ACTA ACUST UNITED AC 2020; 50:355-362. [DOI: 10.1097/nna.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Abstract
Results of the Patient Care and Tracking Increasing Electronics in Nurses' Use of Time (PATIENT) study.
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Affiliation(s)
- Carolyn Sun
- In New York, N.Y., Carolyn Sun is an assistant professor at the Hunter College Hunter-Bellevue School of Nursing and an adjunct faculty member at the Columbia University School of Nursing and Kenrick D. Cato is an assistant professor at Columbia University School of Nursing. Both authors are also nurse researchers at NewYork-Presbyterian
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Walker RM, Burmeister E, Jeffrey C, Birgan S, Garrahy E, Andrews J, Hada A, Aitken LM. The impact of an integrated electronic health record on nurse time at the bedside: A pre-post continuous time and motion study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Therapy Workloads in Pediatric Health: Preliminary Findings and Relevance for Defining Practice. Pediatr Phys Ther 2020; 32:52-59. [PMID: 31842097 DOI: 10.1097/pep.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure time spent by pediatric physical and occupational therapists in performing daily work activities. METHODS Physical and occupational therapists at an urban pediatric academic hospital were observed during a standard workday. Time studies recorded total time spent performing patient care and other workplace-specific tasks. Data were analyzed to identify trends. RESULTS Broad similarities existed in average amounts of time spent in direct patient care, indirect patient care, and nonpatient care tasks. Indirect patient care tasks demonstrated the lowest variability in time spent. CONCLUSIONS This is the first report of pediatric physical and occupational therapists' time in performing daily tasks. The metric and tools derived from these findings support managerial decision-making, provide a comparison of actual versus targeted workload, assist with determining appropriate and safe staffing caseloads, and contribute to measurements of a patient's therapy acuity level.Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A280.
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van den Oetelaar WFJM, van Rhenen W, Stellato RK, Grolman W. Balancing workload of nurses: Linear mixed effects modelling to estimate required nursing time on surgical wards. Nurs Open 2020; 7:235-245. [PMID: 31871707 PMCID: PMC6917947 DOI: 10.1002/nop2.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/14/2019] [Accepted: 09/02/2019] [Indexed: 11/08/2022] Open
Abstract
Aim Quantifying the relation between patient characteristics and care time and explaining differences in nursing time between wards. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15-30 beds, 2012-2014. Methods Linear mixed effects model to study the relation between patient characteristics and care time. Estimated marginal means to estimate baseline care time and differences between wards. Results Nine patient characteristics significantly related to care time. Most required between 18 and 35 min extra, except "two or more IV/drip/drain" (8) and "one-on-one care" (156). Care time for minimum patient profile: 44-57 min and for average patient profile: 75-88 min. Sources of variation: nurse proficiency, patients, day-to-day variation within patients. The set of characteristics is short, simple and useful for planning and comparing workload. Explained variance up to 36%. Calculating estimated means per ward has not been done before. Nurse proficiency is an important factor.
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Affiliation(s)
| | - Willem van Rhenen
- Center for Human Resource Organization and Management EffectivenessBusiness University NyenrodeBreukelenThe Netherlands
- Arbo UnieUtrechtThe Netherlands
| | - Rebecca K. Stellato
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Wilko Grolman
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
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Iordache S, Elseviers M, De Cock R, Van Rompaey B. Development and validation of an assessment tool for nursing workload in emergency departments. J Clin Nurs 2019; 29:794-809. [PMID: 31737962 DOI: 10.1111/jocn.15106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
AIMS To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments. BACKGROUND Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments. DESIGN A two-year, cross-sectional, multicenter study. METHODS Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group-discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines. RESULTS Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements. CONCLUSIONS Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence-based management tool for benchmarking purposes. RELEVANCE TO CLINICAL PRACTICE The use of an evidence-based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.
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Affiliation(s)
- Steluta Iordache
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium
| | - Monique Elseviers
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium.,Clinical Pharmacology, Heymans Institute, University of Ghent, Ghent, Belgium
| | - Rita De Cock
- Nursing Department, Imelda Hospital, Bonheiden, Belgium
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium.,Department of Health and Social Care, Artesis Plantijn University College of Antwerp, Merksem, Belgium
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15
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Yu P, Song L, Qian S, Yao X, Huang J, Min L, Lu X, Duan H, Deng N. Work pattern of neurology nurses in a Chinese hospital: A time and motion study. J Nurs Manag 2018; 27:320-329. [DOI: 10.1111/jonm.12682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ping Yu
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences; University of Wollongong; Wollongong New South Wales Australia
| | - Liying Song
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
| | - Siyu Qian
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences; University of Wollongong; Wollongong New South Wales Australia
| | - Xing Yao
- Huzhou Central Hospital; Huzhou China
| | - Jue Huang
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
| | - Lingtong Min
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
| | - Xudong Lu
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
- Information Systems Group, School of Industrial Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Huilong Duan
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
| | - Ning Deng
- Key Laboratory of Biomedical Engineering, The Ministry of Education; College of Biomedical Engineering and Instrument Science; Zhejiang University; Hangzhou China
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van den Oetelaar WFJM, van Stel HF, van Rhenen W, Stellato RK, Grolman W. Mapping nurses' activities in surgical hospital wards: A time study. PLoS One 2018; 13:e0191807. [PMID: 29689048 PMCID: PMC5916856 DOI: 10.1371/journal.pone.0191807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 01/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. Objective In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. Setting The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. Method We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. Results The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. Conclusions We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences in the patient mix, nurse staffing (proportion of nursing students), type of surgery and region of the body where the surgery was performed. However, we could not explain all differences. We made a first attempt in identifying and explaining differences in nurses’ activities between wards, however this domain needs more research in order to better explain the differences.
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Affiliation(s)
- W. F. J. M. van den Oetelaar
- Division of Internal Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - H. F. van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - W. van Rhenen
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, the Netherlands
- ArboUnie Occupational Health Service, Utrecht, the Netherlands
| | - R. K. Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - W. Grolman
- Division of Surgical Specialties, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Abstract
OBJECTIVE To complete an objective analysis of the activities that occur during the course of daily rounds in a high acuity academic tertiary care pediatric intensive care unit (PICU). DESIGN Prospective observational work sampling design. SETTING Tertiary care academic Children's Hospital Pediatric Intensive Care Unit. SUBJECTS Multidisciplinary PICU teams. INTERVENTIONS None. METHODS Intensive care unit rounds were observed as part of an initiative to improve efficiency over a 2-month period. The number of observations required was determined by Neibel's work sampling method. Rounds were broken into various constituent events and then later classified as "value-added/essential," "value-added/nonessential," and "nonessential" based on whether the observed event was essential to the core mission of PICU rounds. RESULTS The mean time spent per patient for all observed teams was 17.9 min (SD 1.3 min). Teams spent 64% of their time doing value-added/essential tasks (11.2 min, SD 2.2 min) and 13% of their time doing value-added/nonessential tasks (2.4 min, SD 0.9 min). Teams spent 23% of their time on non-value-added activities (4.1 min, SD 2.3 min). The top three non-value-added activities conducted during rounds were travel, waiting, and interruptions regarding care of other patients. Given the consistency of time spent on value-added activities among attendings, these non-value-added activities might explain the significant variability observed among attendings in total time spent rounding. CONCLUSIONS This was an observational study to characterize the activities that occur during the course of a routine PICU work rounds. Although there was significant consistency in the time spent per patient in value-added activities, there was significant disparity in time spent on nonessential activities, such as travel and waiting. A dedicated attempt to reduce time spent on nonessential activities can substantially reduce rounding times and improve the efficiency and value of rounds.
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Olthof M, Stevens M, Dijkstra B, Bulstra SK, Van Den Akker-Scheek I. Actual and perceived nursing workload and the complexity of patients with total hip arthroplasty. Appl Nurs Res 2018; 39:195-199. [PMID: 29422158 DOI: 10.1016/j.apnr.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M Olthof
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - M Stevens
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - B Dijkstra
- Medical Center Leeuwarden, The Netherlands.
| | - S K Bulstra
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - I Van Den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
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Munyisia EN, Hailey D, Yu P. Caregivers’ Time Utilization before and after the Introduction of an Electronic Nursing Documentation System in a Residential Aged Care Facility. Methods Inf Med 2018; 52:403-10. [DOI: 10.3414/me12-01-0024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 03/27/2013] [Indexed: 11/09/2022]
Abstract
SummaryBackground: Despite increasing research on caregivers’ interaction with technology, there has been no attempt to investigate how the introduction of an electronic system in a residential aged care facility (RACF) may affect caregivers’ use of their time.Objective: To assess how caregivers use their time before and after the introduction of an electronic documentation system in an RACF.Methods: An observational work sampling study was undertaken with caregivers at two months before, and at 3, 6, 12 and 23 months after the implementation of an electronic documentation system.Results: During the first 12 months after implementation, the proportion of time spent by personal carers on documentation increased, that on direct care reduced, and the proportion on communication remained unchanged. At 23 months, the proportion on documentation and direct care had returned to pre-implementation levels. The percentage of time spent on these activities by recreational activity officers remained unchanged at most measurement periods after implementation. Changes in proportions of time on other activities were not directly associated with the introduction of the electronic system.Conclusion: It may take over a year for some caregivers in an RACF to integrate the use of a newly introduced electronic documentation system into their daily work. Organisations implementing such systems should develop strategies that support and accelerate the caregivers’ integration of the new documentation practice into their routine activities. The electronic documentation system may not however, replace the role of verbal communication between caregivers in aged care service.
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van Hassel D, van der Velden L, de Bakker D, van der Hoek L, Batenburg R. Assessing the precision of a time-sampling-based study among GPs: balancing sample size and measurement frequency. HUMAN RESOURCES FOR HEALTH 2017; 15:81. [PMID: 29202768 PMCID: PMC5715539 DOI: 10.1186/s12960-017-0254-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Our research is based on a technique for time sampling, an innovative method for measuring the working hours of Dutch general practitioners (GPs), which was deployed in an earlier study. In this study, 1051 GPs were questioned about their activities in real time by sending them one SMS text message every 3 h during 1 week. The required sample size for this study is important for health workforce planners to know if they want to apply this method to target groups who are hard to reach or if fewer resources are available. In this time-sampling method, however, standard power analyses is not sufficient for calculating the required sample size as this accounts only for sample fluctuation and not for the fluctuation of measurements taken from every participant. We investigated the impact of the number of participants and frequency of measurements per participant upon the confidence intervals (CIs) for the hours worked per week. METHODS Statistical analyses of the time-use data we obtained from GPs were performed. Ninety-five percent CIs were calculated, using equations and simulation techniques, for various different numbers of GPs included in the dataset and for various frequencies of measurements per participant. RESULTS Our results showed that the one-tailed CI, including sample and measurement fluctuation, decreased from 21 until 3 h between one and 50 GPs. As a result of the formulas to calculate CIs, the increase of the precision continued and was lower with the same additional number of GPs. Likewise, the analyses showed how the number of participants required decreased if more measurements per participant were taken. For example, one measurement per 3-h time slot during the week requires 300 GPs to achieve a CI of 1 h, while one measurement per hour requires 100 GPs to obtain the same result. CONCLUSIONS The sample size needed for time-use research based on a time-sampling technique depends on the design and aim of the study. In this paper, we showed how the precision of the measurement of hours worked each week by GPs strongly varied according to the number of GPs included and the frequency of measurements per GP during the week measured. The best balance between both dimensions will depend upon different circumstances, such as the target group and the budget available.
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Affiliation(s)
- Daniël van Hassel
- NIVEL, Netherlands institute for health services research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- CAOP, P.O. Box 556, 2501 CN Den Haag, The Netherlands
| | - Lud van der Velden
- NIVEL, Netherlands institute for health services research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Dinny de Bakker
- NIVEL, Netherlands institute for health services research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Tranzo, Scientific Centre for Transformation in Care and Welfare, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Lucas van der Hoek
- NIVEL, Netherlands institute for health services research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- NIVEL, Netherlands institute for health services research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Montayre J, Montayre J. Nursing Work in Long-Term Care: An Integrative Review. J Gerontol Nurs 2017; 43:41-49. [DOI: 10.3928/00989134-20170519-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022]
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Antinaho T, Kivinen T, Turunen H, Partanen P. Increasing value-adding patient care by applying a modified TCAB program. Leadersh Health Serv (Bradf Engl) 2017; 30:411-427. [PMID: 28893120 DOI: 10.1108/lhs-11-2016-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to evaluate a development process aimed at increasing registered nurses' (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals. Design/methodology/approach Basic data for the development process were collected on RNs' working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs' working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis ( N = 64). Findings RNs' working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs' working time use. Practical implications The development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work. Originality/value Even minor changes in nurses' daily work profile can have considerable effects on RNs' work. The TCAB program was shown to be a useful method in developing RNs' work also in psychiatric units.
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Affiliation(s)
- Tuula Antinaho
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland and Central Finland Health Care District, Jyväskylä, Finland
| | - Tuula Kivinen
- Department of Health and Social Management, University of Eastern Finland , Kuopio, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland
| | - Pirjo Partanen
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland
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Campbell JK, Ortiz MV, Ottolini MC, Birch S, Agrawal D. Personal Digital Assistant-Based Self-Work Sampling Study of Pediatric Interns Quantifies Workday and Educational Value. Acad Pediatr 2017; 17:288-295. [PMID: 27965068 DOI: 10.1016/j.acap.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Optimizing clinical proficiency and education of residents has become more important with restricted residency duty hours. Our objective was to investigate how interns spend their time on inpatient rotations and the perceived educational value of workday activities. METHODS We performed a descriptive self-work sampling study using a personal digital assistant (PDA) to randomly query interns on inpatient rotations in real time regarding their activity and the perceived educational value of that activity on a 4-point Likert scale. RESULTS A total of 31 interns participated on 88 workdays over a 5-month period, generating 2082 samples from which the average workday was modeled. Time spent using the electronic health record (EHR) accounted for 33% of intern time, communicating with the health care team 23%, educational activities 17%, and time with patients and families 12%. Time with patients and families was perceived to be the most educational part of clinical service. Time spent using the EHR was perceived as the least educational. Interns perceived clinical service as excellent or good 37% of the time, while planned educational activities were perceived as excellent or good 81% of the time. CONCLUSIONS Interns spend the majority of their time using the EHR and communicating with the health care team. Interns perceive time spent in planned educational activities has more educational value than time spent in clinical service. The distribution of daily activities is discordant with the perceived educational value of those activities.
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Affiliation(s)
| | | | | | - Sarah Birch
- Children's National Medical Center, Washington, DC
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Antinaho T, Kivinen T, Turunen H, Partanen P. Improving the quality of registered nurses’ working time use data. J Clin Nurs 2017; 26:3031-3043. [DOI: 10.1111/jocn.13650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Tuula Antinaho
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Central Finland Health Care District; Jyväskylä Finland
| | - Tuula Kivinen
- Department of Health and Social Management; University of Eastern Finland; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | - Pirjo Partanen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
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Abstract
OBJECTIVE The purpose of this study was to develop a valid and reliable patient classification system (PCS) for a neonatal ICU (NICU). BACKGROUND PCSs have been widely used to determine required care hours, budgeting, and staffing. There is a lack of and a vital need for a valid and reliable pediatric PCS because of differences in needs and treatment from adults. METHODS Data were collected in a NICU using work sampling, chart reviews, and expert opinion. The resulting PCS was assessed for validity and reliability, ease of use, effectiveness, and satisfaction. RESULTS The PCS showed significantly high reliability and validity. Survey scores revealed nurses perceived the tool to be easy to use and effective. CONCLUSIONS Using subjective and objective methods, a NICU PCS was shown to be a valid and reliable measure to determine the hours per patient day required to provide care.
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Roche MA, Friedman S, Duffield C, Twigg DE, Cook R. A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study. J Adv Nurs 2016; 73:1421-1432. [DOI: 10.1111/jan.13224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael A. Roche
- School of Nursing Midwifery and Paramedicine Australian Catholic University and Northern Sydney Local Health District New South Wales Australia
- Faculty of Health University of Technology Sydney New South Wales Australia
| | - Sarah Friedman
- Faculty of Health University of Technology Sydney New South Wales Australia
| | - Christine Duffield
- Faculty of Health University of Technology Sydney New South Wales Australia
- Edith Cowan University Joondalup Western Australia Australia
| | - Diane E. Twigg
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
- Centre for Nursing Research Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Rebecca Cook
- Faculty of Health University of Technology Sydney New South Wales Australia
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van den Oetelaar WFJM, van Stel HF, van Rhenen W, Stellato RK, Grolman W. Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload. BMJ Open 2016; 6:e012148. [PMID: 28186931 PMCID: PMC5129129 DOI: 10.1136/bmjopen-2016-012148] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. METHODS/ANALYSIS The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds. ETHICAL CONSIDERATIONS The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. DISCUSSION This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis.
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Affiliation(s)
| | - H F van Stel
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - W van Rhenen
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, The Netherlands
- ArboNed Occupational Health Service, Utrecht, The Netherlands
| | - R K Stellato
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Grolman
- University Medical Center Utrecht, Utrecht, The Netherlands
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Tenkanen H, Taskinen H, Kontio R, Repo-Tiihonen E, Tiihonen J, Kinnunen J. Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia. JOURNAL OF FORENSIC NURSING 2016; 12:64-73. [PMID: 27195927 DOI: 10.1097/jfn.0000000000000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.
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Affiliation(s)
- Helena Tenkanen
- Author Affiliations: 1Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital; 2Department of Health and Social Management, University of Eastern Finland; 3Department of Psychiatry, University of Helsinki and Helsinki University Hospital; 4Department of Clinical Neuroscience, Karolinska Institutet; 5Central Finland Health Care District
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Bonfim D, Pereira MJB, Pierantoni CR, Haddad AE, Gaidzinski RR. Tool to measure workload of health professionals in Primary Health Care: development and validation. Rev Esc Enferm USP 2016; 49 Spec No:25-34. [PMID: 26959150 DOI: 10.1590/s0080-623420150000800004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/13/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To develop and validate an instrument that addresses the interventions/activities carried out by the family health team as reference for staff planning. Method Methodological research developed in stages: instrument development, content validation, and pilot test in three units located in the southeastern region of Brazil. Results 39 interventions were validated in a single instrument to measure workload for clinician, dental surgeon, oral health technician/assistant, nurse, nurse assistant, and community health agent. In the pilot test, the instrument contained 100% of the interventions observed and the observers reached 93.7% agreement. Conclusion The proposed instrument is an innovating tool because of its configuration for health team and supports staff planning in primary health care.
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Affiliation(s)
- Daiana Bonfim
- Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Célia Regina Pierantoni
- Instituto de Medicina Socia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ana Estela Haddad
- Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brasil
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Tuinman A, de Greef M, Nieweg R, Paans W, Roodbol P. Assessing time use in long-term institutional care: development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC). BMC Nurs 2016; 15:13. [PMID: 26933385 PMCID: PMC4772327 DOI: 10.1186/s12912-016-0133-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language. Methods The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen’s kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero. Results The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa’s were found for interventions in the domains basic (0.67–0.92) and complex (0.70–0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa’s ranged from fair to almost perfect (0.30–1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48–0.99) and poor to excellent for the other domains (0.00–1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found. Conclusions The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.
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Affiliation(s)
- Astrid Tuinman
- School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Mathieu de Greef
- Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roos Nieweg
- School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Wolter Paans
- School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Petrie Roodbol
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; School of Nursing & Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Goulter N, Kavanagh DJ, Gardner G. What keeps nurses busy in the mental health setting? J Psychiatr Ment Health Nurs 2015; 22:449-56. [PMID: 25939246 DOI: 10.1111/jpm.12173] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
Abstract
ACCESSIBLE SUMMARY Recent evidence suggests that the interactional work of mental health nursing has been eroded and redirected to the task-based roles of medicine. This study utilized work sampling methodology to observe the proportion of time nurses working in a mental health setting spend in direct care, indirect care and service-related activities. Nurses spent 32% of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes. ABSTRACT The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes.
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Affiliation(s)
- N Goulter
- Metro North Mental Health Services, Royal Brisbane & Women's Hospital & Queensland University of Technology, Brisbane, QLD, Australia
| | - D J Kavanagh
- School of Psychology, Queensland University of Technology & Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
| | - G Gardner
- School of Nursing, Queensland University of Technology & Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
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Antinaho T, Kivinen T, Turunen H, Partanen P. Nurses' working time use - how value adding it is? J Nurs Manag 2014; 23:1094-105. [DOI: 10.1111/jonm.12258] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Tuula Antinaho
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Central Finland Health Care District; Jyväskylä Finland
| | - Tuula Kivinen
- Central Finland Health Care District; Jyväskylä Finland
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | - Pirjo Partanen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
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Munyisia E, Yu P, Hailey D. The effect of an electronic health record system on nursing staff time in a nursing home: a longitudinal cohort study. Australas Med J 2014; 7:285-93. [PMID: 25157268 DOI: 10.4066/amj.2014.2072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nursing homes are increasingly introducing electronic health record (EHR) systems into nursing practice; however, there is limited evidence about the effect of these systems on nursing staff time. AIMS To investigate the effect of introducing an EHR system on time spent on activities by nursing staff in a nursing home. METHOD An observational work sampling study was undertaken with nursing staff between 2009 and 2011 at two months before, and at 3, 6, 12, and 23 months after implementation of an EHR system at an Australian nursing home. An observer used pre-determined tasks to record activities of the nursing staff at nine-minute intervals. RESULTS There was no significant change in registered nurses and endorsed enrolled nurses' time on most activities after implementation. Personal carers' time on oral-communication reduced, and time on documentation increased at most measurement periods in the first 12 months after implementation. At 23 months, time on these activities had returned to pre-implementation levels. Nursing staff time on direct care remained stable after implementation. No considerable change was observed in time spent on other activities after implementation. CONCLUSION Findings suggest that successful introduction of an EHR system in a nursing home may not interfere with nursing staff time on direct care duties. However, there is scope for improving the support provided by EHR systems through incorporation of functions to support collaborative nursing care.
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Affiliation(s)
- Esther Munyisia
- Illawarra Shoalhaven Local Health District, New South Wales Health, Australia
| | - Ping Yu
- School of Information Systems and Technology, The University of Wollongong, Australia
| | - David Hailey
- School of Information Systems and Technology, The University of Wollongong, Australia
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Qian S, Yu P, Hailey DM, Zhang Z, Davy PJ, Nelson MI. Time spent on daytime direct care activities by personal carers in two Australian residential aged care facilities: a time-motion study. AUST HEALTH REV 2014; 38:230-7. [PMID: 24679365 DOI: 10.1071/ah13161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 12/18/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the time, frequency and duration of each direct care activity conducted by personal carers in Australian residential aged care homes. METHODS A time-motion study was conducted to observe 46 personal carers at two high-care houses in two facilities (14 days at Site 1 and 16 days at Site 2). Twenty-three direct care activities were classified into eight categories for analysis. RESULTS Overall, a personal carer spent approximately 45% of their time on direct care, corresponding to 3.5h in an 8-h daytime shift. The two sites had similar ratios of personal carers to residents, and each resident received 30 min of direct care. No significant differences between the two sites were found in the time spent on oral communication, personal hygiene and continence activities. Personal carers at Site 1 spent significantly less time on toileting and mobility activities than those at Site 2, but more time on lunch activity. Although oral communication took the longest time (2h), it occurred concurrently with other activities (e.g. dressing) for 1.5h. CONCLUSIONS The findings provide information that may assist decision makers in managing the operation of high-care residential aged care facilities, such as planning for task allocation and staffing. What is known about the topic? Overall, 30%-45% of the care staff's time is spent on direct care in residential aged care facilities. What does this paper add? This paper adds knowledge about how much time is required to conduct each direct care activity and the frequency and duration of conducting these activities to meet residents' day-to-day care needs in two high-care houses in two aged care facilities. What are the implications for practitioners? On average, a resident with high-care needs requires 30 min direct care. There may exist a basic minimum desirable ratio of personal carers to residents in high-care facilities. Residents' toileting needs are high after meals. Communication with residents represents an essential role in providing care.
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Affiliation(s)
- Siyu Qian
- School of Information Systems and Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia. ;
| | - Ping Yu
- School of Information Systems and Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia. ;
| | - David M Hailey
- School of Information Systems and Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia. ;
| | - Zhenyu Zhang
- School of Information Systems and Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia. ;
| | - Pamela J Davy
- School of Mathematics and Applied Statistics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Mark I Nelson
- School of Mathematics and Applied Statistics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
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Blay N, Duffield CM, Gallagher R, Roche M. Methodological integrative review of the work sampling technique used in nursing workload research. J Adv Nurs 2014; 70:2434-49. [DOI: 10.1111/jan.12466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Blay
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
| | - Christine M. Duffield
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
| | - Robyn Gallagher
- Chronic & Complex Care Faculty of Health University of Technology Sydney New South Wales Australia
- Charles Perkins Centre Sydney Nursing School The University of Sydney Sydney New South Wales Australia
| | - Michael Roche
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
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Blay N, Duffield CM, Gallagher R, Roche M. A systematic review of time studies to assess the impact of patient transfers on nurse workload. Int J Nurs Pract 2014; 20:662-73. [DOI: 10.1111/ijn.12290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nicole Blay
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Christine M Duffield
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Robyn Gallagher
- Chronic & Complex CareFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Michael Roche
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
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Cruz CWMD, Bonfim D, Gaidzinski RR, Fugulin FMT, Laus AM. The Use of Nursing Interventions Classification (NIC) in Identifying the Workload of Nursing: An Integrative Review. Int J Nurs Knowl 2014; 25:154-60. [DOI: 10.1111/2047-3095.12031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Daiana Bonfim
- University of São Paulo School of Nursing; São Paulo São Paulo Brazil
| | | | | | - Ana Maria Laus
- University of São Paulo at Ribeirão Preto College of Nursing; Ribeirão Preto São Paulo Brazil
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Green CF, Crawford V, Bresnen G, Rowe PH. A waste walk through clinical pharmacy: how do the ‘seven wastes’ of Lean techniques apply to the practice of clinical pharmacists†‡. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:21-6. [DOI: 10.1111/ijpp.12106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 02/04/2014] [Indexed: 11/27/2022]
Abstract
Abstract
Aims and objectives
This study used a ‘Lean’ technique, the ‘waste walk’ to evaluate the activities of clinical pharmacists with reference to the seven wastes described in ‘Lean’ including ‘defects’, ‘unnecessary motion’, ‘overproduction’, ‘transport of products or material’, ‘unnecessary waiting’, ‘unnecessary inventory’ and ‘inappropriate processing’. The objectives of the study were to categorise the activities of ward-based clinical pharmacists into waste and non-waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category.
Setting
This study was carried out in a district general hospital in the North West of England.
Method
Staff were observed using work-sampling techniques, to categorise activity into waste and non-waste, with waste activities being allocated to each of the seven wastes described earlier and subdivided into recurrent themes.
Key findings
Twenty different pharmacists were observed for 1 h on two separate occasions. Of 1440 observations, 342 (23.8%) were categorised as waste with ‘defects’ and ‘unnecessary motion’ accounting for the largest proportions of waste activity.
Conclusion
Observation of clinical pharmacists’ activities has identified that a significant proportion of their time could be categorised as ‘waste’. There are practical steps that could be implemented in order to ensure their time is used as productively as possible. Given the challenges facing the UK National Health Service, the adoption of ‘Lean’ techniques provides an opportunity to improve quality and productivity while reducing costs.
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Affiliation(s)
- Christopher F Green
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Gaynor Bresnen
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Philip H Rowe
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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Time motion studies in healthcare: what are we talking about? J Biomed Inform 2014; 49:292-9. [PMID: 24607863 DOI: 10.1016/j.jbi.2014.02.017] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/17/2014] [Accepted: 02/26/2014] [Indexed: 11/20/2022]
Abstract
Time motion studies were first described in the early 20th century in industrial engineering, referring to a quantitative data collection method where an external observer captured detailed data on the duration and movements required to accomplish a specific task, coupled with an analysis focused on improving efficiency. Since then, they have been broadly adopted by biomedical researchers and have become a focus of attention due to the current interest in clinical workflow related factors. However, attempts to aggregate results from these studies have been difficult, resulting from a significant variability in the implementation and reporting of methods. While efforts have been made to standardize the reporting of such data and findings, a lack of common understanding on what "time motion studies" are remains, which not only hinders reviews, but could also partially explain the methodological variability in the domain literature (duration of the observations, number of tasks, multitasking, training rigor and reliability assessments) caused by an attempt to cluster dissimilar sub-techniques. A crucial milestone towards the standardization and validation of time motion studies corresponds to a common understanding, accompanied by a proper recognition of the distinct techniques it encompasses. Towards this goal, we conducted a review of the literature aiming at identifying what is being referred to as "time motion studies". We provide a detailed description of the distinct methods used in articles referenced or classified as "time motion studies", and conclude that currently it is used not only to define the original technique, but also to describe a broad spectrum of studies whose only common factor is the capture and/or analysis of the duration of one or more events. To maintain alignment with the existing broad scope of the term, we propose a disambiguation approach by preserving the expanded conception, while recommending the use of a specific qualifier "continuous observation time motion studies" to refer to variations of the original method (the use of an external observer recording data continuously). In addition, we present a more granular naming for sub-techniques within continuous observation time motion studies, expecting to reduce the methodological variability within each sub-technique and facilitate future results aggregation.
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Chen J, Daraiseh NM, Davis KG, Pan W. Sources of work-related acute fatigue in United States hospital nurses. Nurs Health Sci 2014; 16:19-25. [DOI: 10.1111/nhs.12104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jie Chen
- College of Health and Human Sciences; Northern Illinois University; DeKalb Illinois USA
| | - Nancy M. Daraiseh
- Center for Professional Excellence; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | - Kermit G. Davis
- College of Medicine; University of Cincinnati; Cincinnati Ohio USA
| | - Wei Pan
- School of Nursing; Duke University; Durham North Carolina USA
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Jones TL, Schlegel C. Can real time location system technology (RTLS) provide useful estimates of time use by nursing personnel? Res Nurs Health 2013; 37:75-84. [PMID: 24338915 DOI: 10.1002/nur.21578] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/11/2022]
Abstract
Accurate, precise, unbiased, reliable, and cost-effective estimates of nursing time use are needed to insure safe staffing levels. Direct observation of nurses is costly, and conventional surrogate measures have limitations. To test the potential of electronic capture of time and motion through real time location systems (RTLS), a pilot study was conducted to assess efficacy (method agreement) of RTLS time use; inter-rater reliability of RTLS time-use estimates; and associated costs. Method agreement was high (mean absolute difference = 28 seconds); inter-rater reliability was high (ICC = 0.81-0.95; mean absolute difference = 2 seconds); and costs for obtaining RTLS time-use estimates on a single nursing unit exceeded $25,000. Continued experimentation with RTLS to obtain time-use estimates for nursing staff is warranted.
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Affiliation(s)
- Terry L Jones
- University of Texas at Austin School of Nursing, 1710 Red River Street, Austin, Texas, 78701
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White DE, Jackson K, Besner J, Norris JM. The examination of nursing work through a role accountability framework. J Nurs Manag 2013; 23:604-12. [PMID: 24279365 DOI: 10.1111/jonm.12186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/29/2022]
Abstract
AIM To use work analysis data to describe the amount of time registered nurses (RNs) and health care aides (HCA) spent on key clinical role accountabilities and other work activities. BACKGROUND Health care providers are not effectively utilized. To improve their efficiency and effectiveness, it is necessary to understand how nursing providers enact their role accountabilities. METHOD Using palm pilot Function Analysis technology, observers recorded the activities of 35 registered nurse and 17 health care aides shifts on a second-by-second basis over 5 days. Work activities were classified using the Nursing Role Effectiveness Model, which conceptualizes nursing practice in terms of clinical role accountabilities. RESULT The registered nurses spent a considerable amount of time on bio-medical assessment/surveillance, relatively little time was spent on patient and family psycho-social-cultural-spiritual assessment/surveillance and support. CONCLUSION Unlike other work sampling studies, this research project examined nursing work within a role accountability framework; an important first step in the call for the measurement of the impact of nursing care. IMPLICATIONS FOR NURSING MANAGEMENT Changes to how registered nurses and health care aides enact their role will require a clear vision by unit managers and their staff of their role accountabilities, and the gap between ideal and actual practice.
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Affiliation(s)
- Deborah E White
- Workforce Research and Evaluation, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Jackson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jeanne Besner
- Health Systems and Workforce Research Unit, Calgary Health Region, Calgary, Alberta, Canada
| | - Jill M Norris
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Bonfim D, Laus AM, Fugulin FMT, Gaidzinski RR. Comparação entre as intervenções de enfermagem realizadas e os registros em sistema informatizado para atenção básica. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000400016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Comparar as intervenções realizadas pela equipe de enfermagem em uma Unidade de Atenção Primária à Saúde com as intervenções registradas em sistema de informação. MÉTODOS: Estudo descritivo, exploratório realizado em duas etapas em uma Unidade de Saúde considerada de boas práticas de enfermagem. Etapa 1: observação direta, não participativa e estruturada durante cinco dias. Etapa 2: aplicação da técnica de mapeamento cruzado nas atividades registradas no sistema informatizado, adequando-as em linguagem padronizada de intervenções de enfermagem. RESULTADOS: Identificou-se que 23,5% e 27,2% das intervenções realizadas pela equipe de enfermagem e enfermeiros foram registradas no sistema informatizado. CONCLUSÃO: O sistema informatizado apresenta campos insuficientes para relatar o trabalho realizado pela equipe de enfermagem em Unidade de Atenção Primária à Saúde.
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Cruz CWMD, Gaidzinski RR. Tempo de enfermagem em centro de diagnóstico por imagem: desenvolvimento de instrumento. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Desenvolver um instrumento para medir o tempo despendido pela equipe de enfermagem, nas intervenções realizadas em centros de diagnóstico por imagem. MÉTODOS: Estudo transversal desenvolvido em hospital geral particular, conforme estas etapas: A) Identificação das atividades de enfermagem por meio de revisão bibliográfica e observação em campo. B) Mapeamento cruzado das atividades identificadas em intervenções de enfermagem, conforme a Classificação de Intervenções de Enfermagem (NIC). C) Validação das intervenções. D) Teste-piloto do instrumento com utilização da técnica de amostragem do trabalho. RESULTADOS: Foram validadas pelos juízes 92 atividades de enfermagem correspondentes a 32 intervenções da Classificação de Intervenções de Enfermagem NIC. As intervenções mais frequentes foram: Assistência em Exames, Documentação, Gerenciamento de Caso, Acompanhamento por telefone, Cuidados na admissão e Troca de Informações sobre cuidados de Saúde. CONCLUSÃO: O instrumento proposto para medição do tempo de trabalho da enfermagem, fundamentado nas intervenções de enfermagem em Centro de Diagnóstico por Imagem, foi validado e encontra-se disponível para utilização.
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Qian SY, Yu P, Zhang ZY, Hailey DM, Davy PJ, Nelson MI. The work pattern of personal care workers in two Australian nursing homes: a time-motion study. BMC Health Serv Res 2012; 12:305. [PMID: 22953995 PMCID: PMC3470967 DOI: 10.1186/1472-6963-12-305] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study is to describe the work pattern of personal care workers (PCWs) in nursing homes. This knowledge is important for staff performance appraisal, task allocation and scheduling. It will also support funding allocation based on activities. METHODS A time-motion study was conducted in 2010 at two Australian nursing homes. The observation at Site 1 was between the hours of 7:00 and 14:00 or 15:00 for 14 days. One PCW was observed on each day. The observation at Site 2 was from 10:00 to 17:00 for 16 days. One PCW working on a morning shift and another one working on an afternoon shift were observed on each day. Fifty-eight work activities done by PCWs were grouped into eight categories. Activity time, frequency, duration and the switch between two consecutive activities were used as measurements to describe the work pattern. RESULTS Personal care workers spent about 70.0% of their time on four types of activities consistently at both sites: direct care (30.7%), indirect care (17.6%), infection control (6.4%) and staff break (15.2%). Oral communication was the most frequently observed activity. It could occur independently or concurrently with other activities. At Site 2, PCWs spent significantly more time than their counterparts at Site 1 on oral communication (Site 1: 47.3% vs. Site 2: 63.5%, P = 0.003), transit (Site 1: 3.4% vs. Site 2: 5.5%, P < 0.001) and others (Site 1: 0.5% vs. Site 2: 1.8%, P < 0.001). They spent less time on documentation (Site 1: 4.1% vs. Site 2: 2.3%, P < 0.001). More than two-thirds of the observed activities had a very short duration (1 minute or less). Personal care workers frequently switched within or between oral communication, direct and indirect care activities. CONCLUSIONS At both nursing homes, direct care, indirect care, infection control and staff break occupied the major part of a PCW's work, however oral communication was the most time consuming activity. Personal care workers frequently switched between activities, suggesting that looking after the elderly in nursing homes is a busy and demanding job.
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Affiliation(s)
- Si-Yu Qian
- School of Information Systems and Technology, University of Wollongong, New South Wales, Australia
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Munyisia EN, Yu P, Hailey D. The impact of an electronic nursing documentation system on efficiency of documentation by caregivers in a residential aged care facility. J Clin Nurs 2012; 21:2940-8. [DOI: 10.1111/j.1365-2702.2012.04157.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dellefield ME, Harrington C, Kelly A. Observing How RNs Use Clinical Time in a Nursing Home: A Pilot Study. Geriatr Nurs 2012; 33:256-63. [DOI: 10.1016/j.gerinurse.2012.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
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Understanding the work of intensive care nurses: A time and motion study. Aust Crit Care 2012; 25:13-22. [DOI: 10.1016/j.aucc.2011.08.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 08/15/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022] Open
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Impact of Bar-code Medication Administration on Nursing Activity Patterns and Usage Experience in Taiwan. Comput Inform Nurs 2011; 29:554-63. [DOI: 10.1097/ncn.0b013e31820662c1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff? Int J Med Inform 2011; 80:782-92. [PMID: 21956002 DOI: 10.1016/j.ijmedinf.2011.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 08/09/2011] [Accepted: 08/24/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine whether the introduction of an electronic nursing documentation system in a nursing home reduces the proportion of time nursing staff spend on documentation, and to use this information in evaluating the usefulness of the system in improving the work of nursing staff. METHODS An observational work sampling study was conducted in 2009 and 2010, 2 months before, and 3, 6 and 12 months after the introduction of an electronic nursing documentation system. An observer (ENM) used a work classification tool to record documentation activities being performed using paper and with a computer by nursing staff at particular times for periods of 5 days. RESULTS Three hundred and eighty three (383) activities were recorded before implementation of the electronic system, 472 activities at 3 months, 502 at 6 months, and 338 at 12 months after implementation. There was no significant difference between the proportion of time nursing staff spent on documentation 2 months before and 3 months after the implementation of the electronic system. Six months after implementation, the proportion of time on documentation increased significantly and after 12 months, settled back to original levels that were recorded in the paper-based system. Over half of the proportion of time on documentation at 6 and 12 months after implementation was spent on paper documentation tasks. CONCLUSION Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff's information needs, and documentation workflow is necessary.
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