Nurses spend an average of only 31% of their time with patients. The authors determined how nurses spend their time and suggest three ways to reduce time spent on non-essential nursing functions: delegation of some tasks to support personnel, greater use of pharmacy personnel in a decentralized setting, and greater use of computers. Together these changes may both decrease demand for nurses' time and enable professional nurses to focus their energy on tasks that require professional expertise.
"However, these approaches do not consider modelling of system variations for process improvements. There are research studies that are focussed on identifying the inefficiencies of the nursing care based on time and motion studies   . Hendrich et al.  utilized personal digital assistants (PDAs), and radio frequency identification (RFID) tags to record time spent by nurses on several care-related activities. "
[Show abstract][Hide abstract] ABSTRACT: Variations in service delivery have been identified as a major challenge to the success of process improvement studies in service departments of hospital such as radiology. Largely, these variations are due to inherent system level factors, i.e., system variations such as unavailability of resources (nurse, bed, doctors, and equipment). These system variations are largely unnecessary/unwarranted and mostly lead to longer waiting times, delays, and lowered productivity of the service units. There is limited research on identifying sys-tem variations and modelling them for service improvements within hospital. Therefore, this paper proposes a modelling methodology to model system variations in radiology based on real time locating system (RTLS) tracking data. The methodology employs con-cepts from graph theory to identify and represent system variations. In particular, edge col-oured directed multi-graphs (ECDMs) are used to model system variations which are reflected in paths adopted by staff, i.e., sequence of rooms/areas traversed while delivering services. The main steps of the methodology are: (i) identifying the most standard path fol-lowed by staff for service delivery; (ii) filtering the redundant events in RTLS tracking data-base for analysis; (iii) identifying rooms/areas of hospital site involved in the service delivery; (iv) determining patterns of paths adopted by staff from filtered tracking data-base; and, (v) representation of patterns in graph based model called as edge coloured directed multigraphs (ECDMs) of a role. A case study of MR scanning process is utilized to illustrate the implementation of the proposed methodology for modelling system vari-ations reflected in the paths adopted by staff.
"Indirect patient care includes charting, preparing medications, and coordinating care (Hobgood et al., 2005). Studies indicated that nurses spent 39% to 48% of their time on indirect patient care (Hendrickson et al., 1990; Hobgood et al., 2005; Hollingsworth et al., 1998). Much of this time involves documentation and communication. "
[Show abstract][Hide abstract] ABSTRACT: Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse’s work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses’ work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.
Reviews of Human Factors and Ergonomics,, Volume 5 edited by F. Durso, 06/2009: chapter Performance in Nursing: pages 1-40; Human Factors and Ergonomics Society.
"In this study, we also used a select list of activities. Selections were made on the basis of a literature study (Minyard et al., 1986; Schuster and Cloonan, 1989; Hendrikson et al., 1990; Cardona et al., 1997), interviews with caregivers in nursing homes throughout the country and observations in nursing homes that offered traditional or integrated care. To test the clearness, validity and usefulness of the list, in two of these homes a pilot study was executed in March 2000. "
[Show abstract][Hide abstract] ABSTRACT: It is generally assumed that integrated care has a cost-saving potential in comparison with traditional care. However, there is little evidence on this potential with respect to integrated nursing home care.
DESIGN/METHODS/SETTINGS/PARTICIPANTS: Between 1999 and 2003, formal and informal caregivers of different nursing homes in the Netherlands recorded activities performed for residents with somatic or psycho-social problems. In total, 23,380 lists were analysed to determine the average costs of formal and informal care per activity, per type of resident and per nursing home care type. For formal care activities, the total personnel costs per minute (in Euro) were calculated. For informal care costs, two shadow prices were used.
Compared to traditional care, integrated care had lower informal direct care costs per resident and per activity and lower average costs per direct activity (for a set of activities performed by formal caregivers). The total average costs per resident per day and the costs of formal direct care per resident, however, were higher as were the costs of delivering a set of indirect activities to residents with somatic problems.
The general assumption that integrated care has a cost-saving potential (per resident or per individual activity) was only partially supported by our research. Our study also raised issues which should be investigated in future research on integrated nursing home care.
International Journal of Nursing Studies 09/2008; 45(12):1764-77. DOI:10.1016/j.ijnurstu.2008.05.005 · 2.90 Impact Factor
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