Abstract
Objectives
Increasing residents' acuity levels and available resources in long-term institutional
care requires insight into the care provided by nursing staff so as to guide task
allocation and optimal use of resources, and enhance quality of care. The purpose
of this study was to examine the relationship between time use and type of nursing
staff, residents' acuity levels, and unit type by using a standardized nursing intervention
classification.
Design
A multicenter cross-sectional observational study was performed using time-motion
technique.
Setting
Five Dutch long-term institutional care facilities participated. In total, 4 residential
care units, 3 somatic units, and 6 psycho-geriatric units were included.
Participants
Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing
assistants, 9 primary caregivers, and 19 health care assistants.
Measurements
A structured observation list was used based on the Nursing Interventions Classification
(NIC). Residents' acuity levels, representing residents' needs, were based on the
Dutch Care Severity Index. Medians and interquartile ranges were calculated for time
spent on interventions per type of nursing staff and units. Linear mixed models were
used to examine the relationship between time spent on nursing interventions and the
type of nursing staff, residents' acuity levels, and unit type.
Results
Observations resulted in 52,628 registered minutes for 102 nursing interventions categorized
into 6 NIC domains for 335 residents. Nursing staff spent the most time on direct
care interventions, particularly in the domain of basic physiological care. Variances
in time spent on interventions between types of nursing staff were minimal. Unit type
was more significantly (P < .05) associated with time spent on interventions in domains than the type of nursing
staff. Residents' acuity levels did not affect time spent by nursing staff (P > .05).
Conclusion
The current study found limited evidence for task allocation between the types of
nursing staff, which may suggest a blurring of role differentiation. Also, findings
suggest that residents received similar care regardless of their needs, implying that
care is predominantly task-oriented instead of person-centered. Managers may reconsider
whether the needs of residents are adequately met by qualified nursing staff, considering
the differences in education and taking into account increasing acuity levels of residents
and available resources.
Keywords
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Article info
Publication history
Published online: October 05, 2015
Footnotes
The authors declare no conflicts of interest.
This study was funded by the Stichting Innovatie Alliantie, Regional Attention and Action for Knowledge circulation (SIA RAAK-PRO), project pro-1–035. The SIA-RAAK-PRO monitored the progress of the project and had no involvement in conducting the results.
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© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
