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BMC Health Services Research

, 11:319

Organization, structure and delivery of healthcare

Abstract

BackgroundTime nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period.

MethodsProspective observational study of 57 nurses for 191.3 hours 109.8 hours in 2005-2006 and 81.5 in 2008, on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing WOMBAT method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated.

ResultsNurses spent 37.0%95%CI: 34.5, 39.3 of their time with patients, which did not change in year 3 35.7%; 95%CI: 33.3, 38.0. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses- time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01. Proportion of time on medication tasks 19.0% did not change. Time in professional communication declined 24.0% to 19.2%, P < 0.05. Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%95%CI 24.5, 30.6 to 39.4%34.9, 43.9. Time with health professionals other than nurses was low and did not change.

ConclusionsNurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-11-319 contains supplementary material, which is available to authorized users.

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Autor: Johanna I Westbrook - Christine Duffield - Ling Li - Nerida J Creswick

Fuente: https://link.springer.com/







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