Indirect Care Tasks Research Articles

A survey of the current nurse practitioner and physician assistant workforce in Dutch ambulance care.

Dutch ambulance service faces future challenges due to acute care development, patient changes, demographics, increased ambulance runs and regional differences. Ambulance Care Netherlands published a framework titled "Pilot physician assistant and nurse practitioner ambulance care". Within this framework, a role is proposed so that their qualifications can provide solutions to future challenges. Despite the introduction of nurse practitioners and physician assistants into Dutch ambulance care, little is known about the effects of this introduction or the tasks these professionals perform. Nevertheless, they are being called upon, even though it is not known whether their potential contribution to the desired outcome described in the framework. This study aims to provide an overview of all nurse practitioners and physician assistants working in Dutch ambulance care and the tasks they perform. We used a cross-sectional exploratory study design. The nurse practitioners and physician assistants participated in a structured telephone survey. Emergency ambulance services in the Netherlands. A total of 56 respondents participated in a telephone survey. We found 53 nurse practitioners and 20 physician assistants working in Dutch ambulance care, 56 participated in the survey. Their performance of both direct care and indirect care tasks differed considerably. While some nurse practitioners and physician assistants were fully autonomous in-patient care, others were bound by regulations and restrictions. We found large variations between respondents in direct and indirect care task, number of working hours, and the different positions within the different Emergency ambulance services in the Netherlands. As a result, the established framework cannot presently function but can provide sound guidance to different ambulance services in positioning their nurse practitioners or physician assistants.

A longitudinal time and motion study quantifying how implementation of an electronic medical record influences hospital nurses’ care delivery

Aim backgroundMany health care services are implementing or planning to undergo digital transformation to keep pace with increasing Electronic Medical Record (EMR) functionality. The aim of this study was to objectively measure nursing care delivery before and following introduction of an EMR. Design and methodsAn extensive program of work to expand an EMR across our health service using a ‘big bang’ methodology was undertaken. The program incorporated digital care delivery workflows including physiological observations, clinical notes and closed loop medication management. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied to undertake a direct observational time and motion study of nurses’ work in a major Australian hospital immediately prior to and six months following the introduction of a full clinical EMR. ResultsTime and motion results were from observing approximately one week of nursing time pre (paper) to six months post (EMR) implementation. A non-significant 6.4% increase in the proportion of time spent on direct care was observed when using the EMR with a statistically significant increase in mean time per direct care task (2.5 min vs 3.9 min, p = 0.001). The proportion of time spent on medication-related activities did not significantly change although the average time per task rose from 2.0 to 2.9 min (p = 0.008). A significant reduction in proportion of time spent in transit and indirect care tasks when using the electronic workflows was reported. No statistically significant changes to the proportions of time spent on professional communication, direct care or documentation were observed. ConclusionsSuccessful EMR implementation is possible without adversely affecting allocation of nursing time. Our findings from deploying a large scale EMR across all healthcare craft groups and workflows have described for nurses that an EMR enables them to spend longer with patients per direct care episode and use their time on other activities more effectively.

Quantifying the Time Used for Renal Dietitian's Responsibilities: A Pilot Study

The purpose of this study was to quantify how dialysis dietitians spend their time and whether the activities that were most frequent varied based on the ratio of patient to full-time equivalent (FTE) dietitian. This study is a cross-sectional, observational, time-and-motion study carried out using the Work Activity Measurement by Activity Timing software/method for time recording. This study was carried out in 14 dialysis centers in and around Cleveland, Ohio. Fourteen registered dietitian nutritionists participated in this study. The mean time/experience of these nutritionists in dietetics was 26.6±8.5years. Percent of time in direct care (e.g., patient interaction) versus indirect care (e.g., documentation and plans of care, professional communication) versus other responsibilities (e.g., administrative work, education of self or others). The mean number of tasks recorded per 3-hour observation session was 38.3±14.0, including 18.5±7.7 indirect care tasks, 7.7±6.2 direct care tasks, and 9.7±5.4 other tasks. The mean number of unique patients seen per observation session was 6.9±5.4; the mean direct care time per patient encounter was 6.95±4.05minutes. Indirect care took the highest proportion of observed time, 56.0±22.2%, followed by direct care, 24.9±18.8%. Increasing the ratio of patient to FTE had a moderate negative correlation with the percent of time spent in direct patient care (r=-0.35, P=.21), but there was no relationship between the ratio of patient to FTE and direct care time per patient (r=0.02, P=.94). About 25% of dietitians' time was available for direct patient care. This is much less than that reported in previous studies and may not be sufficient to improve the nutritional status. Limitations of our study include a small sample size from a single region. Further work is needed to understand the balance of responsibilities among renal dietitians and their impact on patient outcomes.

The impact of e-visits on patient access to primary care.

To improve patient access to primary care, many healthcare organizations have introduced electronic visits (e-visits) to provide patient-physician communication through secure messages. However, it remains unclear how e-visit affects physicians' operations on a daily basis and whether it would increase physicians' panel size. In this study, we consider a primary care physician who has a steady patient panel and manages patients' office and e-visits, as well as other indirect care tasks. We use queueing-based performance outcomes to evaluate the performance of care delivery. The results suggest that improved operational efficiency is achieved only when the service time of e-visits is smaller enough to compensate the effectiveness loss due to online communications. A simple approximation formula of the relationship between e-visit service time and e-visit to office visit referral ratio is provided serving as a guideline for evaluating the performance of e-visit implementation. Furthermore, based on the analysis of the impact of e-visits on physician's capacity, we conclude that it is not the more e-visits the better, and the condition for maximal panel size is investigated. Finally, the expected outcomes of implementing e-visits at Dean East Clinic are discussed.

Psychoeducation in Multiprofessional Psychiatric Care

Introduction Traditionally, in Ukraine as in the other countries of the former USSR, psychosocial rehabilitation was based on the medical model aimed ateliminating the manifestations of a disease and preventing relapses. Psychoeducationis a new area for Ukraine. Methods SQL-36, HARS, HDRS Results, To find the most optimal for Ukraine forms and methods of psychoeducation for different mental diseases we usedthree-step algorithm: Patients’ and their relatives’ informational needsanalysis; Collecting evidence-based data and developing psychoeducationalmodules. The most effective model of psychoeducation in Ukraine hasproved to be the one integrative bifocal, which included a successivelyrealized system of such exposures as information, psychocorrection and sociocorrection given to the patient and themembers of his family. The most effective form of psychoeducation is a multidisciplinarybrigade: aphysician-psychiatrist, a clinical psychologist;a nurse; a social worker and a volunteer. The criteria ofeffectiveness were as follows: stability of remission, frequency ofhospitalization, quality of life, level of anxiety and improvement of mentalcondition. Conclusions Psychoeducationnot only broadens the knowledge about the disease and increases confidence inthe fight against the disease, but also helps achieve indirect care tasks:giving opportunities for confident behavior; improving communicationskills and some other skills of everyday life; educating new strategies tosolve problems; increasing the level of social success. We consider the implementation of psychoeducationalprograms at professional, volunteer, individual and family levels to beperspective for further development of psychoeducation.

The working time of nurse

Introduction: Human resources, not counting financial or information ones, are basic resources of the enterprise, allowing achieving objectives of the organization. Management of human resources should guarantee effective applying of the knowledge and employees’ abilities. On the other hand, it should prevent casting of staff, by assigning support activities to employees. The studies concerning the structure of working hours of nurses on adult department are quite frequently conducted. However, there is a lack of research on working hours of pediatric nurses, so structure of activities of this occupational group performed during hospital duty were recognized as useful to be researched. The aim of the study: Determining the structure of activities performed by nurses on the general pediatric department/ward. Materials and method: Preliminary survey on the structure of working hours was conducted during four 12 - hour duties: two morning and two night duties in one of hospitals of the Podkarpackie province. Constant observation was a research method, and the standardized monitoring sheet - research tool. Results: Analysis of activities undertaken by nurses working at the pediatric department showed that during shift assignments the indirect care tasks constituted the largest percentage of activities (46.01%). About one third of working time was devoted to direct care (28.93%). Coordinating and organizing current work on the ward constituted 14.49%. Breaks and personal activities constituted the smallest percentage (10.57%). Amongst the activities within the direct care scope the following prevailed: performing diagnostic and healing actions and the communication of nurses with parents/ carers and the child. Conclusions: The study pointed at the too low percentage of working hours of pediatric nurses in the direct care. Streamlining work organization of nurses with emphasizing the care and looking after is well justified. Thorough analysis of the support activities associated with the indirect care shows that many of them could be done by outsourced employees and not necessarily at the pediatric department staff.

The relations of daily task accomplishment satisfaction with changes in affect: A multilevel study in nurses.

Focusing on a sample of nurses, this investigation examined the relationships of daily task accomplishment satisfaction (for direct and indirect care tasks) with changes in positive and negative affect from preshift to postshift. Not accomplishing tasks to one's satisfaction was conceptualized as a daily workplace stressor that should increase daily negative affect and decrease daily positive affect from preshift to postshift. Further, because of the greater centrality of direct care nursing tasks to nursing work role identities (relative to indirect care tasks), we expected that task accomplishment satisfaction (or lack thereof) for these tasks would have stronger effects on changes in affect than would task accomplishment satisfaction for indirect care tasks. We also examined 2 person-level resources, collegial nurse-physician relations and psychological resilience, as moderators of the relationships among these daily variables, with the expectation that these resources would buffer the harmful effects of low task accomplishment satisfaction on nurse affect. Results supported almost all of the proposed effects, though the cross-level interactions were observed only for the effects of indirect care task accomplishment satisfaction on affect and not for direct care task accomplishment satisfaction on affect.