Indirect Care Research Articles

The activities/tasks performed by health care aids in hospital settings: a mixed-methods study

The role of Nurses' aides (NAs) in the clinical practice has been widely debated to date. To describe the activities/tasks performed by NAs and the dedicated time; to identify the activities/tasks shifted from nurses to NAs and to investigate the motivations. A multi-center mixed-methods study was conducted. Fifty-six NAs working in 17 hospitals in the North-Italy were observed during daily practice and then interviewed about the motivations associated with task shifting. NAs mainly performed direct care tasks (67.7% of the observed time), such as helping with personal hygiene, feeding and mobilization. Larger hospitals (p = 0.034), surgical units (p = 0.001), a skill mix> 40% (p = 0.044) and a reduced nurse to patient ratio (p = 0.041), were significantly associated with a higher amount of indirect care activities/tasks performed by NAs. The tasks shifted most frequently from nurses to NAs were: mobilization (22; 39.3%) and personal hygiene (21; 37.5%) of unstable patients, feeding patients with dysphagia (19; 34%), intra-venous set replacement (16; 28.6%) and pressure ulcers' dressing (11; 19.6%). NAs reported that they chose to act autonomously because of their experience and the trust-based relationship with nurses, in order to promptly respond to patients needs and to reduce nurse workload. It is necessary to further assess the development of the NAs role in the hospital setting to understand their inclusion in the nursing care.

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.

Specialist healthcare services for UK care home residents: a latent class analysis.

To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence. Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this. A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics. Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff ('predominantly direct care'). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training ('direct and indirect care'). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff ('predominantly indirect care'). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3. LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.

Care and noncare-related activities among critical care nurses: A cross-sectional observational time and motion study

Background: Measurement of nursing activities is used for workload assessment, performance evaluation, and workforce management. Objectives: This study aimed to measure care and noncare-related activities among critical care nurses and to determine their contributing factors. Methods: This cross-sectional observational study was conducted from July to September 2017. All care and noncare-related activities of 70 critical care nurses in a public university hospital in Kashan, Iran, were assessed through the time and motion technique. Each nurse was observed throughout a 6-h morning shift. Data were collected using a nurse and patient characteristics questionnaire and care and noncare-related activities checklist. The paired and the independent-samples t-test, Mann–Whitney U-test, Kruskal–Wallis tests, and the one-way analysis of variance were used for data analysis. Results: The duration of nurses' care-related activities (249.10 ± 65.00 min, i.e., 69.2% of a 6-h shift) was significantly more than the duration of their noncare-related activities (111.00 ± 48.30 min, i.e., 30.8% of a 6-h shift). Respecting care-related activities, participants spent 53.5% of their time on direct care and the rest 46.5% on indirect care; whereas respecting noncare-related activities, they spent 76.5% of their time on personal activities (such as making personal calls) and the rest 23.5% on unit related tasks. The duration of nurses' activities had significant relationships with their unit, nurse–patient ratio, and patients' age, gender, and diagnosis. Conclusion: Critical care nurses spend their time mostly on care-related than noncare-related activities. Closer managerial supervision of nurses' activities, in-service educations about effective time management, and determination of the optimum nurse–patient ratio and the best task division schedule are needed to reduce nurses' workload, improve care quality, and enhance patient satisfaction.

Nursing workload: influence of indirect care interventions.

To evaluate nurses' perception of the degree of interference of indirect care interventions on the team's workload and to verify the association between these interventions and the professional and institutional variables. A research survey through e-mail conducted with clinical nurses, unit managers and service managers from eight Brazilian states. A questionnaire containing 28 indirect care interventions and their definitions proposed by the Nursing Interventions Classification was applied. A total of 151 clinical nurses participated, and a response rate of 14.8% was obtained. The indirect care interventions reported as those which most increase the workload were: Preceptor: employee (M = 3.2), Employee Development (M = 3.1), Physician Support (M = 3.0) and Conflict mediation (M = 3.0). Statistically significant associations between the investigated interventions and the institutional variables (legal nature and size) were evidenced. Nurses in different practice scenarios perceive that indirect care interventions influence the workload in a differentiated way, with emphasis on the demands related to the monitoring and qualification of employees.

A Cost Analysis of Pulse Oximetry as a Determinant in the Decision to Admit Infants With Mild to Moderate Bronchiolitis.

A previous randomized controlled trial showed that artificially elevating the pulse oximetry display resulted in fewer hospitalizations with no worse outcomes. This suggests that management decisions based mainly on pulse oximetry may unnecessarily increase health care costs. This study assessed the incremental cost of altered relative to true oximetry in infants with mild to moderate bronchiolitis. A cost analysis was undertaken from the health care system and societal perspectives using patient-level data from the randomized controlled trial, with a 5-day time horizon after emergency department visit. Infants aged 4 weeks to 12 months with mild to moderate bronchiolitis were randomized to pulse oximetry measurements with true or altered saturation values displayed by artificially increasing saturation 3% points above true values. Direct and indirect health care costs were measured. Sensitivity analyses were performed to assess parameter uncertainty. From the health care system perspective, the average cost per patient was Can $1155 for altered oximetry and $1967 for true oximetry, with a net savings of $812. From a societal perspective, the average cost per patient was $1559 for altered oximetry and $2473 for true oximetry, with a net savings of $914. Probabilistic analyses demonstrated that altered oximetry remained the less costly study group, with an average savings of $810 (95% confidence interval, $748-$872) from the health care system perspective and $910 (95% confidence interval, $848-$973) from the societal system perspective. Reliance on oximetry as a major determinant in the decision to hospitalize infants with mild to moderate bronchiolitis is associated with significantly greater costs.

Testosterone, fathers as providers and caregivers, and child health: Evidence from fisher-farmers in the Republic of the Congo

Les mâles des espèces vertébrées où il existe des soins biparentaux sont souvent confrontés à faire des compromis entre l’investissement dans l’accouplement et les efforts parentaux. Parmi ces mâles, la testostérone est fréquemment élevée pendant l'accouplement et la compétition et plus réduite lorsque les hommes aident à élever leurs enfants. Ces patterns physiologiques peuvent être adaptatifs, ce qui augmente le succès reproducteur (fitness) des hommes grâce à un investissement dans leurs enfants. Cependant, pour certaines espèces, y compris les humains, la parentalité indirecte profite souvent aux enfants, mais peut également impliquer une compétition masculine et un comportement à risque, et peut-être facilitée par un taux élevé de testostérone. Malgré les fonctions adaptatives potentielles des réponses biologiques dans l’investissement paternel, presque aucune étude sur les mammifères n’a tenté d’établir un lien entre la testostérone des pères et la descendance (offspring outcomes) et c’est aussi le cas chez les humains. Les données collectées dans une micro-société des pêcheurs-fermiers de la République du Congo indiquent que les pères qui ont été évalués comme les meilleurs soutiens de famille de soins par leurs pairs avaient un taux de testostérone plus élevée que les autres pères de la communauté. Cependant, les enfants dont le père avait un taux situé dans la fourchette moyenne, comparativement aux pères avec des niveaux plus élevés ou plus faibles, avaient un meilleur statut énergétique (IMC plus élevé, épaisseur du pli cutané du triceps plus important). Les soins directs et indirects des pères ont contribué à rendre compte des associations entre le profil paternel et le profil énergétique des enfants. Étant donné que les soins directs et, en particulier, les soins indirects paternels sont considérés comme importants d’un point évolutionnaire et qu’ils le demeurent dans de nombreuses sociétés contemporaines, ces résultats aident à comprendre le caractère facultatif des réponses biologiques humaines à la paternité et la pertinence de ces facteurs pour le bien-être des enfants.

A prospective investigation of direct and indirect home care activities in three rural Norwegian municipalities

BackgroundHome care providers struggle to manage their day-to-day work, which is increasing in volume and complexity. In general, they are expected to achieve more with the same planning methods, resources, and capacity. To meet emerging needs and use the available resources more effectively and efficiently, evidence and strategies are needed to inform planning methods for home care services. However, limited data are available to inform this change. This paper investigated the amount of time used to carry out direct activities and six indirect activities across three rural Norwegian municipalities (M1, M2 and M3).MethodsHome care staff recorded data over 8 weeks in 2016; the majority of the staff used a smartphone application and some staff used a manual form to report the durations of the activities.ResultsThe median time spent on direct activities was 11–13 min, and this work constituted less than 50% of the total work in the three municipalities. The median driving time was 5–7 min, which accounted for 43–54% of the total indirect work. Administration, particularly reporting and documentation, displayed greater differences across the municipalities, together accounting for 38–50% of the total indirect time. M2 and M3 used substantially more time for documentation, including 20 min in M2 and M3, in contrast to only 1 min in M1. Similarly, the median reporting times were 30 min (M2) and 28 min (M3), compared with only 17 min in M1.ConclusionsHome care staff spent less time on direct activities than on indirect activities, of which several activities have the potential for change. These results may help managers utilize resources effectively and plan appropriately, and they may also serve as a basis for future research to identify areas with improvement opportunities and, in turn, make more time available for direct patient care.

The effect of Therapeutic Touch on Back Pain in Adults on a Neurological Unit: An Experimental Pilot Study

BackgroundChronic back pain affects many aspects of everyday life and is a common reason for medical visits, leading to high direct and indirect health care costs. Innovative and cost-effective nonpharmacologic pain management methods should be promoted to ensure adequate treatment. AimsThe aim of this pilot study was to investigate the pain-relieving effect of Therapeutic Touch in adult neurologic patients with back pain. DesignA pretest–post-test randomized controlled trial. SettingsA university hospital in Austria. Participants/SubjectsPatients with back pain diagnosis (N = 29) on hospital admission. MethodsA pilot study was conducted for 3 months. The control group (n = 14) received the pharmacologic pain management recommended by the World Health Organization; patients in the intervention group (n = 15) received additionally four Therapeutic Touch treatments on 4 consecutive days. The Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale were used as outcome measures to evaluate activity domains affected by back pain and pain intensity. ResultsPain improvement was found in the intervention group according to the mean score of the Quebec Back Pain Disability Scale (day 1: 72.53, standard deviation [SD] ± 14.10; day 4: 39.47, SD ± 8.77; p < .001). The Numerical Pain Rating Scale score averaged 4.33 points (SD ± 2.09) on the first day and 2.47 points (SD ± 1.12) on the fourth day. The long-term effect of Therapeutic Touch was significant and indicated a major effect (Pillai's trace = .641, F(3.12) = 7.1, p = .005, ηp2 = .641). ConclusionsTherapeutic Touch seems to be a noninvasive nursing intervention for back pain management to provide more professional patient care.

Commentaries on health services research

Commentaries on health services research

Work pattern of neurology nurses in a Chinese hospital: A time and motion study.

To investigate nursing work patterns in a neurology department in a Chinese hospital. Knowledge of nursing work patterns is important for nursing management and work design, and for the evaluation of organizational process change associated with the introduction of an innovation. A time-and-motion method was used to observe 14 registered nurses' (RNs') work patterns in a neurology department in a Chinese hospital. There were 147hr of observation. Overall, the most time-consuming activities were verbal communication (28.5%) and documentation (28.3%), followed by indirect care (14.6%) and direct care (14%). Compared to support RNs, charge RNs spent 20% more time on documentation and 11% more time on verbal communication. Two-thirds of the observed activities had a duration of less than 40s. Communication, in verbal and written forms, consumed more than half of the nursing time. Conversely, nurses only spent about a quarter of their worktime on preparation for care provision and direct care provision. This reflects the significant role and resource-consuming nature of communication to provide safe and quality care. Communication methods need to be enhanced to improve nursing productivity. This may be achieved through the introduction of more effective nursing documentation methods.

Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies

BackgroundOptimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these...

Standardized Questionnaire for the Measurement, Valuation, and Estimation of Costs of Informal Care Based on the Opportunity Cost and Proxy Good Method.

Costs of informal care account for a significant component of total societal costs for many chronic and disabling illnesses. Yet, costs associated with the provision of informal care is seldom included in economic evaluations of new health technologies, increasing the risk of suboptimal decisions on the allocation of resources from the perspective of society. Our objective was to propose a standardized questionnaire for the measurement, valuation, and estimation of caregiver indirect (productivity) and informal care costs as separate mutually exclusive subsets of total costs in cost-of-illness studies and as an input to economic evaluations from the societal perspective. We developed a questionnaire for data collection and step-by-step analysis procedures for resource valuation and cost estimation. Data concerning absenteeism from work and time devoted to informal care were recorded using the recall method. Indirect (productivity) and paid informal care costs were valued and estimated according to the human-capital approach as the loss of production. Unpaid informal care costs were valued and estimated as the loss of leisure time quantified using the opportunity cost and proxy good method. The new questionnaire, titled the Caregiver Indirect and Informal Care Cost Assessment Questionnaire, contains 13 questions regarding caregiver current and previous work status, productivity, and the provision of informal care (stratified by time devoted to household activities, personal care, practical support, and emotional support). The proposed questionnaire should be helpful to inform the design, implementation, and execution of future cost-of-illness studies and economic evaluations from the perspective of society.Electronic supplementary materialThe online version of this article (10.1007/s40258-018-0418-2) contains supplementary material, which is available to authorized users.

Economic benefits of treating medication-overuse headache - results from the multicenter COMOESTAS project.

Medication-overuse headache is a costly disease for individuals and society. To estimate the impact of medication-overuse headache treatment on direct and indirect headache-related health care costs. This prospective longitudinal study was part of the COMOESTAS project (COntinuous MOnitoring of Medication Overuse Headache in Europe and Latin America: development and STAndardization of an Alert and decision support System). Patients with medication-overuse headache were included from four European and two Latin American headache centers. Costs of acute medication, costs of health care services, and measurements of productivity were calculated at baseline and at 6-month follow-up Treatment consisted of overused drug withdrawal with optional preventive medication. A total of 475 patients (71%) completed treatment and were followed up for 6 months. Direct health care costs were on average reduced significantly by 52% ( p < 0.001) for the total study population. Significant reductions were seen in both number of consumed tablets (-71%, p < 0.001) and number of visits to physicians (-43%, p < 0.001). Fifty percent of patients reduced their number of consumed tablets ≥ 80%. Headache-related productivity loss, calculated either as absence from work or ≥ 50% reduction of productivity during the workday, were reduced by 21% and 34%, respectively ( p < 0.001). Standardized treatment of medication-overuse headache in six countries significantly reduced direct health care costs and increased productivity. This emphasizes the importance of increasing awareness of the value of treating medication-overuse headache. The trial was registered at ClinicalTrials.gov (no. NCT02435056).

Nurses' and Patients' Perceptions of the Quality of Psychiatric Nursing Care in Jordan.

The quality of care provided for patients in mental health-care facilities remains a challenge for health-care providers in general and for nurses in particular. Identifying the level of quality of care provided for patients in mental health-care facilities as perceived by nurses and patients may help health-care providers improve the quality of care and improve patients' outcomes. The purpose of the study was to assess the perceptions of nurses and patients of the quality of nursing care, and explore the differences in their perceptions of quality of care in mental health-care facilities in Jordan. A cross-sectional study was conducted using two convenience samples of 123 nurses and 150 patients. The nurses completed the Karen-personnel instrument, a self-administered questionnaire; One hundred and fifty patients from several mental health-care facilities in Jordan were interviewed using the Karen-patient instrument. The interviews were structured. Sixtyfour percent of nurses rated the quality of psychiatric nursing care as satisfactory, and 47.6% of patients perceived the quality of nursing care as satisfactory. Male nurses, who attended courses in mental health nursing, chose to work in a psychiatric unit, committed to work in the future in a psychiatric unit, and were providing indirect care have significantly higher perception of quality of psychiatric nursing care than their counterparts. Patients in military hospitals have significantly higher perception of quality of psychiatric nursing care than those in governmental ones (p < .05). To improve the quality of care in psychiatric units, patients and nurses need to be educated about the quality indicators set by Joint Commission international standards related to mental health-care facilities.

PATTERN OF HEALTH CARE EXPENDITURE OF PRIVATE AND PUBLIC: A CASE STUDY OF HOSPITAL PATIENTS IN KANNUR DISTRICT, KERALA, INDIA

In Kerala, the disturbing trend is that the public health care system is getting alienated from the people since 1980’s. About 30% of the lower income families seeks medical service from the government hospitals. This is because of the fall in the quality of the services of the government hospitals. In the present situation, the rate of utilization of the private sector can be increased drastically pointing to the poor performance of the public health care system. The government hospital has some problems like poor physical or infrastructure facilities, ineffective leadership and unsatisfactory supply of drugs and medical supplies faculty of staffing procedure. These above stated problems do not exist in private hospitals. Therefore, the present study carried out to assess the healthcare expenditure of government and private hospitals patients in Kannur district. The study was conducted during 2015-16. The sample size of the survey contains a total of 120 respondents from Kannur district. The study analyses the interrelationship between health care expenditure and major socioeconomic factors such as monthly income, age, gender, marital status and occupation. The health care expenditure divided into two-direct and indirect health care cost. The direct health care cost includes- user fee charge, medical charge, diagnostic charge and surgical cost. The indirect health care cost comprises of transportation charge, food and bevarages charge and accommodation charges. The study found that the direct cost of health care is high in both private and public sector hospitals. Finally, the study suggests that an initiative along the role of government is requested to secure the health demands of poor as health care costs are growing over time.

Audiology Assistants: Results of a Multicenter Survey.

Although audiologists have been using support personnel for over 45 yr, controversy and variability continue with respect to the entry-level education, training methods, and scope of practice. As part of a larger clinical practices survey, this report focuses on use of audiology assistants (AAs) for pediatric settings and "life-span" facilities that had a significant population of pediatric patients. A questionnaire was sent to 116 facilities in geographically diverse locations. Of the 25 surveys returned, 22 had sufficient data to be included for analysis purposes. The majority of respondents assigned duties to AAs as follows: assisting with conditioned play audiometry and visual reinforcement audiometry, infection control, mail management, disposing of protected health information, ordering supplies, calling families, fielding family phone calls, and stocking supplies. In addition, of the nine pediatric facilities that used AAs and reported job duties, the majority assigned troubleshooting equipment and auditory brainstem response (ABR) screening. Two of the five life-span facilities that reported job duties assigned several duties not assigned by any of the pediatric facilities: pure-tone screening, earmold impressions, assisting with videonystagmography and ABR, and in-house hearing aid repairs. Of facilities that use AAs and reported staffing, the ratio of AAs to audiologists ranged from 0.03:1 to 1:0.37, with an average of 0.15 for life-span facilities and 0.17 for the pediatric facilities. Minimum educational levels required were reported as follows: high school (n = 8), college (n = 3), certificate (n = 1), and no requirement (n = 1). Within a small sample size of pediatric and life-span facilities, 14 of 22 centers used AAs to perform a variety of direct patient care, indirect patient care, and clerical duties. Based on the duties recommended within the American Speech-Language-Hearing Association guidelines and by many states, expanded employment of AAs, as well as expansion of assigned duties should be considered. Data are needed to determine the appropriate ratio of AAs to audiologists within different settings and to determine the impact of AAs for accessibility, productivity, and profitability.

Mapping nurses' activities in surgical hospital wards: A time study.

BackgroundBalancing 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.ObjectiveIn our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards.SettingThe research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds.MethodWe 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.ResultsThe 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%.ConclusionsWe 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.

Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey

Background: Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery. Aim: This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists’ perceptions of opportunities and challenges when delivering and developing palliative care services. Design: A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time). Results: In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers. Conclusion: Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

ICU nursing workload analysis of certain general hospital in Kunming City

Objective To decide ICU nursing workload through measuring the nursing work hours of ICU patients so as to provide basis for reasonably allocate ICU nursing human resource. Methods A total of 133 patients treated with ICU in 5 weeks were randomly selected to measure the nursing hours and calculate the actual nursing workload of ICU. Results ①The most time-consuming direct and indirect care items were hemodialysis and the writing of critical patient records.② The operation frequency of nursing programs related to intravenous infusion was higher and time-consuming.③There was no statistically significant difference in the per capita direct nursing hours, per capita indirect nursing hours, and per capita personal activity hours(P>0.05). ④The per capita direct nursing work of the patients in the white class was greater than the night shift.⑤ The direct and indirect nursing hours and individual work hours were in the proportion of 55.25%, 36.46% and 8.29%.⑥ The theoretical bed nursing workers should be in the proportion of 1∶3.3. Conclusions Measuring ICU nursing workload can provide basis for scientifically allocating ICU nursing human resource. Key words: Nursing human resources; Stopwatch measurement; Nursing workload; ICU