Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study.
OBJECTIVE
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.


METHODS
A multicenter cross-sectional observational study was performed using time-motion technique.


METHODS
Five Dutch long-term institutional care facilities participated. In total, 4 residential care units, 3 somatic units, and 6 psycho-geriatric units were included.


METHODS
Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing assistants, 9 primary caregivers, and 19 health care assistants.


METHODS
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).


CONCLUSIONS
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.
School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands. Electronic address: a.tuinman@pl.hanze.nl.
Astrid
A
Tuinman
Faculty of Medical Sciences, Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Mathieu H G
MH
de Greef
School of Nursing, Professorship in Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
Wim P
WP
Krijnen
School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
Roos M B
RM
Nieweg
School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands; School of Nursing and Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Petrie F
PF
Roodbol
D003430:Cross-Sectional Studies; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009426:Netherlands; D009740:Nursing Staff; D013996:Time and Motion Studies
Long-term care; nursing home; nursing interventions; nursing staff; time use; time-motion study