Nursing care delivery: Comparative studies of nursing activities by skill mix and case mix

2.50
Hdl Handle:
http://hdl.handle.net/10755/152800
Type:
Presentation
Title:
Nursing care delivery: Comparative studies of nursing activities by skill mix and case mix
Abstract:
Nursing care delivery: Comparative studies of nursing activities by skill mix and case mix
Conference Sponsor:Sigma Theta Tau International
Conference Year:1992
Conference Date:August 6 - 8, 1992
Author:Conway, Patricia, MSN/MN/MNSc/MNE
P.I. Institution Name:Children's Hospital
111 Michigan Ave NW
Title:Programs Manager
The purpose of this paper is to report the results of comparative studies of nursing care activity distribution conducted in 1987 and 1991 in a tertiary pediatric hospital. The studies were a part of a program of research in nursing resource consuption conducted in collaboration between nursing administration and nursing research.



Statement of the Problem: The allocation of nursing resources is of both clinical and economic consequence. Organizational, structural, and policy variables such as method of nursing care delivery, resource allocation policies, and ratio of professional to alternative caregivers may influence the distribution of nursing resources in hospitals. Between 1987 and 1991, this pediatric tertiary hospital changed the skill mix of nursing caregivers, from an all RN staff to a mix of RN and alternative caregivers, and implemented policy changes in staffing patterns. The purpose of this study was to compare the distribution of nursing care activities by skill mix and case mix before and after policy changes. These studies were based on the classic Methods of Studying Nurse Staffing in a Patient Unit (Division of Nursing, 1978), which categorizes clinical unit nursing practice as direct care, indirect care, and unit related activities.



Methods and Instrumentation: In 1987, a work sampling of all professional nursing direct caregivers was conducted. In 1991, the study was expanded to include alternative caregivers. In these descriptive field studies, the instrument used was the fifteen item Children's National Medical Center (CNMC) Work Sampling Instrument which categorizes care as direct, indirect, or unit related activity. Content and criterion-related validity were established. The simple was all nursing caregivers on inpatient units, which included professional nursing staff, patient care assistants, care technicians, and BSN interns. Data collectors were trained to a reliability criterion of .90. Random sampling of inpatient units, was conducted for 24 hours per day for two weeks. Over 19,000 observations of nursing care activity were recorded in the two studies.



Data Analysis: Frequency distributions of the fifteen nursing activities in categories of direct, indirect, and unit related activities were analyzed by unit, critical or general care case mix, and skill mix. Nursing activities of planning and documentation, supervision, direct care and professional communication were compared by case mix and skill mix. Results from 1987 and 1991 were compared for the nursing activities by clinical unit and case mix.



Findings: Direct care ratios for professional staff were relatively constant between 1987 data and 1991 data. Indirect and unit related nursing activities varied by clinical unit, by case mix, and by skill mix. Patterns of care distribution by case mix such as neonatal, intensive, and general care varied between clinical units and between 1987 and 1991. Nursing activities of documentation, administration, and supervision varied substantially between clinical units and between years of study. Comparability of nursing activity distribution over time is valuable for monitoring effects of policy and organizational changes. Such studies also provide baseline data for future studies of patient and family outcomes resulting from nursing activities.
Repository Posting Date:
26-Oct-2011
Date of Publication:
6-Aug-1992
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNursing care delivery: Comparative studies of nursing activities by skill mix and case mixen_GB
dc.identifier.urihttp://hdl.handle.net/10755/152800-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Nursing care delivery: Comparative studies of nursing activities by skill mix and case mix</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1992</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">August 6 - 8, 1992</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Conway, Patricia, MSN/MN/MNSc/MNE</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Children's Hospital<br/>111 Michigan Ave NW</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Programs Manager</td></tr><tr><td colspan="2" class="item-abstract">The purpose of this paper is to report the results of comparative studies of nursing care activity distribution conducted in 1987 and 1991 in a tertiary pediatric hospital. The studies were a part of a program of research in nursing resource consuption conducted in collaboration between nursing administration and nursing research.<br/><br/><br/><br/>Statement of the Problem: The allocation of nursing resources is of both clinical and economic consequence. Organizational, structural, and policy variables such as method of nursing care delivery, resource allocation policies, and ratio of professional to alternative caregivers may influence the distribution of nursing resources in hospitals. Between 1987 and 1991, this pediatric tertiary hospital changed the skill mix of nursing caregivers, from an all RN staff to a mix of RN and alternative caregivers, and implemented policy changes in staffing patterns. The purpose of this study was to compare the distribution of nursing care activities by skill mix and case mix before and after policy changes. These studies were based on the classic Methods of Studying Nurse Staffing in a Patient Unit (Division of Nursing, 1978), which categorizes clinical unit nursing practice as direct care, indirect care, and unit related activities.<br/><br/><br/><br/>Methods and Instrumentation: In 1987, a work sampling of all professional nursing direct caregivers was conducted. In 1991, the study was expanded to include alternative caregivers. In these descriptive field studies, the instrument used was the fifteen item Children's National Medical Center (CNMC) Work Sampling Instrument which categorizes care as direct, indirect, or unit related activity. Content and criterion-related validity were established. The simple was all nursing caregivers on inpatient units, which included professional nursing staff, patient care assistants, care technicians, and BSN interns. Data collectors were trained to a reliability criterion of .90. Random sampling of inpatient units, was conducted for 24 hours per day for two weeks. Over 19,000 observations of nursing care activity were recorded in the two studies.<br/><br/><br/><br/>Data Analysis: Frequency distributions of the fifteen nursing activities in categories of direct, indirect, and unit related activities were analyzed by unit, critical or general care case mix, and skill mix. Nursing activities of planning and documentation, supervision, direct care and professional communication were compared by case mix and skill mix. Results from 1987 and 1991 were compared for the nursing activities by clinical unit and case mix.<br/><br/><br/><br/>Findings: Direct care ratios for professional staff were relatively constant between 1987 data and 1991 data. Indirect and unit related nursing activities varied by clinical unit, by case mix, and by skill mix. Patterns of care distribution by case mix such as neonatal, intensive, and general care varied between clinical units and between 1987 and 1991. Nursing activities of documentation, administration, and supervision varied substantially between clinical units and between years of study. Comparability of nursing activity distribution over time is valuable for monitoring effects of policy and organizational changes. Such studies also provide baseline data for future studies of patient and family outcomes resulting from nursing activities.</td></tr></table>en_GB
dc.date.available2011-10-26T11:50:19Z-
dc.date.issued1992-08-06en_GB
dc.date.accessioned2011-10-26T11:50:19Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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