| Learning Objective #1: Critique current available nursing workload measurement systems | |||
| Learning Objective #2: Evaluate a model that describes the demands on nurses that are driven by patients' caring needs, families, and physicians |
This study used focus group methodologies with 14 groups in 6 hospitals and interview data from 96 registered nurses. Nurses represented acute inpatient, children's, and rehabilitation nursing in not-for-profit, for-profit, and teaching hospitals. Validity and reliability were addressed through member-checks, coding audits, inter-rater agreement calculations (using Cohen's Kappa) and interviews exploring contradictory and inconclusive responses. Adequate sample size was confirmed by achievement of saturation. Constant-comparison analytic methods were applied.
Analysis resulted in the development of a model of demands on nurses' time. Two major categories of demands included: Actions required of the nurse; and Characteristics of patients, families and physicians. A third subsidiary category included mediating conditions related to client characteristics. Actions included: empowering, integrating information, advocacy, and demonstration of competence. Characteristics included patient physical condition, family dynamics, resources available, coping skills, demographic characteristics, interpersonal and emotional states, previous experience with illness and hospitalization, and flexibility. Mediating characteristics include commitment, mutual respect, and physical presence.
This study identified demands created by non-task needs of clients, an under-estimated workload parameter. The model reflects measurable parameters and viable options for inclusion in severity measurement systems. Next steps include developing and testing measurement and structural models of the direct and indirect impact of these demands on patient outcomes.