Nurses’ activities and time management during home healthcare visits

Abstract

Aim: To describe nurses’ activities and time management during HHC visits from the perspective of master’s-level nursing students. Background: The shift from community-based hospitals to home-based, person-centred services for patients with a variety of acute or chronic health problems challenges nurses’ professional competence and time management during home healthcare visits. Design and methods: A cross-sectional study in accordance with STROBE guidelines. Observation sheets (n = 196) from two municipal home healthcare organisations were analysed with descriptive quantitative analysis. Ethical issues and approval: While no external ethical committee evaluation was necessary for this quality improvement study, research ethical principles were followed. Results: The nurses spent 50% of each eight-hour shift on indirect patient contact activities and about 38% on direct patient contact activities. The majority of activities underlying the home visits could be linked to long-term illnesses: medication (57%), blood samples (23%), wound care (17%) or measurement of blood pressure (14%). Patient education was offered during only 3.5% of visits. Limitations: The accuracy of the students’ observations is related to their individual capacity to objectively and selectively observe. Conclusions: There were a number of activities conducted for the patient, to promote continuous intra- and interprofessional patient care, but fewer nursing activities conducted with the patient. To ensure integrated, person-centred, safe patient care, vital reforms are needed. Relevance to clinical practice: The appropriate balance between indirect and direct patient contact activities should be discussed intra- and interprofessionally, delineated and made explicit in nurses’ work plans and nursing documentation, alongside discussions pertaining to relevant resource allocation.