Nursing Intervention Analysis in COVID-19 Negative Pressure Isolation Wards and General Wards: Observational study

Abstract

AbstractIntroductionWith the global spread of Coronavirus disease (COVID-19) and public health crisis, appropriate allocation of healthcare human resources has been necessitated. Although nursing practice takes up a larger part of medical practice in hospitals, the quantitative assessment of nursing care has not been investigated for human resource allocation in the medical field. The objective of this study to explore the time spent for each nursing intervention, and compared provided amount of nursing intervention between negative pressure isolation wards (NPIWs) and general wards (GWs) provided by COVID-19 hub hospitals.MethodsThis research is a time-motion (TM) observational study. Three trained external observers recorded their observations for every minute in 19 different work schedules in 2 NPIWs and 2 general respiratory wards. Observation items were chosen based on the standard operating guidelines of Integrated Nursing and Caring Services developed by the Ministry of Health and Welfare and National Health Insurance Service. The average nursing workload per shift was compared by calculating the sum of the spent time of three nurses staffed in each shift in each ward between two groups. In addition, to compare the amount of directed nursing care for patients between two types of wards, nursing work category was divided into directed and undirected nursing interventions.ResultsIn the comparison of demographic characteristics of nursing workforce between two groups, there was no statistically significant difference (p>0.05 respectively). In both groups, the most time-consuming nursing work category was recording in three work shifts. The average duration of those work tasks was 312.5 minutes in NPIWs and 307 minutes (per 3 nurses) in GWs, having no significant difference (p>0.05). Of all nurse duties, the second most time-consuming work category was others (including changing to protective clothing) in NPIWs, and medication administration and transfusion in GWs. The mean duration of performing the category for others that include wearing PPE was 308 minutes in NPIWs and 160 minutes (per 3 nurses) in GWs, showing a significant difference (p<0.05). The greater amount of time was taken for hygiene management in isolation wards. Medication administration and transfusion and nursing assessment were more frequently performed in GWs, demonstrating a statistical significance. In the aggregated spent time for all duties including directed and undirected nursing care, the time spent for directed nursing care was 654 minutes longer in GWs than in NPIWs (per 3 nurses) in each work shift, displaying a significant difference.ConclusionThis study provides the quantitative difference in time-consuming nursing works between NPIWs and GWs by direct observation. Recording was the most time-consuming nursing work category in both NPIWs and GWs. Considering nurses in each duty in GWs provided more directed nursing care than nurse in NIPWs, careful considerations are required in allocation of nursing workforce.