Hendrich Ann, Chow Marilyn P, Skierczynski Boguslaw A, Lu Zhenqiang
Perm J. 2008 Summer;12(3):25-34. doi: 10.7812/tpp/08-021.
Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness of nursing care is essential to hospital function and the delivery of safe patient care.
We undertook a time and motion study to document how nurses spend their time. The goal was to identify drivers of inefficiency in nursing work processes and nursing unit design.
Nurses from 36 medical-surgical units were invited to participate in research protocols designed to assess how nurses spend their time, nurse location and movement, and nurse physiologic response.
Nurses' time was divided into categories of activities (nursing practice, unit-related functions, nonclinical activities, and waste) and locations (patient room, nurse station, on-unit, off-unit). Total distance traveled and energy expenditure were assessed. Distance traveled was evaluated across types of unit design.
A total of 767 nurses participated. More than three-quarters of all reported time was devoted to nursing practice. Three subcategories accounted for most of nursing practice time: documentation (35.3%; 147.5 minutes), medication administration (17.2%; 72 minutes), and care coordination (20.6%; 86 minutes). Patient care activities accounted for 19.3% (81 minutes) of nursing practice time, and only 7.2% (31 minutes) of nursing practice time was considered to be used for patient assessment and reading of vital signs.
The time and motion study identified three main targets for improving the efficiency of nursing care: documentation, medication administration, and care coordination. Changes in technology, work processes, and unit organization and design may allow for substantial improvements in the use of nurses' time and the safe delivery of care.
护士是医院的主要护理人员。提高护理工作的效率和效果对于医院运作及提供安全的患者护理至关重要。
我们进行了一项时间与动作研究，以记录护士如何分配他们的时间。目标是确定护理工作流程和护理单元设计中效率低下的驱动因素。
邀请来自36个内科-外科护理单元的护士参与研究方案，该方案旨在评估护士如何分配时间、护士的位置和移动情况以及护士的生理反应。
护士的时间分为活动类别（护理实践、单元相关职能、非临床活动和浪费时间）和位置（病房、护士站、单元内、单元外）。评估总行走距离和能量消耗。跨单元设计类型评估行走距离。
共有767名护士参与。所有报告时间中超过四分之三用于护理实践。护理实践时间的大部分由三个子类别构成：记录（35.3%；147.5分钟）、给药（17.2%；72分钟）和护理协调（20.6%；86分钟）。患者护理活动占护理实践时间的19.3%（81分钟），而护理实践时间中只有7.2%（31分钟）被认为用于患者评估和生命体征读数。
时间与动作研究确定了提高护理效率的三个主要目标：记录、给药和护理协调。技术、工作流程以及单元组织与设计的改变可能会大幅提高护士时间的利用效率和护理的安全提供。
