A prospective investigation of direct and indirect home care activities in three rural Norwegian municipalities

Abstract

BackgroundHome care providers struggle to manage their day-to-day work, which is increasing in volume and complexity. In general, they are expected to achieve more with the same planning methods, resources, and capacity. To meet emerging needs and use the available resources more effectively and efficiently, evidence and strategies are needed to inform planning methods for home care services. However, limited data are available to inform this change. This paper investigated the amount of time used to carry out direct activities and six indirect activities across three rural Norwegian municipalities (M1, M2 and M3).MethodsHome care staff recorded data over 8 weeks in 2016; the majority of the staff used a smartphone application and some staff used a manual form to report the durations of the activities.ResultsThe median time spent on direct activities was 11–13 min, and this work constituted less than 50% of the total work in the three municipalities. The median driving time was 5–7 min, which accounted for 43–54% of the total indirect work. Administration, particularly reporting and documentation, displayed greater differences across the municipalities, together accounting for 38–50% of the total indirect time. M2 and M3 used substantially more time for documentation, including 20 min in M2 and M3, in contrast to only 1 min in M1. Similarly, the median reporting times were 30 min (M2) and 28 min (M3), compared with only 17 min in M1.ConclusionsHome care staff spent less time on direct activities than on indirect activities, of which several activities have the potential for change. These results may help managers utilize resources effectively and plan appropriately, and they may also serve as a basis for future research to identify areas with improvement opportunities and, in turn, make more time available for direct patient care.

Workflow for Intensive Care Unit Nurses: A Time and Motion Study

“…The terms direct and indirect nursing care were defined based on previous studies (Helgheim et al, 2018;Westbrook & Ampt, 2009). Direct nursing care refers to activities in which the nurses spend time with the patient and/or the patient's family; indirect nursing care refers to activities that are not applied directly to patients or are performed in preparation to engage in direct nursing care.…”

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders’ perspectives on organizational work redesign concepts based on the Goldilocks Work principles

“…A majority of the HCWs in these units were assistant nurses with high school education, followed by nurses and other college/university health educated personnel (e.g., occupational therapists or welfare nurses), and assistant healthcare workers without formal education. HCWs’ work tasks included both direct and indirect care [ 3 ]. Direct care encompassed providing medical or practical assistance (i.e., assistance in hygiene, eating, dressing, and client transfers) [ 2 , 11 ], whereas indirect care tasks incorporated documentation, administration, drug preparations, teaching and training tasks, and transportation [ 2 , 3 ].…”

“…Home care workers (HCWs) in Norway provide nursing care and practical help for citizens who live at home but require assistance in daily living [ 1 , 2 ]. Due to an aging population and a shift from hospital and institutional care to home-based health care, the need for HCWs in Norway, as well as in most Western societies, is increasing [ 3 – 5 ]. At the same time, HCWs find their work to be physically demanding and exhausting due to factors related to physical and psychosocial work demands created at the organizational level, as well as individual factors [ 6 – 10 ].…”

Is patients’ activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

“…Home care workers spend a large part of the workday (approximately 50%) on direct patient care assignments [ 20 , 21 ]. Therefore, if patients’ ADL self-care score functions as a proxy of home care workers’ standing time at work, the home care sector has a nationally available score that can be used to distribute the occupational standing time in a more health-promoting manner.…”