The average nursing time and frequency for each nursing activity that were performed at the medical and surgical nursing units are listed below in Table 4 and 5.
The nursing activities such as blood pressure check, respiratory rate measurement, respiratory pattern measurement, respiratory sound measurement, body temperature measurement, pulse check, monitoring, consciousness check, and management of patient chart are calculated more than 10 times during a shift per a nurse.
The nursing activities such as naso-oral suction, tracheal suction, nursing procedure r/t T-cannula exchange, nursing procedure r/t intubation, observation and maintenance of respirator, feeding assistance, application of hot & cold regular, nursing procedure r/t diversion and relax, accomplish encourage, walk accompany, shaving, nail cavity cleansing, sits bath, isolation & closely of observation, CVP check, clergy counseling consulting, religious support, group education, intravenous infusion via heparin lock, intravenous
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infusion via central line, and coordination and consulting between units are performed with less frequency i.e., less than 3 times during a shift per nurse at the both units.
The nursing activities such as blood sugar measurement, intake and output measurement, tube feeding, nursing procedure r/t TPN infusion, encourage skin care, simple position change, position change using Stryker, position change circle bed, nursing procedure r/t skin traction, nursing procedure r/t skeletal traction, and transfusion are performed with higher frequency at the medical nursing unit than the surgical nursing unit.
On the other hand, the nursing activities such as cleansing enema, glycerin enema, retention enema, gas enema, thoracic drainage maintenance, bililary drainage maintenance, and hemo-vac & sump tube drainage maintenance are performed more regularly at surgical nursing unit than medical nursing unit.
The average nursing time of each nursing activity at medical and surgical nursing unit is listed in Table 3. The nursing activity in which the nurses spend the longest time is transfusion with 31.1(±10.5) minutes, assisting doctors with technique procedures takes 10.2(±3.0) minutes at medical unit and 19.4(±10.3) minutes at surgical unit, coordination and consulting for people take 9.7(±7.8) minutes and complex dressing takes 12.5(±5.7) minutes.
There is a difference in nursing time for the nursing activities between the two units e.g., counseling personal takes 9.7 minutes at medical unit and 4.2 minutes at surgical unit;
assisting doctor on a ward round takes 11.1 minutes at medical and 4.7 minutes at surgical unit; sterilizing equipments management takes 4.9 minutes at medical and 9.2 minutes at surgical unit.
For a detailed explanation, there are 38 nursing activities which take less than 3 minutes to be performed e.g., respiration sound measurement, respiration of pattern measurement, infusion via heparin lock, management of patient chart, nursing procedure r/t T-cannula, diaper change & skin care, pulse check , body temperature , close observation for suicide, monitoring, blood pressure check, body height, measurement, body weight measurement, postural drainage humidifies apply, stool sampling, consciousness check, assistance of bed span use, nasal prong, O2 mask apply, observation and maintenance of respirator, nursing procedure related to diversion and relax, order checking, naso-oral suction, urine sampling, blood sugar level measurement, CVP measurement, position change
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using, stryker, intake and output measurement, encourage rest nursing procedure related to partial restraint, lab finding review et al.
There are 68 nursing activities that need from 4 to 6 minutes to be performed e.g., encourage skin care, nursing procedure for fall down prevention, oral medication, gastric drainage maintenance, encourage sleep, recreation instruction, partial change of sheet, simple position change, tracheal suction, humidity regulation, clergy counseling consult, record information computer, blood sampling, nursing procedure for prevention contraction, intramuscular injection, transfer using stretcher, exercise and position, assistance of mobility disturbance, observation & check for fire, position change circle bed, bladder training et al.
There are 14 nursing activities that need from 7 to 9 minutes to be performed e.g., sterilizing equip management, family support of patient, document of ward management, nursing procedure related to TPN infusion, supplies management, simple dressing, nursing related to intubation, nursing procedure on deathbed, drainage fluid sampling, group education, religious support, cleansing enema and assisting staff (radiography).
There are 5 nursing activities that need from 10 to 12 minutes to be performed e.g., retention enema infusion via central line, assist doctors on a ward round, complex dressing and coordinating & consulting between medical personal.
There are 2 nursing activities that take from 13 to 15 minutes to be performed e.g., assist doctors with technique procedure, complete isolate for infecting prevention.
There is 1 nursing activity that takes from 16 to 18 minutes to be performed such as bed bathing.
There is 1 nursing activity that takes more than 30 minutes to be performed such as transfusion.
The average time of each nursing activity which was performed by medical and surgical nursing unit is almost the same. However, there are nursing activities with different average time of performance at medical and surgical nursing unit such as 10 and 4.1 minutes for retention enema, 10 and 3.5 minutes forinfusion via central line,
10.2 and 19.4 minutes
for assisting doctors on technique procedure, 11.1 and 4.7 minutes for
assisting doctors on a ward round,4.0 and 1.5 minutes for
CVP checking,4.9 and 9.2 minutes for
sterilizing equipment management,4.9 and 7.3 minutes for
family support of patient,5.0
and 15 minutes for
application of hot & cold,8.0 and 5.0 minutes for
group education,27
9.7 and 5.2 minutes for
coordinating & consulting b/t medical personal for the medical and surgical unit respectively.Table 3
The Frequency and Average Time of Each Direct Nursing Activity during a Shift per Nurse at Medical and Surgical Units
Direct MNU (n=100) SNU (n=101)
Nursing activities n Mean(±SD) Fre(±SD) n Mean(±SD) Fre(±SD) Respiration
Resp. rate measure 86 0.9(±0.2) 12.3(±6.5) 65 0.8(±0.2) 11.5(±7.8) Resp. pattern measure 76 0.7(±0.3) 12.1(±5.8) 48 0.6(±0.2) 14.8(±16.2) Resp. sound measure 72 0.6(±0.2) 11.5(±5.7) 47 0.6(±0.2) 12.5(±6.7) Postural drainage 31 1.4(±0.6) 3.5(±4.1) 14 1.1(±0.3) 2.0(±1.0) Physiotherapy 15 4.3(±1.4) 2.3(±2.7) 15 3.2(±1.6) 3.3(±2.8) Naso-oral suction 3 2.0(±1.0) 2.7(±1.5) 3 2.7(±2.1) 1.7(±0.6) Tracheal suction 5 3.2(±1.8) 4.4(±3.4) 3 5.0(±0.0) 2.3(±2.3)
NA r/t T-cannular 1 1.0(±0.0) 2.0(±0.0) - -
-Nursing /t intubation 3 6.7(±2.9) 1.7(±0.6) 1 10(±0.0) 1.0(±0.0) Nasal prong, O2 mask 33 1.9(±0.8) 1.8(±0.9) 14 2.6(±1.3) 1.9(±1.2) humidifies apply 25 1.5(±0.9) 1.8(±1.1) 8 2.1(±1.5) 1.9(±1.4) Observation of resp 4 2.0(±0.0) 2.3(±0.5) 3 1.0(±0.0) 7.7(±10.7) Nutrition
Body weight measure 22 1.3(±0.5) 1.8(±1.0) 31 0.8(±0.3) 6.6(±8.8) Body height measure. 20 1.3(±0.4) 1.5(±0.8) 31 0.8(±0.3) 6.6(±8.8) Blood sugar 40 2.2(±0.9) 2.0(±1.1) 23 1.9(±0.9) 2.0(±1.2) I/O measurement 27 2.4(±1.5) 2.7(±2.2) 9 2.8(±1.7) 3.9(±4.7) CVP measurement 7 2.4(±1.1) 2.6(±1.5) 2 1.0(±0.0) 11.5(±6.4) feeding assistance 2 5.0(±0.0) 2.0(±1.4) 2 1.5(±0.7) 6.5(±4.9) Partial feeding assis 32 4.0(±1.3) 2.4(±1.9) 31 2.5(±1.7) 4.6(±3.7) Naso tube inserting 9 4.2(±2.6) 2.7(±1.8) 5 5.0(±0.0) 1.4(±0.5)
Tube feeding 20 4.5(±2.3) 3.4(±1.7) 6 6.0(±3.5) 1.7(±0.8)
Feeding via gastro 1 5.0(±0.0) 5.0(±0.0) - -
-TPN infusion 58 6.0(±2.3) 3.3(±1.9) 38 7.1(±4.4) 4.1(±3.3) (Unit, min)
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Blood sampling 57 3.6(±1.3) 2.6(±1.7) 40 3.5(±1.4) 2.5(±1.7) Elimination
Cleansing enema - - - 18 6.5(±4.0) 4.1(±4.8)
Glycerin enema - - - 9 1.4(±0.5) 4.3(±2.4)
Retention enema 1 10(±0.0) 2.0(±0.0) 9 4.1(±1.7) 3.2(±3.0)
Gas enema 4 4.3(±1.5) 2.0(±0.8) 16 2.5(±1.6) 3.1(±1.9)
encourage skin care 17 3.0(±0.9) 1.9(±0.7) 7 3.3(±1.3) 1.6(±0.5) Stool sampling 7 1.7(±0.8) 1.0(±0.0) 1 1.0(±0.0) 1.0(±0.0) Simple catheterization 13 4.8(±0.6) 1.8(±0.8) 15 5.2(±4.3) 1.7(±0.8) indwelling cath. 6 5.2(±2.9) 2.5(±1.1) 14 5.0(±1.7) 2.4(±1.5) Bladder training 11 3.9(±2.5) 1.8(±1.0) 11 4.1(±1.6) 1.6(±0.9) Bladder irrigation 9 4.9(±6.0) 2.3(±1.3) 6 4.5(±1.2) 1.5(±0.8) Assist of bed span use 5 1.8(±0.5) 1.8(±0.5) 5 3.2(±1.7) 1.6(±0.6)
Skin care 1 1.0(±0.0) 2.0(±0.0) 1 2.0(±0.0) 2.0(±0.0)
Urine sampling 16 2.0(±1.4) 1.9(±0.8) 12 2.0(±0.4) 2.5(±2.7) Urine measure 21 2.3(±0.6) 2.1(±1.3) 7 4.9(±0.9) 3.3(±2.0)
Thoracic drainage - - - 5 3.6(±1.3) 4.4(±3.1)
Bililary drainage - - - 11 3.4(±2.5) 3.0(±2.6)
Hemo-vac & drainage - - - 3 3.7(±2.3) 4.0(±1.7)
Gastric maintenance 4 3.0(±2.3) 1.5(±0.6) 10 2.3(±1.1) 2.8(±2.6) Drain. fluid sampling 5 7.8(±6.6) 1.2(±0.5) 4 1.5(±0.6) 1.0(±0.0) Sputum sampling 16 2.4(±1.4) 1.3(±0.5) 3 3.3(±1.5) 1.0(±0.0) 24 hours time sampling 14 4.9(±5.0) 1.4(±0.8) 3 5.7(±1.2) 1.3(±0.6) Exercise
Simple posi.change 30 3.2(±1.3) 2.4(±1.3) 9 3.7(±1.3) 3.2(±2.7)
Posi. change Stryker 7 2.4(±1.1) 3.1(±1.4) - -
-Position w/t circle bed 13 3.9(±1.4) 1.5(±0.7) 1 2.0(±0.0) 2.0(±0.0)
Exe patient 5 3.6(±1.5) 2.8(±1.1) 3 4.0(±1.7) 2.0(±1.0)
Prevention contract 15 3.6(±1.3) 2.7(±2.2) 2 2.5(±0.7) 1.0(±0.0)
Kin traction 13 4.8(±1.8) 1.7(±0.9) 1 2.0(±0.0) 1.0(±0.0)
skeletal traction 12 2.8(±1.1) 2.5(±1.1) 5 1.4(±0.6) 3.4(±2.5) Simple assist on exe 10 4.1(±1.5) 1.5(±0.5) 10 3.6(±1.9) 2.8(±1.6)
Assist on pros. use - - - 3 5.7(±4.0) 2.3(±0.6)
Assistance on crutch - - - 5 4.8(±1.1) 1.6(±0.6)
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Passive ROM exercise 20 4.4(±1.1) 3.8(±2.3) 15 3.7(±1.3) 2.7(±1.8) mobility distur 14 3.6(±1.6) 2.0(±1.2) 16 3.8(±1.4) 2.8(±2.4) Transfer using wheel 17 4.0(±2.0) 1.8(±1.2) 20 4.1(±1.4) 2.1(±0.8) Transfer using stretcher 7 3.6(±1.4) 1.9(±1.1) 5 4.4(±1.3) 2.0(±1.2) Comport
Encourage sleep 18 3.1(±1.1) 2.6(±1.3) 10 1.7(±0.7) 3.6(±3.5) Encourage rest 44 2.5(±0.8) 3.5(±1.9) 27 1.6(±0.8) 6.5(±5.8) Body temperature 73 1.0(±0.2) 11.1(±6.1) 53 1.4(±0.6) 10.2(±6.8) Hot & cold pack apply 6 4.5(±1.2) 1.7(±0.5) 5 4.4(±0.9) 2.2(±1.1) Apply hot & cold 2 5.0(±0.0) 3.5(±0.7) 1 15(±0.0) 1.0(±0.0) Humidity regulation 44 3.5(±1.6) 5.0(±4.1) 32 2.7(±1.10) 4.7(±2.6) N. diversion & relax 1 2.0(±0.0) 2.0(±0.0) 1 1.0(±0.0) 10(±0.0) Accomplish encourage 2 4.0(±1.4) 2.5(±2.1) 6 5.2(±5.9) 4.0(±4.2) Recreation instruction 55 3.1(±1.3) 5.6(±4.2) 34 2.9(±1.6) 6.1(±5.0) Walk accompany 1 2.0(±0.0) 5.0(±0.0) 1 5.0(±0.0) 1.0(±0.0) Hygiene
Bed bathing - - - 2 17.5(±3.5) 1.5(±0.7)
Shaving 2 5.0(±0.0) 3.0(±0.0) - -
-Nail cavity cleansing 2 5.0(±0.0) 3.0(±0.0) 3 1.3(±0.6) 5.0(±4.6) Perinea nursing 8 4.1(±2.8) 2.0(±1.1) 4 4.3(±1.5) 2.0(±1.4)
Sits bath - - - 1 5.0(±0.0) 1.0(±0.0)
Total change of sheet 15 2.9(±1.7) 1.3(±0.5) 13 2.4(±0.8) 3.6(±2.9) Partial change of sheet 11 3.1(±1.7) 1.5(±0.8) 15 3.5(±1.4) 3.0(±3.0) Clothes change 11 2.9(±1.4) 1.2(±0.4) 9 2.4(±1.0) 4.0(±3.4) Safety
Compl. iso to inf. pre 1 15(±0.0) 1.0(±0.0) - -
-Part. iso for infection 9 5.0(±0.0) 1.3(±0.5) 8 3.8(±1.5) 3.8(±3.7) bed sore preventing 19 4.4(±1.1) 2.3(±1.5) 6 3.7(±1.5) 1.5(±0.6) Simple dressing 37 6.5(±2.1) 2.1(±1.0) 36 5.3(±1.1) 3.6(±2.3) Complex dressing 24 12.5(±5.7) 1.3(±0.5) 26 11(±3.8) 2.8(±2.4) Opiod & poison check 27 5.2(±3.0) 1.6(±0.7) 20 5.1(±2.5) 1.9(±2.1) obser for suicide 1 1.0(±0.0) 5.0(±0.0) 3 4.3(±4.9) 2.3(±1.5) Fall down prevention 36 3.0(±1.5) 2.5(±1.3) 28 3.1(±1.4) 2.7(±1.4) Isola. & close obser 4 4.0(±2.0) 4.3(±1.5) 2 3.0(±2.8) 2.0(±1.4)
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Obser & check for fire 52 3.6(±1.6) 1.8(±0.7) 26 4.1(±1.3) 1.8(±0.6)
partial restraint 10 2.5(±1.4) 2.7(±1.6) - -
-Consciousness check 71 1.7(±1.0) 7.8(±5.9) 47 1.1(±0.3) 11(±6.89)
CVP check 4 4.0(±1.2) 2.3(±1.0) 2 1.5(±0.7) 4.5(±3.54)
Blood pressure check 83 1.1(±0.4) 12.4(±6.4) 64 1.1(±0.3) 11.2(±6.5) Pulse check 83 1.0(±0.1) 11.5(±5.9) 65 1.1(±0.3) 12.2(±8.1) Monitoring 84 1.1(±0.3) 11.6(±6.2) 60 1.5(±3.8) 11.5(±5.8) Spiritual support
Clergy counseling 4 3.5(±1.7) 1.8(±0.5) - -
-Religious support 4 8.8(±2.5) 1.3(±0.5) - -
-Family sup.of patient 9 4.9(±3.2) 1.8(±0.4) 3 7.3(±4.6) 2.3(±0.6) Nursing on deathbed 9 7.0(±2.9) 1.9(±0.8) 1 10(±0.0) 2.0(±0.0) Admission interview 22 4.4(±1.0) 2.2(±1.1) 15 4.0(±1.7) 4.9(±3.2)
Counseling 18 5.1(±2.0) 2.6(±1.3) 12 3.2(±1.3) 6.8(±8.4)
Personal education 69 4.1(±1.5) 3.6(±2.1) 59 3.4(±1.3) 5.0(±3.6) Group education 4 8.0(±4.0) 8.3(±0.0) 1 5.0(±0.0) 2.0(±0.0) Medication
Oral medication 15 3.0(±2.1) 4.7(±2.4) 19 3.6(±2.3) 6.1(±5.9) General intra. infu 66 4.4(±1.1) 4.0(±2.0) 42 4.3(±2.3) 5.5(±3.7) Infu.via heparin lock 2 0.8(±0.4) 6.5(±5.0) 5 2.2(±0.8) 1.8(±0.8) infusion via central line 5 10(±5.0) 1.4(±0.6) 2 3.5(±2.1) 2.0(±0.0) Intramus. injection 57 3.6(±1.3) 2.5(±1.5) 41 2.5(±0.9) 5.4(±2.9) Subcutan. injection 27 2.8(±1.2) 1.6(±0.6) 21 2.1(±1.2) 1.8(±1.1) Droplet apply 37 5.5(±2.1) 2.7(±1.0) 20 4.2(±1.4) 3.8(±2.0) Suppository apply 5 2.8(±0.5) 1.2(±0.5) 1 5.0(±0.0) 2.0(±0.0)
Transfusion 12 32.1(±0.0) 1.0(±0.0) 1 30(±0.0) 1.0(±0.0)
Communication
Coordi b/t med perso 46 9.7(±7.8) 1.7(±1.1) 39 4.2(±1.2) 3.0(±2.2) Consulting b/t units 5 5.0(±3.1) 3.6(±3.8) 9 2.9(±1.4) 3.1(±2.9) Others assisting
Assist doctors round 13 11.1(±5.6) 1.2(±0.4) 11 4.7(±2.2) 4.1(±2.5) Assist doctors w/t pro 26 10.2(±3.0) 1.3(±1.4) 14 19.4(±0.5) 1.8(±0.7) Assisting staff (radio) 9 4.1(±1.4) 1.6(±0.7) 8 6.4(±9.7) 2.0(±1.2)
Note. MNU, Medical Nursing Unit; SNU, Surgical Nursing Unit; min, minute.
Table 3 - Continued (1)
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The indirect nursing activities such as recording of document patient care, patient charting, order checking, recording on computer, medication management are calculated more than 5 times during a shift per nurse at both units.
The indirect nursing activities such as equipment, sterilizing equipment and supplies management are calculated less than 2 times during a shift per nurse at both units.
The indirect nursing activities such as lab finding review, film checking and arrangement, supplies management and ward environment are calculated from 2 to 5 times during a shift per nurse at both units.
There are differences of frequency for the indirect nursing activities between the two units; e.g., recording of document patient care takes 5 times at medical nursing unit and takes 9.6 times at surgical nursing unit; films checking take 2.5 times at medical nursing unit and take 6.6 times at surgical nursing unit.
There are 3 indirect nursing activities that take from 5 to 10 minutes to be performed e.g., document of ward management, handing over shift to shift and supplies management.
There are 2 indirect nursing activities that take less time about 2 minutes to be performed such as patient charting and lab finding review.
The nursing activities such as equipment management, medication management and recording of document on computer need to take from 2 to 5 minutes to be performed.
There is a difference of the nursing time for the indirect nursing activities between the two units; e.g., sterilizing equipment management takes 4.9 minutes at medical nursing unit and takes 9.2 minutes at surgical nursing unit.
The nursing activity need to take much time and frequency to be performed is recording of patient document with 5 to 10 minutes and 4 to 6 times.
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Table 4The Frequency and Average Time of Each Indirect Nursing Activity during a Shift per Nurse at Medical and Surgical Units
Indirect MNU (n=100) SNU (n=101)
Nursing activities N Mean(±SD) Fre(±SD) N Mean(±SD) Fre(±SD)
Recording
Docu of patient care 84 4.2(±1.3) 5.0(±2.3) 71 5.3(±6.8) 9.6(±8.0) Docu of ward manage 52 5.5(±4.3) 2.3(±1.3) 46 6.4(±4.8) 3.6(±3.5) patient chart 78 0.9(±0.2) 11.4(±6.2) 61 1.5(±1.9) 12.6(±8.2) Record on computer 46 3.5(±3.0) 5.6(±3.9) 47 4.0(±3.9) 8.8(±5.4) Handing over shift 76 5.3(±2.2) 1.5(±1.0) 68 5.6(±4.3) 3.3(±5.6) Others (label) 57 2.6(±1.5) 4.7(±3.8) 66 2.3(±2.3) 6.8(±5.7)
Checking
Order checking 92 2.0(±0.8) 7.4(±5.1) 79 3.3(±3.9) 8.3(±6.0) Lab finding review 56 2.6(±1.3) 2.3(±2.2) 46 2.2(±1.2) 4.5(±4.1) Film checking & arrange 39 4.0(±1.4) 2.5(±2.2) 35 4.1(±2.9) 6.6(±2.4)
Equipment checking
Equipment management 51 5.1(±3.8) 1.5(±1.1) 42 5.1(±1.7) 1.4(±0.8) Sterilizing equip ma 32 4.9(±1.0) 1.3(±0.5) 30 9.2(±7.5) 1.3(±0.5) Supplies management 38 6.3(±6.4) 1.3(±0.7) 33 7.7(±7.1) 1.5(±0.7) Medication management 83 4.5(±1.5) 5.7(±3.3) 55 5.2(±3.2) 4.4(±2.7) Ward environment 43 4.1(±1.6) 2.3(±1.0) 38 5.2(±2.4) 2.5(±1.3)
Note. MNU, Medical Nursing Unit; SNU, Surgical Nursing Unit; min, minute.
In short, the medical nurses used the higher frequency of nursing activities as compared to the surgical nurses for the nursing domains like nutrition nursing, exercise &
posture maintenance and safety. On the other hand, the surgical nurses used higher nursing activities frequency as compared with medical nurses for the nursing domains like caring focused on elimination, recording and checking.
Question 3: What was the proportion of direct and indirect nursing time during a shift