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First Regional Nursing Studies Seminar, Manila, Philippines, 2-30 April 1965 : final report

31 décembre 1965 Organisation mondiale de la santé

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Texte intégral

REGIONAL OFFICE FOR THE WESTERN PACIFIC of the

Worlcl Health Organization Manila

REPORT ON THE FIRST REGIONAL NURSING STUDIES SEMINAR

2-30 August 1965, Manila, Philippines

WPRO-121

Sponsored by' the I

. WORLD IlEAIlrH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

"', "

Manila, Philippines 2-30 August 1965

FINAL REPORT

Nor FOR SALE PRJlmID AND DISTRIBtJrED by the

REGIONAL OFFICE FOR THE WESTERN PACIFIC of the World Health Organization Manila, Philippines September 1965

The views expressed in this report are those

of the advisers and participants of the seJl1inar and do not necessarily reflect the official policy of the World Health Organization.

....., ,

This report has been prepared by the Western Pacific Regional Otfice of the World Health Organization for Governments of Member States in the Region and for those who participated in the Seminar on the First Regional NurSing studies, Manila, 2 to 30 August 1965.

Page 1. 2.

INTRODUCTION..... • PLI\NHING FOR THE SEKINAR

1 2

ORGANIZATION OF SD4INAR

. . . . . . ..

ACTIVl!l'IES OF SEMINAR • 4.1 Qpening Session. 4.2 Seminar Programme 4.3 Closing Session

6 7 12 12

.... ,

APPRAISAL OF RESULTS

LIST OF ANNEXES ANNEX I ANNEX II ANNEX III ANNEX IV ANNEX V ANNEX VI

Members of the First Regional Nursing Studies Seminar • •

. . . . . . . 14/15 .

Nursing Activity Study Information for OPO Personnel Bibliography •• Evaluation Forms Goals of Seminar Group

. . . . . 19 22/23

.. ..

29/30 42/43 45/46 48/49

Problems Checked by Participants Information About Participants .

~I"I

ANNEX VII ANNEX VIII ANNEX IX ANNEX X ANNEX XI ANNEX XII ANNEX XIII

Opening Address - Dr. I.C. Fang • • • • . 51/52 Timetables. • • . • . • . Library Study • • • •

. . . . . .. . . . . . . . . ... .

53/54

60/61

66/67 Codes aDd Definitions Observerls Record • . • • • • • • •• Practice Exercises • . • • • • . . . • • • 76/77 Assignments for Activity Studies in OPO Closing Address - Dr. F. J. D,y • • • • •

81 96

ANNEX :xIV -

.. 1.

INTRODUCTION

Nurse leaders in the Western Pacific Region of WHO, like those throughout the world, continue to struggle with shortages of nurse power created by the increasing demands for nursing personnel to maintain ongoing and to activate nursing services in new health and medical care programmes. Plans by natiC'nal health administrations based on matching the country-' s health needs With the health and personnel resources have frequently failed to take into account the additional potential nurse power available in the 6xisting supply of nurses if such nurses were used to the maximum of their preparation. The share of responsibility which nurses carry in implementing health programmes as well as the changes in the nature of nursing and the methods of delivering nursing service within particular socio-economic and cultural settings emphasize the importance of establishing staffing patterns ~hich attempt to match the nursing care needs of people and the utilization of nurse personnel in terms Qf their preparation to meet such needs. The effective use of nursing personnel is a real factor in the translation of nursing progress and a large share of medical progress into action. If nursing personnel, who possess professional nursing "tools" are not fully utilized the nursing service which ~tould result from modern nursing education programmes is diluted in both quantity and quality. As a first step to action inclarifyiDg the shortage of nurse power and in evolving staffing patterl:.6, it was considered essential to prepare nurse leaders in a systematic study approach to nurse utilization, using research techniques.

The First Regional Nursing Studies Seminar was convened by the WHO Regional Office for the western Pacific in Manila, Philippines, from 2 to 30 August 1965. The broad purpcee of the Seminar was to assist selected nurse leaders in developing a systematic study approach With particular reference to staffing problems in health agencies. There were 13 participants from 8 countries in the Region, 3 members of WHO Field Staff assigned to projects in 3 countries in the Region and one observer frOm the Rockefeller Foundation (See Annex I). The main objectives toward which the work of the Seminar was directed were: (1) (2)

to provide a learning experience in nursing activity study, using selected research techniques; to provide an experience in the systematic collection, tabulation, presentation and use of data in clarifying problems basic to staffing; to clarify principles of staffing through interpretation of study data and thinking through recommendatiOns of the nursing activity study in relation to other data essential to staffing;

(3)

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(4) (5)

to provide an experience in "built-in" evaluation as a continuous process in staff.and programme developmentj to st1mulste "self_starters" in using the study approach. II. PIIINNING FOR THE SEMINAR

Administrative Planning In previous years continuous efforts by governments, in many instances with WHO assistance of vsrious forms heve been concentrated on increasing the supply of nursing personnel of vsrious categories. However, the increased supply is not providing a solution to the shortage of nursing personnel. In same instances, the introductton of on-thejob or otherwise trained auxiliary workers in nursing service is .acting to dilute the quality of nurSing care. In other instances, the improper use of fully qualified nurses is aggravsting the shortage of staff for patient and family care. The need for a seminar with special training in staffing grew out of the complex staffing problems with which nurse leaders in the Western Pacific Region were faced. The preparation of guides on staffing by WHO Genevs, the first of which was to b.e published in 19631 , reinforced the interest in organizing training courses with emphesis on research techniques applied to staffing problems. The possibility of organizing a three-month course during the summer session within a university in one of the coutries in the region was envisioned. Although interest was expressed by several countries, the idea wes not found feasible because ot administrative and financial problems.

Early in 1963, planning for a seminar streamlined by budgetary exigencies to one month, was resumed because of the urgent need to assist nurse leaders to locate the hidden nurse potential within the existing supply of nursing personnel through nurse utilization studies. Exploratory planning was started by the Regional Nursing Advisers with the Nursing Consultant to the Secretary of Health, the Chief of the Office of Health Education and Personnel Training, Department of Health, the Technical Adviser to the Secretary of Health and nurses fram the Bureau of Health and Medical Services of the Department of Health, Government of the Philippines. At thet tilne, the Department of Health agreed to make available the facilities of outpatient departments and public health agencies as a field laboratory for the learning experiences of partiCipants and to appoint a nurs~-liaison officer for the Seminar. At the request of the Regional Director, the University of the Philippines sgreed to release the Dean of the College of Nursing to serve as s Consultant to the Seminar and to. give lesdership to the follow-up activities of the Seminar in the Philippines. APPointment of the full Seminar staff and resource persons wes made later (Annex I).

1 The Staffiug of PUblic Health and Outpatient Nursing Services, Methods of Study, DoriS E. Roberts, Public Health Papers 21, WHO/Genevs.

- ,In January 1965, letters yere sent to the gC've:rments in the Region inviting them to nominate fully qualified nurse partlcipants·who met the folloY1n~ criteria:

(1) (2)

who were in administrative and/or supervisory positions in public health or in outpatient department services, and/or are teaching public health at the advanced level; who had post-basic or post-grsduate preparation preferably including some experience in research; who would be in a position of carrying on operatiooal research

in their own country, following the Seminar, and of receiving the assistance of a consultant for the implementation of research projects. Pre-planning . Beginning the last week in June 1965, the Co-Director of the Seminar, the Governmentjlmo Nurse Liaison Officer and the Consultant from the :fh1lippioes visited hospitals, outpatient departments and health centres for the purpose of exploring a potential field laboratory for the Seminar participants to secure learning experiences in conducting nurSing activity studies. It was decided to select outpatient departments ~s field ~bora tories because of the importance of the outpatient department as the major link in continuity of patient care between the hospital and the cOUIIIIUnity. Most outpatient departments are providing both preventive and curative services for sick and well children and adults as well as continuing ambulatory treatment for discharged patients with chronic and other illnesses and supportive care during rehabilitation. Another reason for selecting the outpatient department as the field laboratory was the potential contribution of this type of service to the general improvement of the health of the coUIIIIUnity. ReviSits were made to outpatient departments to note whether or not they had certain characteristics which might be considered as "typicaln in the countries in the Region, i.e. if (1) (2) (,) (4) (5) there were both preventive and curative clinic services; there was a large daily cliniC attendance; the nursing personnel included more than one category of workers; student nurses were receiving experience as part of a planned clinical programme; "g~ps" in nursing staff occurred as a result of frequent absences, study or other leaves of absence;

(6)

pressure of workload was creating frequent paid or unpaid overtime on the part of nursing staff.

- 4 _ Other factors noted during the revisits included the physical la)"OUt of the outpatient department and the apparent deaire on the part of administrative staff' both medical and nursing, to study what nurses 'Were doing. The two outpatient departments selected as field laboratory were: Philippine General Hospital Outpatient Department Jose Reyes Memorial Hospital Outpatient Department (North General Hospital) IB.te in July the total Seminar staff' 'liaS brought together and definitive planning for the Seminar content, method and procedures took place. The staff' also visited the· outpatient departments selected to serve as the field laboratory, and held meetings With the chief. medical and nursing administrative officers, chiefs of services, the training officer and the chiefs of other departments in the hospitals. These meetings served to clarify the purpose of the Seminar, same problems related to the shortage of health personnel, especially nurses, the relation of nurse utilization to shortage, the purposes, method and potential contribution of a nursing activity study. Full. support of the administrative staff' was off'ered and subsequent meetings 'Were held with the medical and nursing administrative staff' of the Outpatient Department to make definite plans for the nursing activity studies including the orientation of personnel, (Annex II), the selection of t~e clinics to be studied, the timing o:i: a "dry run" and of the study. Plans were also made for a discussion of the findings of the study with the administrative personnel. ,. 1. Semill8.r Staff' ORGANIZATION OF SEmNAR

The Sem1l18.r staff' of six was organized with an Operational Officer, two Co-Directors of the Seminar, one Temporary Adviser and two Consultants all of whom took major responsibility for one or more aspects of the Seminar. Two part-time members of the Regional Office staff' assisted with the Seminar, one as lecturer on the tabulation of data and the other as adviser on the graphic presentation of the nursing activity study data and the use of computers. The three WHO field staff' were frequentlY called upon to assist with S(1J!le activity of tlw Seminar. The observer from the Rockefeller Foundation served also as a special lecturer for the Seminar. 2. location

The general sessions of the Seminar were held in the Conference Room on the fourth floor of the WHO Regional Office. An adjoining room housed the library of books, periodicals, studies and pamphlets that 'Were selected as reference materials for the Semill8.r (Annex III). A librariun was on duty during the entire Seminar to facilitate the use of the library materials. Practice sessions on classification of nursing activities, the use of the slide rule and cauputer snd the tallying of data 'Were held in the same rooms.

,. ,

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Individual offices were set aside for the small group discussions and for the tabulating and writing teams for the final reports of the two nursing activity studies conducted by the participants.

The field laboratories were located in the outpatient departments of the I'hllippine General and the Jose Reyes Memorial Hospitals.

'Workiag Hours

The official vorking hours of' the Seminar were from 0800 to 1200 and from 1400 to 1700 Mondays through Fridays and from 0800 to 1200 on Saturdays. Duriag the week of' the tabulation of' data and the writing of the final report on thewrsing activity studies, work continued often beyond 2000 hours. 4. Committees of' the Seminar (a) The Planning Committee composed of the Seminar staff was responsible for decisions on Seminar objectives, programme, methods and learning activities within the framework of' the defined Seminar purpose. The Comm1ttee ~eed upon a teachiag approach which would provoke thinkiag on the part of' the participants, f'oster the habit of using resources, both material and human and pro_ vide as complete an experience as possible in conducting a nursing activity study. The staff also served as resource persons to the small groups, to the Nurs1Dg Activity Study groups and to the individual participants by helping them to clarify problems and their thinking rather than by providing answers to problems. This committee met frequently, if' not dally, from 0730 to 08co and f'rom 1330 to 1400 hours. (b) Evaluation Comm1ttee A committee of five members was responsible f'or preparing f'orms (Annex IV) used by participants and Seminar staff to express their reaction to the programme, methods, procedures and resources, and to make suggestions for changes. The timetable was kept sufficiently f'luid to permit adaptation to suggested changes. On the first day of' the seminar, participants were asked to write their expectations of' the Seminar (Annex V) and to rate the importance of selected nursing problems on a check list (Annex VI). Participant reactions to the Seminar were written weekly, summarized and reported back to the participants by the Chairman of the Evaluation Committee • •

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Prior to the close of the Seminar, final evaluations were written by the. participants and reported back to the group at the last day's general session. At the same session participants were asked to write about any follow-up action they hoped to take within the one-year period following the Seminar. A letter and form for reporting plans for and/or completion of nursing activity studies by the participants were prepared and will be sent to each participant in September 1966. by the Western Pacific Regional Office of wen.

ec)

PUblicity CoIllDlittee '.: 'l!h1s committeelOf three:.,re.lvresponsible.1'ar co-operating with the PUblic Information Office or WHO in the Western PacUic Region to assure the rlow or appropriate news into the various publicity channels.

(d)

Social CoIIIDlittee This committee or four arranged for the introduction of the participants to Philippine living through a delightful programme of entertainment throughout the Seminar.

(e)

Final Report Team The CO-Direct:n-sc1' the Serilinar were responsible for writing the Seminar report.

Participants

Exclusive of the three WHO field staff, there were 13 participants from ~ countries in the Region. Participants were nurses in leadership positions in the public health and hospital service or educational setting. AD. participants had had some post-basic education, University or noll-univerldty (Annex vn). . 4. 1. Opening Session ACTIVl'l'IES OF THE SEMINAR

Following registration of the participants, Dr. I.C. Fang, Regional Director, WHO Regional Office for the Western pacifiC, welcomed the participants and set the tone of the Seminar. (Annex vm). Dr. Fang mentioned the difficulty nursing leadership is facing in meeting the demands ror nursing service. However, he was opt1m1stic that today' s problems which are the product of scientUic advances resulting from man's thinking and reasoning, can be resolved by the same reflective process. In advis_ ing the Seminar participants, he stated: " ••• the nursing proression, like all other professions, has the responsibility of defining its own functiOns, determining the

- .., scope of its practice, setting, improving and maintaining the standards of the service the profession undertakes to provide to society ••• In order to do this, members of the profession must be prepared and ready to examine the service being given and take necessary action needed to safeguard this service which the profession delivers to society... In arriving at the goal of a high quality as yell as quantity of nursing service, the highest priority has to be given to ensure the economic and appropriate use of nurse power. II Following the Opening Session, the participants were introduced to the Seminar objectives, methods and procedures. The participants spent the afternoon in general discussion of the urgent problems related to staffing for nursing service in their own countries. Problems common to all countries included: (a) the use (or misuse) of existing nursing resources as a result of such factors as the overlapping and duplication of services; the failure to differentiate fUnctions of the various categories of nursing personnel; the lack of clarity in job descriptions; the tendency of agency administrators to look to nursing service personnel to supply essential services of a non-nursing nature for patients and families such as clerical, housekeeping, dietary; the division of responsibility at national levels into policymaking under one authority and service operation under another, creating a disequilibrium between posts budgeted for nursing and nursing service to be delivered; between educational goals and process of nursing education and the extent ot service responsibility carried by students; the inadequate Ilxmetary rew.rd and conditions of work which fail to take into account the educational preparation and experience of graduate registered nurses aggravate the shortage of nurse power and stimulate the exodus of qualified nurses from the profession, and frequently, from the country; the planning for health and medical care services and for the construction of hospitals and health centres without involving nurses in the planning leads to facilities which not only impede the efficient flow of nursing services to patients and families but establishes service goals which create additional problems of staffing for service and of ensuring sate nursing care.

(b)

(c)

J. (d)

.. 2. (a)

Seminar ProIfl'fl!!!!nP (Annex IX) First Week - Content

Content covered in general sessions during the first week included the following topics although not necessarily in the order listed: (i) Observation EI8'a research technique - use and suitability of observation in studying nursing activities

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- objectivity in observation - need to estBblish criteria to focus observation - types of observation used in nursing activity stud1e~ suitBbility of each - recording observations, need for accuracy (i1) Activity study - problems 1Ihich can and cannot be answered by activity study - nursing functions in relation to activity study - work sampling applied to nursing activity study Use of resources - kinds of resources available at Seminar - use of resources in relation to learning

(iii)

(b)

First Week - Activities Participants met in general sessions for content of the Seminar.

Methods used included lectures, general discussion, round tBble disCUSSion, assigned readings for each phase of the work - study progra.mme. (Annex X). Participants were assigned the tBsks of estBblishing criteria to be used as a basis for observation of nursing activity and of constructing an instrument for recording observations. To accomplish the tasks three groups were formed, two groups of five members each and one group of six members. Groups were structured to include:

(1) (2) (:~)

members from d1f'f'erent countries public health and oospitBl nurses members with and without previous experience and/or preparation in research one member of the WHO field stBf'f

(4)

Examples of criteria 1,2,3, established and used in other countries were given to the groups to use as a point of departure for group discussion. In these smell groups, participants had the opportunity to become acquainted with each other, to clarify their understBnding of nursing and to become acquainted with the impact of varying cultures on nursing, thus facilitBting communication among the nurses from the several countries.

1 How to Study Nursing Activities in a Patient Unit, Public Health Monograph No. :570 Revised 1964, US Government Printing Office 2 Adams, A., How to Study Nursing Activities in an Outpatient Department, Public Health Monograph No. 497 3 Rob~S, D., StBf1'ing of Public Health and Outpatient Nursing Services, Public Health Papers No. 21, WHO/Geneva, 1963

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Group reports, progress and problema were shared in gene:ral sessions. A list of definitions to be used in observing nursing activities and a form for recording were agreed upon by the three groups. Practice exercises in using the definitions and the form were held in preparation for a two-day dry run in observation at the outpatient departments serving as a field labo:ratory. Discussion of problems in using the definitions led to mioor modifications. (Annex XI). (c) Second Week - Content Content in the second week included: (1)

Organization and presentation of data enume:ration of data, hand tallying construction of tables use of slide rule and the computer in calculations preparation of work tables and analytical tables

(2)

Interpretation of data - g:raphic presentation of data - suitability of various types of g:raphs, charts

(d)

Seo:!ond Week - Activities

The mornings of the first two days were spent in the outpatient departments in observing the activities of nursing personnel and in testing the use of the definitions in clasSifying activities. Participants were assigned in teams of two members to provide opportunity for comparison of classification activities. Staff members assisted with problems in using the definitions, in recording difficulties and held discussions for clarification of problems between scheduled periods of observations. In the afternoons, partiCipants came together in gene:ral session to share experiences and to discuss unresolved problems. These discussions led to further reviSion of the definitions and of the Observer's Record for recording activities. Presentation of cQntent on the organization and presentation of data in gene:ral session vas followed by pl'B.ctice exercises in tallying data collected in the two-day dry run in the outpatient departments, and, in the use of the slide rule and the calculator in computations. PartiCipants were grouped in teams of two members for these exercises. (Annex XII). (e)

Third Week - Nursing Activity Studies

•

The participants (including"lffiO field staff) 'Were assigned as observers to conduct two nursing activities studies during the entire third week •

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. Ten observers, under the guidance of two staff members, were assigned to one outpatient department that had a staff of 15 registered nurses, 6 nursing attendants and 11 nursing students (Annex XIII). Six observers, under the guidance of one staff member, were assigned to another outpatient department with a staff of six l'egistered nurses, five nursing attendants and ten nursing students (Annex XIII). The observers alternated scheduled observation periods of two to two-and-one-half hours to provide for instantaneous intermittent observation of all the nursing service personnel during all the work hours of each five consecutive days. The maximum hours of observation scheduled for an observer on any one day were four and ususlly did not exceed two hours. When an observer was scheduled for four hours in any one day, a two-hour rest period was provided between the first and the second periods to avoid excessive fatigue interfering with accuracy in recording. Each observer was assigned from six to ten members of the nursing personnel for observation. Assignments of nurSing personnel to observers _re changed every second day. The staff member assigned to the outpatient department circulated periodically for spot-checking of observation techniques, consulted with observers as needed, assisted observers in editing their records, and checked the coding of activities for accuracy. On completion of observation at the outpatient departments, the participants were scheduled for daily tabulation of the data collected. TWo staff members guided the teams of "participant tabulators" in rooms set aside in the Seminar headquarters (Annex XIII) (f) Fourth Week - Content

Content during the fourth week was introduced into the two small groups of participants that had constituted the two nurSing activity study teams, one in each of the two outpatient departments where the nursing activity studies were conducted. Content introduced by resource persons in each of the two groups included: (1)

the use of community health and population statistics and of agency reports and related data in interpreting the findings of nursing activity studies;

content in the general sessions held the last two days of the Seminar included: (2) Foundations, their role in society _ general information on objectives of foundations in the United States _ foundations as a potential source of funds for financial assistance, i.e. fellowships, grantS-in-aid for research in nursing _ how policies of foundations affect aid given

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(3) Summary of Seminar experiences as basis fOr: - planning studies in nursing - understanding factors which influence staffing for nursing service The summary of the Seminar Content and Activities brought out the knowledge and experience gained as follows: (1) Planning Studies - definition of the problem (awareness of difficulty, recognition of problem area, statement of problem, hunch about the "answer", discussion for clarity, decision as to possibility of study of problem, survey of literature) - procedures, methods and techniques for finding the facts and the relationship between them (objectives or questions to be answered) use of survey method for description of facts, ob_ servatiOn technique based On work sampling, i.e. instantaneous intermittent observations at intervals of 15 minutes, established criteria as basis for measuring which activities were nursing, decided On means to be used to collect data, i.e. constructed a form, selected sample to be studied which would give reliable data for projecting to future, the collection, tabulation and analysis of data, study of findings in relation to other related data as basis for conclusions, suggested actiOn and further study. - writing the ~~rt and discussion of findings with administrative medical and nursing personnel from the two participating hospitals. (2) Factors influencing staffing

Insights into some factors which affect staffing patterns emerged from the Seminar experiences as follows: _ government economy, (budgeted posts for nursing and services) _ population (size, composition, economic status, complexity of needs, understanding of use of services, special health problems, attitudes about health, illness, nursing, medicine, habits of eating and rhythm of daily living; nature and extent of "'!Wlily bonds, superstitions, traditions, educational background) _ profession, (educational approach and standards, numbers graduating in relation to needs for service, potential for recruitment, exodus from the country or profession, belief in and practice of continuing education, ratio of other health workers to nurses) _ agency, (objectives of agency, availability of services to support nursing, policy 10 relation to provision of clinical learning e~riences for students or their use to provide

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service, settins where nllrsins is expected to function, way in which jobs are described, incentives provided to maintain and attract qualified personnel, amount and nature of professional supervision provided, opportunities for promotion) (g) Fourth Week - Activities

Monday through Friday the two nursins activity study teams were engaged in lIl'itins the f'inal reports of' their studies. Two resource persons worked with the two teams and other resource persons were used as needed. Saturday mornins, the Seminar Staf'f' met separately with the medical and nursins administrative personnel of' the two outpatient departments to review the nature of' nursing activity study, the tindinss and to discuss suggested action to utilize more ef'fective~ the nursing personnel. Although participants did not participate act1ve~ in these meetings and discussions, they were present to expE:rience the follow through with the administrative personnel of' the agencies.

Clpsing Session

Dr. F.J. Dy, Director of' Health Services, Western Pacif'ic Region of WHO, in his closing address, commended the Seminar participants on the "impressive results" of their endeavours during the f'our-week period. He advised the partiCipants, in initiating action studies in their own countries, to plan caref'ul~ each phase of' the study, involving other health personnel at an early stage, and to make the f'ullest use of' the human and material resources available. He stated f'urther: -

"It (participant effort which produced impressive results) also conf'irms the f'aith we have in the nursing leadership in the countries in this region and our f'aith that given the opportunity and support needed they can and will carry the responsibility that is placed on them to provide the nursing service required f'or the successf'ul execution of' health and medical care programmes. It (Annex XIV). PIlan Hajjah Fatill6h bt. Raji Sula1 !DAn spoke on behalf of the participants and expressed their appreciation f'or the opportunity provided them by WHO to attend the Seminar. She thanked all those who had contributed to making the Seminar a real educational experience including the Regional Director, Director of Health Services, the Regiocal Nursing Advisers of' the Western Pacif'ic Office of' WHO, the other members of' the Seminar staff, the secretarie.l group, the librarian and the administrators of' the two agencies which served as f'ield laboratories. She expressed warm friendship f'or and appreciation to all the participants f'rom the Philippines that made this Manila visit an unforgettable one. 5. APPRAISAL OF RE3UIl1.'S

Since four of the f'ive objectives defined f'or the Seminar by the Seminar Staff' were largely concerned with providing certain learning experiences, the actual nursing activity studies completed and the involvement of the partiCipants in the on-going evaluation activities

•

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wuld seem to indicate that a substantial contribution to the fulfillment of the four objectives was made (See page 1). In the final evaluation of the Seminar 23 unsolicited cOlllJllents on the personal goals of participants and staff expressed on the first day of the Seminar indicated that certain personal goals had been achieved, as follows: (Annex V)

1) obtained greater knowledge in the use of activity methods 2) received ideas on running a nursing seminar such as this one 3) obtained a greater understanding of research methods 4.) gained wider knowledge 5) acquired insight into problems of staffing in other countries 6) met people from other countries thus attained better understanding (7) learned more about the wrk of WHO The fifth objective of the Seminar, i.e. to stimulate "self_starters n in using the stuCl}t approach, can be measured only when action is taken by participants in conducting studies in their countries. Plans expressed by participants for action they hope to take within the one-year period following the Seminar lend an optimistic outlook on the nwnber of "self_startersn rQsulting from the Seminar. Follow-up of the participants will determine the extent to which their plans for action materialized. Plans included: Eleven participants who plan to do activity studies Two participants who plan to teach this study approach to their post-basic students and to stimulate such studies by students in their wrk Situation. Participants, in expressing reactions to the Seminar, indicated almost unanimously that in the future, similar seminars should be six weeks in length to relieve the pressure of work inherent in the expectations of the objectives.

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A1IlIEX I FIRST RIDIONAL NURSING STUDIES SEMINAR 2-30 August 1965

LIST OF PARTICIPANrS

Country of Origin

Name of Participant Miss Margaret R. Porter

Official title and address Deputy Matron Royal Hospital for Women Paddington, Sydney N.S.W., Australia Chief of P.H.D. and M.C.H. I P.O. Box 112, Taichung City Taiwan, Republic of China Chief, Public Health NurSing Department of st. Luke's Hospital Assistant Professor, St.Luke's College of Nursing St. Luke's Hospital 53 Akashi-cho, Chua-1m Tokyo, Japan In-charge of Public Health Nurse, c/o Nursing Section Medical Affairs Bureau Ministry of Health and Welfare 2-1 Chome, Kasumigaseki Chiyoda-Im, Tokyo Japan Acting Chief of Public Health Nursing Division Nationsl Institute of Health . 28 Sam Chung Dong Chong Ro Xu Seoul, Korea Assistant Principal Matron Minist~ of Health Young Road Kilala Lumpur, Malaysia Nurse Inspector c/o Division of Nursing Department of Health P.O. Box 5013 Wellington, New Zealand Assistant Director, Division of Nursing (Hospital Nursing Service) c/o Department of Health P. O. Box 5013 Wellington, New Zealand

Ay atre 110

China

Miss Fong-Chiao Lin

Japan

Miss Kazuko Matsushita

Miss Yukiko Inoue

!".

Korea

Mrs. Pya Hi Lee

Malaysia

Puan Rajjah Fat1mah bt.. Raji Sulsiman

New Zealand

Miss Jean 1. Sutherland

.:.

Miss Shirley M. IDwe

COUntry of Orisin Philippines

Name of Participant Mrs. Henedina P. Suanes

Official title and address Chief Training Officer, Nursing D.M. Jose R. Reyes Memorial Hospital (Formerly North General Hospital) Manila, Philippines Assistant Regional Training Nurse Regional Health Training Center Regional Health Office No. 3 Department of Health San Iazaro Compound Manila, Philippines Su;pervising Nurse Instructor Office of Health Education and Personnel Training Department of Health San Iazaro Compound Manila, Philippines Instructor in Public Health Nursing Administration Institute of Hygiene University of the Philippines 625 Herran Street Manila, Philippines Matron, O.P. Service c/o Principal Matron Ministry of Health Singapore

Mrs. Natividad B. Asuque

Mrs. Josefina A. Mendoza

)-;

Miss Julita Yabes

SiDflllIlOre

Miss Siew Huah Yeoh

LIST OF WHO FIELD STAFF - PARrICIPANTS

Miss Kathleen A.B. Fowler (Singapore) WHO Senior Nurse Educator 7 Nasstm Hill Flats Singapore 10 Miss Eliza~>eth Wilson (Philippines) WHO Public Health Nurse Educator c/o WHO Regional Office for the Western Pacific P.O. Box 2932 Manila, Philippines Mr. John Waterer (Cambodia) WHO Senior Nurse Educator Organisation mondiale de la Sante Boite postale 111 Phnom-Penh Cambodia

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.,.LIST OF SEMINAR STAFF - CONSUIlrANTS, TEMPORARY ADVISER AND WHO STAFF

Dr. Vera Fry Maillart Nursing Research Consultant Palais des Nations WHO, Geneva Switzerland

Consultant and Co-Director

Dean Julita V. Sotejo Dean, College of Nursing University of the Philippines DLliman, Quezon City Miss Maria Palmira Tito de Moraes Nurse Officer WHO, Palais des Nations Geneva, Switzerland Professor Athol Congalton Deputy Head of Department School of Sociology University of New South Wales Kensington, N.S.W. Australia Miss Maria de Lourdes Verderese Regional Nursing Officer c/o WHO Regional Office for the Western Pacific P.O. Box 2932 Manila, Philippines Miss Lily M. Turnbull Regional Adviser on Nursing c/o WHO Regional Office for the Western Pacific P.O. Box 2932 Manila, Philippines Mr. A. Aldama-Contreras

Consultante

Consultant

Temporary Adviser

Co-Director of Seminar

Operational Officer

Resource Person/Statistics(Part-time)

Regional Statistician and Programme Evaluator c/o WHO Regional Office for the Western Pacific P.O. Box 2932 Manila, Philippines Mr. A. santos

Resource Person/Statistics(Part-time)

Clerk/Statistician c/o WHO Regional Office for the Western Pacific P.O. Box 2932 Manila, Philippines

- 18 OBSERVER

Miss Virginia Arnold Associate Director Medical and Natural Sciences Rockefeller Foundation 1ll West 50th Street New York 20, New York U.S.A. LIBRARY

Mr. S.M. Sena Librarian WHO/WPRO

Manila TYPING POOL

Miss A. Directo Mr. P. Layson Mrs. D. Gregorio

19ANNEX II FIRST REGIONAL NURSING STUDIES SEMINAR 2-30 August 1965

NURSING .ACTIVITY STUDY

Information for OPD Personnel Your Outpatient Department is co-operating With the First Regional Nursing Studies Seminar, Western Pacific Region, W.K.O., by providing the Seminar participants With the opportunity to learn Nursing Activity study techniques. The Seminar partiCipants Will spend August 9 and 10, and August 16 through 20, in the various clinics of the Outpatient Department. The purpose of the Nursing Activity study, which they Will be conducting to learn the necessary techniques, is to determine what activities nursing personnel are performing. They will be using the technique of instantaneous, intermittent observation, i.e., an Observer, at specified intervals Will record what is being done the instant he observes a nurse. The Observer is not concerned With the quality of what is being done; only with what is being done. The data he collects provide the information neededtO determine the scope, range and volume of activities as perfonned. During the observations, an Observer may ask the nurse observed a question if the purpose of what she is doing is not immediately clear. For example, if the nurse is telephoning, and the purpose of the telephone call is not clear to the Observer, he may ask the nurse, ''Would you tell me with whom you were speaking1" The nurse should reply briefly, giving the facts. She might reply (as the case may be) ''To the Chief Nurse about the assigmnent of nurses" or "The call was personal". The Observer may also ask the nurse where she was if she was not at her duty station when the Observer was recording, "Can you tell me where you were when you were out of the clinic?" Again, as the case may be, the nurse should reply, "Having a snack" or "For personal reasons" or "To X-ray to get a patient's report". At all times, the nurse should answer briefly with the facts. Remember, the Observer is not controlling what is being done in any way, but is rerecording information to learn how to use observation technique. To be able to identify quickly and accurately the personnel who function in nursing service, the nursing personnel Will be asked to \lear blue ann bands with a letter or symbol in black. The use of the arm band makes it easier for the Observer to pick out the nurse in the crowded clinic. Please note that the nursing personnel are not identified by name during the Activity Study. To identify the Observers who may ask the nurse questions, each Observer will wear a badge with the inscription "OBSERVER", a laboratory coat over street clothes and carry a chart back With papers for recording.

::.

-20 ..

will rotate during the 8 hours· assigned.

Observers will be assigned in teams to the various clinics and Although o~ 4 Observers will be on or off duty at any one time, nurses may meet as many as 10 different persons during the five-day period. In addition, a Director of the learning activities of the Observers will, fram time to time, appear in the clinics. She will alao wear a laboratory coat and a badge with the inscription RDIREcr<>R". Participation of the SgPervising Nurse - OPO 1) The Observers will report on duty at 7:30 a.m. or whenever the nursing attendant arrives to set up the clinics. Specific instructions on were to report at 7:30 a.m. and were the nursing attendant reports in should be given to the Director of the Study. 2) At 7:50 a.m., the Observer will report to the Office of the Supervising Nurse to check the number of personnel on duty and the clinic assigDment of personnel. for that day. If students are to be present that day, this information shoul.d be given to the Observer. GeneraUy, the number and types of nursing personnel. on duty for each day can be pre:p8red the day before. Then at 7:50 a.m. the Observer need only confim the schedul.e and make changes where last-minute shifting of nursing personnel. was necessary. A simpl.e fom will be helpful, e.g.: OPO - Jose Reyes Memorial. Hospital. Date- l.6 August 1965

Personnel. tiupervising Nurse

Assigmnent . Supervision all clinics Gyn - OB and Paediatrics

Hours on Duty

8:00 a.m. 7:45 a.m. 8:00 a.m. l.0:00 a.m. 10.:00 a.m.

4:00 p.m.

.mr _ l. !1m. l. student - l. student • l. Helpers - 3 l. RN _ l.

- . 3:45 p.m. • 4:00 p.m. - 12:00 noon • 12:00 noon

ENT Dem. & Med1c.ine

All Clinics Surg. Treat I!o OR Surgery

7:30 a.m. 8:00 a.m. 8:00 a.m.

•

3:30 p.m. 4:00 p.m •. 4:00 p.m.

- 21 -

.,.3) Please note that "1m" is used instead of the nurse's DBJDe, and should appear as mallY" times as there are graduste nurses on duty each day. The same procedure holds true tor the nursiD8 attendants and the students. 4) The Supervising Nurse should inform all nursing (and medical personnel) of the Nursing Activi'\¥ Study, the objectives as indicated on :page 1, of the i'unction of the Observer, of the importance of answering the Observer's questions brieflY and accurately, ot the purpose of the arm bands tor identification ot categories ot nursing personnel, and of importance ot not changing their usual way ot world.ng. I f changes in the usual. lI!IY ot world.ng are made by the nurses, the whole purpose of the study and the potential benefits ot the tindiIl@!il will be ilXV8.l1dated. 5) Nurses or students who are on duty part time should be instructed to leave the arm bands with the Supervising Nurse. It these nurses or students are replaced by other part-time nurses, the S\:q>ervisor should be sure those who cane on duty have tm. appropriate arm band.

6) The distribution ot the arm hands should be done by the Supervising Nurse when the nursing staff reports on duty. All arm bands should be returned to the Supervising Nurse's Office when the staff reports off duty. 7) The Supervising Nurse should arrange tor a roan or ott1ce where the Director and the Observers can rest am can summarize their recording activities. 8) I f a canteen is available, the SupervisiD8 Iilurse should clear with the canteen to determine it Observers can be accommodated between 12:00 noon and 12:30 p.m. tor lunch. It not pOSSible, the Director should be notified so Observers can be advised to "pack a lunchn. 9) AllY" questions or problems which may arise should be il!lm.Uately discussed with the Director. 10) Director ot Study at Jose Reyes Memorial Hospital, OPD _ Dr. Vera Fry-Maillart CO-Directors ot Study at Philippine General Hospital Miss Maria Tito de Maraes Dean Julie Sotejo

•

ANNEX III T-

FIRST REnIONAL NURSING STUDIES SEMINAR

2-30 August 1965

BIBLIOGRAPHY 1.

Indices - General References Grandbois, M. (1964), CUmulative index to nursing literature, Glendale Sanitarium and Hospital, Glendale, 6-8, (1961-63) Henderson, V. (1963), Nursing studies index, prepared by Yale University School of Nursing Index Staff, J.B. Lippincott Co., Philadelphia, ~ (1957-1959) International Labour Office (1958) International standard classification of occupations. Lennon, Sir Mary Isadore (1954) Teaching in the outpatient department. Matheney, Ruth V. and others (1964) Fnooa_ntala of patient-centered nursing. Simmons, L.W. & Henderson, V. (1964), Nursing research: assessment, Appleton-Century-Crofts, New York A surveyaoo

Wallace, Helen M. (1962) Health services for mothers and children. II. Statistics Walker, H. & Leo, J. (1958) Elementary statistical methods, New York, Henry Holt Co. LeVine, E. (1959) Interpreting statistical data, Amer. J. Nurs., 230-233 LeVine, E. (1959) The ABCs of statistics, Amer. J. Nurs., III. Methods Abdellah, F. & Levine, E. (1954) Work sampling applied to the study of nursing personnel, Nursing Resear~ 3, 11-16 Adams, A.O. (1957) How to study the nursing service of an outpatient department, Washington, United States Public Health Service, Department of Health, Education and Welfare, Publ. Hlth. Servo Publ. No. 497 Adams, Apollonia O. (1958) NurSing resourceS: a progress report of the program of the Division of NurSing Resources, U.S. Public Health Service Publ. No. 551. American Public Health Association (1961) Guide to a community health study. Arnstein, M.G. (1953) Guide for national studies of nursing resources, Bull. Wld. Hlth. Org., Suppl. 7, Geneva, World Health Organization.

22"

22..

71-75

- 24 _ Arnstein, Margaret G. (1956) Design for statewide nursing surveys: baeis for action. U.S. Public Health Service ··Pub. No. 460. a

Cohart, E. & Willard, W.R. (1955) A time study method for public heal.th, Publ.. Hl.th. Rep., Wash., 70, 570. Ferguson, M. Publ.1c heal.th IIUrsing service to patients, (1959) Washington, United Sts'~es Publ1c Heal.th Service, Department of Health, Education aDd Wel.fare, Publ. Hl.th.Serv.Publ.No. 685, Publ.Hl.th. Manogr. No. 22Ferguson, M. Work measurement aDd performance budgeting (1959) Nursing Otrf;look, J., 570-572 Ferguson, M. How to determine IIUrsing expeDdUure in small health agencies, (1962) Washington, United States Public Health Service, Division of NurSing, Publ. Hl.th. Serv.Publ. No. 902 Florence Nightingale International FOundation (l956) International Conference on the Planning of Nursing Studies, Sevres, london International Council of Nurses. Florence Nightingale International Foundation (1960) Learning to iIlVestigate IIUrsing problems, london, International Council of Nurses Forehand, Garlie A. (1964) Environmental variation in studies of organization behaviour. Psycho. Bull. §.g: 361.;382. Freeman, R.H. (1961) Measuring the effectiveness of public health service, NurSing Outlook, ~ 605-607 \.

Good, C.V. & Scates, D. (1954) Methods of research: educational, psychological, SOCiological, New York, Appleton Century-Crofts, Inc. Gunter, L.M. (1964) Research techniques applied to nurSing, NurSing Research, 1" 230-2~ Holliday, J. (1964) The exploratory study method. design, Nursing Research, 1" 1, '7-44 An aid to research

International;, Labour Office (1959) Introduction to work study. International Labour Office (1962) Job evaluation. Leeds Regional Hospital Board (196,)· Work measurement as a basis for calculating IIUrsing establishments: an analytical study. Levine, E. (1960) Experimental design 1'1 nursing research, NurSing Research, 9, 20'-21' Meyer, Burton & Heidgerken, loretta (1962) Introduction to research in nurSing, L1ppincot~ .!

•

,..-

- 25 ~ney, H. Willi8111

Public Health

~nograph

(1962) Methodology in two California health surveys. No. 70.

Patients and personnel speak: a method of studying patient care in hospitals, United States Public Health Service, Division of Nursing Resources, Washington, D.C., 1957. Philippines. Bureau of Heslth (1953) PUblic health nursing manual.

Roberts, D. (1963) The staffing of public health and outpatient . nursing services: Methods of study, Geneva, World Health Organization, PUblic Health Paper No. ~ Stanford, Elinor D. (1957) How to study supervisor activities in a hospital nursing service. U.S. PUblic Health Service PUb. No. 496. United States of America, National Organization for Public Health Nursing (1950) Cost analysis for public health nursing services, New York, National League for Bursing U.S. Government Printing Office (1953) The head nurse looks at her job, Public Health Service Publication No. 227, Washington, D.C. U.S. Government Printing Office (1954) How to study nursing activities in a patient unit, Washington, D.C. U.S. GoverD!llent Printing Office (1964) How to study patient progress, Public Health Service Publication No. 1169, Washington, D.C. U.S. Public Health Service (1964) Hospital outpatient services: guide to surveying clinical procedures. A method for documenting medical services and administrative procedures. U.S. Public Health Service Pub. No. 930-c-4 • .;; IV. Administration of Services John, Audrey L. and others (1963) The nurse in mental health practice. Report of a Technical Conference. WHO Public Health Papers 22. Lambertsen, Eleanor C.· (1953) NurSing te8111 organization and functioning Results of a study of the Division of Nursing Education, Teachers College, Columbia University. twman, K. (1961) Basic nurSing educatioo programmes: a guide to their plsnning, Geneva, World Health Organization, Public Health Paper, N0.1 National League for Nursing (1953) The head nurse at work. United States of America, National League for Nursing (1961) Criteria for evaluating the administration of a public health nurSing service, New York.

-26 World Health Organization, Expert Camnittee on Nursing (1950) Report on the first session, W1d Hlth Org. techno Rep.Ser. No. 167 World Health Organization, Expert Committee on Public Health Administration (1952) First Report, Wld Hlth Org.techn.Rep.Ser. No. 55 World Health Organization, Expert Committee on Public Health Administration (1954) Methodology of planning an integrated health programme for rural areas, Wld Hlth Org. techn.Rep.Ser. No. 83. World Health Organization (1959) Public health nursing. Fourth report of the Expert Committee on Nursing. WHO Tech.Rep. Ser. 10. 167. World Health Organization (1959) Public health nursins, ehron.Wld Hlth Org., y, 225-228 World Health Organization, Expert Committee on Professionsl and Technical Education of Medical and Auxiliary Personnel (1961) The use and training of auxiliary personnel in medicine, nurSing, midwifery and sanitation, Wld Hlth Org. techn.Rep.Ser. No. gg World Health Organization (1961) Aspects of public health nursing, by various contributors. WHO Public Health Bapers 4 World Health Organization (1961) Public health nurSing, ehron. Wld Hlth Org., 15, 79-92 World Health Organization (1962) Mental health prog1'8l!lDE!s in public health planning, Chron. Wld Hlth Org., !§., 306-311 V.

Studies Abdellah, F. & Levine, E. (1958) Effect of nurse staffing on satisfactions with nursing care, Chicago, American Hospital ASSOCiation, Hospital MonOgraph Series No •..2!: Akin, K. (1962) Work measurement studies in small health departments, Nursing Outlook, 29 , 544-546 Bennis, W. et al. (1961) The role of the nurse in the outpatient department, New York, American Nurses Foundation Boyle, R. (1960) A study of student nurse perceptions of patient attitudes, Washington, D.C., U.S.P.H.S., Publ. Hlth. Serv. Publ. No. 769 Brown, Esther Lucile (196l) Newer dimensions of patient care. Part I. The use of tre phySical and social environment of the General Hospital for therapeutic purposes.

- 27-

Brown, Esther Lucile (1962) Newer dimensions of patient care. Part 2. Improving staff motivation and carq>etence in the General Hospital

Brown, Esther Lucile (1964) Newer dimensions of patient care. Part ,. Patients as people. Burling, T. et a1. (1956) The give and take in hospitals: human organization, New York, G.P. Putnam. a study of

Cartwright, A. (1964) Human relations and hospital care, wndon, Routledge and Kegan Paul Conga1ton, A.A. (1962) The public image of nursing, Research Reports in NurSing, No. 1 Sydney, Australia, The New South Wales College of Nursing Conga1ton, A.A. (1962) Young people look at nursing, Research Reports in Nursing, No.2, Sydney, Australia, The New South Wales College of Nursing Connor, R.J. (1961) A work sampling study of variations in nursing work load, Hospitals, 35, 40-41; 111 Daly, O.M. (1963) Ward housekeeping expe;riment, Nursing Times, July 5 de M. Warren, D. (1964) Ward housekeepers: authority, NurSing Times, November 20 an experiment in delegated

Elms, R. (1964) Effects of varied nursing approaches during hospital admiSSion: an exploratory studYj Nursing Research, 13, 266-267 Feyerberm, A.M. & Kirk, W.R. (1964) Effect of census variation on nursing activity patterns, Hospitals. 38. 62-70; 74 Gordon, E.M. & Hoffman, V.M. (1960) Evaluating an occupational health nursing program by a work sampling study, Caned. Nurse, 56 314-320 Hasselmeyer, Eileen G. (1961) Behavior patterns of premature infants. A study of the relationship between a specific nursing procedure and general well-being of the prematurely born infant. U.S. Public Health Service Pub1. No. 840 International Isbour Office (1960) Employment and conditions of work of nurses. Kellogg, W.K. Foundation (1961) The planning and operation of an intensive care unit. An experience brochure. Levine, E., Siegel, S. & Puente, J. de la (1961) Diversity of nurse staffing among general hospitals, Hospitals, ~ 9, 42-48

- 28 Manaser, J. & Wener, A. (1964) Instrunents for study of nurse-patient interaction, New York, Macmillan Co. Meyer, GeneVieve Rogge (1960) Tenderness and techniq~8. Nursing val.ues in transition. Mil.l.er, S.J. & Bryant, W.D. (1964) How minimal can nurse staffing be! Modern Hospital, l.03, 111-113 New, Peter et al. (1959) NurSing service and patient care: experiment, Kansas City Mo. Community Studies a staffing

Rines, Al.ice R. (l.963) Eval.uating student progress in l.earning the practice of nursing. A NurSing Education Monograph. Roberts, D.E. (l.962) ~ effective is public heal.th nurSing! J. Publ. Hlth., 52, l.077-l.083 Amer. -I I

Schwartz, D. (1960) NurSing needs of chronically ill. ambulatory patients, Nursing Research, 2" 185-188 Schwartz, M.S. et al. (1956) The nurse and the mental. patient: of interpersonal. rel.stions, New York, Russell Sage Foundation. Survey Report: 56-63 a study

The real.ities of staffing (l.962) Amer.J.Nurs., 62

I I

The Brazil.iBn Nursing Association (1963) Survey of needs and resources of nursiIg in Brazil, Trans. in EngUsh, Rio de Janeiro, Brazil. Wright, M.J. (l.963) Staffing the nursing service, Hospitals,

9l.-99

,...

- .'i1;}

/'}O ANNEX IV

• '. FIRST RIDIONAL NURSIOO STUDIES SEMINAR

2-30 August 1965

Please write below the answer to the following question: What would you like to get out of this Nursing Studies Seminar? Please state the speoific help you expeot to get out of this Seminar.

_ 3l/~ _ ANNEX IV FIRST RIDIONAL NURSING STUDIES SEMINAR i I ,

2-30 August 1965

I I I

I I

REACTION FORM '-. I I

What did you think. about this week's meetings? Please comment on content, methods used, group lIOrk, library assigmnent, resources available, or other aspect of this week of the Seminar. Cae you suggest how things might be changed or done differently next week?

II ,

" II

II II II

-- ,,/?ft_ ANNEX IV

FIRST RmIONAL NURSING STUDIES SEMINAR

2-30 August 1965

REACTION FORM

What did you think about this 3rd week of' the Seminar?

Please

camnent on any aspect, in a way that will help us to evaluate the whole week.

- ?J5/Y5 -

.ANNEX IV

,-,

REACTION FORM

FmAL EVALUATION

The seminar is about to conclude. It is important that you look back over the past four we.ks to see what effect the total experience has had on yo!;., in relation to your needs. Please write about your impressions of the whole periOd of the seminar, and in particular help us to answer the following two questions: 1.

What were the poB1tive aspects of the seminar? What could have been done to make the seminsr better?

- YTI138 -

F'lllIJr RmIONAL NURSIl'Il ertJIIES SEXINAR

2-30 August 1965

REACTION FORM

FINAL EVALUATION - Supplementary You can help us in the overall evaluation of the seminar if you write a sentence or two under each of the following headings, to let us know your own personal reactions and opinions. Please be frank. from your comments. 1.

Please be helpful.

Future plaDOing will benefit

organization

Content

Methods

4. Resource Persons

Library

6. Discussions

- 39-

~ogth

of Seminar

8, Value of the Seminar • I

9. Cross-cultural contacts

10.

Other aspects

. 11.

What I liked least

12,

What I liked best

- 40/11-1 ANNEX IV FIRST RroIONAL NURSIlG STUDIES SEMINAR

2-30 August 1965

FOLLOW-UP FORM

Soon the Seminar will have concluded and you will be returning to your own country to work among t'amiliar surroundings, but we hope that during the next twelve months you will continue to think ot' the specific objectives and achievements of the Seminar. We hope that you will do what you can to ensure the spread ot' the nursing activities study method as a method of clarifying problems basic to staffing. We know that there will always be certain administrative difficulties to be overcame; accordingly, when we ask you to indicate below what you think you personally can do in the next twelve months to further the objectives of the Seminar, we want you to write down only what you think you can realistically accomplish. Some people may already have plans to implement a study similar to the one just completed; others may plan to encourage or advise the appropriate authorities to consider this approach to staffing problems.

•

We want you to give same thought to your own contribution and to record it below. One year from now we will be writing to you and asking you whether or not you were able to accomplish your objective. Please do not feel that we are asking you to make a promise to carry out any suggested plan, and do not t'eel that in a year t s time we will hold you to your statement. We just WIlt an idea of how you think you can carry forward the benefits you have obtained from the Seminar. Write below your idea of what you realistically think you can accomplish in the next twelve months, related to the Seminar.

- 42/43 ANNEX V

FIRSr RIDIONAL 'NURsING STUDIES smmlAR·· 2-~

August 1965 BY THE SEMINAR GROUP

GOAUl AND ACHIEVEME:N're,AS EKPRE&l.ED AUGUST 2nd

27th

'IO ACQUIRE KNOWLEDGE (SKTILS) (EXPERIENCE):

To get help in selecting problems in nursing that can be subjected to research. To be able to conduct studies in the field of PH To know how to solve PH

1 2

c. D.

staffing problems.

To learn how to evaluate the needs of people for nursing services. To learn how to make better utilization of nursing staff.

3 1

To discover how to determine nursing functions by priority. To get a greater knowledge in the use of activity methods. To get some ideas on teaching research methods.

4 7

To get some ideas on running a nursing seminar such as this. To get a greater understanding of research methods. To get an understanding of methods of studying individual work loads.

8 1

J. K.

1 2

L. M.

To hear of what research others are doing. To know the ideal ratio clinic.

of staffing of OPD or PH

1 1 2 1

N. O.

To learn more about OPD and PH departments. To gain a wider knowledge.

8 2

'IO ACQUIRE INSIGHT INTO PROBLJ!lI'5 OF STAFFING IN OTHER

COUNTRIES 3. 'IO DEFINE WHAT ARE NURSING DUTIES AND WHAT ARE NOT

- !i4. -. '1

AmOOT

4. 5. 6.

ID LEARN MOllE ..tIBOUT THE WORK OF WHO ID MEET PEOPLE FROM 0'DmR COUNTRIE9, FOR BE'1'1ER UNDERS'mNDING 'IO MAKE PUBLIC HEALnf ~OO foI)llE AT1'RACTIVE ~ING

3 2 1

7. foI)llE EFFECTIVE PUBLIC HEALnf

'IO CONTRI8U'lE, IN ANY WAY POSSIBLE

9. MISCELLANEOOO

- 45/46 -

FIRST RIDIONAL NURSIl'n STUDIES SE!aNAR

2-30 August 1965

PROBLEM CHECK

Below are listed a number of problems mentioned as important by nurse administrators.

PROBLEM

I Very Important

Quite Important

Important

Unimportant

Very unimportant 1 1

'!he lack services of supporting 6 2 2 • ______ 1 _ hospital ___________________________________

Inadequate equipment for 8 1 2 • ______ 1 _ patient care - _______________________ • ______________

Inadequate clerical help for 3. nursing services ____________ _

-------.------ ----------~--- --~-- -----~-2

-------~--------

Inadequate laundry services __ _

~-----l--2 1

Inadequate housekeepi~~ • 5· services in hospitals ________

7 + _____ _------5 .~----

2 ~

--------~------

Inadequate dietary services 4 in hospitals _______________________

-------- ------ r--------2

Inadequate ____________________ printed forms for _______ 5 7. recording of co-ordination between 8. Lack public health and hospitals _________ 11

5 ~ -

~------

_______________________ _ 2

I~ot

enough graduate registered

nurse staff

------------------t------,

------r------,

.. 47 -

Very PROBLEM

Important

Quite Impor- Unimimpor- tant portant tant

Very unimport-

ant

10.

Not enough auxiliary nurse staff to assist the graduate registered nurse staff _____ _

------.------- -------f------- -----

832

11. 12. Functions of nursing personnel not clearly defined ____ _

------ -------+1 _ __ ~

13. Misuse of ___________________ available nursing 10 2 1 personnel ______ ______________________________ _ 14. '!he doctor's idea of the . nurse's role ___________________ 1______

~__

___________________ _

15. Lack of job satisfaction 16. Lack of job satisfaction

10 in nursing generally -------- ------

-------r-------r------ ----------

at the staff nurse level ---- __ 2_______ at the administrative level _______________________ _

4:._+_______ ------ r--------I 4

;

17. Lack of Job satisfaction 9

-------1-------- ----------------

- 48/49 ANNEX VII FIRSr RIDIONAL NURSIHl ertJDIES SEMINAR 2-30 August 1965

INFORMATION AOOtJr PARrICIPAN'l'S

(a)

Country of Origin Count;!Z of Orie;in No. of Partiqipants Australia 1 1 2 1 1 2

China(Ta1wan) Japan Korea Malaysia New Zealand

Philippines Singapore Total I..

4 1 13 Education No. of Participants

(b)

Education

University Education - Masters degree - Bachelora degree - One year of atudy Post-basic Diplaua Courses - Administration Specialized Certificates - Public Health Nursing

4 2 2

3 1

- Midwifery Total

1 13

50 •

(c)

Previous Research Experience Research Background

!a Completed courses in research Participated in or conducted research Conducted nursing activity studies 9 9 4

Total

4 4 9

13 13 13

(d)

Nature of Agency Setting .Field of Nursi!lfi and Type of Position No. Participants Total Public Health Nursing Administration Supervision Instruction Hospital Nursing Administration Instruction Total 4 2 2

- 51752 i'IBSr ROOIONAIr lIUBSmG fmlDIES

ANNEX VIn

2-30 August 1965

S»lIlWI:!.

OPENING AmRBSS OF 'mE REGIONAL DIJIEC'roR TO 'mE FIRST REGIONAL NURSING STUDIES SEmNAR It is a great pleasure for me to welcaue you all to this Pirst Regional Nursing Studies Seminar. I am sure that you will find it a stimulating experience to meet and work with your colleagues frau the several countries in the Western Pacific Region and the panel of consultants who have been brought together to work with you. You will be thinking together about problems of mutual concern in assuring nursing services to the people. '!bere is no doubt that nursing 18 facing a difficult task in meeting the demands for nursing service. However. many of the problems we are now facing have been brought about by the advances in the medical and other sciences which have grown out of man's thinking and it is through this same process of thinking and reasoning that they will be solved. '!be theme of your seminar "Nursing Studies Seminar" and its obJectives indicate that the nurses in this region are looking ahead to the application of the process of thought applied to finding solutions to the problems of providing nursing service. Looking back fifteen years in the history of WHO assistance in this region the major effort has been to assist countries in identifying their health problems; then. in establishing a basic structure of adequate. balanced and integrated health services. and in educating and training health personnel. lttich has been accaupl1shed in the field of nursing and foundations have been laid for continuing development. Schools of nursing and midwifery are producing increasing rrumbers of graduates with better basic preparation; postbasic courses are preparing nurses for more responsible and specialized functions and everywhere general nursing practice is being upgraded. However. the rapidity with which health services continue to develop. the advance in medical science and the changing and growing needs of society for nursing services present tremendous challenges for nursing leaders in most parts of the world, this region being no exception. '.the nursing profession, like all other professions, has the responsibUity of defining its own functiOns, determining the scope of its practice, setting, improving and maintaining the standards of the service the profession undertakes to provide to society. In order to do this, members of the profession must be prepared and ready to examine the service being given and take necessary action needed to safeguard this servioe Which the profession delivers to sooiety. '.this means study and evaluation, this means planning for needed action and continuous assessment towards the end that the profession is making its fullest possible contribution to carrying its share of responsibUity for the implementation of health and medical care progrSlllJles now and in the future. In arriving at the goal of a high quality as well as quantity of nursing service, the highest priority has to be given to ensure the economio and appropriate use of nurse power. "" In conclusion, I extend to you the greetings and best wishes of the Director-General. my staff, and myself. I am pleased to note that the Seminar objectives are direotly related to the ultimate purpose of any seminar which is action. A successful seminar is only really successful when learning has been translated in your daily work in your own situation. I now deolare the First Regional Nursing Studies Seminar open.

- 53/54 Coffee Brel!k: Daily - 10,00 a.m. ~ 10~30 a.m. 3ioo p.m. - 3:30 p.m. Mtlnday

TltolE'NIBLE FIRST RmIONAL NURSING S'roDIF.S SEMINAR

ANNEX IX

Week of 2 - 7 'August 1965

-Registrat10n of Building ToUr

August 2

feremony A ss-Dr.I.C. Fang Introduotion Miss L. M. 'lUrnbull 9:30

9~!!e~

-- ..... - --

Introduotion to Seminar ob~V?S, meMil.illart and Verderese)

.Disoussion of

8 'l\1esday August 3

~ Slble:WhatA~ o ~ro ems are nis rators of Nu1Ing ices ft:rf~t ~ S:rt g on, Ma 1 , bull, T1 to de Moraes, Waterer, Wilson)

10:30 12 ObservatIon in Aotivity Study (Maillart) 10:30 Group Work and

:~~a;ity 2

Problems in Countries B;~m whioh part 0 pants oome. (Dean SoteJo) 2:30 2 Nursil;.lS Functions in relation to

Summary of problems as these relate to staffing 3:30 5, Small Group Assignmenta, Purposes, DeadlInes (Maillart)

(Maillart) 12 Group Work and Library Study 4:30 5 Report Back to General Session (Dean SoteJo)

8 9:30 We<lnesday ;:!ources ~f J.)l':~al A t 4 Congal ton - Ustng Reugus !gyroe~ • How do Pprtc pan s see use 0 resouroes? Bow do Resoure? Persons see their ~b? Congal ton, Maillart, to de Morass, SoteJo, Verderese) 9:30 Round Table: What Library 'lhursdaJ' August 5 i~I;fm!n1!~1gilF Study ~o vtys es Mai11art, T1to de oraes, Congalton, Verderese,Wi1son,Lowe) I:l 9:30 WorkfiiPrepa- LIbrary 6 Group ration of nal Study Re~rts! Codu De 1n1t ons

Library Study

J 10130 11:30 12 Reco~Ob- LIbrary servati Study (Ma1l1art) 2

5 Group Work and LIbrary Study

=.11{

10130 fession

Final Reports in Generill

11:30 12 Practice Ses~on

2 Group Work and Library Study 2 ~:

5 ,

l:m~

and

t~'nart)

cord-

9:30

~ •

'~an ~'". ~!al RUn t1one Ma1111U"t and

Verderess) . "-

cc=m:

12 10130 EvalUatlOOC; of Week' 8 Sessions ~ongal ton and SoteJo

5 Library open all day Sa~ for we of resouroes ''i .

...........

-_.

- 55 -

OVERVIEW OF LAST 'lHREE WEEKS OF sm.mmR

As shown in the Timetable for August 2 - 7. the first week is devoted to preparation for using observation technique in doing a nursing activity study. The second week will include tabulation, presentation and interpretation of data. Two full days will be spent in trial run, using instantaneous observation in work sampling of the nursing activities in the Outpatient Departments of the North General and Philippine General Hospitals. The third week. two study teams of observers and resource persons

will conduct five-day Nursing Activity Studies of the abovementioned outpatient departments. The fourth week. final reports of the Nursing Activity Studies will be written and the Seminar activities summarized.

NOTE:

Timetables for each week will be distributed weekly.

- 56/57 o.ffee Break: Daily - 10:00 a.m. - 10:30 a.m. 3:00 ,.m. - 3:30 p.m. ~

TDlE'l'ABLE .F]JIST !lPXJDJNAL NURSllfQ STUDIm SEMINAR ~eek

ANNEX DC'

of 9 - 14 August 1965

8 Molll18y Trial Run Observations at the North General ana PhHippine Genera~ August 9 Hospitals Philippine oeneral Hospital - Dean sotejo and Miss Tito de Moraes North General Hospital. Dr. V. Malllart and Miss Verderese .J:t . August 10 2.

"' Group MeetlDgs with Resource Person: Discussion of problems errors and neede A modifications ij ~

Repons to General ~Sll1ct. . Malllart) ij:3O

-'"

Same as Monday's schedule (August 9) (3

wednesday Tabu~tion or Data August 11 (Mr. A1dama-Contreras) Include practice in hand tally

10 Library study 10 Practice Session on graph tables (Mr. Aldama_contreras) 10' Group Work and Ubnry study (Reading studies) 10 Evaluation of this week

t'l"aClil.Ce 011 Tallying Activities

l:!

3:30

Group worK ana Library study

e Thursday Organization of Data August 12 (Mr. Aldama-contreras)

2 :3 Work Tables and AoaJ.yti. cal Tables. Activity Study 2

3:30 Group Work on EXercises and Library Study

8 Interpretation of Data Friday August 13 (CODgalton & NUrse Staff)

3 ~oup

Planning the Activity study (Malllart) 12

Work and/or Library study

e Saturday Activity Study Teams and August 14 Resource Teams for NOH and RlH. RellllOosibil1ties (Ma1llart) ,

4:30 5 Geperal Session Report back to Problems

----

..i,

i .

- 58/59 ANl'IEX IX

TJlolETABLE FmsT Rl!nIONAL NUllSOO STUDXI!S SEMINAR

Week of 2.5 - " M:>nday August 2.5

August 1965

8.00 A.M•• 4.00 P.M.

IDH and FaH Tabulating Teams meet with Professor Congalton and Miss Verderese. Tabulating Team Meetings

4.00 P.M· • 5.00 P.M. Tuesday August 24 Wednesday August 25 Thursday

General Session rlGH Group Report IDR Group Report I«lR Group Report FaR Group Report FaR Group Report FaR Group Report

8.00 A.M. • 5.00 P.M.

8.00 A.M. - 5.00 P.M.

August 26

8.00 A.M •• 5.00 P.M.

Report to be fin1shed by 5.00 p. m. Friday

A.M.

August 27

Adopting Methodology TO Other Situations Activity Study Findings in Relation to Other Reports

P.M.

To be con1'1rmed

saturday 2.00 A.M •• 12.00 Noon Summary - steps Used in Planning study August 28 Foundations - The1r Role in Society, Objectives ___ )t>nday

t--..

8.00 A.M.

August"

Principles of Staffing • As !bese Emerge From OUr Work Evaluation of Seminar Follow

Activities

3.00 P.M.

ClOSing Ceremony

r--

Coffee Break: Daily - 10.00 a.m. - 10." a.m • .5.00 p.m. - 3." p.m.

- ffJ/6l -

Al'INEX X FIRS!' REGIONAL NURSING STUDIES SllMINAR

2-,0 August 1965 LIBRARY STUlX * I SOOGESTED READIOOS

15. 17. 19.

u.s. Government Printing Office (1954) How to Study Nursing Activities in a patient unit, Washington, D.C. u.S. Government Printing Office (195') The head nurse looks at her Job, Public Health Service Publication No. 227, Washington, D.C. Adams, A.O. (1957) How to Study the NurSing Service of an outpatient

department, Washington, United States Public Health Service, Department of Health, Education and Welfare, Public Hlth. Servo Pub. No. 491 2,. Roberts, D. (196,) The staffing of public health and outpatient nursing services: Methods of study, Geneva, World Health organization, Public Health Paper No. 21 Abdellah, F. & Levine, E. (1954) Work sampling applied to the study of nursing personnel, Nursing Research, " 11-16 M!Ltheney, Ruth V. and others (1964) Fundamentals of patient-centered nursing, pp. ~-~

25. 64.

For all library study during the Seminar, you should read as maoy as possible but not less than one of the suggested readings. You should become thoroughly acquainted with Reference No.2, (Roberts) which has been given to you. The numbers of references are the same as those in the Bibliography prepared for the Seminar.

*Read

at least one.

Al'IREX X

FIRST .RlinIONAL ~DlG ::mmIES SEMINAR 2-30 August 1965

LIBRARY READOOS* II I

•

BTJ:lGESTED READOOS

! 8. Florellce Nightingal.e International FouUj1ation (1956) International Conference on the Planning of Nursing Studies, Seures, It>ndon, International Council of Nurses pp. 26-31; 51.62 Florence Nightingale International Foundation (1960) Learning to Investigate NurSing Problems, London, International Council of Nurses, pp. 20-23; 2~-25; 26-30; 52-55; 56-58 Good, C.V. & scates, D. (19~) Methods of Research: educational, psychological, sociological, New York, Appleton century-Crofts, Inc • pp. 33-63; 7~-102; 255-276; ~6-662 Gunter, L.M. (19~) RESearch techniques applied to nurSing, Nursing Research, 13, 230-232 Levine, E. (1960) Experimental design in nursing research, Nursing Research, 2, 203-213 Holl1day, J. (l~) The exploratory study method. research design, Nursing Research, .u., 1, 37~~ An aid to

10. ..L

11. 12. 13. 26. 32.

Meyer, Burton & Heidgerken, Loretta (1962) Introduction to research in nurSing, Lippincott, pp. l-l~~ World Health Organization, Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel (1961) The use and training of auxiliary personnel in mediCine, nurSing, midwifery and sanitation, Wld. Hlth. Org. techno Rep. Ber. No. g,g World Health Organization, Expert Committee on NUrsing (1950) Report on the 1st session, Wld.Hlth.Org. tech.Rep.Ser.No. 167 World Health Organization (1962) Mental health programmes in public health planning, ebron. Wld. Hlth. Org. 16, 306-311 World Health Organization (1959) Public Health NurSing, Chron.Wld. Rlth. Org.,.l2z 225-228 World Health Organization (1961) pUblic Health NurSing, ebron.Wld. Hlth. Org., l1, 79-92 Congalton, A.A. (1962) Young people look at nursing, Research Reports in Nursing, No.2, Sydney, Australia, The New South Wales College of Nursing

...

33·

34. I(

35.

36. 51.

*Read at least one.

- 64 -

" 52. Congalton, A.A. (1962) The public i.ma.ge of nursing, Research Reports in Nursing, No.1, Sydney, Australia, The New South Wales college of Nursing. For those who wish to prepare for sessions on ststistical work, you may want to read the fOllowing, trom the bibliography list Nos. 5, 6, 25, II "

26.

, " ,

- 65 .ANNEX X ~ BmIONAL NURSmG STUDIES

BPmNAR

2-30 August 1965 LIBRARY STUDY* III SUlGESTED READINGS

5. 6. 8.

Levine, E. (1959) Interpreting statistical data, Amer.J.Nurs., 230-233

Levine, E. (1959) The ABCs of statistics, Amer.J.Nurs., 59, 71-75 Florence Nightingale International Foundation (1956) Internatioaal Conference on the Planning of Nursing Studies, Seures, London, International Council of Nurses, pp. 44-50; 66-87 Florence Nightingale International Foundation (1960) Learning to Investigate Nursing Problems, London, Internatioaal Council of Nurses pp. 31-44; 59-73; 77-82 Abde11ah, F. & Levine, E. (1954) Work sampling applied to the study of nursing personnel, Nursing Research, 1, 11-16 for evaluating the administration of a public health nursing service, New York

25.

29. United States of America, Natioaal League for Nursing (1961) Criteria

41. Bennis, W. et al. (1961) The role of the nurse in the outpatient department, New York, American Nurses Foundation

"'-

42.

Abdellah, F. & Levine E. (1958) Effect of nurse staffing on satisfactions with nursing care, Chicago, American Hospital AsSOCiation, Hospital Monograph Series No. !! & Bryant, W.D. (1964) How minimal can nurse staffing be? Modern Hospital, 103, 111-113

46. Miller, S.J. 48. 49. 50.

Gordon, E.M. & Hoffman, V.M. (1960) Evaluating an occupational health nursing program by a work sampling study. Canad. Nurse, 56, 314-320 Feyerherm, A.M. & Kirk, W.R. (1964) Effect of census variation on nurSing activity patterns, Hospitals, 38, 62-70; 74 connor, R.J. (1961) A work sampling study of variations in nurSing work load, Hospitals, 35, 40-41; 111

~ead at least one.

- 66/61 -

ANNEX XI FIRSr REGIONAL NURSING eruDIES SEMINAR

2-30 August 1965 *CODES AND DEFINITIONS - NURSING ACTIVITY STUDY I CLASSIFICATION OF ACTIVITIES ACCORDIl«} TO AREA

The areaa of activity for this study are four: II8lIl8ly, patient centred, personnel centred, unit centred, and other centred.

PATIENT CENTRED ACTIVITIES

These activities may occur in the patient's presence or away from him. There are five subgro~s of patient-centred activities With identifying code numbers - ll, 12, 13, 14 and 15. Codes II and 12 Will be used only when the person being observed is actually With patients. Code Number II - Givicg Care Activities occurricg in the presence of the patient, which involve the giving of care, including: Carryicg out a nursing procedure. heights and weights. This includes measuring

Assisting doctors with treatment or procedures. Giving or assisting patients with personal hygiene. Code NUmber 12 - Other Direct Activities Activities in the patient's preaance not classified as giving care, including: Conversing or exchanging pleasantries with the patient. Evaluating the patient's need for care. Escorting patients. Listening to requests, wishes, and cauplaints of patients. Mald.ng interpretations to patients. Observing the physical condition and behaviour of patients.

*Adapted fran "How to study Nursing Activities in a Patient Unit", Public Health Service No. 310 Revised 1964 and Adams, A., "How to Study the Nursing Service of an Outpatient Department", Public Health Service Publication No. 491, Gov't. Printing Office, Washington, D.C.

Code lfumber 13 - "Teaching Patient"includes: Those explanations and demonstrations in relation to health, medications, treatment, or needed follow-up Which include a specific reason or answer "why" for the patient. Not a statement such as "Because the doctor wants you to," "This is good for your health", or "This will make you feel better." Because patient teaching is considered an importsnt outpatient department service it is listed and coded separately. Observers will need special orientation to identify this activity from merely "telling" or giving of general information. Code lfumber 14 - "Patient: Excha e of Information About or With Patient", includes: (May or may not be done in presence of patient Exchanging verbal reports about or with a specific patient or patients with unit personnel, nursing service administration, physicians, other hospital departments, patient's family and friends, and other interested persons or agencies. Listening to or giving a.m. or p.m. report. Discussing, giving and receiving an assignment related to patient care. Scheduling patients' appointments. Referrals. Discussing/ordering drugs, supplies, or equipment by telephone for a specific patient or patients. (It is understood that the observer will ask the reason for scrutiny of reports). Code Number 15 -"Patient: Indirect Care" means all other patient-centred activities not in the presence of the patient and not involving an exchange of information about a' patient. It includes: Care of records and record forms relating to patient care. Charting of care given. Checking of doctor's orders. Errands for patients. Preparation of medications and treatment trays. Setting up and terminal care of equipment. Planning and evaluating patient care away from the patient. (The receiving of individual drug supplies is considered part of preparation of medications.

PERSONNEL CENrRED AorIVITIES These activities are primarily concerned with the profe~sional growth and development of nursing service personnel and with personnel management. Code Number 21 - Professional Development of Staff Participation in all activities conducive to improved nursing service, as well as planned and unplanned events which increase the knowledge and skill of the staff, including: Demonstrations for teachi~

staff members individually or collectively.

Giving or receiving planned or impromptu instruction. Observing and evaluating the quality of work performed. Orienting new staff members to unit. Reading or questioning to gain more information about a drug, treatment, etc. Code Number 22 - Personnel: other

Activities having to do with personnel management (personnel centred activities) including: Staff meetings. Individual conferences on personal matters which relate to work. Maintaining personnel records and conferring about personnel matters. Code Number 23 - NurSing Student Programme. These activities include: Discussions about the nurSing students' progrlllDlJl8 with unit personnel, physicians, clinical instructors, and others. Observing and evaluating the quality of work perfonned by nursing students. Planning snd selecting experiences for nursing students. Tesching nurSing students, impromptu or planned. (NOTE: Activities in which nursing students are involved must be weighed carefully in terms of whether they are patient centred or personnel centred. I f personnel centred, a detenninstion must be made whether the activity is for the student or for unit staff of which the stUdent is considered to be a part).

.. 10 - .

Code NUmber

,1 - This classification includes:

Housekeeping, maintenance of cleanliness, order, and safety on the unit. Obtaining, preparing and dispensing s1.q>plies, equipment and records and all discussionssnd exchanges of information regarding these activities. Interpreting a hospital policy or procedure to persons other than unit staff or patients. Example: Explaining hospital regulations to visitors. Serving on committees for the purpose of discussing, revising, or formuJsting hospital and nursing policy and procedure.

I , I ,

, I,

I I II

Activities related to this study. Discussions, compilation of data, and so forth, for any other research studies. Errands in search of unit personnel. Making unit records such as time sheets, leave records and daily report. Reporting on or off duty. calling out patients' names and numbers. patients. OTHER-CENTRED ACTIVITIES Code Number 01- Personal These activities include: All activities of a personal nature; such as, coffee breaks, conversation about personal affairs, and the like. Code Number 02 - Stand-by Time Time spent waiting for the arrival of a person or thing prior to the start of an activity including: Waiting for a doctor to arrive to assist him with a spinal runcture. Waiting for a sterile dressing tray to arrive in order to change a patient's dressing. Routing and directing

-.~

II " II

I! "

" " "

-7lII CLASSIFICATION OF ACTIVITIES :er SKILL LEVEL

The skill levels for this study are six: administration, nursing, housekeeping, clerical, messenger and unclassified. Code A - Administration

Administration includes activities requiring nurSing jUdgment. These involve responsibility for planning and providing effective patient care, for developing unit personnel, and for managing and operating the nursing unit. Patient care activities include: Assi811ing personnel to meet the individual needs of patients. Planning and participating in unit education programmes to ensure safe and effective nursing care. Assisting the physiCian in his plan for patient care by directing the execution of his orders and reporting to him the patients' symptans, reactiOns, and progress. Supervising and evaluating the effectiveness of patient care.

• ,

Giving nursing care for the purpose of observing a patient, establishing rapport with a patient, or teaching a member or members . of the nursing staff. Promoting, supervising, and evaluating the education and rehabilitation programme for the patient and his family. Making nursing rounds to assess patient's condition, progress, and immediate environment. Development of unit personnel includes: Plannirs for and participating in continuous learning experiences for nursing personnel. Promoting personal growth and development of unit personnel. Written and oral evaluations of the work performance of staff members. Unit management activities include: Planning for and maintaining an environment conducive to the wellbeing of patients and personnel. Pranoting good interpersonal relations~1.Ps.

Assisting in the develoPlient and 1qllementation of objectives am policies of the nursing service.

-72Code N - Nursing Activities Nursing activities include the direct and indirect activities involved in giving nursing care to patients: Preparing a nursing care plan for direct patient care.

II Carrying out orders prescribed by the physician for his individual patients. Observing and reporting on patient's symptoms, reactions and progress. Code C - Clerical level activities include: Copying records, as nursing time sheets. Maintaining graphic records. Assembling chart foms on patient's admission. Directing patients to services. Filling in chart headings and recording heights and weights. Checking charts on discharge. Making out requisitions for specimens, laboratory services, X-rays, or other professional services, making appointments. Copying, routing, maintaining, and filing records and 'Written communications that are essential in co-ordinating professional services in a department or between departments. Theae duties will be considered clerical, whether or not a clerk is on the service when they are performed, and regardless of who perfonns them. Routing patients (calling numbers or names) Code H - Housekeeping level activities such as: Cleaning floors, willdows, bathrooms and service rooms (except narcotics cabinet). Preparing supplies for the unit. Emptying wastebaskets, dusting furniture, general cleaning of head nurse station, folding linen, washing furniture. Straightening and cleaning examining rooms when patient not present. (A nurse may do the initial cleaning up when a patient spills something, or in caring for patient when she is with him. This is not considered housekeeping levell.

" "

...

- 7} -

Code M - Messenger level activities include:

i l

Delivering materials and supplies, charts, records, routine requisi tiona, etc. Picking up emergency orders of drugs am supplies. Accompanying patients to other parts of outpatient department, if this is established policy. (It is understood that carrying drugs be recorded as a messenger activity) • It was decided that the observer should ask any- nurse accompanYing patients to other parts of the department the reason for doing so. The reply will indicate tIE skill level, e.g., "nursing" or "messenger"). Code U - Unclassified Activities. Unclassified activities are those which are eliminated by definition from any- of the preceding codes. Code U is used to identity those activities which refer to the person as an individual. For example:

(

Time 10:00 10:30

Person observed RNl RN2 RN3

Area 21 01 02

Level U U

Description Reading new pamphlet on diabetes. Drinking chocolate milk. Waiting to with a ass~sinBbysician re s •

ll:oo

- 74/75 FlllST RI!XlIONAL BI1RSIiIl S'l'tlDlES SBMINAR

2-30 August 1965 Observer's Record Gb~

_________________________ ~----------------------------Fl'erPlace ~

Date _ _ _ _ _ _ __

~ 'l'imc

Page CODE

sefte(

(What is being done) Description of Activity

euJ.-

Skill-,

Level

PERSONNEL Supervising NUrse Nurse Rn Registered Nurse (Staff) ClI Clinical Instructor Na NUrsing Attendant St Student SuN lIN Head

AREA OF ACTIVITY Patient Centred: Giving Care 12. Patient Centred: Other direct activities 13. Patient Centred: Teaching Patient 14. Patient Centredl Exchanging Information 15. Pat1ent Centred: Indirect Care 21- Professional Development of Staff 22. Personnel - Other Professional Student ~. NUrsing Programme 31. unit Centred Activities 01. Personal 02. Standby ll.

SKILL-LEVEL

N. C.

H. M. \1.

Administration Nursing Clerical Housekeeping Messenger Unclassified

- 76/'nFIRm! RF.X;IONAL NURSINl S'l!UDIES SEMINAR

1tRREX XII

2-30 August 1965

H\ACTICE SESSION

LEVEL

1Uf StN HN

Preparing cotton balls Dustiog the tables setting up injecti~n

trays

lIN2 lIN, NA, lIN4 lIN

Helping NAI to move tables Talking to Supervisor about assignment Putting record forms on registration desk Showing patient to medical clinic Writiog records of return visits Changiog patients' dressine; Announcing call numbers of patients Standing by (waitiog for report on patient Sitting readine; record Helping patient on examining table Talking to patient about his clinic card Lookine; for emesis basis Preparing rubber gloves for clinic Listening to doctor's complaint Taking patients' blood pressure Listening te doctors complaint (needed equipment) Not in clinic (personal) Preparing sterile dressings tray Boiling instruments Standing by doctor Who is talking to patient Waitiog for doctor to f1nish talk1ng to patient Looking for the Supervisor I

i ,

I I

lIN2 HN

Sup!( lIN, Nal ~

SupN StuN Bl'!'4

°2 ~ HN

lINl Na,

~ lIN, RN4

- 18~

Nal SupN UN

Explaining to patient how to f:l.nd dispensary Calling patients from waiting ~m

Iff clinic (went te records to ask about patient's record) Counting patients waiting to see doctor Cleaning dreSSing table Arranging examining table for patient Stacding by (waitieg for doctor to finish ~ing dressing) Giving patient injection '!alking to patient (about returning to clinic) IDoking for cotton balls Writing patient's name in record book Showing patient where toUet is located Sitting at desk rec.rding information re patient ,etting specimen bottle for patient Helping patient undress H1lding patient while doctor does dressing Asking &lctor if' he can see more patients Bersonal (off for coffee) ~cqSBiBg -~

RNl Nal StuN RN2 RN4 N~

.).........

Na4 UN

Na,

lIN, StuN RNl RN2 SupN RN4 ·3 -1 01 I "

aesignment with Supervisor

Showing student how t. take blood pressure eft clinic (looking for equipment-needles)

Na, BN

Taking patient's temperature Talking with mother about her medicines Asking Supervis.r for change of assignment Arranging classes for a group of patients Giving a pattent care assignment to RN Preparing duty schedules for p~rsonnel

RN3 HNl SupN UN2

- 79 -

HN~

Making out reqUisitions for specimens Making appointment for return visit of patient Preparing requisition for stock supp1ies Maintaining c1inic attendance record of visits to cUnics today

RN RN2

Na2 Nal

Telephoning - 100king for doctor Picking up orders of lrugs and supp1ies Restocking examining rooms between patients Cleaning equipment after care of patients Reporting on dutt - to UN Ta1king with nursing staff in reo po1icies and procedures Discussing students' programme with instructors to changes in c~.iDical

P1anning experiences for nursing students Conversation with patient's wife regarding regime of patient. Checking physician's orders in book RN4 HNl BN2 RNl RN, SupN Na~

Writing referrals for patients to other clinics Transporting patient to X-ray Distributing patient charts to examing rooms Transporting specimens to 1aboratory Attaching X-Ray report onto charts. Inserting additonal sheets to charts Giving impromptu instructions to lI. Attendants Reading a book on Pharmaco1ogy Attending staff meeting

RN4 ; I ___ ..

Tidying desk Checking supply closet for adequacy of 11nen suppues

- 80 -

.,.. lU'IJt. Na

(Jolleet1ng dirty 11nen Distr1but1ng fresh l1nell supplies lJ»k1ng cab1net after clinic hours Filing records ,

SupN lUl2 StuN !lN3

Rece1ving an erder from HNl ' to ass 1st phys1cian w1th pat1ent Ass1st1ng pat1ent to move from one place to 'faking a coffee break Report1ng to Ch1ef OPD concerning operation of clinic Cleaning tables 1n the clinic ieceiv1ng recommendations to be followed in relation to patient care in clinc Waiting for a doctor to arrive to assist him with a spinal puncture Checking whether patient's understanding of doctor's recommendatioDS.

HNl SupN lUll Cl I ~

Nal

.. . .:.'f. ..

•

- 81 ANNEX XIII ABSmlMERrS OP RURSIRl PERSOmmL ~ OBSERVERS A'l lIOJI'.l'H GENERAL HOSPITAL, ot1l'PATIERr DEPARl'MEm! 16, 17, 18, 20 and 21 August 1965

I!m 16 August

OBSERVEIIS

ABsmNMEM' lOIBER I II II I I II

John Waterer Shirley Lowe Josie Mendoza Che Fat1mah Pyo lA!e Yukiko Inoue

Beginning the 17th August observers will exchange Assignment Numbers everyday as follows: John Waterer exchange with Shirley lowe Josie Mendoza n "Che Fat1mah Pya lA!e

Yukiko Inoue

'1,

)

• 82183 -

ASSIGNMENTS OF NURSlNG PERSONNEL TO OBSERVERS AT PHILIPPINE GENERAL HOSPITAL, OVl'PATIENT DEPARTMENT 16, 17, 18, 20 and 21 August 1965

OBSERVER H. K. M. S. J. K. N. E. J. F. Suanes Fowler Porter Yeoh Sutherland Matsushita Asuque Wilson Yabes Lin

ASSIGNMENT NUMBER I II I II I II III IV III IV

16 August First Floor

Ground Floor

Beginning the 17th August observers will exchange Assignment Number everyday as tollows: First Floor: H. Suanes with K. Fowler M. Porter with S. Yeoh J. Sutherland with K. Matsushita N. Asuque with E. Wilson J. Yabes with F. Lin

GrourJi Floor:

1),

'I.

,,I

•

- PA/55 GROUPS* OF NURSING PERSONNEL FOR OBSERVATION AT NORTH GENERAL HOSPITAL, OI1rPATIErl'l' DEPAR'l'ME:lfr 16, 11, 18, 20 and 21 August 1965

Total Personnel As silllDlent I ':'ssigllDlent II SuN, Rn4 Rn5 Na, Na4 st5 St6 st 1 st8 CU, Rnl R~

9 10

Rn, Nal Na2 Stl St2 st, st4

*Note:

Additional staff or students will be assigned daily i t personnel changes.

N.B.

Always control the assigned list of personnel with the Supervising Nurse 10 minutes before starting Observations for any last minute changes in personnel •

. "'

--li_ . . _____

I..

- 8f,/Bri GROUPS* OF NURSING PERSONNEL FOR OBSERVATION AT PHILIPPINE GENER(\L HOSPITAL, OVl'PATIENT DEPARrMENT 16, 11, 18, 20 and 21 August 1965

Ground Floor Assignment III Assignment IV First Floor Assignment I Assignment II *Note: N.B. :

Total Personnel Rn8 Rn9 Dental Aide, Rn1 Hn, Na, Hn4 RnlO Rnll Na 5 Na4

6 5

Hnl Rnl H~

Rn, Nal R~

5 5

Rn4 Rn5

Na 2

Student nurses will be assigned daily, depending on presence. Always control the assigned list of personnel with the Supervising Nurse 10 minutes before stsrting observations for any last minute changes 1n personnel .

..,

... ~

)

-~FIRST REGIONAL NURSING STtDIES SEMINAR

2-30 August 1965 NtmSn«J ACTIVI'lY S'l'tJDY

Philippine General HospitBl Outpatient Department Observer's Schedule

August 16, 17, 18, 20 and. 21, 1965

Name of

Observer Date

H. Suanes K. Fowler Hours

M. Porter S. Yeoh Hours

K. Fowler Hours 12:30 - 2:00 2:00 - 4:00 7:30 -10:00 10:00 -12:00 11:00 -12:00

H. Suanes

J. Sutherland. K. Matsushita Hours 2:00 - 4:00 12:30 - 2:00 10:00 -12:00 7:30 -10:00 12:30 - 3:00 j

Monday

16 August Tuesday 17 August Wednesday 18 August Friday 20 August Sa'blrday 21 August

7:30 -10:00 10100 - 12:00 10:00 -12:00 12:30 - 2:007:30 - 10:00 2:00 4:00 2:00

2:00 - 4100 12:30 7:30 - 9:00

9:00 - 11:00

Name of Observer

N. Asuque E. Wilson Hours 7130 -10:00 10100 -12:00 12130 - 2:00 2100 - 4:00 7130 - 9:00

J. Yabes F. Lin

N. Asuque E. Wilson Hours

J. Yabes F. Lin NHours

Date MondaY'

Hours

16 August Tuesday 17 August Wednesday 18 August Friday 20 August Saturday 21 August

10:00 - 12:00 12:30 - 2:00 7:30 - 10:00 2:00 -

2100 - 4:00 12:30 - 2:00 10:00 -12:00 7:30 -10:00 12:30 - 3:00

2:00 - 4100 7:30 -10:00

4:00

12:30 -

2:00 10:00 -12:00

9:00 - 11100 11100 -12:00

FIRST RIDIONAL NURSING STUDIES SEMINAR 2-30 AuguSt ~965 .

North Genera~ Hospita~ Outpatient Department

August ~6, ~7, 1.8, 20, and 2~,

1965

Observer's Schedule

.. 1t

Name or Observer Date Monday ~6 August Tuesday 17 August Wednesday 1.8 August Friday 20 August Saturday· 2~ August

John Waterer Shirl.ey Lowe Hours 7:30-~0:00

Jode Mendoza Che Fat1mah Hours 10:00-~:00

John Waterer Pyo Hi lee Shirl.ey Lolli!! Yuld.ko Inoue Hours Hours ~:30-2:oo

2:00-4:00 ~:30-2:00

10:oo-~:00

7:30-W:00 ~:30-

2:00-4:00 10:00-12:00 7:30-10:00 ll:OO-12:oo

2:00-4:00 12:30-2:00 7:00-9:00

2:00

7:30-l0:00 ~0:00-12:00

2:00- 4:00 12:30- ,:00

9:00-11.:oo .

•

- 92/9'5 FIRST REGIONAL NURSING STODIES SDIINAR

2-30 August 1965 Assignments for Tabulations 16, 17, 18, 20 and 21 August 1965 Place: Room 414, WHO Miss Verderese Philippine General Hospital OPD, Activity Study

Resource Person:

HOURS Morning Date Monday 16 August 8:00-10:00 10:00 - 12:00 K. Matsushita J. Sutherland Afternoon 2:00 - 5:00 3:00 - 5:00

M. Porter S. Yeoh

N. E. H. K.

Asuque Wilson Suanes Fowler

TUesday 17 August

J. Sutherland K. Matsushita

N. Porter S. Yeoh

J. Sutherland K. Matsushita J. Yabes F. Lin

Wednesday 18 August

M. Porter S. Yeoh

M. Porter

Yeoh

J. Sutherland K. Matsushita

H. Suanes K. Fowler N. Asuque E. Wilson

Priday 20 August

M. Porter S. Yeoh

J. Sutherland K. Matsushita

M. Porter S. Yeoh J. Yabes F. Lin • H• Suanes

Saturday 21 August

J. Sutherland K. Matsushita

M. Porter S. Yeoh

K. Fowler N. Asuque E. Wilson

• '.

- 94/95 -

FIRS.!! RFIUONAL NURSIW STUDIES SliKINAR 2-30 August 1965

16, 17~, 20 and 21 August 1965 6 ,

Assi~nts

for Tabulations

Place:

Roan 415, WHO Professor Congalton

North General Hospital OPD, Activity study

Resource Person:

Date

HOURS Morninp; Afternoon

8:00 - 10:00 Monday 16 August Tuesday 17 August Wednesday 18 August Friday 20 August Saturday 21 August Pyo Lee Yukiko Inoue Josie Mendoza Che Fatimah Josie Mendoza Che Fatimah Josie Mendoza Che Fat:l.mah

10:00 - 12:00 2:00 - 5:00 3:00 - 5:00 Pyo Lee Yukiko Inoue J os1e Me nib2a Che Fatimah

.bsJe MenOOm Che Fat1mah Pyo Lee Yukiko Inoue Josie Mendoza Che Fatimah Pya Lee

John Waterer Yukiko Inoue Shirley lowe John liIterer Pyo Lee Yukiko Inoue Shirley lowe

- 96 FIRST RmIONAL NOmING S'lU>ml SEMINAR - WPRO-l21 2 - 30 August CLOSDD ADDRESS OF !I!m DIREC'roR OF HEAL'lH SERVIcm3 'ro !I!m FIRS~ REGIONAL NURSDD SWDIES S:avIINAR I am very happy to have this opportunity to meet with the Seminar group at the closing session of the First Regional NUrsing Studies Sem1nar. I have followed with great interest the history of this seminar from the first proposals for holding such a seminar more than two years ago, through each step in its planning and finally the implementation

or oonduct of the seminar. I mention the planning phase in particular since this is such an important aspect and one which you wlll be faced within your own countries if and When you find it possible to initiate aotion based on the knowledge and experienoe you have gained during the seminar. 'DIe suo cess of your endeavours will depend to a large extent on caref'ul planning, one part of which must include involvement of all those concerned at an early stage and the tapping of the resources available both 1uDan and material. It may even mean seeking outside assistance. In this respect, I would like to assure you that just as the Organization has sponsored this seminar, the objective of whioh was to give you, the participants, the opportunity to leam among other things how to become self-starters, in using the study approach we hope it Will be possible for us to give as much follow-up assistance as is possible within the means at our disposal. To oome back to the seminar itself', I have been impressed with the amount of' work that bas been undertaken and the impressive results. It speaks well of the oapabilities of the partioipants and the potential for future action. It also confirms the f'ai th we have in the nursing leadership in the countries in this region and our faith that given the opportun! ty and the support needed they oan and Will oarry the responsiblli ty that is placed on them to provide the nursing service required for the sucoessful execution of heal thand medical oare programmes. 'DIe analysis, interpretation and findings of the study you oarried out as part of' your learning experienoe during the seminar has been revealing and brings me to the next point I would like to make and that

is to stress again the need for investigation, study, analysiS, evaluation whioh Dr. Fang stated in his opening address as important elements in planning. I am sure this is one thing that has been brought home to you during the month-long seminar. I would like to express our appreoiation of the contribution made by the seminar staff and resource persons. May I be permitted to pay speoial tribute to the Seminar Director, Dr. Vera Fry-Maillart. to Dean JUlita Sotejo, Professor Congalton and Miss Maria Palmira Tito de Moraes. We are particularly fortunate to have been able to bring together persons with such a wealth of experienoe to assist us to plan and oarry out this seminar. May I also express our appreoiation to Miss Virginia Arnold for favouring us with her attendance and for her support and assistance. '!bank you all very much.

- 97 -

•

To the part1c1pants, I would l1ke to say how pleased we are to have had you with us for this sem1nar, we admire the way you have contr1buted to the sem1nar and how successful you have made 1t. The success of any seminar can only be measured by the response of the part1c1pants and from what I have learned you have done an outstand1ng Job. To all of you, may I say thank you for your co-operat1on and support, good luck and "bon voyage".

, WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTI!!

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU R~GIONAl DU PACIFIQUE OCCIDENTAL

A STIJDI OF

NURSING ACTIVrrIES m THE Otm'ATIENT DEPARTMENT PHILIPPINE GENmAL HOOPlTAL

BY TIlE

PARTICIPANTS OF THE FOOT lIE'JIONAL NURSOO STOIJ'i SEMINAR

WPRO 1 MANILA. PHILIPPINES

AWtET 16 TO 21, 1965

... lJFf:/340/65

- I -

Thanks are expressed to the Dtrector of the Philippine General Hospital, the various heads of departments, particularly the Chief of the OUt Patient Department. and members of the nursing staff for their very generous co-operation~

making this study possible; the

Secretary of Health and his staff; the Chief, Office of Health Education and Personnel Training, and the Nursing Consultant, Office of the Secretary of Health for al10wing a member of her staff to act as a liaison officer between the World HeaUh Organization (wmO) and the various health agencies. We gratefully acknowledge the invaluable help given to us by the Secretariat of the Seminar and the various Committees Which facili_ tated the work of the participants.

- II ,--~

TilBLE OF CONrENrS

ACKNOWLEmEMENT CHAPTER I. INTRODUCTION ••••••••••••••••••••••••••••••••••• How the Study Came About •••••••••••••••••••••••••••••• Description of the OUtpatient Department Philippine General HOspital ••••••••••••••••••••••• Scope, Objectives of the study •••••••••••••••.••••••• CHAPTER 1 1

••

II. METHODOLOGy.................................. 15 FINDINGS, ANALYSIS AND IN'l'mU'RETA~A

CHAPTER III.

T]QN OF

••••••••.•.••.••••••••••••..•.••••.••••.•

CHAPTER n. SUMMARY OF FINDINGS AND SWGEETIOlm •••••••••••••••••••••••••••••••••••••••••••••••• APPENDlCES

, ...

Description of the Phil1ppine General Hospital Short Historical ICltroduction ••.••••••.••••••••••• School of Nursing and College of Medicine ••••••••• Sketch Floor Plan of the out Patient Department ••• Codes and Definitions - Nursing Activ1ty Study ••••••• Roster of Participants - Nursing Activ1ty Study •••••• Comparable Designations Commonly Used in out Patient Nursing Services ••••••••••••.••••••••• Analytical Tables, Charts and Graphs ••••••••••••••••• Examples of Completed Work Tables 1, 2, 3 and Obaer-ver's Record ••••••••••••••••••••••••0.........

41 47

52 53 55 59

9B 103

BlBLl(X}RAPIrl •••••••••••••••••••••••••••••••••••••••• ,.......

- mLlST OF TABLES

ANAUTI.CAL TABIE U. - Number 01' hours spent at different skill levels by nursing service staft •••••••••••••••••••••• ANAUT:r.cAL TABIE lB. - percent 01' Time spent at d1tterent skill levels by nursing service staff •••••••••••••••••••••• ANAUT:r.cAL TABLE 2A. - Number 01' hours spent in areas 01' activities by nursing ae.vice staff •••••••••••••••••••••••• ANAI:iT:r.cAL TABIE 2B. - percent of time spent in areas 01' activitIes by nursing service staff •••••••••••••••••••••••• ANAUTICAL TABLE~. - Comparison 01' average amount 01' nursing care time available per patIent from each category 01' nursing personnel with the average amount 01' time spent on patient centred activ1ties and other activ1ties •••••••••••••• ANAUT:r.cAL TABlE 4. - Average amount 01' time per patient each category 01' nursing personnel spent in the presence of the

60 61

patient.....................................................

ANAUT:r.cAL TABLE 5A. - percent 01' time spent at each area and level or activ1ty by each category of personnel during a sample workweek of '57 hours, ~ (BN) • • • • • • • • • • • • • • • • ANAUT:r.cAL TABIE 58. - Average number of hours spent at each area and level ofactiv1ty by each category of personael during a sample workweek of ~ hours, HEAmUBSE (RN) ••••••• ANAUTICAL TABLE 5A.- percent of time spent at each area and leVel·of activ1ty by each category of personnel during a sample workweek of ~ hours, REXlISTERED NURSE (RN) ••••••••• ANAUTICAL TABIE 58. - Average tlUlllber of hours spe\!t at· each area and level of activ1ty by each category of personnel during a sample workweek of ~ hours, REXlISTERED NORsE ••••• ANALYTICAL TABLE 5A. - percent of time spent at each area and level of activ1ty by each category of personnel during a sample workweek of ~ hours, NURSING M"l'ENDAN'l' (NA) •••••••• ANAUTICAL TABIE 58. - Average number of hours spent at each area and level of activ1ty by each category of personnel during a sample workweek of ~ hours, NURSIm M"rENIlAM' (HA).

ANAUTICAL TABIE 5A. - Percent of time spent at each area and level of activ1ty by each category of personnel during a sample workweek of ~ hours, STUImIT NtlBSE (St) ............. 92

...

ANAUTICAL TABIE 58. - Average ~r of hoUl"B spent at each area and level 01' activity by each category 01' personnel during a sample workweek of 37 hours, fmJ:llim NUISE (st) ..... 93

- rv LIST OF Gful.PBS AND ClIAR'l'S

Figure 1. Percentage distribution of patient attendance at the f'\PD, PGE: during the period July 1964 to June Figure 2. Percent of "I;ime spent at different skin levels by nursing service staff PGH.OPD, August

1965 .............. ·......... "........ 0 .............. 0............

16-18, 20 & 21, 1965 •••.•••••••••••••••••••••• ~.........

59a

Figure 2A. Percent of time spent at different skill levels by nursing service staff in the order of their magnitude, PGH-OPD, AU€USt 16-18, 20 & 21, 1965 ••••••••• Figure 2b. Percent of time spent at different skill levels by each category of nursing service staff for A.M. and P.M., PGH-OPD, August 16-18, 20 & 21, 1965 •• Figure,. Percent of time spent in areas of activi~ieG by nursing service staff, PGH-OPD, August 16-18, 20 &

59a

59b

....

21, 1965 ................................................................................................ Figure 3a. Percent of time spent in areas of activities by each category of nursing service staff for the A.M. & P.M., PGH~PD, August 16-18, 20 & 21, 1965 •••••••••••••• Figure :3b. Percent of time spent in aree.s of activities by nursing service sta:ff, PGH-OPD, August 16-18, 20 &

59c

59d

21, 1965 ................................................................................................ Figure 3c. Percent of time spent in areas of activities by nursing service staff 1n the order of theix magnitude, PGH-0PD, August 16-18, 20 & 21, 1965 •••••••••••• Figure 4. Percent of average amount of total nursing care time available per patient for patient centred and other activities from each category of nurSing personnel, PGH-0PD, August 16-18, 20 & 21, 1965 ••••••••••••••• Figure 5. student Nurse: percent of time spent in the areas of activity during a sample workweek of 37 ho~s, PGH-0PD, August 16-18, 20 & 21, 1965 ••••••••••••• Figure 58. Student Nurse: percent of time spent at different skill levels, PGH-OPD, August 16-18, 20

5ge

5ge .. il

59f

59g

& 21, 1965 •••••••••••••••.•••.•••••••.•••.••••.••••••••

59h

--CHAPTER I - INTRODUCTION A - HOW THE ST::JRY C,'}IE 1,ROur

The countries in the Western Pacilic Region of the WHO are and have been facing a shortage of health personnel particularly nurses, to meet the services. I",

rapidly increasing demand for health and medical care The shortage of nurses is most felt because of the major

role they play in delivering health services to sick and well people. Past efforts, largely the introduction of auxiliary workers to "stretch" nursing persomel, have not provided a solution. Problems

of staffing for nursing services continue to handicap the implementation of health and medical care services. One of the factors aggravating the shortage of nurse power in many countries would appear to be the misuse of fully qualilied nurses. To

assist national health administrations to plan better use of nurse power, the WPRO of rHO conducted a Nursing Studies Seminar for Key Nurses from 7 countries to train thelll in nursing activity study methods. Part of

their learning experience included the conduct of a nursing activity study in an outpatient department. In providing for this learning experience

outpatient departments presenting problems which might be considered "typical" in the countries were sought as a laboratory. teristics taken into consideration included: Typical charac-

large cliniC attendance,

service pressures on staff, absences and/or leaves of absence of nurses ,r v.

creating"gaps" in staff, frequent overtime, paid or unpaid, on the part of staff, clinical services of both a preventive and curative nature, mare than one category of worker in nursing service personnel and the inclusion of a student programme for clinical learning experiences. Toward the above purpose of the Seminar, the following planning was done in 1.

two phases: Preliminary "top" planning with the Nursing Consultant, the Chie:f 1IlId,

of the Office of Health Education.

Personnel '1're.1n1ng (0. <!i,E. p, '1', )

the Oovernment/Wlll/tlNICEF Lie.1son Of'f'icer IIlId !brses from the Bureau of

- 2 -

Health and Medical ServicHs of the Department of

H~al th,

Goverrunent

of the Philippines by the two RegIonal Nursine; Advisers of the WPRO of ~mo.

This preliminary planning, started 18 months prior to the Seminar, brought the full support and understatJdi.ng of key personnel in the Department of Health and facilitated later visiting of agencies for the selection of the outpatient departments to be studied. 2. The second pla"lning phase for the Nursing J.ctivity Study began

~ • I

the last week in June preceding the Seminar with survey visits to hospitals, outpatient departments, health centres, and other health agencies in and outside NBnila. Visits were made by one of the Seminar Directors accom-

panied by the nurse designated to serve as liaison with the GoverrnrBnt. During each visit discussions on the purpose of the visit were held with Medical and Nursing administrative and operational staff. were also Conversations

held with patients and their families, as the occasion arose. fo~

Decision on the Outpatient Department to serve as the field

the

Nursing j,ctivity Study was reached by 15 July and the first definitive steps were taken to secure the participation, understanding and assistance of medical nursing and other personnel. On 20 July, a "Top" Committee composed of the chief mecical and nursing administraoive officers, training officer, the chiefs of Dietetics and Housekeeping and the agency's adndnistrative officer met with the Seminar Staff. (See list in Appendix).

At this meeting, the purposes of the Nursing Studies Seminar, the shortage of health personr£l, especially nurses, the relation of nurse utilization to shortage, the purposes, method and of Nursing Activity Studies "'ere discussed. potenti~l

contribution

Keen interest was expressed ,,~th

and full support was given for subsequent planning

the

adnDL~istra

tive an:! other personnel of the OPD, and for a follow up meeting to discuss the Study findings and plan for needed action.

tive, m~dical

lIt this meeting, the dis-

Several days later, a smaller committee composed of the administraand nursing staff of the OPD met.

cussion included the purpose, method and potential contribution of the Nursing Activity Study; the problems of providing OPD services; the need for the study in relation to the problems expressed by the OPD staff; the plan for orienting the OPD personnel to the study, the clinics to be studied, and the dates of the study. Decisions on other aspects of the planning essential to the smooth conduct of the Study were made with the Chief, Assistant Medical Chief

of the OPD and the Supervising Nurse who served as an Executive Committee but were not so designated. Such aspects included the arrangement of

space for the Director of the Study and Observer Teams, the method of

orienting tile rl.lZ'B1ng and otbar personnel 1n the 01'1), tb8 ~ta for two half-days of "dry run" for the observers-in-training, the exclusion of the dental or dermatological clinics from the ActiVity Study "field and the provision of other data from OPD records to be used with Activity Study findings.

The "executive committee" met frequently before and during the Study and made possible the efficient conduct of the Study.

I.s part of the plan for the orientation of the nursing personnel in the Outpatient Department, the Supervising Nurse met twice with the total Seminar Group. The Supervising Nurse met several times with the

nursing staff of the OPD to orient them to the Study and to their role in it. "mimeographed statement was also prepared to assist with the

orientation of personnel. Two hal£-days of "dry run" for the Observers served to assist in the orient2tion of the OPD personnel as well as to train the Observers in using the codes of the observation forms.

The duration of the observation period The five-day nursing activity studY

was carried out from 16 to 21

August 1965.

On 19 '.ugust, the clinic was closed due to the national

- 4 holiday "Quezon's Birthday". The entire study period included, therefore,

four days of e:l.ght hotU'6 oork (M:lncmy, Tuesday, WednesdFIy and Frlday) and

one-half day, Saturday. wen the cl:1n1cs were 6('lled'..lled to orerate onl.v dur:1ng f:1ve hours. B - THE OUTPAT IENT DEPfJn'MENl' OF THE HiILIPPlNE Physical layout The Outpatient Department situated to the southeast of the hospital is an attractive two-atory building 13.25 by 24 meters in size. GE~R..L

liOSPITi.L

On the lower floor at ground level are to be found, to the left of the main door, the ear, nose and throat clinics, dental and eye cliniCS, and a toilet room containing four flush closets. In the right side are

located two obstetric clinics and a well baby clinic. are provided with sinks and lockers.

The clinic rooms

A central portion, situated between the left and right w:ings, consists of the general medical and medical specialists clinics, two small medical cliniCS, a fluoroscopy, social service and domiciliary service rooms, the office of the Chief, OPD, part for students, and a patient's waiting hall. of which is a medical clinic

On the second floor are located, at one end, a surgical unit and, at the other end, the gynaecology and paediatrics clinics and an operating room. Between the two wings are surgical, paediatrics and surgical Also situated on the second floor is a laboratory.

speciality clinics. Purpose

The outpatient department of the Philipp:ine General Hospital has for its purpose: the examination and immediate treatment of charity patients

";i

not confined :in the hospital; follow up of patients discharged from the hospital; teaching and tra:ining of medical and nursing students. Population served Outpatient Department Services are available to a1\)' one needing the services. ;, national tax-supported institution, t!1e PGH OPD serves not only

the city of Manila and its environs with an estimated population of

- 5 1 142 500 (1965)1 but also patients from cities aDd provinces all over the coun-

try.

The 1965 estimate of population of the Al1lippines is ~ millions. 2 Patients atteDded receive tree services. However, those who canlRY for

X-Ray and laboratory tests, as determined by the Social Service Department of the Hospital, are made to pay. given tree of charge. Prescriptions which cannot be found in this pharmacy will need to be bought elsewhere by patients. General Health Data of the Philippines In order to view the role of the OPD within the medical care needs of the

Mildicines available at the OPD pharmacy are

population served, i t is worthwhile to examine some of the national health statistics for 1963. Among the ten3 leading causes of morbidity in the PhUippines in 1963 the following are preventable and, if symptoms are recognized or reported early by patients, these diseases may be controlled by adequate socio-medical action. These diseases are: bronchitiS, gastro-enteritis, influenza, respiratory tuberculosis, pneumonia, malaria, whooping cough, measles and all forms of~ntery.

The ten leading cause~ of deaths among infants under one ;year in the Philippines also point to the importance of preventive measures and patient teaching in the Well Baby, Paediatrics, aDd Obstetrical Cl1nics. These leading causes of deaths include: pneumonia, bronchitiS, gastro-entllritis aDd col1tis, post,. ~

natal asphyxia and atelectasis, 1mmat1.U"ity, tetanus, nutrition maladjustment and congenital malformation. Among the ten major causes 5 of deaths in the Phil1ppines for 1963 are four chronic diseases: tuberculosis, diseases of the heart aDd the vascular system, malignancies aDd three acute debil1tating diseases: pneumonia, gastro-enteritis aDd colitis and bronchitis. With the early discharge of patients with chronic illnesses from the hospitals to the OPD for continuing ambulatory treatment aDd supportive care lWormation secured from the B1.U"e8U of Census aDd Statistics - August 26, 1965 2Ibid 3PhU1pp1ne Health Statistics 1963 Annual Report ~pared by the Disease Intelligence Center, Department of Health,pp. 35C, 145», 201.1). 4Ibid

- 6 -

specially during rehabilitation and with increasing difficulty of separating preventive and curative services of sick and well child~en

and adults, the

importance of the OPO in continuity of patient care and in general improvement of the health of the community is immediately evident. Organization of Clinic Services The following are the clinics in the outpatient department respective specialties: 4 ,~th

their

Medical:

Cardiovascular, Gastrointestinal, Diabetic, ThyrOid, Neurology, Psychiatry, Dermatology, Arthritis

Surgical: Orthopaedics, Neurosurgery, Urology, Proctology, Plastic Thoracic

Paediatric:

vlell Baby, HaematolQgy, Cardiovascular, Allergy,

Tuberculosis, Meningitis, Renal follow up

4. EYE, ENT

Cornea, Lacrymal, Motility, Glaucoma, Retina,Ptaerygium, Audiology, Nasal.alergy and pharyngeal, ,~trophic

Rhinitis, Naso-

~-<l$eophagology

5. 6.

Obstetrics:

Postpart~~

and Dystocia

Gynaecology: Sterility, Functional Bleeding and follow up ~:

7. Dental

Cancer Clinic:

Breast; Head and Neck; Gastro-intestinal, Rectum

and Chest; Bones, Genito-urbary, Haematology, Gynaecology cases

Lnti-Rabies Clinic

Hours of Operation Clinic services are available daily Except Sundays and holidays, frO!ll

. 8 to 12 and 2 to 4. On Saturdays, clinics close at 12. OPD is 5-1/2 days a week.

The normal work week of the L~cludes

The month of hugust

a national

holiday which is celebrated yearly and reduces the work week to 4~1/2 days.

4 Fhilipp:ine General Hospital, Outpatient Department, p. 1 (typewritten copy)

- 7Admission hours: 7:30 to 10:30 a.m.; 1:30 to 2:30 p.m. except the There are

lIm.EN!' clinics which are 7:30 to 9:30 a.m.; 1:30 to 2:00 p.m.

instances men those in charge of the clinic find that t.hey cannot finish the cases within the alloted period. Volume of services For the period of July 1964 to June 1965, the daily average of clinic attendance was 980 patients. 886. During the 5-day study, this dail,y average was

The same week in 1964 showed a dail,y average clinic attendance of 680 Fig. 1 represents the percentage distribution of clinic atten-

patients. • '<

dance per major departments during July 1964 to Jure 1965, and Table 1 shows the census for the same period. On Table 2, the clinic attendance during the

week of 17 to 22 A~ust 1964 and the week 16 to 21 fUJgust 1965 are shown. This table indicates the decrease in the clinic attendance in the clinics of medicine arrl surgery during the 5-day study week as compared with the number of patients corning to these clinics during the same waek period in 1964. When

we compared the total clinic attendance figures for six months (September to February) of 1959/1960 with those for six months (September to February) of

1964/1965, a decrease in attendance was found for this last period. ~.

(120.211

in 1959/1960 and 119.154 in 1964/1965). See Fig. 1 The fluctuations of the figures representing weekly attendance liQuld indicate that it would highly profitable that a very close examination be made of the precise details of clinic attendance over a long period of time and an attempt made to relate these findings to econorrdc, social and health matters concerning the population served by the Outpatient Department. The few findings in this report are simpl,y noted here since time did not allow for further probing to find out if they had real significance, Aoother p:>lnt ot interest concerned the comparison of attendance at the Well Bnby Clinic with the same period in 1964; the number of babies attending in 1965 had more than doubled.

,..~

I I I l ,-.

nG. , ..

l'EIlCEIffAGE DISTFIBllTIOH OF l'AtrEHT J.:1TEIIIMNCE AT nIB CVl'PAl'lEJ!r DEPAil".HeIfI, l'HILIl'PJJlE GEIiERAL HOSPITAL DllRIlIG TilE PERIOD JULY 1%4 to Jmt: 196:i

NOT E 1) VERMATCWGl ClIliTG NOT (NCLl1L>F.D 2) INCL11PES.A TrEl'illAlICl! Vll:l~ l5AI<X CLUIIC

SOURCE

I'JU:PA"RED IIOK 2'11!: l'HILIWINE C,DlKIIAL JI05PIl'AL OUT-PAl'J'BNT J)"El'AlI.TlU:Wr Sl:A'l'ISfrCS

- 9 • So

TABLE I PHILIPPINE GENERAL hOSPITAL

OlITP1.T lENT DEPARl'MENT CENSUS DURING ThE PERIOD JULY 1964 to JUNE 1965

DEPARl'MENI'S AND CLINICS

Tar.iU. ATTENDi.NCE

PERCENI' AGE

PER UNIT

Medicall Surgery Paediatrics2 Eye Ear, Nose and Throad Obstetrics Gynaecology Dental i.nti~abies

60.728 41.167 40.038 25.550 24.632 15.111 8.185 16.046 4.461 235.918 I

25.7 17.4 17.0 10.8 10.4 6.4

3.5 6.8 2.0 100.0

Total ..............

I 1 Dermatology Clinic not included

Source - Prepared from Philippine General Hospital Outpatient Department

2 Includes attendance Well Baby Clinic

- 10 TABLE 2 ATTENDANCE AT THE OUTPATIENT DEPJlRTMENT OF THE FHILIPPINE GENERAL HOSPITI.r, DURING THE WEEKS FROM AUGUST 17 TO 22, 1964 AND AUGUST 16 TO 21, 1965, PER MAJOR DEPlIRTMENrS AND CLINICS --

•

ATTENDAN C E IlEPl.RTMENTS AND CLINICS

, WEEIt August 17 to 22, 1964 Number Percentage 24.7 22.6 13.6 10.4 11.9 6.4 3.0 5.6 1.8 100.0 --

WEEIt

August 16 to 21, 1965 Number 968 684 784 581 435 305 138 340 12 4,247 -

Percentage 22.8 16.1 18.5 13.7 10.2 7.2 3.2 8.0 0.3 100.0 - --" ~~,-----

Medicall Surgery Paediatrics3 Eye Ear, Nose and Throat Obstetrics Gynaecology Dental Anti-Rabies Total ••.

794 727 438 333 381 207 93 181 58 3 ~212 - -~--.

-..

Source - Prepared from Philippine General Hospital Outpatient Department Statistics 1 Dermatology not included 2 August 19 not included since the Outpatient Department was closed due to boliday 3 Clinic attedance Well Baby Clinic in 1964: 84 babies in 1965: 219 babies

• Medical Personnel

J..L -

The medical staW of the OPD consists of 1 chief' of the Outpatient Department, 15 consultants, 27 resident physicians and 32' internes. .Clinical clerks of the College of Medicine are also assigned to the various clinics as follows: 15 in Medicine; 10 to 15 in Surgery; 5 in Obstetrics; 5 in

Paediatrics; 4 in the Eye; 4 in the Ear, Nose and Throat; 4 in the Well Baby clinic; 4 in Gynaecology and 4 in -the Operating Roam. in the different clinics. An average of 16 dental eXternes work under the supervision of the chief of the dental cliniC service. Nursing Personne18 The official budgeted posts for nursing service in the OPD are seventeen - one for supervisor, seven for senior nurses and nine for staff nurses. Internes also rctilte

One 9taff nurse mo needed to work in a lighter department was transferred to the OPD from the pay ward of the hospital. However, another staff nurse has

replaced her on the ward aOO to all intents and purposes, this staff nurse is a permanent staff. member of the OPD nurs10g service. Positions for nursing attendants are not speCified. However, there are Nursing atten-

six including a dental aide assigned to the various clinics. dants are ~ined

on the job.

The nursing service personnel co-operates in providing clinical learning experiences for students of the Philippine General Hospital and of the College of Nursing, University of the Philippines. Job descriptions of nursing personnel in the various categories have special defined duties (see appendix). The nursing personml are allowed 30 minutes far lunch time and 15 minutes Helpers A staff of six helpers is responsible for the cleaning of the clinics

daily for snack.

aOO the OPD.

They work under the direction of the nursing supervisor.

7Information given by Dr. Lourdes Manahan, Chief, OpD, PGB, August 25, 1965. 8Infornation secured from Miss Amparo Quesada, ':'sst. Chief Nurse, PGH, August 26, J.965.

• - 12 -

'!be cl:ln1cs and the nursing personnel on this study All cl:ln1cs of the Outpatient Department were included in the study With the exception of the dermatology clinic. The number of observers was

not sufficient to permit the inclusion of this cl:ln1c which was located on the third floor of the building.

'!bis clinic was opened only 4 working During the five-day study. this 'lbe clinic is staffed

days a week. 2 hours in the afternoon.

ol:ln1o had an average e.ttendanct' of 46 patients. by a head nurse and an attendant.

Since the cl:ln1c hours for this ol:ln1c

are in the afternoon, this head nurse during the morning hours was on the staff of the ENT clinic, while the attendant served in the paediatric and gyoaecology clinics. In this capacity, both were included in the study.

'lbe nursing staff of the Outpatient Department is composed of one

supervising nurse, seven head nurses and ten registered nurses. attendants serve Blso in the staff of the Outpatient Department. supervising nurse circulates throughout Bll

Six 'lbe

clinics during the working

hours.

Since she bBs to cover three floors of the OPD, floating from one

to another and, since the observation study.·was carried out only in two

floors of the OPD, the supervising nurse was uqt included in this study. During the entire period of the study one of the registered nurses was off duty due to illness. included in the study was Therefore the total number of nursing persconel

head nurses

9 registered nurses 6 attendants All staff worked full time: on

8 a.m. to 4 p.m. daily and 8 a.m.

to 12 noon

saturdays.

During the five day study, II students of nursing were

incl.uded in the study.

'they were asSigned to the ENT and surgery Clinics.

- 13 i'he distribution

ot nursing pereonnel showed marked variations and

according to the different clinic hours they were assigned from one clinic to another. In surgery, the department had one head nurse and 4 registered i'he clinic occupied 2 roans.

nurses and one attendant.

Of the four regis-

tered nurses in this clinic one was in charge ot the smallest clinic roan. The attendant circulated serving both clinic rooms.

'!he paediatric clinic

elso included 2 clinic rooms.

'!he staff of this clinic was composed of

one registered nurse and one attendant both serving the 2 clinic rooms. 'DIe largest clinic room received almost the totsl Il1IIIIber of patients

while the smaller room was seldom used.

'.!'he attendant of this clinic Both clinics the '.!'he operating room was m ....charge

served not only this clinic but elso the gynaecology clinic. had the same scheduled hours of operation.

ot one head nurse.

'lhis nurse being elone had the entire responsibility tor

caring tor the patients, managing the clinic and attending to supplies and equipment. On the ground floor, the dentsl clinic staft was composed

ot on

one registered nurse and one dentsl aide.

In the

E:ye and

EN'!' clinics one

attendant served both clinics. ~

'!he eye clinic was manned by one nurse while the EN'!' clinic had 2 head nurses and one registered nurse. '!he tact that this clinic had 2

head nurses is due to the circumstances that one of the head nurses was in charge ot the dennatology clinic which opened at ditterent hours from the ENT clinic. attendant.

In the med1cel clinics we tound 2 head nurses and one

'!here was elso in the staft of this department one more reg1s-

tered nurse but this nurse was absent during the tive-day study period due to illness. '!he obstetric clinic was manned by one head nurse and received the divided her working time between this clinic

help of one attendant who and the Well Baby clinic.

'.!'he Well Baby clinic had one registered nurse do

- 14 its staff only. BeC8UBe many of the nursing sts1'f members moved from one Observers were assigned

clinic to another at different periods of the day.

to observe individual staff members rather than in particular clinics. The duration of the observation period. The 5-day nursing activity study was carried out 16 to 21 August, 1965. On 19 August, the clinic was closed due to the national holiday

nQuezon's Birthdayn. The entire study period included therefore 4 days of eight hours' work (Monday 1 Tuesday, Wednesday and Friday) and one half day, Saturday yllen the clinics were scheduled to operate only for 5 hours.

General Purpose The purpose of the nursing activity study at the Philippine General Hospital, Outpatient Department was to secure information on the activities of the nursing service personnel as a basis for assessing staff needs. SpeCifiC Objectives The specific questions to be answered in the study were: 1. What are the areas of activities performed by nursing personnel

in the outpatient Department? 2. What is the volume of nurSing activities carried by the nursing

service personnel? ,. He·" much patient teaching is done by the nursing service personnel? Are the special skills of each category of worker is nursing

being used to the maximum extent possible? 5. Would a re-assignment of one or more of the nursing service per-

Bonnel permit nurses to spend more time in patient care activities? 6. Do the activities performed by nurses in the Outpatient Depart-

ment indicate the need for other categories of workers to assist in the functioning of the Outpatient Department!

7. What nursing service posts are budgeted by the administration to ac~pli4h t~~ nbJec~~veB o~

tho

QU~p5t1ent

Department?

- 15 CHA~

ME'ImXlLOGY For the collection of data on the activities performed by the nursing service personnel in the Outpatierit Department, the technique of instantaneous intermittent observation at 15 minute intervals was used. 'lh1s tech-

nique was developed from the work sampling method. used in industry and is based on statistical evidence that the number of times an activity is observed being performed during a whole work-day for a normal work-week correlates closely with the total amount of time spent in the performance of the activityl. '!he technique of instantaneous intenn1 ttent observation was selected

for the systematic collection of data because: 1. All nursing personnel in the Outpatient Department were to be included as subjects of observation and there were not enough observers to employ the technique of continuous observation; and, the period of data collection extended over five work days

considered to be a reliable sample2 • 2. A representative picture of the tl'.1rsing activities

was needed Since

rather than the sequence or duration of the activit1es.

in nursing in the Outpatient Department the performance of the same kind of activities occurs at irregular intervals, a random time distribution already existed and observations could be made at fixed intervals without jeopardizing the rel1abUity of data.

NUrse observers could be trained and definitions of activities could be made to ensure specificity in observation •

. --

1Abdellah, F. and Lev1ne, E., Work Sampling Applied to the Study of NUrsing Personnel", NUrsing Research, Vol. 3. No.1. June 1954, pp. 11-16. 2Arnstein. M. Time Studies of NUrsing Activities in Intemational Conference on Planning of NUrsing Smdies, International CouncU of Nurses, England 1956. p. 28-29.

- 16 -

Procedure for collecting data Observers alternated scheduled observation periods of 2 to 2.5 hours to provide for observation of all the nursing service personnel during all the work hours of each of 5 consecutive working days. of observation scheduled for an observel ·on did not exceed two. any

1he maximum hours

one day were four and usually any

When an observer was scheduled for 4 hours in

one

day, a two-hour rest period was provided between the first 2 hour observation period and the second to guard against fatigue interfering with accuracy of recording. Each observer was assigned from 6 to 10 members of the nursing personnel for observation in the daily scheduled data collection period because the personnel did not always have fixed assignments c;U' personnel. Observers exchanged ass18nments of persoonel on alternate days during the 5 day study period. TO facilitate identification of the category of worker, nursing personnel were a blue annband with the category code printed in black. (See Appendix-Codes). out the Outpatient Tb permit free circulation of the Observer throughand to enable her to be identified by the --<

Dep~ent

nursing personnel each Observer wore a while laboratory coat with a badge labelled "Observer" pinned on. The Observer sampled the activities of her assigned nursing personnel,

by walking through the Outpatient Department units every 15 minutes and recording what the worker was doing at the instant she was located. She

continUed her tour through units until she had recorded one observation for each member of the nursing personnel assigned to her. If, for example, the Observer started her tour through the units at 7;00 a.m., she continued walking, observing and recording the activities of the nursing personnel assigned to her as she met them. When she had -('-'

recorded one observation for each member of her personnel assignment, the

- 17 -

7:00 a.m. series of obsel"V'lltions was caupl.eted and a new series of observations was started at 7:15 a.m. 'lbe Observer started each series of observations in a random pattern

to avoid observing the same personnel in the same order. On completion of the assigned observation period, the Observer edited

and checked the recorded observations and conferred with the Study Directors

on any problems. RECORDDlJ

.•

A form for recording the nursing activities was developed by the observers. (See Appellliix p. ). The (llserver reCorded the activities of the

nursing service personnel on the Form and Coded them using the code shown on the Definitions (Appendix p. 1. 2. 3. )• 'lbe Observer had to:

identify the activity and describe it on the recording forms. classify the activity according to area. classify the activity according to skUl level.

Generally the observer could identify the activity by what she saw or '-

•

what she heard.

When the purpose of the activity was not evident from the

overt behaviour of the worker observed, the observer asked the worker the purpose of what she was doing. When a verbal exchange took place between the nurse and a patient, the discussion was in Tagalog which was understood by only three of the

ten observers.

'lbe purpose of such an exchange between a nurse and a

patient was arrived at through a brief explanation in English by the rmrse and was accepted as an accurate representation of the activity.

The recording for each 15 minute series of observations was made on a separate Observers Form. 'lbe data for the f1ve-day study period on

each category of nursing personnel were tabulated from these forms.

- 18 Fersonnel observed in the study were defined as: Definitions Since the activity was the basic unit of the Study, activities were recorded in terms of area (functional purpose) and skill level (the training and skill required to perform the activity). Definitions developed

for this study are modifications of those developed for outpatient Depart-

men~ and for In-Patient

U'n1i'2.

Areas of activity were defined as: patient-

centred, personnel centred, unit centred and other centred activities not directed towards the :5 preceding purposes. (See Appendix). Skill

levels of activity were defined on thebaa1e of the training and skill needed to perform the activity and included administration, nurSing, clerical, messenger and unclassified. (See Appendix). The definitions

were tested in the trial observation period on August

9 and 10, at the

OPD and modified on the baSis of minor difficulties encountered. DEFINl!rION AND C01E3 OF PERSONNEL

Sup N, lin or

Director, Supervising Nurse, Nead Nurse or Assistant Head Nurse. Activities which involve planning, directing, evaluating, co-ordinating, reviewing, and making decisions concerning nursing care in the department and clinics. Giving nursing

Ahn

care in order to have opportunity to observe patients, to establish rapport with patients, or to teach nursing staff. Rn Reg1stered Nurse Staff Those nursing procedures listed in the registered nurse job description. st Nursing Student A student in a profeSSional nursing education programme.

11Adams , P., li)w to study the Nursing Service of an OUtpatient Department, Public Health Service Publication No. 407 m Govt. Printing Off. 195'( Wash. D.C. 12 How to Study Nursing Activities in a Patient Unit. Public Health Services Publication No. Y{O. Revised 1964, Govt. Printing Office, Washington, D.C.

- 19 Cl 1 Clinical Instructor Responsible for educational programme Nursing Attendant Refers to all activities in her Job description, which involve nursing skills, or a.re taught in courses giVen to this group. OBSERvm8

The observers who compromised the Study fersonnel were nurses from seven different coutries attending the First Regional Nursing Stndies Seminar.1 :5 Preparation for their roles as observers was an important part of the Seminar progranme and included, among others: group discussions for the clarification of' the functions of' nursing personnel and the definitions of areas and skill levels of activities used to class~

the activities observed;

discussion of observation as a research technique, purpose and method of activity study; practice exercises in USing the definitions and in coding activ1ties; '-

briefing on the physical nlayout" of the OUtpatient Department; participation in the construction of' the Observer's Form for recording observations (See Appendix). Prior to the initiation of the Study, Observers were assigned in teams of two for 2 half' days of ntrial observationn in the OPD. Teams

were used to facilitate comparison of the Coding of Activities by observers and to clarify problems in using the definitions and the accuracy of recOrding and using the codes. Following the trial observation, definitions

were modified and the form for recording observations changed in accord.

ance with the trial observation experiences •

13Held 2-30 August 1965. Countries represented were Japan, Taiwan. Korea, Philippines. New Zealand. Australia and Malyssia.

- 20 -

A Study Team of ten observers collected data for the five-day study period at the Philippine General Hospital Outpatient Department (See Appendix for observation schedules), under the supervisi;::l of two Study Directors. The Observers and the Study Directors reported at the Outpatient Department 15 minutes before the observations were scheduled to begin. During this period the nursing personnel scheduled to be on duty were checked against the nursing personnel assigned to the observers, identifying data on the Observers Forms were filled in and nursing personnel were surveyed to be certain they were wearing the coded armbands. Two Observers were scheduled on each floor during the same observa-

tion period to include the total nursing personnel in the study. nel assigned to each observer varied from

Person-

9 to 10 for the morning out-

patiE'lilt department hours to 4 to 5 during the afternoon hours. Observations began at 7:30 a.m. and finished at 4:00 p.m. with a lunch break from 12:t6 12:30 for the first day of the study. For the

remaining three days observation began at 7:30 a.m. and finished at

4:00 p.m. without a lunch break.

On the fifth day observations began

at 7:30 a.m. and finished at 12:30 p.m. The l.ltudy Directors reported on duty with the Observation Team scheduled for the opening of the Outpatient Department and left when the nursing service personnel reported off duty at the closing of the Outpatient Department. They supervised the collection of data by the

Observers and during the study 1. planned for the assignment of Observers during the s·tudy and facilitated the operation of observer's assignments;

checked schedules of nurSing personnel with the Supervising Nurse of the Outpatient Department to ensure the accuracy of the assignment of p£rBonnel.

- 21 -

circulated in the OPD periodically durillg observations for "spot checking" the observation techniques;

consulted with the observers as needed; spot~checked

the codillg of activities for accuracy by comparing the

activity described with the way it was coded;

reviewed the observer's record for completion and accuracy as each observer completed her scheduled observations;

7. '-

l'Ilanned schedules for the tabulation of data collected by the observers with one of the Seminar Staff who directed the tabulation of Mta;

assisted in the interpretation of data and the preparation of the written report of the Nursing Activity Study.

''''-

- 22 CHAPTER III

FINDINGS, ANALYSIS AND INTERPRETATION OF DATA

The information gathered on the activities of the nursing personnel

observed is viewed in tenns of specific questions, relevant to the objectives of the study, which are mentioned in the early part of this report. It seems appropriate at this point to state that the nursing personnel observed were: seven (7) head rrurses; nine (9) registered

nurses (staff nurses); six (6) nursing attendants (including a dental aide); and eleven (11) students. 'lhis is important to bear in mind if

the true meaning of the figures in the analytical tables is to be had. WHAT IS THE NURSING STAFF

ron)}?

Analytical Table l-A gives the following results: l Of the grand total of 783.6 hours spent by the nursing staff on all the skill levels of administration (A); Nursing (N); Clerical (C); Housekeeping (H); Messenger (M) and Unclassified (U), more than 1/3 or 222.8 hours were at the housekeeping level and nearly 1/4 or 184.8 hours at the clerical level. It is interesting to observe that overall

rrursing skills (administration and ~rsing) combined, consumed just a little more than 1/3 of the total time spent. The clerical, housekeeping

and messenger skills occupied more than 1/2 of the total time spent by

all nursing personnel. Taken separately, as a group, the head nurses gave, out of 229.8 hours of service, only 63.5 or a little mC're than 1/3 to nursing and 24.2 hours or less than 1/10 to administration. Again it is important

to note that the clerical, housekeeping and messenger skill levels engaged close to 1/2 of the head nurses I total hours of work.

!see Appendix

- 23 Considering the type of' preparation of the head nurse and the OPD head nurses' own understanding of their duties and responsibUities (as

presented to the study groug, the findings seem to indicate that the head nurses, whose chief concern is administration, actual.ly are spending a very great part of their t1me on nan-nursing activities (clerical., housekeeping messenger). They are al.so engaging for a significant

portion of their working time in IUlrsing which is primarily a function of the registered nurse (staff nurse). Our personal. observation of the PGH OPD nursing situation tells

us that, considering the volume of work in this department, as reveal.ed in the patient census, the following factors might be contributory to the f1ndings noted above:

There are far too III8l1Y patients to attend to during the actual. clinic hours, particularly in the morning, and the adIp1nistrative aspect of the HN's work is relegated to the background.

In certain clinics the only IUlrsing personnel are the head

IUlrses who by force of circumstances must do activities (not administration) at nearly al.l skill levels and areas. The registered nurse group appears to have given more time than the head nurses to administration and IUlrSing. However, this can be

misleading unless interpreted in terms of the total. number of Rna observed. Actual.ly, there is no great difference in the hours Like the HNs,

spent for these 2 levels of activities by each group. r "' __

the Rna spent al.most 1/2 of their total. hours on tlle clerical., howiekeeping and messenger levels of work.

- 24 ~ir

N\lrsing . attendants gave most of housek~p1ng,

hours to

nursing and a small part to administration.

Messenger

and clerical activities amount these levels.

to 77

hours or

113

of the total for

It is very clear that nursing service personnel all do a big amount· of work at the clerical level. Certainly these hours may well

be spent in nursing by the FIns, in more administratipnbythe ENs and in more housekeeping and elementary nursing work by the nursing attendants. Instead of spending 129.3 hours on housekeeping activities these may profitably be devoted to nursing and administration by both the RNs and the FIns. The fact that 28.1 hours are used by all categories of nursing

persOlUlel for messenger work would seem to point up the need for some other kind of personnel to do this Job. The same COIJIIIIent applies to

the patimt need for clerks to do clerical work and thereby free the nursing group to do What their level of preparation prepared them to perfollD.· c'

'lbe fact that"unclassified activities" is

COlllllOIl to

all groups

is an indication that either many of the things curt'ently being done by nurSing service people are unclass1fiable or that the areas of

activities and class1fication of skill levels and codes developed were not comprehens1ve enough.

~.I1

- 25 lmalytical Table IB Percent of time spent at different skill levels by nursing .service staff complements the results found in Table L\.l At all the skill levels of activities, 55.7% of time is spent on nonnursing activities comprising the clerical, housekeeping and messenger activities, whereas overall nursing skills (administration and nursing) combined cover

305% of the total time spent by the nursing service staff~

There is actually no great d1f'ference in the·-percentage of time spent by the HN and the Rn on the administration and nursing skill levels. Both spent about the same percentages of time on clerical, housekeeping and messenger level activities. The nursing attendant spent most of her hours in housekeeping and nursing and a small percentage in administration. messenger activities amount to 35.3% of her tiJre. It is worthwhile noting that only a negligible number of hours was devoted to teaching patientsby the nursing personnel. junong the stated purposes of the OPO PGH are, as quoted elsewhere in this report, the following: The follow-up ofpaUents discharged from the hospital and tOO teaching and training of medical and nursing students, it can be inferred that teaching of Illthough not expressly stated Clerical and

patients, particularly those discharged

from the hospital, is a function of OPD personnel, especially nurses, whose contacts with patients are close. It is also submitted that among the most effective educational methods of training medical and nursing students is the demonstration of good care an::! treatment of patients, ohich can be emulated. They are,

The kind of patients .mo come to OPO are not seriously ill.

therefore, in a position to receive teaching or pOinters pertinent to the immediate care of their sickness and the maintenance of their own health. The long wait experienced by patients waiting to be called into the clinic

lsee Appendix V - Table IB 2see Appendix V, FigureS 1, 2, 2a and 2b

- 26 might be utilized profitably for health instruction purposes by nursing

personnel. Related to the question of teaching patients, however, are the matters of time for teaching, the circumstances in Which teaching should take place am the very content of teaching am materials for teaching aids. Would nurses have the time to teach? They would have, if the hcurs devoted to the care of the surroundings, supplies and equipment were diverted to patient-centered activities and teaching patients given due importance. It can be assumed that the registered professional nurse would know What to

teach, how to teach and Where to teach.

Certainly, the value of the now

abundant materials on mother and baby care, on nutrition am mental health, accident prevention am prevention of communicable diseases c~not

be over-

emphasized in the attempt to promote health consciousness Rmong the OPD patients. Perhaps, a reView :'Ind rescheduling of clinic hoors might provide the clue as regards time am place for teaching. very little time was spent by the head nurse and registered nurse groups on professional staff development. Ag~in

this is related to time

available and the subject matter of staff development. The demands of heavy patient load and unit-centered activities may not allow staff development activities unless am until time and other categories

of personnel are provided and who vill be doing non-nursing activities.

"''"'

Analytical Tables lA and lB (separate tables for A.M. and P.M.)l show that there is a big dif'f'erence in the 8IJIOunt of time spent by nursing personnel in nursing and housekeeping activities in the morning as compared with afternoon hours. Activities at the nursing skill level

were carried out mostly in the morning and occupied one-third of the total morning time, while only one-tenth of the total afternoon time was thus occupied. Housekeeping activities took almost half the time of the nursing personnel in the afternoon, while accounting for only one-fifth of the morning time.

!see Appendix

- 28 HOW MUCH TIME DOES THE NURSIm STAFF SPEND IN SPECIFIC AREAS OF ACTIVITIES?

l shows that the 435.3 hours spent by all categories of perTable 2A sonnel in care of environment, supplies and equipment is almost twice that spent for patient-centred areas of activity which is only 220.5 hours. (Those devoted to personnel and standby activities amounting to

99.6 hours are a little more than three times the number of hours spent in professional staff development and other personnel activities and nursing student programmes). Table 282 - The percentage of time spent in areas of activities by nursing service staff complements Table 2A. This table shows that the

55.6% of time spent by all categories of personnel in the care of environment, supplies and equipment is almost twice that spent in patientcentred areas of activities which is only 28.1%. Personnel and standby

activities amounting to 12.7% is a little more than three times the personnel activities and nursing student programmes. 3 It is worthwhile noting that only a negligible percentage of time,

that is 0.6%, was devoted to teaching patients. true for professional staff development.

This holds equally

Analytical Tables 2A and 2B (separate tables for A.M. and P.M.)4 reveal a similar finding in the areas of activities where nursing personnel spent their time. Patient centred activities accounted for more

than one-third (1/3) of their hours in the morning as compared to the afternoon hours which took a little less than one-sixth (1/6) of their time. Unit centred activities occupied almost half their morning hours, whereas two-thirds (2/3) of the morning hours were spent in such act ivities.

Ieee Appendix V 2see Appendix V - Table 2B 'see Appendix V, Figures 3, 7&, 3b and 3c

%ee

Appendix "

- 29 ROW MUCH OF THE NURSING STAFF'S TlME IS SPENT ON PATIENT CEl'll'RED

ACTIVITIES ? Analytical Table 3 shows: 5 Of the 11.2 total minutes available per patient from the Hn, Rn

and Na, 2.2 minutes are spent on patient centred activities on the nurs-

ing level, that is on giving direct and indirect care and patient teach_ ing. ""st of their time or 9.0 minutes is spent on other activities These activities may be on personnel Both the fin and Rn Obviously

not in the presence of the patient.

centred, unit centred or other centred activities.

spent more time on other activities than with the patient.

the nursing attendant who does most of the housekeeping and clerical activities spent most of her time away from the patient. 6 ROW MUCH TIME DOES THE NURSING STAFF SPEND PATIENT?

m THE

PRESENCE OF THE

Analytical Table 4 shows that the Hn, Rn and Na spent with the patient a total average amount of 2.2 minutes per patient. Half of this time with the patient was spent by the registered

nurse, while attendant.

36.4'1>

was by the head nurse and 13.6,/> by the nursing

5see AppendiX V

6See AppendiX V

- 30 HOW l«H READ NtlBSE TIME GOES INTO ACTIVITiES THAT COULD BE PERFORMED BY C1l'EER CLMlSES OF PERSONNEL?

Analytical Table 5A.

- Percent of time spent at each area and level of

activity by head nurse group during sample workweek of Y7 hours reveals that the highest percentage of time 47'1> was spent by the HN for unitcentred activities, the secood highest 35'1> was on patient_centred activities, the third highest, 14.4% on personal and standby activities and the least percentage on personnel centred activities which include professional staff development, other personnel activities and nursing student programme. Giving care is the one 1tem within patient centred activities receiv. ing as much as 18'1> or slightly more than hAlf of the total 3'7% for the patient centred area. This is a good sign although a question can again

be raised as to whether or not the EN should function more as administrator than as a nurse. As in Table 2A, teaching patients received

hardly 1% of the time spent by the head nurses.

The percentages tor housekeeping skill level dealing with environment, supplies and equipment are very high. This is also true for the These indi-

percentage ot time devoted to skill at the clerical level.

cate expenditure of time in areas and at skill levels where perhAps other categories ot personnel can function better so thAt the head nurses can be doing more on the administration, teaching and staff development. Analytical Table 51\2 reveals that the highest number of hours:. 17.~, was spent by the head nurses for unit centred activities, the second highest 13.0 hours was on patient centred activities, the third highest 5.4 hours on personal and standby activities, and the least percentage on personnel centred activities which include profeSSional staff development, other

:!see Appendix V - Table 5A - HN 2See Awendix V

• 31 • personnelI';. tivities and nursing student progrannnes. Giving care istile One item within patient centred activities receiving as much as 0.3 hours or slightly more than half' of' the total 13 hours f'or the patient_centred area. Analytical Tables 5A and 5B (separate tables for A.M. & P.M.) 3 are per-

cent of' time, and number of hours spent by the Headnurse Group at each

area and level of activity during a sample workweek of' 21 and 16 hours in the morning and afternoon respectively show that the patient centred activities, 45.1~ or 21 hours, a little less than one half' of' the head· nurses' time vas spent in the morning. Out of' this time, 36.9~ or 7.6 This

hours vas concentrated on activities at the NurSing Skill level.

total time of' 45.1~ in the morning decreased to 16.~ or 2.6 hours in the afternoon out of' which 8.8% or 1.4 hours occupied more on activities at Nursing Skill Level. It was observed however, that very negligible time was spent by the headnurse on the level of' administration both in the morning and afternoon which amounted to

2.?I/o

or 0.5 hours and 1.8% and 0.3 hours respec-

tively as compared to the clerical skill level where they occupied a

little more time amounting to or 0.9 hours in the afternoon •

5.?I/o

or 1.2 hours in the morning and

5.~

Unit centred area of activity occupied a. little more than one-third (38.4'1> or 8.1 hours) of their time in the morni~ whereas, in the afternoon, it accounted f'or less than two-thirds (62.9'1> or 10.1 hours). Personal and Standby time accounted for 11.7'1> or 2.4 hours in the morning and increased to 19.?f!, or 3.1 hours in the afternoon. No appreciable time was spent in teaching patients in the afternoon,

and only 1.'-' or 0.3 hours was accounted for in the morning. Personnel centred activities also accounted f'or a very small preparation of time, 5~

or 1.2 hours in the morning and only 1.2'1> or 0.2

hours in the afternoon.

AppeacUx V

. BY C7rlIER CLASSES OF PERSONNEL?

HOW MUCH BEAD NURSE TIME GOES INTO ACTIVITlES THAT COULD BE PERFORMED

~:roAL TABLE 5A.l. Percent of t1me spent at each area and level of activity by heoanurse gr,oup during s~le

workweek of 37 hours reaveals that

the highest percentage of time 47'1> ,,-no cpent by the HN for unit-centred activities, the second highest 3~ vas on patient_centred activities, the third highest, l4.4'/. on persooal and standby activities and the least percentage on personnel-centred activities which inClude professional staff development, other personnel activities and nursing student programme. Giving care is the one activities receiv. item Within patient-centred . ing as much as lB'/. or patient-centred area.

Sl1~tlY more than half of the total 3~ for the This is a good sign although a question can again

be raised as to whether or not the HN should function more as administrator than as a nurse. l~

As in Table 2A, teaching patients received hardly

of the time spent by the head nurses. The percentages for housekeeping skill level dealing with environ-

ment, supplies and equipment are very high.

This is also true for the These indi-

percentage of t1me devoted to skill at the clerical level.

cate expenditure of time in areas and at skill levels where perhaps other categories of personnel can function better so that the head nursos can be doing more on the administration, teaching and staff development.

lsee APpe.bdix. V - Table 5A - HN

I I I \

HOW MOOR STAFF NURSE'S TIME GOES INTO ACTIVlTIES TflAT COULD BE PERF0RMED BY OTHER CLASSES OF PERSONNEL?

Analytical Table 5A (RN) _ Percent of time spent at each area and level of Getivity by each category of personnel during a sample workweek of 37 hours l indicates that the percentage of time spent by the RN group was divided :I.nto the different areas as follows: unit-centred activities occupied almost half (4B.~) the time; almost a third, or

•

32'1>

lias spent on patient-centred activities; a little more

than liB or l3.~ in personal aodstandby time; aod the least amount of time vas devoted to personnel-centred activities. Of the total time of it (lB.l~)

(32'1» spent on patient-centred activities, more than

hal:f

vas spent in giving I!are. '!he other half vas divided alJDost equally

into other direct nursing activities, exchange of Information, and indirect care

(4.4~, 4.4~ and 4.~ respectively), The remaining O.~ vas utilized in teachlog

patients. Ullit-centred activities, i.e., cleaning of the unit, preparation of supplies and care of equipment made up 48.~ of the total time of the RIf. Because of tile high percentage of time used for these activities the question is raised whether or not the EN should be relieved of these duties so 1hat her time may be devoted to giviog patient care. It can be clearly seen from the table that those activities associated with

the profeSSional development of staff, both personnel and nursing student, occupied a negligible percentage of the time (5.~ of the EN group). As shown in the preceding analysis, it is obvious that the EN group could

devote their nurSing sk1lls to giving care, teaching patients, and professional development leaviog those activities which she now perf'orms to other categories of personnel. ,

Aoalytical Table 5B 2 - AD average number Qf hours spent at each area and level of activity by the RN group during a workweek of' 37 hours complements Table 5A. The table reveals that the highest number of hours was spent by the RN group for unit centred activities which amounted to lB.l hours; the second highest 1l.B hours was on patient centred activities; the third highest on personal and standby activities which amounted to 5 hours and the lE~t

number of' hours on person-

nel centred activities. Giving cere which is one of the items in patient centred activity received

6.7

hours as compared with lB.l~ received on unit centred activities.

Isee J\rpeildix V-Table 5A - EN

- 34 .Analytical Tables 5A and 5Bl (Separate tables for A.M. and P.M.) on percent of time, and number of hours spent at each area and level of activity by the Registered Nurse group during a sample workweek of 21 and 16 hours in the morning and afternoon respectively show that of all areas of

l! "

activity the registered nurses spent IOOre time in the morning on the unit centred area of activities amounting to ~ or 8.7 hours IOOstly on the II

clerical skill level (3.9 hours).

This amount increased to 9.5 hours in

the afternoon mostly on the housekeeping skill level which consumed 6.7 hoo.Jr6 or 4.&1>. The Patient Centred area of activity ranked second among.the areas. In this area time vas mostly spent on the nursing skill level, 6.9 hours (33.6'1» in the morning. This time decreased to 2.5 hours or 14.1$ :I.n the

afternoon. Of the total 6.9 hours on the nursing skill level, 4.7 hours were spent in giving care. Very negligible amount .;f time was spent on other

direct activities, teaching patients, exchange of information, and indirect

care. Other centred area of activities which rated third, in the morning, 2.3 hl'lurs or 10.&1> included personal and standby time on an unclassified skill level. afternoon. Coming last is the Personnel Centred area of activities which received very negligible amount of time amounting to 6.&1> or ll6 hours only on the administrative and clerical slli! level; this time decreased 0.8 hours or This time increase slightly to 2.9 hours or 18.3'1> in the

4.3'1>

in the afternoon.

~ee Appendix V

- 35 HOW MtK:H TIME DO THE NURSOO ATTENDAtfl'S SPEND AT EACH AREA AND lEVEL OF ACTIVITY? Analytical Table 5Al - Percent o~ time spent at each area and level o~ activity by each category of personnel during a sample workweek reveals that the highest percentage o~

time, 75.?f1" was spent by the NA in unit

centred activities which concentrated on housekeeping and clerical activities. She spends 14.9% on patient centred activities and the least on Only 0.1"/0 vas spent on professional As in all other tables and clerical skill levels.

personal and standby time, 9.7"/0.

staff development on the nursing skill level. the NA spent most o~

her hours on

hous~eeping

Analytical 5A and 5B 2 (Separate tables ~or A.M. and P.M.) on per cent o~ time, and number o~

hours spent at each area and level of activity by the

Nursing Attendants during a sample workweek of 21 and 16 hours in the morning and afternoon respectively, show that the nurSing attendants spent 15.1 hours or 72.8% on unit centred activities in the morning. This time

increased to 80.6% or 12.9 hours in the afternoon and vas mostly concentrated on clerical and housekeeping skill levels. amount o~ o~

The next greatest

t1I:le, 3.6 hours or 17.6"/0 vas spent on patient centred activities

which 10.2% or 2.1 hours concentrated at the nursing level in the mornThis decreased to 0.6 hours or 3.4% in the afternoon. very negligible

ing.

amount of time was spent on indirect patient activities, on the administra'~

tion skill level, 0.2% in the morning and 0.?f1, in the afternoon.

Igee Appendix V 2See Appendix V

- 36 WHNr TYPE OF EXPERlENCES ARE THE NURS:Jm STUDEIfl'S RECEIVOO Nr THE OPD? It 1s important to introduce the Analytical Tables 5A-5B (St) by saying that students were observed as i f they were nurses who constituted part of' the nursing service personnel.

The table shows the same trends

among RNs and RNs and these are:

the highest, 40.9'% of' their time was

spent on unit centred activities which includes, among others, 31.9'% on the housekeeping level; 6.li on the clerical level; and O.8i on messen~ ger level. Patient centred activities ranked next Yith

29.5i,

personal

and standby third with 19.5% and personnel centred activities last with 10.1%. Considering the emphasis now being placed on developing the nursing students' ability to teach health to patients, it is worthwhile to note that only 0.2 per cent of' students' time was spent on teaching patients. Indeed it can be said that they were hardly involved in this activity. They, nevertheless, devoted

22%

of' their hours on duty at the OPD to

giving nurSing care.- Collectively, however, the 29.6% spent f'or nursing skill level of activities was slightly lower than the 32.J~ devoted to housekeeping. ConSidering that the RNs and the RNs themselves also spent

considerable time on clerical and houSekeeping and messenger levels of activities (see Tables lA, 2A, lB, 3) and very little on teaching patients and prof'essional staff' development arid nursing student programmes (2B) one wonders whether or not nursing students have actually observed or listened to teaching-patient activities in the OPD. The absence of' the

clinical instructor in the OPD to guide students as they work may account partly for the negligible amount of'time spent in patient teaching.

- 37 Analytical Table 5A and 581 (Separate tables for A.M. and P.M.) on per cent of time, and number of hours spent at each area and level of activit1 by the nursing student group show that they spent more time on patient centred area of activity, 36.9'1> or 7.5 hours out of which 35.2'/. or 7.3 hours were concentrated on the nursing skill level in the morning. This decreased to 22.~

or 3.7 hours in the afternoon out of lIhich 18.4i or 3 hours were mostly spent on the nursing skill level. It is interesting to note that the time spent on unit centred area of

activity, 23.9'1> or 5.3 hours, in the morning lIIA1"k.e~ increased to 62.4i or 9.9 hours in the afternoon, of which on the housekeeping skill level. Almost the same amount of time 23.21> or 4.9 hours were spent by the nursing students on other centred area of activity in the morning out of which 18i or 3.8 hours occupied standby time. The foregoing leads us to wonder what the goals for student experience in the OPD might be and whether these are being attained or not. In any

56.8i or 9.1 hours was concentrated

event the data on student activities are very revealing and perhaps call

for a review of the aimsauil,purposes of clinical education in the OPD. The high percentage of time spent on unclassified activities may stem :from the :failure of the code to provide for activities done by students themselves in connection with their clinical education.

. !see Appendix V

- 38 - . SUMMARY ,OCNCLUSIONS AND. SU::lGESTIONS

The OPD of the Philippine General Hospital has for its purposes the examioation and immediate treatment of charity patients not couf'ined : n the hospital, follow up of patients discharged from the hospital, ar.d '~e

teaching and training of medical and nursing students.

It serves n::i> only

the City of Manila and its environs but also cities and provinces allovEr the country. It carries a heavy volume of work.

Dlring the 5 day-study week the

daily average clinic attendance was 866 patients. The official budgeted posts for nursing service in the OPD are se"-':>llteen: nurses. The nursing staff 1ncluded in this study were 7 head nurses (llli), 9 staff nurses (RN) and 6 1:.ursing attend1Ults. (Na). The findings of the study shaw: 1) That the present clinic schedules account for the concentration one for a supervisor, seven for senior nurses and nina for staf'f'

of patient centred activities within short perior:s both in the morning and 1n the afternoon. They also account for a long break in the sequence of

act1vit1es of nursing personnel wh1ch 1s routinely utilized for unit centred activities at housekeeping level. 2) That much of the professional nurses' time (head nurses and

staff nurses) goes into activities that could be performed by other categories of personnel.

The head nurses and the staff nurses spend a very large proportion of their working hours in housekeeping, clerical and messenger levels of' act iv1ties. Therefore, the amount of time available for staff supervision and

development and for patient care 1s reduced to a minimum.

- '-i> considering that highly trained nursing personnel are utilized in perfOrming non-nur$ing activities to a large extent - it appears that this pattern may become very costly to the Hospital •

.5) That ·among all activities classed in thiB study as patient centred, a negligible amount of time is devoted to patient teaching, which constitutes one of the main functions of an OPD. 4) That there is no clear cut definition of functions of the differ-

ent categories of nursing personnel. OVerlapping of skill levels of activity is evident from the data gathered. The head nurses perform staff nurses andnursing attendants' functiOns as well as activities which require only clerk and messenger Skills. nurses are engaged in aaaiu1a,*1t1au The staff

and even the nursing attendants

carry some amount of admin1strative functions and nursing care activities. All categories of nurSing personnel functions in all areas of activi- . ties, tb! difference being only in the amount of time devoted to several areas. 5) That the activities perfr.rmed by the students in the OPD follow

more or less the same pattern as that of the professional nurses. The time spent in non-nursing activities is sufficiently large to warrant the question whether or not the purpose of a nursing education programme is being fulfilled. On the basis of the findings it is suggested that:

The Hospital and nursing service administrators, within the resources available, give consideration to the previously mentioned findings in order, 1) To find out what factors are responsible for tb! type of activities

being performed by the nursing personnel and the amount of time spent on them. 2) To iden~ify

the extent to which present nursing activities can be

reassigned to different categories of nursing personnel, according to their level of preparation with the objectives of: a) 1Jtiliz1ng the professional nurses (head nurses and staff nurses) to the fullest level of their training.

Increasing the amount of the professional nurses' time available for patient care, patient teaching and professional development of staff and teaching students of nursing.

c) Relieving the professional nurses from

non~nursing

activ1ties at

housekeeping, clerical and messenger levels which could be d,-,legated to the nursing attendants and/or to other categories non-nursing personnel. 3) c~

Considering that one of the objectives of the OPD is to serve as

a laboratory for the learning experiences of nursing students, it is also suggested that the clinical education programme of nursing students in the OPD be reviewed io terms of the educatiotlal goals to be attained.

- 41 -

msCRIPrION OF THE PHILIPPINE GENERAL HOOprrAL A. B. C. Short Historical Iotroduction School of NUrsing and College of Medicine Sketch Floor Plan of the Out Patient Department

II.

coms AND IEFINITIONS - NURSING ACTIVlTY STtllX ROO'l'J!'.R OF PARTlCIPANTS, NURSING ACTIVrrY STtllX

m. IV.

COMPARABLE lESIGNATIONS COMMOtru! USED IN OUT PATlENr NURSING SERVICES ANAUTlCAL TABIES, CHARTS AND GRAPHS

VI. VII.

EXAMPU'.S OF COMPLETED WOOK TABIES 1, 2, 3 BLANK F'CIRlE AND WClUerABIES

• •'--

- 42 -

APPENDIX

Descrl.pt10n 01: the Phi.:'.i:ppine General Hospital School e-1: Nursing College 01: Medicine Sketch Floor Plan 01: the OPD, PGE:

- 43 APmRDlX I - A SHORT Hl:STCEICAL IN'l'ROOOCTION TO THE PHILIPPINE GENERAL HctprrAL Condensed from the Golden Jubilee Book of the Philippine General Hospital, 1 September 1910-1960 The Philippine General Hospital was opened on 1st September, 1910 during the administration of the Han. Dean C. Worcester, Secretary of the Interior and

Dr. Victor G. Heiser, Director of Health Services. In JUly, 1947 it was transferred from the administration of the Office of the President to the UniverSity of the Philippines. '!he hospital was planned to accommode.te 1500 beds but owing to constructional and economic difficulties the bed strength now approximates 1000. The buildings are located on Taft Avenue in Ermita District. At the centre is the main building flanked by the Outpatient Department on the right and the nurses dormitories on the left. These comprise a hos-

pital that has become rightfully an important part of a medical centre to treat the afflicted, to educate medical students and nurses, and to foster medical research. Departments of the Philippine General Hospital The Department of Medicine The Department of Medicine began as a department of the Philippilll8 Medical School, narthe College of Medicine of the University of the Philippines. first head of the Department of Medicine was Dr. William E. ~grave,

'!he

who came

to the PhiUppines during the early years of the American era in the

COI111tJ7.

The Chair of Medicine, as of 1965, has been occupied by six successive heads. In order of their termre of office, Dr. William E. ~grave,

1907 to

1916; Dr. Ariston Bautista y Dim, 1916 to 1928; Dr. Luis El1gio Guerrero y Sison, 1951 to 1960; and Dr. Paulo Campos, 1960 to date.

The bed strength of the Department has increased from 100 to 147.

_ 44 -

The Department of Surgery The present Department of Surgery started as the Surgical Department of the Philippine Civil Hospital during the early years of the twentieth century.

In 1910 it was formally affiliated with the University of the Philippines. The Department of Surgery includes the Gynaecological service, Cancer ~

Diagnostic Clinic, Tumour Clinic and Gener&l Surgery.

Semi-sutonomous sur-

gical services were cre:3.ted in 1939 and sections on speciality surgery were formed subsequently: ur-:.logy, orthopedics, neurosurgery, plastic surgery,

thoracic surgery and anesthesiology. The number of surgical beds is now 169. The Department of Obstetrics The Philippine General Hospital was inaugurated on 1st September 1910 with a ~50

bed capacity.

More than 50 beds were assigned to the Department

of Obstetrics. The bed capacity has now increased births in 1960 was 8511. The Department of Eye, Ear, Nose and Throat In May 1911, eigth months after the opening of the Philippine General Hospital, the Department of Eye, Ear, Nose and Throat was organized as a distinct unit. Service rendered, at that time, was in the form of a free outpatient clinic handling all eye, ear, nose and throat cases. Later the department provided ~1 beds - 16 for males, 16 for females and 5 for children. The department has at this time a total of 56 beds: children 51 adults and 5 .... l' •

138

beds.

The total number of

....-

- 45 The Department of Paediatrics In 1915 a definite ward was established for paedtatric cases with a bed capacity of 61. The diseases then rampant were infantUe beri-beri and typhoid.

The department has developed gradually throughout the years until about tj() beds are now available for paediatrics. 'Dle Department of Gynaecology The Department of Gynaecology started as a division of surgery. 'Dle first

hysterectomy performed in the PGH was on 7th January 1911 by Dr. John R. McDill. The new Department of Gynaecology was inaugurated in 1922, under the direction of Dr. Fernando Calderon. The department has now a bed capacity of 156 and is part of the recently reorganized Department of Obstetrics and Gynaecology. The Department of Radiology, Physical Medicine, and Cancer Institute When the Philippine General Hospital first opened its doors to the public In 1910 the department was only an embryonic unit occupying a portion of Floor 15. It also included a small Radium Emanation Room under the direction of Dr.

A. Clemente, Ph.D. (Chem.).

Since 1918 the functions of the department were varied and embraded services as roentgen, electrical and other physical diagnostic facilities for selected groups of patients; etc. In 1952 the following special roentgene-graphic procedures were introduced: myelography, angiocardiography, splenoportogrlttiphy, cerebral angiography, etc. The department has been constantly active in the field of clinical research. At present the compliment of the medical and nursing staff

ot the department

consists of 4 resident physicians and 9 nurse-therapeutic technicians.

An Occupation Therapy Workshop has been established under the Department ",-- -,

of Radiology.

- 46 -

'D1e Department of Laboratories The Department of Laboratories is the oldest of the entities rendering laboratory service to the Philippine General Hospital. It started inconspicuously in 191' as a branch of the Department of Pthology and Bacteriology under the direction of Dr. Jose Hilario. In 1926 the department became an indepen dent unit with the name of Department of Laboratories. During the war years, the activities of the laboratory were greatly affected by the shortage of supplies and by the general insecurity of the times. With the reestablishment of the Commonwealth Government in August 1945, the Department of Laboratories officially came back to life. During the twenty years following its reestablishment, the Department of Laboratories bas made great strides in the quantity and diversity of work produced. The Receiving and Emergency Department The Receiving and Emergency Department was established when the Philippine General Hospital came into being on 1st September 1910. It bas continued 'l'.

to operate effectively during the past 50 years and now has 112 emergency beds.

-I.'

•

Appendix I - B

- 4'7 -

THE SCHOOL OF NURSING

The hospital operates a large school of nursing offering the 3-year diploW. programme·. which qualifies its graduates to take the state examination for re.

gistration as nurses.

Its present enrolment is 341 of which 102 are in the Only

third or senior year; 106 in the second year and 133 in the first year.

those who have completed 1 year of prescribed collegiate work in a recognized college or university and have otherwise qualified themse:ves are admitted to the school of nursing. The School of Nursing faculty is composed of a Principel (head tutor) an assistant principal, thirteen full-time instructors (tutors) and four part-time instructors. Medical lectures are given by resident physiCians. The faculty

of the School of Nursing is appointed by the director of the hospital. The Philippine General Hospital School of Nursing is the oldest government school of nurSing having been established by an act of the Philippine Legisla. ture (now Congress of the Rlllippines) in

1906.

The first group of students

were admitted in 190'7 and graduated in 1911.

·-

- 48 -

TBF.: COllmE OF MEDICINE, U.P.

In 1905 J at the Annual Meeting of the Philippine Islands Medical Association; Dr.

wm.

M. Musgrave read the resulte of his survey which showed that there

was in the Philippines only one phYSician for every 4~ sq. miles and for every 20,209 inhabitants. Smallpox, plague and cholera were ravaging the population A result of this report was

and there was appalling lack of medical assistance.

the creation, under Act 1415 of the Philippine Commission (Taft Commission), of the Philippine Medical School which opened on June 10, 1907. \/hen the Univer-

sity of the Philippines was established in 1908, the Philippine Medical School was formally affiliated with it, its name changed to College of Medicine and Surgery and its management and control transferred to the Board of Regents of the University. In 1923 the name was shortened to College of Medicine.

Formerly housed in an old building of the School of the Deaf and Blind on Mslcom Drive, the physical facilities of the college kept expanding over the years; it now occupies its own building on Herran St., Manila. The Philippine

General Hospital, which opened to the public in 1910, is used for clinical instruction of medical students, with the clinical faculty of the College also serving on the hospital staff and exerciSing control and supervision over the clinical facilities of the Hospital. The growth of the Philippine General Hospital pralle led that of the College. The programmed of expansion initiated in 1938 by the Philippine Common-

,,'

wealth Government and completed shortly before the outbreak of the Pacific War in 1941. Included a separate three-story building for the outpatient department The battle

(dispensary) and a large two-story edifice for the Cancer Institute.

for the liberation of Manila brought untold havoc and destruction of the college and hospital. The bed capacity became 850. The post-war reconstruction

of its buildings and acquisition of equipment, apparatus and books were made possible by the War DamIIge CommiSsion, the MUtual Security Agency (Ir::A) of the

- 49 -

United states Government, the China Medical Board of New York, Inc. and the National Economic Council, Republic of the Philippines. In the early years of the college the medical course was but two years in length. Eight graduated in 1909.

Administration of the college is vested in the Dean who 1s directly responsible to the President, University of the Philippines. Changes in curriculum have been instituted as required. A 2-year prepara-

tory medical course was prescribed for applicants to the five-year medical cur-

riculum.

Started in 1960, following the approval of the Medical Act of 1959,

only those who have finished the Bachelor of Science (B.S.) or Bachelor of Arts (A.B.) or equivalent became eligible for admission to the COllege. are rigid methods of selection of medical students. In 1964-65, its enrolment was 498 of which There

B9 were 1st year students;

84 were 2nd year; l22 were 3rd year; 99 were 4th year and 104 were 5th year students(internes). Medical course. cine. Internship at the Hospital comes in the 5th year of the

Graduates take the state examination ibr the practice of medi-

Ninety-six students were taken into the 1st year class this academic year 1965-66. The practical phase of medical education calls for clinic experience

of medical students during their 4th and 5th years at the various clinics of the outpatient department. The College of Medicine was approved as a "Class A" medical school by the Associates of American Medical Colleges in 1940 and has since been a member in good standing. When :Ebllippines became independent in 1946, the College became

an affiliate member of the association.

•.

*College of Medicine, univerSity of the :Ebilippines 1961-63 catalogue, 1963-64 Announcements, pp. ;lO-3B.

~ '1,(.,8:.; '. h:-; '.""',

:;::,

.":'.;~; ;', If·~':.v:· : .~":;.~,::;::~.\;·:{:;~::':~:.:(.~>t:~~;~t:l~o':b~~~~i~;.?~~~·::"~t:.?~::;:~;;}::{:::3Y;;::·,:;(:~'::.~ i,.··e.,·,;,;" ;I'.:.~' ;, c.

A2.FEiiiJu.: - Ie

" ,.u __ ..... : ";.,:-.: ,,'\"-'

•

<'i/! '.;: :':;.

:'_'

. '~::': .·';,,:....GG~,--.- ..-1

:., .. ,; .•.•: ...• ' :"

G~<; DENTAL CLINIC

._~.

PHILIPPINF GBJ.lERAL HOSPITAL ..... .. ,: " ., " .,.. 77" ._" .. ="". _ _ .o:---,:,,~.J ~. . OFFICE OF'- .- _.. - - . . . . ~. . .~J T';.:C'.\ ~ WELL BABY I:.":'::;;:; __ THE '. . . ~ -:1 CLINIC ,_ OPD GENERAL l'iEDICAL .. & NEDICAL SPBX:IALISTS ·'IED •. CLINIC OLINIC CLINIC ~'=::pl OBSTEl'RIC FOR CLINIC STUDrnTS ,'.:. :.:, -

~HIEF'

:'~~:=: ~··I if4¥J- --

,=-:r r \ IARY ERVICE .

,.- =-

I' ~-T~ [ . . -=.~- "~"

OBSTETRIC CLINIC

,= "'1== "\"--'" ") - ....~~ ~

1.______... -

I INICIL-'FLUOR:r-'ICAJHE'DICAL

C()P.:'1ic~NICL II CLINIC

lr II

".0.

,. iXl

( EYE CLINIC

\. IL..,..

=--

RO(,n

===-==11=

.--ll-. "'1

L "\ . SOC~'::~V~C~

\1=

o ==;1

,.. H

I EAR, NOSE & THROAT CLINIC

r.. o <Il I=l

PHARMACY

J>:

~UEZON INSTITUTE EXTENSION SERVICE /

o o iXl

J>:

FLOOR

FIR S T

_ :)1 -

t-'

:.-

tJj

0 ~

(

:.>'3 0

::<J t-<

"'.I

en (")

t-'teJ

~o ~z

- 52 -

APPENDIX II

CODES AND DEFINTIIONS - NURSING ArJrrvTI'i STUIJi

....

ANNEX XI

FIR8r REGIONAL NURSING STUDmS S»!INAR 2-30 August 1965

*CODES AND DEFINITIONS - NURSING ACTIVITY STUDY I CLASSIFICATION OF ACTIVITmS ACCORDING TO AREA

The areas of activity for th1s study are four: namely, patient centred, personnel centred, unit centred, and other centred. PATIENT CENTRED ACTIVITms

These activities may occur in the patient's presence or away from him. There are five subgroups of patient-centred activities with identifying code numbers - 11, 12, 13, 14 and 15. Codes 11 and 12 will be used only when the person being observed is actually with patients. Code Number 11 - Giving Care Activities occurring in the presence of the patient, which involve the giving of care, including: Carrying out a nursing procedure. heights and Weights. This includes measuring

ASSisting doctors with treatment or procedures. Giving or assisting patients with personal hygiene. Code Number 12 - Other Direct Activities Activities in the patient's including: pre8~nce

not classified as giving care,

Conversing or exchanging pleasantries with the patient • Evaluating the patient's need for care. Escorting patients. Listening to requests, wishes, and complaints of patients. Making interpretations to patients. Observing the physical condition and behaviour of patients.

• ';-

*Adapted fran "How to Study Nursing Activities in a Patient Unit", Public Health Service No. 370 Revised 1964 and Adams, A., "How to Study the Nursing Service of an Outpatient Department", Public Health Service Publication No. 497, Gov't. Printing Office, Washington, D. C.

~2b

Code Number 13 - "Teaching Patient"includes: Those explanations and demonstrations in relation to health, medications, treatment, or needed follow-up which include a specific reason or answer "why" f'or the patient. Not s statement such as "Because the doctor wants you to," "This is good for your health", or "This will make you feel better." Because patient teaching is considered an important outpatient department service it is listed and coded separately. Observers will need special orientation to identify this activity from merely "telling" or giving of general information. Code Number 14 - "Patient: Exchange of Information About or With Patient", includes: (~ or may not be done in presence of patient) Exchanging verbal reports about or with a specific patient or patients with unit personnel, nursing service administration, physicians, other hospital departments, patient's family and friends, and other interested persons or agencies. Listening to or giving a.m. or p.m. report. Discussing, giving and receiving an assignment related to patient care. Scheduling patients' appointments. Referrala. Discussing/ordering drugs, supplies, or equipment by telephone for a specific patient or patients. (It is understood that the observer will ask the reason for scrutiny of reports). Code Number 15 -"Patient: Indirect Care" means all other patient-centred activities not in the presence of the patient and not involving an exchange of' information about a patient. It includes: Care of records and record forms relating to patient care. Charting of' care given. Checking of' doctor's orders. Errands for patients. Preparation of medications and treatment trays. Setting up and terminal care of eqUipment. Planning and evaluating patient care away from the patient. (The receiving of individual dnig supplies is.considered .part of preparation of medications.

•

- 52c "~

PERSONNEL CENTRED ACTIVITIES These activities are primarily" concerned with the profe~!3ional growth and development of nursing service personnel and with personnel management. Code Number 21 - Professional Development of Staff Participation in all activities conducive to improved nursing service, as well as planned and unplanned events Which increase the knowledge and skill of the staff, including: Demonstrations for teachiqg staff members individually or collectively". Giving or receiving planned or impromptu instruction. Observing and evaluating the quality of work performed. Orienting new staff members to unit. Reading or questioning to gain more information about a drug, treatment, etc. Code Number 22 - Personnel: other

Activities having to do with personnel management (personnel centred activities) including: Staff meetings. Individual conferences on personal matters Which relate to work. Maintaining personnel records and conferring about personnel matters. Code Number 23 - NurSing Student Programme.

.- -

These activities include: Discussions about the nursing students' programme with unit personnel, physicians, clinical instructors, and others. Observing and evaluating the quality of work performed by nursing stUdents. Planning and selecting experiences for nursing students. Teaching nursing students, impromptu or planned. (NOTE: Activities in Which nursing students are involved must be weighed carefully in terms of Whether they are patient centred or personnel centred. If personnel centred, a determination must be made Whether the activity is for the student or for unit staff of Which the student is considered to be a part).

UBIT-CENTRED ACTIVITIES Code Number 31 - This clasll1.1'ication includes: Housekeeping, maintenance of cleanliness, order, and safety on the unit. Obtaining, preparing and dispensing suppUes, equipment and records and all discussions and exchanges of information regarding these activities. Interpreting a hospital policy or procedure to persons other than unit staff or patients. Example: Explaining hospital regulations to visitors. Serving on committees for the purpose of discussing, revising, or 1'ormllie.ting hospital and nursing policy and procedure. Activities related to this study. Discussions, compilation of data, and so forth, for any other research studies • . Errands in search of unit personnel. Making unit records such as time sheets, leave records and daily report. Reporting on or 01'1' duty. Calling out patients I names and numbers. patients. OTHER-CENTRED ACTIVITIES --{

Routing and directing

Code Number 01- Personal These activities include: All activities of a personal nature; such as) coffee breaks,

J: •

conversation about personal affairs, and the like. Code Number 02 - Stand-by Time Time spent waiting for the arrival of a person or thing prior to the start of an activity including: Waiting for a doctor to arrive to assist him with a spinal puncture. Waiting for a sterile dressing tray to arrive in order to change a patient' s dressing •.

CLASSIFICATION OF ACTIVITIES BY SKILL LEVEL

The skill levels for this study are six: administration, nursing, housekeeping, clerical, messell8er and unclassified. Code A - Administration Administration includes activities requirill8 nursing Judgment. These involve responsibility for planning and providing effective patient care, for developing unit personnel, and for managing and operating the nursill8 unit. Patient care activities include: Assignill8 personnel to meet the individual needs of patients.

Plsnning and participating in unit education programme. to ensure safe and effective nursing care. Assisting the physician in his plan for patient care by directing the execution of his orders and reporting to him the patients' symptoms, reactions, and progress. Supervising and evaluating the effectiveness of patient care. Giving nursing care for the purpose of observing a patient, establishing rapport with a patient, or teaching a member or members. of the nursing staff. Promoting, superviSing, and evaluating the education and rehabilitation programme for the patient and his family.

Making nurSing rounds to assess patient's condition, progress, and immediate environment. Development of unit personnel includes: PlanniQ1; for and participating in continuous learning experiences for nursing personnel. Promoting personal growth and development of unit personnel.

'.i

Wri tten am oral evaluations of the work performance of staff members. Unit management activities include: Planning for and maintaining an environment conducive to the wellbeing of patients and personnel. Pranoting good interpersonal relatioDS~i;pS.

Assisting in the development and implementation of objectives aod policies of the nursing service.

- 52f' Code N - NurSing Activities Nursing activities include the direct and indirect activities involved in giving nursing care to patients: Preparing a nursing care plan for direct patient care. Carr,ring out orders prescribed by the physicisn for his individual patients. Observing and reporting on patient's symptoms, reactions and progress. Code C - Clerical level activities include: Copying records, as nursing time sheets. Maintaining graphic records. Assembling chart forms on patient's admission. Directing patients to services. Filling in chart headings and recording heights and weights. Checking charts on discharge. Mak1ng out requisitions for specimens, laboratory services, X-rays, or other professional services, making appointments. Copying, routing, maintaining, and filing records and written camnunications that are essential in co-ordinating professional services in a department or between departments. These duties will be considered clerical, whether or not a clerk is on the service when they are performed, and regardless of who performs them. Routing patients (calling numbers or names) Code H - Housekeeping level activities such as: Cleaning floors, windows, bathrooms and service rooms (except narcotics cabinet). Preparing supplies for the unit. Emptying wastebaskets, dusting furniture. general cleaning of head nurse station, folding linen, washing furniture. Strai~htening and cleaning examining rooms when patient not present. (A nurse may do the initial cleaning up when a patient spills something, or in caring for patient when she is with him. This is not considered housekeeping level). -.;'

.,.....

,..'

Code M - Messenger level activities include: Delivering materials and supplies, charts, records, routine requisitions, etc. Picking up emergency orders of drugs am supplies. Accompanying patients to other parts of outpatient department, if this is established policy. (It is understood that carrying drugs be recorded as a messenger act1v1ty) •

It was decided that the observer should ask any nurse accOIl\Panylng pat1ents to other parts of the department the reason for doing so. The reply will indicate tIE skill level, e.g., "nursing" or "mesaenger") • Code U - Unclass1fied Activities. Unclassified activities are those which are eliminated by definition frem any of the preceding codes. Code U is used to identify those activities which refer to the person as an individual. For example:

Time 10:00 10:30

Person observed RNl RN2 RN3

Area 21 01 02

Level U U

Description Reading new pamphlet on diabetes. Drinking chocolate milk. Waiting to with a 5SSistci?ysician ressl. •

11:00

- 53 -

APPENDDC

III

ROOTER OF PARTICIPAl'ITS, NUBSOO ACTIVl!rY: STUDY, IDH

• ;<

' .....

- 54 -

APPENDDC III

FJBST EmIONAL NURSmJ STUDIES SEMINAR - WPRO ROSTER OF PARTICIPANl'S NURSmJ ACTIVITY STUIlY Philippine General Hospital

CO-Director Field Directors Participants

Miss Maria de Lourdes Verderese Miss l-tU"ia Palmira Tito de }.braes Dean Julita V. Sotejo Mrs. Miss Miss Miss Miss Miss Mrs. Miss Miss Miss Natividad B. Asuque Kazuko Matsushita Kathleen Fowler Fang-chiao Lin Margaret Porter Jean Sutherland Henedina P. Suanes Elizabeth Wilson Julita I; Yabes Siew Yeoh

....

- 55 -

APPENDIX

COMPARABlE IESIGMrIDle C~

USED IN

our

PATlElfr

NURSOO SERVICES

. ..

FIRST BmIONAL llURSOO STUDIES SEMINAR - WIRO CHART SHOWOO COMPARABLE DESIGNATIONS COMMONLY USED IN OUTPATlENT NURSOO SERVICES* PHILIPPINES l'

JAPAN

TAIWAN

MALAYSIA

NEW ZEALAND

KOREA

AtlBTRALIA

SnUAPORE : Departmental NUrsing , Sister i

Departmental Departmental Supervising SuperviBor Supervising SuperviBine NUrsing Supervisor Supervisor Nurse NIo':!'Bimg NUrse Nurse Sister Head Nurse Staff NUrse Clinical Instructor Student Nurse Head NUrse Staff NUrse Head NUrse Staff NUrse Senior Staff Nurse Staff NUrse Departmental Siate!' Bead NUrse

I I

Sister Clinical Instructor Student Nurse Nursing Aid NUrsing Assistant

Senior NUrse Staff NUrse

Staff' Sister , : Staff' and NUrse Staff NUrse Clinical Instructor Student NUrse Community NUrse Hospital Aid Clinical Instructor Student NUrse

'!R

\ Clinical Instructor Student NUrse Assistant NUrse

6. 7.

Clinical Clinical Sister Instructor Instructor Tutor Student Nurse Assistant NUrse NUrses Aid NUrsing Student Student NUrse Assistant NUrae

J I

I I

4. 5.

NUrB1ng Attendant

Assistant Hospital NUrse Attendant

*These deSignations apply to those countries represented by partiCipants of the seminar

- 57 CLASSIFICATION OF PJmSONNEL lis the participants came from d1f:f'erent countries, discussion was neces-

sary to identity the various grades of nursing statt in the hospital, with their levels of responsibility, and to compare these with the grades in the d1tterent countries. The follaw1ng definitions were agreed upon: Supervisor or Supervising Nurse Bas administrative responsibility for the

whole department.

Her activ1ties involve

planning, directing, evaluating, co-ordinating and me.k1ng decisions concerning nursing care in the department and clinics. !:he responsibility is similar to that of: Department Supervisor in New Zealand and Japan Departmental Sister Senior Sister *-tron, Grade II Head Nurse ~:

in the United Kingdom in *-laya in Singapore Bas administrative responsibility for a

clinic or unit.

Her activ1ties include

plsnn1ng, directing, evaluating, co-ordinating and making decisions concerning nursing care in the unit or clinc. She!1'B.Y give

nursing care in order to have an opportunity to observe patients, to establish rapport with patients, or to teach nursing staff, as well as to supply service needs. The responsibil1ty is s1milar to that of Ward Sister in some countries.

- 58 -

Registered Nurse Code: Rn

Is a registered pro1'essional nurse.

Her responsibilities are direct and indirect patient and 1'amily care.

The responsibility is that 01' a Staf1' Nurse in sorne countries. NUrsing Student COde: Is a student in a professional nursing educational programme.

In some countries the n.n-sing student has student status, but in other countries the service needs take precedence over her educational needs. Clinical Instructor Code: Cl. I Is responsible for the educational programme o1"the student nurses. She is not

primarily concerned with service needs. In some countries she is a member of the Nursing School Faculty. Nursing Attendant Code: Wa Receives lion the job" training which varies from 2 to 12 weeks. Her responsibilities "housekeeping~

are largely concerned with

and unit supplies, but also include certain nursing duties de1'ined in her job description. In some countries her responsibilities are comparable with those of a nursing orderly. It is noted that in Ma~a

and Singapore the

hospital attendant (male) and amah (1'emale) are responsible 1'or cleaning, etc. and their duties are comparable with the "helper" in Manila (The Practical, Assistant or State Enrolled NUrse in other countries receives organized training and accepts responsibility for basic cursing care under the supervision of a professional nurse or a doctor.) -< •

- 59 -

APPENDIX V

CHARrS, GRAmS

ANAIX'rICAL TABIES

Figure 2 PERCENT OF TIME SPENT AT DIFFERENT SKILL lEVEL BY NURSOO SERVICE STAFF PHILIPPINE GENERAL HOSPITJ..L, OUTPATIENT DEPI,RTMENT WGUST 16-18, 20 & 21, 1965 Per c e n t o 10 20 30 40 50 60 70 80 90 100 A

Figure 2a PERCENT OF TIME SPENT AT DIFFERENT SKILL LEVEL BY NURSING SERVICE STAFF IN THS OlER OF Mtt.GNITUDE, PHILIPPINE -GENERAL HooPITJ,L. OUTPLTIENT DEPARTMENT AUGUST 16-18, 20 & 21, 1965

o H

20 30

Percent 40 50 60 70

100

LEGEND:

t~~@.~~f::~f~1 M

= H

SOURCE: Analytical Table lB

- 59b Figur e 2b

,04

CATEGORY OF NURSING SERVICE STAFF PERCENT OF TD'iE SPENT AT DIFFERENT SKILL IEVEL BY EACH DEPARTMENT FOR A.I1. AND P.M., PHILIPPINE GENERAL HOSPITAL, OUTPATmNT 1965 AUGUST 16-18 , 20 & 21, Percent 80 70 60 40 50 90 100 30 20 10 b $ .!

Total all Perso nnel

.Head Nurse

(All Day

Regis tered Nurse

i ~

\ ~

A.M. P.M.

Nursi ng Atten dant

;

(AllDaY .h.M.

P.M.

LEG END :

{ ~~1 A N

i~i:i~t1a::1 C

",mI H M

~ u ,

. _."~'. ,'~ '

SOURCE< AnaJ.y ticaJ. Table - IB

- 59c Figure 3 PERCENT OF TIME SPENT IN AREAS OF ACTIVITIES BY NURSING SERVICE STAFF PHILIPPINE GENERAL HOSPITAL, OUTPATIENT DEPARTMENT

AUGUST 16-18, 20 & 21, 1965

o Total Patient Centred C -11

;"---

Per c e n t 20 30

50 60 -'-- _ _ _ _ ..J

k~:Y/./$///~ I~/:"//~ , IXd !

C -12

C -13 C -14 C -15 Total Personnel Centred C - 21 C - 22 C - 23

Total Unit Centred C - 31

Total others Centred C - 01 C - 02

':' , .. '1 .:.;.;.;.:. .. ; ....... ) ........

-, LEGEND

1''"'''''''''9

r~%t~~:1

Patient Centred SOURCE

f,-:--:':.

. . .,. .... '1 ' ..... . .

Personnel Centred

Unit Centred

others Centred

/,nalytical Table - 2B

- 59d Figure 3a PERCENT OF TIME SPENT IN AREAS OF ACTIVITIES BY EACH CATEGORY OF NURSING SERVICE STAFF FOR TIE A.M. & P.M.. PHILIPPINE GENERAL HOSPITAL. OUTPATIENT DEPARTMENT AUGUST 16-18.20 & 21, 1965 PERCENT o 10 20 3() 40 50 60 70 80 90 100

All Day

Total all Personnel A.M. P.M. ·1

All Day

•••••• ... -.. ...... • • • a .••

....

Head Nurse

P.M.

Registered Nurse

A.M. P.M.

All Day

Nursing Attendant

LEGEND

Patient Centered SOURCE: Analytical Table 2B

Personnel Centered

Unit Centered

Other . Centered

Figure 3b

PERCENT OF TIME SPENT IN AREAS OF ACTIVITIES BY NURSING SERVICE SUFF PHILIPPINE GENERAL HOSPITA.L, OUTPf.TIENT DEPARTMENT AUGUST 16-18,20 & 21, 1965

o Patient Centered Personnel Centered Unit Centered Other Centered

PERCENT 40 50 60

100

Figure 30

PERCENT OF TD1E SPENT IN AREAS OF ACTIVITIES BY NURSING SERVICE SThFF IN TIlE OOIER OF THEIR 11lLGNITUDE, PHILIPPINE GENERi'.L HOSPITAL, OUTPl.TIENT mPIJiTMENT AUGUST 16-18,20 &21, 1965

o Unit Centered Patient Centered Other Centered Personnel Centered

PERCENT 40 50 60

LEGEND

Patient Centered

• o...... • • • 0 0 •

Personnel Centered

....... o 0

Other Centered

- 59f -

Figure 4 PERCENT OF AVERAGE AIDUNT OF TOTAL NURSING CARE TIME AVAILABIE PER PATIENT FOR PATIENT CENTERED AND OTHER ACTIVITIES FROM EACH CATEGORY OF NURSING PERSONNEL PHILIPPINE GENERAL HOSPITAL, OUTPATIENT DEPARTMENT AUGUST 16-18,20 & 21, 1965

I Act. ~u

7.1%

I "V~U"~.~u n. ~

Act.

22.1$

! ' i

LEGENDz

~ = Head ~

Nurse Nurse

<ltt "'""

~ = Registered = Nursing

Attendant

- 59g -

Figure 5 STUDENT NURSE - PERCENT OF TD1E SPENT IN THE AREAS OF ACTIVITY DURING A SAMPIE WORKWEEK OF 37 HOURS PHILIPPINE GENERli.L HOSPITAL, OUTPATIENT DEPARTMBNT AUGUST 16-18, 20 & 21, 1965

II II II

II "

•

- 59h Figure 5a STUDENT NURSE - PERCENT OF TIME SPENT AT DIFFERENT SKILL rEVELS PHILIPPINE GENERAL HOSPITAL. OUTPJ.TIENT DEPJ.RTMENT J.UGUST 16-1B. 20 & 21. 1965

....................,. " .a ...... ..................... . .... .. .· ................ ..... .. .. .. ... ,. . ,.,,,.. .. . . ................. , .... .,'~::'::;:~::~::~:;::'~::'::':::" · ............ , ..... , ,. . . .... , .................. . • • .. .. .. • • • • • • • r ........... .

••••••••••••. U-29.3ft)

. , ... ......................... . ......................... ,., ..................... ,."., ......................... ,.,. .................. , ........ " . ••••••••••••• ,. '.' ....... ,.'w ................ ............ ........-...... " .. ............ ~tt.' ..... ' .""1.',,~

.................. , ................. . ....... ... . . .. .. .. .. . . .......... . .., ...... .......................... ., ., ................ .,.,.,".. . . ........... .. ., .. ., .............. ., ...... ., " .................. ., ., ...... ".,.... ..................................... . . .." . . . .. .. .. .. . . .. .. ., ............ ., .... .. .. .. .. .. .. .. .. .. .. .. .. ..'"...... ., .............. .......................... ., .. ., ...... .,". .. .. .. ., ., ........ ., .................... ., .. ., .. . . ..., ........ . .. . .,...................... . .. , .......... .,".,.. .......... ....... ., ., .... .,, ........... ., ........... ,. ..... ., ., ........ , .... .. . .. . .., ........... ., ........ ., ................. " ....................... ., .... ., ., ............ . .... c . . . . . . .. ~ ~

.....

;

•••••••••

••••••••••• ,'

. ; . . . .- - r T " t I . . . . . . . .

•

................. 1

•

• • • • • .. • • .. • • • • • • • • .. • • • • r , , , •• t . . . . . . . . . . . . . . . . . . . ••••••• , • • • • • <1 • • • • • • ;

~.·

• t., •• · . · , •• • ......... ••• • . . . . . . . . . . . , • • • • • r . . . . . . ...

..... .

•••••• tr . . . . . . .

~r·

,J. LE G E N D

A N C

= Administration = Nursing z

~ 11m@1H

m :

Clerical

M : U =

Housekeeping Messenger Unclassified

-60NlJRSING AC'l'lvrI'I' STDDY ANALY'l'lCAL ~Pr.mL

lA - Number of hours spent at different skill levels by nursing service staff

____________________ _ PaH

oro ______________________ __ ,/

Total: A.M. - P.M. DA'lES OF S'roDY August 16-21, 1965 Skill level of activity

Personnel observed

Total,

all levels Total, all personnel _____

T M

783.6 62.3

1176 .8 184.8 222.8

28.1 108.8

Head Nurse _ _ _ _ _ _

229.8 24.2 63.5 56.0 46.'5 336.2 33.8 92.5 73.4 82.8 -~--

"5.8 35.8 2.7 51.0

Registered Nurse _

4.3 20.8 55.4 93.'1 21.6 22.0

Nursing

Attendant

217.6

Nursing Student ___________ 179.4

1.0 53.0 12.9 57.5

2.3 52.7

- 61 PHILIPPmE GENERAL HOOPrI'AL, ourPATIElfr lEPARTMENT

ANAUTEAL TABlE lB - PERCENT OF TIME SPENr Nt DIFFERENT SKILL IEVEIB BY NURSING SERVICE STAFF

ANAUTEAL TABlE lB. - Perceut of t1me spent at d1fi'ereut sk1ll'Uoftls b)' 1l\I1"S1cg service staff HOOPrrAL _-::.;lU::,:B:....-_ _ _ _ _ _ _ _ TarAL: A.M. P.M.

OPD

DNm3 OF STUDI

August 16-21, 1965

Skill level of activity Personael observed Total, all

A ,

C i

levels .'J.'otal, all persouce1 - - ' lOO

I I I

7·9 1 22.E j .2;5.; 28.7

;5. : 1;5.8

Bead NUrse - - - - - - - - - Registered NQrse -----------Clinical Instructor --------NUrsing Attendant ---------Supervising NQrse -----------

lOO l.(Y.'

.10.5

zr.E ·24. '1.1 20.2 24.6

1." o.€

15.6 15.2

10..1 1 21..-12L€

100

9.E 25.4 ~3.0 ,

9.9 10..1

I NUrsing Student ------------

100

0.5 29.-

7.'1 32.1

1.;5 29.3

- 62 NURSING ACTIVITY STUDY ANALYTICAL TABLE 1A. - Number of hours spent at different skill levels by nursing service staff II)SPlTAL _ _ _...:PG:..=:H:...-_ _ _ _ __ ~. A.M. P.M.

OPD

DATES OF STUDY August 16-21 , 1965 Skill level of activity Personnel observed Total,

all 1 levels Total, all personnel _ _

508.5 48.0 J.48.5 132.4 99.3

19.5 60.8

Head Nurse - _________

149.5 17.7C 56.5 36.0 16.5 2l.4.7 'Zl.5 74.5 52.2 31.8 144.3 2.8 17.5 44.2 51.0

Registered Nurse _________ Nursing Attendant _______ .

3.0 19.8 2.2 26.5 14.3 14.5

Nursing Student _____

100.2

0.5 38.5

8.2 12.5

2.0 38.5

I lNUmber of hours Nursing Students spent on levels of activities are not included. •

ANALl'l'ICAL TABLE lB. HOO~AL

Per cent. of t1me spent at different slt1.ll levels by nurs1Dg service staff .~_.A.M.

~Rlli~

___________

OPO _ _ _ _>1' _ _ _ __

DATES OF STUDY

16-21. August 1965

Skill level of act1 v1 ty Personnel observed Total all A

levels 9.5 29.2 26.0 19.5 3.8 12.0

Total, all personnel ------- 100.0

Head Nurse ------.-----------

100.0

ll.9

"57.8 24.1 ll.O

2.0

13.2

Registered Nurse Nur~ing

----------

100.0 100.0 100.0

12.8 1.9 0.5

34.6 24.8 14.8 12.1 30.6 35.3 38.4 8.2 12.5

1.0 9.9

12.0 10.0 38 .4

Attendant ___________

Nurs11~ Student -------------

2.0

•

- 64 >r" •

NURSIm AC'rIVI'IY S'roDY ABALl'l'ICAL 'D'.BLB lAo - Number of hours spent at different skU! levels by IU.\l'Sing service staff' OOSPITAL _ ..POH::.='--_ _ _ _ __ _ _ _ _ _--:A.M. ~

P.M.

om _____ ________ ~~

DA'lE9 OF S'roDY August 16-21. 1965 Sk1l1 level of' activity I

.Personnel observed

Total, levels

aU 1

Total. all persormel

275.1 ~4,.3 28.3 52.4 123.5 , ....

8.6 48.0

.." ,

Head Nurse _

80.3 121.5

6.5 7.0 20.0 30.0 .

0.8 16.0

Registered Nurse _ Nursing Atte~t

6.3 18.0 21.2 51.0 1.5 3.3 11.2 42.5

0.5 24.5 7.3 7.5

73.3

Nursing student _ _ _-'-_ ,

79.2

0.5 14.5

4.7 45.0

0.3 14.2

Number of hours Nursing Students spent on levels of activities are not included.

•

.. ANALYTICAL TABlE lB. HOO~

- 65 -

Percent of time spent at. d1fferent. sk1ll level.s by nurs1IJg service staff _ _ _ _ _-..:A.M.

__~ro~H~____

P.M.

DATES OF S'l'UDY August 16-21., 1965

Sldll level of act! vity

PersomIeJ. observed

Total all levels

Total, all personnel ----_

100 100

5.2 10.3 8.1 8.7

19.0 44.9 24.9 37.4 17.4 42.0 1.5.3 58.0 6.0 56.8

3.1 17.5 1.0 1.9.9 0.4 20.2 J.O.O

Head Nurse --------------Registered Nurse --------N:.(7:l1ng

100 100 100

5.2 3.4.8 2.0 4.5

Attendant ------

10.2

Nursing Student. -----------

0.6 lB. 3

0.4 17.9

- 66 -

AKAIn'lllAL TABLE 2A. _ Number of hours spent in areas of activities by uursicg sl':r:v1ce staff ms~AL

_____~ro~H____________

.~------~~~-----------.Area of activ1ty

Total A.!4. - P.M. 1lATES ~F STliDY August 16-21, 1965 category of personael observed

Reg1sTotal all ' ,Head tered person Nurse Nurse nel

Nursing NursC1.i 1ug Super- Student n1csl Ins- Atten- vis1ng Nurse 1;ruc- dant tor

I ,

Total, all areas ----Total, patIent centered.

783.6 22').8 220.5

336.2 107.4 60.8 15.0 2.4 14.7 14.5

21(.6

11 GIv10g care - - - - - - - 119.4 12 ether direct activitIes ;4.5 13 Te~ch1cg Patient --~---- 4.6 14 Exchacge of Infermation 27.5 15 Indirect Care -------- 34.5 Total, personnel centered,,-___ '

80.8 41.3 13.() 2.0

i i

179.4 52.7

10.8 13~7

32.3 17.) 6.5 0.2 2.0 " 6.3

'-M

5.3 0.2 1.8 5.9-

28.2 21 Professional developmentstaff ________ .,ther ____ 22 Personnel: 23 Nursicg Student'

8.2

19.8 2.5 1.0

0.2

18.2 18.2

4.7 1.8

2.0 , 0.8 ' 5.5

0.2

program

---~---

_____

21.8

16.3 16 3.5 163.5

I -

,T9ta1,

uni~

centered -

435.3 107.8 435.3 107.8

164.'1 164.Q

! 73.5

31 EnvirolllDE!nt, supplies, and equipment _______ Total, other centered ------

,I 73.5

99.6 78.3 21.3

33.0 27.5 5.5

45.5 34.5 11.0

~l.l

I ~

35.0 22.0

01 Personal ---__________ f'2 Standby ___________

16.3 4.8

'I 13.9

. .:.' i .-

PHILIPPINE GENERAL HOOPlTAL, OTJ.rPA'l'JENT DEPAR':l'MElfr ANAUTICAL TABIE 2B PERCDl' OP TIME SPENT m AREAS OF ACTIVlTm3 BY NtRIm; SERVICE firm ~ICAL TABLE 28. - Percent of time spent in areas of activities by nurdll8

service staff

HOSPlTJIl. . OPD

PGR

Total:

A.M. - P.M • DATES OF STUDY A'!5USt 16-21, 1965

Category of personnel observed

, , ,

Area

of act'1v1t;v

Total, all personnel

Head Nurse

Registered Nurse

C11I11cal

Instrue-

ing Attendant

18u1 vis1ng

&!en

Nurse

tor

100.0 100.0 100.0 Total, patient centered28.1 .. ~.1 ~.O· . Total, all areas ------11

'--

I 100.0

-I, ,. 1-

100.0

14.8 i 8.0 i 2.9 I 0.1 0.9 2.Q

JL 29.4 22.0 2.9 0& 0.6 3.3 10.2 10.2 ..

Giving care ---------- .. 15.2

12 Other direct activities-

4.4 0.6 3.5 4.4 3.6 0.6 0.2 2.8 55.6 55.6 12.7 10.0 2.7 I

18.0 18.1 5.6 . 4.5 0.9 4.7 5.9

13 Teaching Patient

------

14 Exchange of information15 Indirect care ---------Total, personnel centered --------

0.7 4.4 4.3 5.8 0.1 0.3 4.8 48.6 48.6 13.6 10.3. 3.3 i

I I I

3.6 . 0.9 0.3 2.4 46.9 46.9 14.4 12.0 2.4

0.1 0.1

Pr· t'essional staff

·developnent ---------22 ·Personnel: . other ~~~-

...

N\,;•• ~ ~

student -~----

program

Total, unit centered ---

'l"i.4

40.9

I 31 Environment,.. supp11es and equipment -------Total, other centered --

75.4 Q.7

40.9 19.5 ! I

01 Personal --------------02 Standby ----------------

7.5 2.2

I I

.17..2 .. 12.3

- 68 -

ANAU:TICAL TABLE 2A. - Number of hours spent in areas of activities by nursing service staff HOSPITAL _~PG,:;:;H,"-

_ _ _ _ _ _ __

_ _..:.'11 _ _ _ _ A.M. _ _ _ _ _ _ P.b!.

OPD _ _ _ _

~~~

______________

DATES OF STUDY _..!A:.:::u:i:ig::::us::.:t::......::l;;;;6~-2::.;1:;,;1~19i:.:6:;,,5::.-._ Category of personnel observed

Area of activity

Total, Head all person- Nurse nel

Regis tered Nurse

Clinical Instructor

NursSuper. iug Atten. visine dant Nurse

, Nursing Student

Total, all areas

------

508.5 14<;'.5 214.7 , 172.9 100.1 29.7 4.4 20.2 67.5 37.3 11.0

144.~

1 100 •1

Total, patient centered 11

85.9 .

25.5 14.8 5.5 0.25 1.75 ~.~

36.9

Giving care ----------12 other direct activities 13 Teaching patient ------

14 Exchange of Information 15 Indirect Care --------Total, personnel centered 2l

24.5 21.9 1.4 1.8 18.7 253.3 253.3 54.4 42.1 12.3

2.0 - .. 7·( 10.2 7.2 1.2 0.8 5.2 "~.3

48.0 13.2 2.2 11.5 11.0 11•• 5

i! 28.0 3.0 .2 1.0 4.7 16.0 16.0

---

.2 .2

Professional staff development

----------

1.0 13.5 91.0 91.0

22 Personnel: other ---23 Nursing programStudent ______________ Total, unit centered -

105.0 105.,)

24.00 24.00

31 Environment, supplies and equipment Total, other centered

------------

57.3

17 . 5 14.5

~.3'

13.6

23.2 5.2 18."

II II I'

,I Personal ,2

Standby --_____________

--------------

18.3 5.,0

9.3 4.3

3.0

" II '\

- 69 -

TABLE 2B. - Percent of time spent in areas of activities by nursing service staff HOSP:rJ.'AL _ _.,PG;.:H=--_ _ _ _ _ __ ==-~/=="'A.M. P.M. CPO DATES OF STUDY August 16-21, 1965

AN~ICAL

j ,

Category of personnel observed Nursing Student Area of activity Total, RegisHead tered all person- Nurse Nurse .nel C1inical Ins-

Wrc-

Nursing Attendent

Supervising Nurse

I , I

Total, all areas -------Total, patient centered-

100.0

100.0 45.3

100.0 39·9 22.3 6.2 1.0 5.' 5.1 6.8

100.0 17.7 10.2 3.8 0.3 1.2 2.2 0.2 0.2

100.0

I i l l Giving care -----------I 112 Other direct activities-

35.4 21.0 5., 0.8 3.5 4.8 6.3 2.9 0.3 3.1 45.5

36.9 28.0 3.0 0.2 1.0 4.7 16.0 16.0

25.0 7.4 1.3 4.7 6.9 4.8 0.8 0.5 3.5 38.3

I '13 Teaching Patient ------114 Exchange of Information15 Indirect care ----------

I I

.>._

Total, personnel centered -------i 121 ProfeSSional staff development ---------·22 Personnel: other -----23 Nursing student program -------------Total, unit centered --31 Enviroument, supplies and equipment -------Total, other centered -101 Personal --------------102 StandbY ~--------------l !

0.5 6.3 42.5 72.8 23.9

12.8 7.8 5.0

11.6 9.6 2.0

10.8 8.5 2.3

9.3 6.4 2.9

23.2 5.3 17.9

- 70 -

NtlRSIRl ACTIVl!l"r STlJD!C

ABAIX'l!ICAL TABU: 2A. - N\1Diber of hours spend in areas of activities b7 IIIll'8ing service statf ~~AL_'

__~ro~H~___________

_______ A.M. _ _ _ '_v___ P.M.

________~Y/~___________ Category of personnel observed Nursing Cll- NursStudent Regis- o1cal ieg SuperTotal, all Head tered Ins- Atten· vising person- Nurse Nurse . truc- dant Nurse tor nel

Area of activity

Total,: all areas ------ 275.1 ....

80.3 121.5 '.

73·3 6.8 2.5 1.0

79.3 15.8 11.5 2·3 0.8 1.2

'total, patient centeredi1 Giving care ----------12 Other direct activities 13 Teaching Patient -----1~ Exchange of Information 15 IDd1rect Care --------,

~1.6

13·3 ~.o

21.5 12.8 1.8 0.2 3.2 3.5 '

19·3 ~.8

2.0

0.2 7.3 10.0

0.3 3.0 .

3.8 3.5

Total, personnel centered ---__ 21.l'!:"Ofessio.nal staff 'development .--------22 Personnel: Other-----,

6.3 3;3

1.0 0.8 ,

5.3

2.2 2.2 ., .•.

-- 2'S'. ,-.' .. "'"

23 Nursing Student program ------------Total, .unit centered~~ 31 Environment, supplies, ' 'aDd. equipment ------

3·0 182.( l82.c

0.2 505 50·5

2.8 72.5 72.5

!o• ','

' 59.( 59.(

49.5 49.5

i !

Total, other .. centered

-~-

45.< 36.~

15.'5 13.0 2.5

22.2 16.2 6.0

7. c

11.8 7.8 ~.o

01 _ 0 " , " - - - - 02 Standby ------------~-

1.( O. '

- 71 -

NURSrnG ACTIVITY STUD'i AN~ICAL

TABLE 28.

Percent of time spent in service staff

~eas

of activities by nursing

HOSPITAL OPD

_-,F,-"G~H I ;,-_.

=-==-==,...,...=-"A .1'11. ,/ P.M. DATES OF STUDY August 10-21, 1965 Category of personnel ob.3erved

Area of activity Total, Head person- Nurse nel all

I Regis- Cl1mtered cal Nurse Instructor Nursing Attendant Supervisiog Nurse

Nursing Student

Total, all areas ------Total, patient centered-

100.0 15.2

100.0

100.0 17.7 10.5

100.0 9.3 3.4 1.4 6.4 4.1

100.0 19.9 14.5 2.8 1.0 1.6 2.8 2.8

16.6 _5.0 .2.5 4.7 4.4 1.2 0.9

11. Giving care --------12 Other direct activities-

7.0 1.8 0.1 2.7 3.6 2.;1

13 Teaching Patient ------14 Exchange of Information15 Indirect care ----------

1.5 0.2 2.6 2.9 4.4 2.1

Total, personnel centered --------

21 Professional staff development ---------22 Personnel: other -----23 Nursing Student program -------------Total, unit centered ---

1..2

1.1

0.3 62.9 62.9 19.3 16.2 I

2.3 59.6 59.6 18.3 13.3 5.0 \ ,

66.1 6L.l

80.5 80.5 10.2 9.5 0.7

62.5 62.5 14.8 9.8 5.6

31 Environment. supplies and equipment----~----

Total, other centered --

16.4 13·1 3-3 I \

01 Personal --------------02 Standby ----------------

3.1

- 72 -

PHILIPPINE GENERAL ImPITAL. OUTPATIENT DEPAR'lMENT AlWJ'.l'1CAL 'lJalLE ,. C(MIABJSON OF AvmAGE Al>llUN'l' OF NmS!!l; CARE fiMI!: AVAILABLE PER PATIENT FROM EACH CA'IBlORY OF NORSDO PERSONNEL wrm 'DlE AVERAGE ~ OF 'l'IME SPENT ON PATIEN'l'-CEN'mBD ACTIVITIES AND O'DIER AC'l'lvrr1E3..

BOOprrAL _...;l'G=H_ __

'l'()'l'AL:

A.M. - P.M.

OPD

" Type of personnel

DATES OF S'l'UDI

August 16-21, 1965

Spent on patlent Total mlnutes centred activ1_" Spent on ties at tae nurs_ other aetivavailable illl!: level lUes

Total, all personnel--------

ll.2

2.2

9.0

Bead NUrse -------------------

'.' 4.8 '.1

0.8 1.1

2·5

Registered Nurse -------------

'·7 2.8

NUrsing Attendant -----------.....

0.' .

....

NUrsing student--_____________

2.5

0.6'

1.9

ANALlTICAL TABLE 4. - Average amount of time per patient each category of nursing personnel spent io the presence of the patient

BOSmAL _ _--=:mH=-_______ OPD _ _ _ _-->II~

Tbtal.

A.M. - P.M. August 16-21, 1965

DATES OF STUDY

Type of personnel

AVerage minutesj per patient I Percent of I :spent in presence of patient total

Total, all personnel -----------___________ _

2.2

100.0

Head Nurse ------~------------------------- ____ _

0.8 1.1

~.4

Registered Nurse ------------- _________________ _ Nursing Attendant ------------------___________ _

50.0

0.3

Nursing Student ------------__________________ _

0.6

100.0

- 74 PHILIPPINE GENERAL HOOP:r:PAL, OUTPATlEl'll' DEPAR'ThIENT ANALYTICAL TABIE 5A PERCElfl' O~' TIME SPENT AT EACH AREA OF ACTIVITY BY EACH CATEnORY OF PERSONNEL DURlliG A SAMPIE WORKWEEK OF 37 HOURS

ANALYTICAL TABIE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a s~mple workweek of 37 hom's. HOSPITAL FGH PEHSO~jNEL

OBSERVED

OPD

HN ----

TarAL A.M. - P.M. DATES OF STUDY August 16-21, 1995 I

, Area of activity Total all Total, all areas lC"vzl ,

Skill level of activity

i I

J I A I

, ;

N i I ~

i ,

, M I I I I

----------_.

i loo.OilO.5 27. 6 i24.4 35.0-1 2.11 27. 1 I , 5·3 18.0 ; ,.. r ' .)~I)

, 1

20.3 0.2

1.6 0.3

15.6

Total, patient centered ----. 11 Giving care -----------------

I o.h ~ , , I

18.0

T 0.2 , I

12 Other direct activities ----. 13 Teaching Patients ----------. 14 Exchange of Information ----. 15 Indirect Care --------------Total, personnel centered. 21 Professional staff development --------------------J 22

0.8 ! 0.2 I

I I I

3.7 1.3 0.6 2.4 1.3 2.7 0.2 0.1

4.7

1.0 0.5

I I

5.9 3.6

i 2.4 1 I i I

0.1

2.6 i 0.1 0.1 I ,

0.7

I !

O.Q

0.1

i 0.6 I 0.1 I

Personnel:

Other ----------~ Progra~

0.3 I 0.3 2.4 47.0 2.2

23 Nursing Student

-_.

Total, unit centered ----. 31 Environment, equipment

! I

i I I

0.1

I r

I I 1

~~:::~~-~~---J --_.

I I I

, !

Ii! 5.8 ! 0.4119.0 i 20.0 I ! I i I i I I , I I

I i

i1.3

, 0.5 i

I I ,

Total, other centered

14.4

i I

I I I I !

01 Personal -------------------

I ;

T ! ,

'12.0 2.4 , I

02 Standby --------------------~

;

1 I I

i :

I I

.. HOSPITAL _..:FGf-H::-__ ,/' OPD

- 75 NUBSIm l!CTrV'J!fi STUDf

ANAUTIUAL TABLE 58. - Average number or hours spent at each area and level ot activity by each category of personnel during a sample workweek ct ~ hours PERSONNEL O~VED HN TC7l'AL: A.M. - P.M.

DATES OF STUDY

August

16-21 &

1965

Skill level of activity Area ofactiv1ty Total, all levels 37·0 13.0 6.7 2.1 0.3 1.8 2.1 1.2 0.1 0.1 0.4 0.1 1.0 A N C

TOtal, all areas

---------

3.8 10.2 9.0 7.6 0.7 lO.l 2.0 0.1 6.7 1.4 0.'5 0.2 0.9 0.'5 0.9 1.0 0.1 ..

0.6 0.1

5.8

Total, patient centered --11 Giving care --------------12 Other direct activities---13 Teaching Patients

0.1

---.---

14 Exchange of InformatiQn---15 Indirect care ----------Total, personnel centered21 Professional staff development --------------22 Personnel: other --------23 Nursing student program --T9tal, ~nit ~entered

0.2 0.2

0.1 0·9 17.4 2.1 .... '"

-----

31 EUvironment, supplies and equipme,nt

----------5.4

0.1 ,7.0 7·5

0,2

0.2

Total, other centered----01 Personal ------------------

4.4 1.0

02 Standby ___________________

- 76 llURSING ACTIVITY Sl'UDY

ANALYTICAL ~ 5A. -

Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 21 hours. A.M • ../

HOSPITAL _-,PG~H"--_ _ PERSONNEL OBSERVED --=HN~_ OPD _ _ _~V _ _ __

DATES OF STUDY 16-21 August 1965

Skill level of activity Area of activity Total i all levels .

;

Total, all areas ----------. 100 Total, patient centered ----. 11

11.9 2.3

37.8

24.0 11.1 5·3 0.2

2.1 13.3 0.4

45.1 24.9 1.3 1.3 4.7 6.9 5·0 0.9 0.5 3.6 38.4 38.4

36.9 ' 24·9

Giving care ---------------. Other direct activities ----.

0.3 0·3 1.0 0·7 3·9 0.2 0.5 3.2 5·7 5.7

5.0 1.0 2·5 3.5 0.2

1.8

0.2

13 Teaching Patients ----------. 14 Exchange of Information ----. 15 Indirect Care --------------Total, personnel centered21 Professional staff development --------------------. 22 Personnel: Other ----------.

1.2 2·3 0.2 0.2 0.9

I I II I

0.7

23 Nursing Student Program

-_.

0.2 0.7 18.7 10.9 0.7 18.7 10.9 1.7 1.7

0.2 0.7

Total, unit. centered ----31 Environment, supplies and equipment

...., .j, 0.7 II

----------------

Total, other centered ---01 Personal -------------------02 Standby

11.7

11. 7 9.7

, I

, ,

9·7 2.0 !

I --------------------~_ f ,

i 1

I 2.0

- 77 NURSING ACTIVrrY STUDY ~ICAL TABlE 5B. - Average number of hours spent at each area and level of

activity by each category of personnel during a sample workweek of 21 HOOprrAL --=ffi=H__ OPD PERSONNEL OBSERVED --=HN=-_

hours P.M.

_ ___.:....../~A.M.

DATES OF STUDY

August 16-21 I 1965

Skill level of activity Area of activity Total, all levels

, A N

C i~2

Total, all areas -----_____ Total, patient centered --11 Giving care --------------12

21.0 2.6 9.:5 0.5 5.2 1.5 0.1 0.:5 0.1 1.0 0.2 1.:5 0.1 1.2 0·9 0.2 0.:5 0.:5 0.7 0.6 8.1 1.2

7.8 7.6 5.2 1.0 0.2 0.5 0.7 0. 1

2.~

0.4

2.7

1.2

Other direct activities----

0.4-

1:5 Teaching Patients---------14 Exchange of Information---15

0.:5 0.5 0.2 0.2

Indirect Care

-------------

Total, personnel centered21 Professional staff development------------------22

Other --------2:5 Nursing Student program---Total, unit centered------:51 Environment, supplies and equipment -----------

Personnel:

0.1 0.1 4.0 2.:5 0.4 0.1

8.1 1.2

0.1

4.0

2.:5

0.4

0.1

Total, other centered----01 Personal -----------------02 standby -------------------

2.4 2.0 0.4

- 78 NURSING ACrrVITY ANALlTICAL TABLE 5A. -

grory{

Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 16 hours. PERSONNEL OBSERVED _.:;:HN::..A.M. ./ P.M.

HOSPITAL _-"'l'G.::;H=--_ _

OPD

DATES OF STlmY August 16-21, 1965 Skill level of activity

Area of activity

Total all levels

A 8.0

N 8.8

I ,

, ,

IH 37.4 0.3

1M 0·9 0.3

Total, all areas ---------~-- 100. Total, patient centered ----11 Giving care ----------------12

25.0

19·9

16.6 5.0 2.5

1.8

8.8 5·0

5.5

Other direct activities-----

0.6

1.3

0.3

13 Teaching Patients ----------14 Exchange of Information ----15 Indirect Care --------------Total, personnel centered21 Professional staff development _ ---------------~_- ____ 22 Personnel: other ----------2; Nursing Student Progrrun ---

4.7 4.4 1.2 0·9

0·9 0.3 0.3

2.2 0.3

1.6 3.5 0.3 0.3 0.3 0.3 0.3 0.3 0·3

0.3

0·3 5.9 5·9 19.3 36.8 19.3 0.6 0.6 0·3 0.3

Total, unit centered ----- 62.9 31 ElIVironment, supplies and eqUipment ---------.------ 62.9

36. Ii

I Total, other centered ----01- Personal -------------------02 Standby --------------------~ 19.3 1.6.2 3.1 --

19·3 -

16.2 3.1

1 ,

- i9 NURSING ACTIVITY EmlDY

ANALlTICAL TABLE 5B. - Average number 01' hours spent at each area and level of activity by each category 01' personnel during a sample workweek 01' 16 hours. HOSPITAL _ _P_G"'H 7.--_ _ _ PEtlSONNBL OBSERVED HN A.M. / P.M. OPD -/ . DATES OF STUDY: August. 16-21, 1965

I Area of activity Total, f all levels 16 2.6 0.8 . 0.4 '0.1 A 1.3 0.3

Skill level 01' activity I , I N M C H 1.4 1.4 0.8 0.2 0.1 4.0 0.9 6.0 0.1

Totsl, all areas -------~---. Total, patient centered 11 12

3·2

----.

Giving care ----------------. Other direct activities ----

13 Teaching Patients 14 15 ~change

---------,;.... 0.7 0·7 0.2 0.1 0.1 0.1 0.4 0.2 0.6 0.1

of Ini'ormation ----

Indirect Gare ------~-------. Total, personnel centered.

21 Professional staff development -------------------22

0.1

Personnel:

Other ----------

23 NurSing Student program ----

0.1

0.1 0.9 0.9 3·1 3·1 5.9 0.1 0.1 O.l.

Total, unit centered .---:" .. 10.1 . . ...... 31 Envirollll1ent, supplies and equipment --------~------l.O.l

5.9

0.1

Total, other centered ---1 01

I , • I

3.1 2.6 0·5 ,

3.1 2.6 0.5 I

Personal -------------------~

Standby --------------------~I I

•

----- -

--"~

- 80 NURSING AC'l'lvI'lt S'roDY A~YTlCAL ~

SA. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 37 hours· PGR t/

HOSPITAL

PERSONNEL OBSERVED

Total:

A.M. - P.M.

DA'lE9 OF S'ruDY August 16-21, 1965 Skill level of activity

Area of activity

all i levels' Total,

Total, i

I U

all areas ___________

100.0 10.1 27.3 21.9 24.6 32.0 1.0 26.1 18.1 18.1 4.4 3.1 0.8 0.2 0.6 4.4 0.7 2.1 4., 0.1 2.2 5.8 4.7 0.2 4.6 0.1

0.8 15.3 0.2

Total, patient centered ____

Giving care ________________

I I

12 other direct activities ____ 13 Teaching Patients __________ 14 Exchange of Information ____ 15 Indirect Care ______________ Total, personnel 2l cente~

1.2 1.6: 1.8i 0.1 0.1:

0.1

I I

I 0.8 0.5 0.2 0.1 0.5 1.0 1.0 I I

Professional staff development • ____________ • ____ ._ Other __________ 22 Personnel: 23 Nursing Student program ____ Total, unit centered _______

0.7 0.1 D."'> 0.1 4.8 4.5 48.6 4.4 48.6 4.4

0.1

O.l T 0.1,

.,I

, I

;

1.0'17.2 24.5 1.0 17.2124.5 ;

supplies and 31 Environment, equipment _________________

, i I I

01 02

Total, other centered _______ . 13.6 Personal ____________________

I , I I

, !

i r , !

0.5 ! I

0.1 i13.5 0.1

Standby _____________________ . i ,

10.3 3.3

! , j t

, 110.2 ; , 3.3 : I

I, ,

II ,

.. OPO . V

- 81 NT,RlING ICUY1!l"i

S'.l'I1IW:

ANAIX'l'lI:AL TABLE 5B. - Average number of hours spent at each area and level ot activity by each category ot personnel during a sample workweek ot hours

.a..

HOSPrl'AL _..:lG""H=-_ _ _ PERSONNEL OBSERVED R.N.

Total :

A.M. - P.M.

DATES OF STUIJY:

August 16-21 I 1<)65

Skill level of activity Area of activity Total, aU levels A N C

Total, all areas ---------Total, patient centered --Giving care --------------12 other direct activities --U

3.9 10.0 8.1

9.1

'.2

5·7

u.8 6.7 1.5 0.3 1·7 1.6 2.1

0.5

9.5 .-

1.7

6.7

1.1 J.4 0.1 0·3 0.1 1.8 0.1 1.1 1.6 ,.~

13 Teaching Patients --------14 Exchange of Information --15 Indirect

0.2 0.8 0.6

care -------------

O.S 0.7 0.3 0.2 '.1

Total, personnel centered-

21 Professional staff deveI .

loJXDent - - - - - - - - - - 22 Personnel: Other ---------

23 NUrsing Student program---Total, unit ceatered -----

0.3 0.1 1.7 18.1

0.4 6.4

9.1

0.2

0.4 0.4

Env1ronment~

supplies and eqUipment ------------

18.1

1.6

0.4 6.4

9.1

0.2

Total, other centered ----

5.0 3.8 1.2

01 Personal -----------------02 Standby -------------------

- 82 -

ANAIrllCAL 'l'ABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of .31..hours IItSPrl'AL Rl:H· Pl!1lSONNEL OBSERVED EN / A.M..

P.M.

OPDI/'

DATES OF STUDY August 16-21, 1965 Skill level of activity

Area of activity

'l'otal, all

levels Total, all areas -------Total. patient centered - II

lOO.O 12.9

34·7 24.2 14.8 5·3 22.4 4.3 l.l

1.0 12.4 0.2

40.0 22.4 6.1 1.0

1.4 33·1

Giving care -----------Other direct activities ---

0.1

13 14 15

Teaching patients --------Exchange of Ioformation ---

0.2

0•. 8

5.4 5.1 6.8

1.1 .2.6 0.1 3.0 6.1

1.7 l~

Indirect Care ------------Total. personnel centered ProfesBional staff deve-

0.1 ('.5 I

0.2

lopment ----------------22 ··Personnel: Other ---------

- 0.5 6.3 42.4

0.1 6.0 0.2

0.4 0.1 0.7 1.2

23 . Nursing student program --,. Total, unit centered -----.. . ..

5.4 1.6 18.7 14.8 5.4 1.6 18.7 14.8

• J I,

Env1romaent~

supplies and

equiJment -~---------------

0.7 1.2

Total. other centered _____ 01 02

10.6 ..

0.1 10.7 0.1 8.4 2.3

Pereonal -----______________ Standby ___________________

8.5 2.3

NtlBSIm ACTIVrJ.'X' STUDJ:

ANAUTICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of ~ hours HOOPrrAL _.,....!.Rl:::!H:!..-_ _ OPD v PERSONNEL OBSERVED RN

DATES OF STUm August 16-21 I 1965

A.M.

P.M.

Skill level of activity Area of Activity Total, all levels A

Total, all areas Total, patient centered ---

2.7

7.1 5.2 6.9 1.2 4.7

3.1

0.2 0.1

2·7

...

8.4 0.2 4.7 1.4 0.2 1.1 0.2 1.0 1.6 1.4

11 Giving care --------------12

other direct activities

---

0.9 0.4 0.2

0.1

13 Teaching Patients --------14 Exchange of Information --15 Indirect Care ------------Total, personnel centered21 Professional staff development -----------------22

0.5 0.4 , 0.6 0.4 0.1 0.1

Personnel; Other ------..;

0.1 1.5 1.4 8.7 1.1 8.7 1.1 0.2 0.1 3.9 3.1 3.1 0.1 0.1

0.1

23 Nursing student program--,Total, unit c::entered7--31 Environment , sup;lies and equipment ------------

0.3 0.3

0.2 3.9

Total, other ceot.ered ----

2.3 1.8 0.5

2.3 1.8 0.'5

01 Personal -----------------02 Standby -------------------

- 8If. _ -

~AL

TABlE 5A. - Percent of time spent at each area and level of acti:vityby~ch category of personnel during a sample workweek of 16 hours PGH . PERSONNEL OBSERVED RN A.M. ./

ED:!Pr;rAL OPO .

I>.M. .

v .

DATES OF STUm AUgust 16-21 I 1995.,

Skill level of activity A N

Area of activity

Total, all levels 100.0

TOtal, all areas

--_ .. _--------~'

5.2 14.9 17.4 42.0 14.1 10.6 ,

0.4 20.1 0.2

'I'Otal, patient centered 11

17.7 0.2 10.6 . 1.4 0.3 2.6 2.B 4.3 o.~

3.0

0.2

Giving care --------------~12 other direct activities

----

•

1.0 ....Q.~? 4 _

_.--- -.-

0.2 -- -- . -- --_._--

13 Teaching Patients 15 Indirect care

- ..-------

0.3 1.4 0.8 O.B 1.2 1.6 0.2 1.2

14 Exchange of Information - - - .

---------

Total, personnel centered 21 Professional staff deve_ lopO'lent --------------.;-.--~

2.;

2.0 . l.1I

QQ4

1.2

22 Personnel: other --'"----.-' ·,2} . NurSing Student program .....-..... Total, unit centered ----... ,

. 2.3 . 59.7 .. 1.~

'.4 , ."

2,'

.14.4 41.B

0.2

0.6 I'

31 Environment, supplies and equipment -----------------

59.7

2.~

14.4 41.B

0.2 0.6

Total,Ctbar.center&d 01

---

lB.3 13.4 4.9 ,

l8.~

personal·------~~-_-- ___ --_

1204 4.9 , .

02 standby - _______-----------.

- 85 NmSlm ArJrr.lrI!t STtlD1'

ANAI:!TD:!AL TABLE 5B. - Average number of hours spent at each area and level of

activity by each category of personnel during a sample workweel: of .1:§... hGurs roH " PEBSONNEL OBSERVED

BOOPrrAL OPD

ror .DA'm)

A.M.

,,/

P.M.

OF STUDY

August 16-21, ~965

Skill level of activity Area of activity Total, all levels 16 2.8 1.7 0.2 0.1 .

I I

I , , I

Total, all areas----------Total, patient centered---11 Giving care --------------12

0.8 . 2.5

3.0

6.7

3.0

2.3 0.5 . I 1.7 0.2 ' !

other direct activities ---

13 Teaching Patients --------14 Exchange of information---15 Indirect Care ------------Total, personnel centered21 Professional staff development -----------------22 Personnel: other --------23 NUrSing student program---Total, unit centered ----- I , :

0.1 0.2 0.2 0.1 i 0.3

I ; i

0.4 0.4 0.8 J

I ,

! 0.4 1

0.2 10.2 0.1 0.2 0.1

0.4 10.1 0.4 10.3

I ..

9.5

I ·0.4 !

2.3 I

6.7

0.1

31 EnVironment, supplies and eqUipment ------------

9.5

0.4

2·3

6.7

0.1

I Total, other centered ---01 Personal -----------------_ standby -------____________ 02

, i I

I , , 2.9 1 2.1

! 2.9

2.!l 0.8

, J

0.8

- 86 NURSING ACTIVlTY STUDY

AlIAIn.ICAL TABlE 5A.

Per cent. of time spent at each area aDd l.evel of activity by each category of personnel during a sample workweek. -",NA~_

HOOPlTAL _.::.PG:::H=--_ PEFiSONNEL OBSERVED

Total A.M. - P.M.

OPD

_---.,;1 ___

DATES OF STUDY August 16-21, 1965

Skill level of activity Area of activity all areas ____________

Total, all levels

Total,

100 14.9 7·9 2.0 0.1 0.9 3.0 0.1

Total, patient centered ----II GiviDg care ----------------12 other direct activities _____

1.9 0.2

9.5 9.4 7.9 0.8 0.1

25.7 43.0 2.7 0.7 0.8 0.6 1.3 0·7

9.8 1.8

10.1 0.1

1.4 0.2 0.2 0.1

.13 Teaching Patients ---------__ 14 ExcbaQge of Information ----15 Indirect Care --------------Total, personnel centered-

0.2

0.6

21 Professional staff development --------------------22 Personnel: Other -----------

0.1

23 NursiDg Student

ProgralllDle ---

Total, unit centered -----

75.3 75.3 9.7

1.7 1.7

23.0 42.3 23.0 42.3

8.0 8.0

0.3 0.3 9.7 7.5

31 Environment, supplies aDd equipment ---------------Total, other centered-----

01 Personal -----------.-------02 Standby ---------------------

2.2

.. ABALITlCAL TABIE 5B. HOOPITAL _.!.:PGH~_ _

- 87 l'JURSING Am'IVlTY STUDY Average llUIDber of hours spent at each area and level of activity by each category of personnel during a BBIIlPle workweek of ~ hours. PERSONNEL OBSERVED .....::NA:::...__ Total A.M. - P.M. DATES OF STUDY Aup:ust 16-21. 19~

OPD

Skill level of acti vity

Area of activity

Total, A aU levels ~

Total, all areas --------Total, patient centered---

0·7

3.5 3.4 2.9 o.~

9·5 1.0

15.9 0.3

3.7 0.7

3.7

5.5 0.1 2.9 1.1 0.3 1.2 0.1 0.1 0.1

11 Giving care -------------- . '12 Other direct activities --

0.3 0.2

0.5 0.1 0.3 0.1

13 Teaching Patients -------14 Exchange of Information -_ 15 Indirect

care ------------

0.2 0.1 0.1

0.5

Total, personnel centered---_

21 Professional staff deve_ lopment ---------------22 Personnel: Other -------

23 Nursing Student ProgrammeTotal, unit centered ------

I 1, 27. 8 10 . 6 ! ,

8.5 8.5

15.6 15.6

3.0 3.0

0.1 0.1 3.6 2.8

31 Enviroument, supplies and equipment -------------_ Total, other centered----

?I.8:0.6 ,

3.6 ! 2.8i i

01 Personal ---- _____________ 02

Standby --________________

0.81

0.8

- 88 NURSIm ACtlvl'lY S'roDY

ANALYTICAL ~ SA. - Percent of time spent at each area and lavel of activi ty by eaoh category of personnel during a sample workweek of 21 hours ImPlTAL

OPO

------PQII------v'

PERSONNEL OBSERVPD

A.M.

P.M.

. DATES OF S'lU>Y August 16-21, 1965

SkUl level of activity Area of activity all levels Total, all areas ___________ Total, I I

I i i 1

i I

100.0 17.6 10.2 3.8 0.1 1.3 2.3 0.2 I

1.9 12.1 30.7 :5.3 1 0.2 11.9 2.7 10.2 0.1 0.7 0.2 0.7 1.0

10.0 10.0 2.7 0.1

Total, patient centered ____ Giving care _________________

12 other direct activities _____ Teaching Patients ___________ 13 14 Exchange of Information _____ 15 Indirect Care _____________ ._ Total, personnel centered ___ staff develop21 Professional ment ______________________ 22

0.9 1.0 I

. 1.9 !

! . i I

J 0.4 i 0.4 ! I I

0.1

0.2

;

I •

Personnel: Other -.-------23 Nursing Student program _____ Total, un! t centered ________

I I

72.8 I I

, 1.7; ! I !

supplies and 31 Environment, equipment _________________ Total; other centered _~

27.9

35.3

7.3

0.5 9. 4 I 1 6.41

_____

9.4

I I t

;

•

01 02

Personal -------------------Standby _____________________ i

, t

t ! ;

I t

I 3.0' i ,

- B9 -

HOSPITAL PGH OPD _ _ _ V _ __

NURSING ACTIVITY STUDY

ANALYTICAL TABLE 56. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 21 hours PERSONNEL OBSERVED NA

A.M. _ _-,P.M. August 16-21, 1965

DATES OF STUDY I I

Area of activity

I I

Total, all levels Total, allare!S ___________ Total, patient centered ____ , 11

Skill level of activity , , , N C H

21.0 0.3 3.6 2.1 0.9 0.2 0.4 0.4

2.9 6.3 2.5 0.5

7.4

2.1 0.6

2.0

...

Giving care ________________

, 2.1 0.3 0.2 I i i

12 Other direct activities _____ 13 Teaching Patients __________ 14 Exchange of Information ____ Indirect Care ______________ 15 Total, personnel centered __ 21 22

0.4 0.1 0.1

I , ,

, I

0.1 0.1 0.2 0.4 .

, !

i I i,

Professional staff deve__________________ lo~ent

0.4

I ,

[

0.4 : I

I ,

! i

1 , ,

...

Personnel: Nursing Student program ____ Total, unit centered _______

Other __________

15.1 0.3 15.1 0.3 1.9 1.3 0.6 i

I ! 5.8 I i

7.4 i ,

1.5 i

0.1 0.1 1.91 1.3 i 0.6 . !

supplies 31 Environment, and equipment _____________

I 5.8 7.4

i 1.5

Total, other centered _______

01 02

Personal ____________________ Standby _____________________

;

I !

I , , i

! ! !

1 , ,

i . ,

: I

..,.

- 90 NURSIOO ACTIVITY STODY "

ANALYTICAL 'mIlLE SA. - Percent of time spent at each area and level of activity by each catego~ of personnel during a sample workweek of 16 hours HOOPITAL

OID _______ ________ ~~

_--,PG~H~_ _

PERSONNEL OBSERVED

A.M.

P.M.

DA'mS OF S'lUDY August 16-21, 1965

I Area of activity Total, I all A levels

Skill level of activity N

, U

;

I i

Total,

100.0 Total, patient centered ____ 9.1 3.4 1.3 0.4 4.0 I

all areas ___________

2.0 4.4 15.4 513.0 0.3 4.4 2.1 2.0 3.4 0.7 I . 0.3 !

9.9 10.3 0.3

Giving care _________________

12 Other direct activities

13 14 Exchange of Information _____ 15 Indirect Care _______________ Total, personnel centered ___

Teaching Patients ___________

-----

0.3

0.3 0.3

0.4 1.4

2.0

I I

I !

staff develop21 Professional ment ______________________

! ,

22 Personnel:

Other ___________

23 Nursing Student program _____ Total, unit centered ________ supplies and 31 Environment, equipment _________________ Total, other centered _______

i !

i 1.7 1.7 13.3 56.0 13.3 56.0

80.6 80.6 10.3 Q.6 0.7 ! , i

9.6

9.6 10.3

I I ,

01 -Personal -------------------Standby _____________________ 02

I j

, ;

, 9.6 I 0.7 I , I

, ,

-- 91 NURSIOO AC'!'!v!'IYS'!UDY.

ANALYTICAL TABLE 58. - Average hUmber 'of hours spent" at each area and" level of activity by each category of personnel during a sample wo~ek of 16 hours IKlSP!TAL _--!l'GH..:!!!._ _ OPO _ _ _ _.!:: .....

=--__

PERSONNEL OOSERVED

A.14.

0/ P.M.

DAms OF S'lUDY August 16-21, 1965 Skill level of activity .

Area of activity

Total, all levels

I .

I N

, • C

Total, all

areas ___________

16.0 0.3 1.5 0.6 0.2 "

0.8 2.5 0.8 0.4

9.3 0.3

1.5 1.6

Total, patient centered-____ 11

---

Giving care ________________

0.6 0.1 0.1 0.1 0.1 0.2 0.3

12 Other direct activities ____ 13 Teaching Patients ___"-______ 14 Exchange of Information ____ Indirect care ______________ 15 Total, personnel centered-__ " "

0.1 0;6

21 22

Professional staff developnent _______________ --personnel: ""

I " 12.0 1."3 O. I

Other"~ __ -------

23 Nursing Stucient progr'!lll--..,.,. Total, unit "centered" __ ;.:;.;.._;. " :

2.1 ""

9.0

"1.5 1.5 1 166

31 Environment, supplies and equipnent __ ;.;. ____;.;.__ Total, other centered ______ "

"12.9 ,-0.3 1.6 I 1.5 0.1 I

2:1 I , I

9.0'-

I I , I T

01 02

Personal ___________________ , Standby ____________________ I!

I ! I

i I

! I ,

I I

! 11.5 i I 0.1

I i :

;-~

r'- '

-92PHILIPPINE GENERAL HOOprrAL, OurPATIENT IEPAR'l'MENl' ANAUTICAL TABlE 5A. - PERCENT OF TIME SPENT AT EACH AREA AND IEVEL OF ACTIVIT! BY EACH CATEXlORY OF PERSONNEL 'CURING A SAMPlE WORKWEEK OF Yr HOURS

,...

ANALYTICAL TNBLE SA. - Percent of time .spent at each area and level of activi ty by each category of personnel during a sample workweek of 37 hours IIlSPI~

PGH

PERSONNEL OBSERVED

OPO

DAms OF SWDY August 160021, 1965

Total:

A.M. - P.M.

Skill level of activity Area of activity Total, all levels A N

Total, all areas ___________ 100.0 Total, patient centered _____ 29.5 11 Giving care __________________ 22.0 12 other direct activities ______ 2.9 13 Teaching Patients __________ 0.2

0.6 29.6

7·~_22.l

0.6 27.8 1.0 : 22.0 1.8 0.7 0.2 0.9 2.9 0.3 1.7 0.1 1.7 0.1

o .r q

1.2 29.3 0.4 0.1

0.4 0.1 0.2 8.3 8.3

14 Exchange of Infonnation _____ 15 Indirect Care ____________ ,

0.9 3.3 10.1 10.1

Total, personnel centered __ 21 Professional staff development _______________________ 22 Personnel: 23 Nursing Student program ____ Total, unit centered __ 31 Environment, supplies and equipment _________________ 1-

Other ___________

_ 40.9 40 .9

0.6 0.6

0.1 0.1

6.1 31.9 6.1 31.9

0.8 0.8

1.4 1.4

Total, other centered ____ Personal __________________ 01 02 Standby ___ --------

" 19.5 19.5 7.2 12.3

" II

- 93 -

Area of activity

NURSIOO ACTIVITY STUDY

ANALYTICAL TABLE 56. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 37 hours lmPlTAL ~PG~H,--_ _ PERSONNEL OBSERVED St OPD _ _~V~_ _ __ DUES OF S'lU)Y Total A .M.-P .M. August 16-21., 1965

Skill level of activity Total. all levels __0-

U -

. 0.2 10.8 2.7 11.9 10.2 0.4 0.1 8.1 0.7

37 Total. patient centered ---- 10.9 11 Giving care ________________

Total. all

areas____________

0.5 0.2

_. _. 10.9

8.1 1.2 0.1 0.3

12 Other direct activit1es _____ Teaching Patients __________ 13 14 Exchange of Information ____ Indirect Care ______________ 15 Total, personnel centered-

0.3

0.2

0.1 0.3 1.0 0.1 0.6 0.1 3.1

1.2 3.7

Professional staff development _______________

Other __________ 22 Personnel: 23 NUrsing Student program ---Total. un1 t centered -----

3.7

0.6

3.1

15.1

0.2 0.2

2.3 11.8 2.3 11.8

0.3 0.3

0.'5

supplies 31 Environment, and equipment ___________ 15.1

0.5

01 02

Total, other centered---Personal _________________ Standby __________________

7.3 2.7 4.6

-94NURSING ACTIVITY' ST!lDY ANALYTICAL T.ruBLE SA. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 21 hours JK)SPITAL _ _...;.PGH..;:::._ _ OPD _ _ _....::/:....-:_ __ PERSONNEL OBSERVED

St DAms OF ST!lDY

V A.M. P.M. August 16-21, 1965

Skill level of activity Area of activity f

Total'l A all levels Total, all areas __________

, M

I !

I U

100.0 36.9 'Zl.9

Total, pat1ent centered _____ 11

0.5 38.5 8.3 12.4 35.2 0.8 0.2 I

2.0 I

38.3 0.2

0.5

G1v1ng care _________________

'Z7.9 I .2.0 0.5 0.3 . • 0.8,

12 Other direct act1vit1es _____ 13 Teach1ng Pat1ents _______

3.0 0.3 1.0 I 4.7 16.0 16.0

0.5

~---

14 .Exchange of Informat1on _____ Indirect Care _______________ Total, personnel centered ___ ment ______________________ Other _________ 22 Personnel: 23 Nurs1ng Student program _____ . _ ~

r 0.2 , ,

0.2

4.2 0.3 3.0 0.3 I I f

12.7 I , f

21 Professional staff develop-

3.0 0.3 j i

12.7

Total, un1t centered ________

23.9

0.5 ...

I '! . 0.3' 7.2 i 12.2 j

1.5

2.2 2.2 23.2 5.2 I 18.0 ! I

~v.1ronment supplies and equ1pment , _________________

23.9 23.2

0.5 I ,

.1I i! 0.3'7.2112.21 . I

11.5

01 02

Total, other centered __ ~ ____ Personal ____________________ . Standby _____________________ ~.

i i I

i T' , I !

I !

•

I ,

! j

I ,

I '.

i I

OOSPITAL OPD _-..:P;.::GH~_ _

- 95 • NURSIm ACTIVITY S'lUDY

ANALYTICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of personnel duringaa sample workweek of 21 hours ", -

A.M. _ _--....P.M.

DATES OF STUDY August 16 21-I 1965 SkUl level of activity

Area of activity

Total, all levels 21

Total, all areas

-----------

0.1

8.0 1.6 7.3 0.1 5.8 0.4 0.1 0.1 0.1 0.9 0.6

2.6

0.4 0.1

8.3

Total, patient centered ____ 11

, :

7.5 5.8 0.6 0.1 0.1 0.9 3.3

Giving care ________________ Other direct activities _____ Teaching Patients __________ Exchange of Information ____ Indirect Care ______________ Total, personnel centered-

12 13 -14 15

0.1 , ,

2.7 2.7

. : ,

staff deve21 Professional lopment __________________ 22 Personnel: 23 Nursing Student program ____ Other __________

3.3

0.6

, , Total, unit centered _____ supplies 31 Environment, and equipment ____________

5.3 5.3

0.1

0.1 1.5

2.6 2.6

0.3 0.3

0.7 0.7 :

0.1 . 0.1 1.5

" 01 02 Standby __________________ Total, other centered _____ Personal - __________________

4.9 1.1 3.8

- 96 NllRSIm AC'I'lv!'H S'ltDY

ANALTriCAL 'D\lLE SA. - Percent of t1me spent at each area and level of activity by each category of personnel during a sample workweek of 16 hours lnlP1'lJ\L _.....;;.;l'GH:;.;;;.._ _ PERSONNEL CESERVED

A.M.

P.M.

oro ____--:;./ __

DAms OF S'lU)Y

August 16-21, 1965

Skill level of activity Area of activity Total, all levels I

, , H

;

Total.

all areas ___________

Total. patient centered ____ 11

100.0 0.6 18.4 6.0 56.8 18.4 l.3 22.8 14.5 2.9 1.0 l.0 4.4 14.5 l.6 1.0 1.0 1.0 l.3 0.3 I

0.3 17.9 0.3 2.8

Giving care ________________

12 Other direct activities ____ 13 14 Exchange of Information ____ 15 Total, personnel centered __ Teaching Patients _~

0.3

________

Indirect Care ______________

2.8

I ,

21 Professional staff develop. ment _____________________ 22 Personnel: Other __________

I 62.4 0.6 :

23 Nursing Student program ____ Total, unit centered" ______ supplies and 31 Environment, equipment ________________ Total, other centered ______

4.7 56.8

0.3

62.4 0.6 14.8 9.8 5.0 I ;

4.7 " 56.8 i

I I , !

0.3 14.8 9.8

01 Personal ___________________ Standby ____________________ 02

i , I I i

I ! !

j 5.0

I )fl'

I I

t ,

- 97 NURSING ACTIVI'lY S'roDY

.ANALYTICAL ~ 56. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 16 hours OOSPI'DIL PGH V

PERSONNEL OOSERVED

St DA'lES OF SroDY

A . M . . / P.M.

OPO

August 16-21 • 1965

--~

SkUl level of activity Total, A all levels Total, all areas __________ N

.Total , patient centered ___

16.0 . 0.1 3.0 3.7 . 3.0 2.3 0.5 0.2 0.7 2.3 0.3 0.2 0.2

0.9 9.1 0.2,

2.9 0.5

I I I

Giving care _______________

12 Other direct activities ___ 13 Teaching Patients _________ 14 Exchange of Information ___ 15 Indirect Care _____________ Total, personnel centered _

0.2

0.5

- -

21 Professional staff development _____________ Other _________ 22 Personnel: 23 Nursing Student program ___ Total, unit centered ______

9.9

0.1

0.7 9.1

31 Environment, supplies and equipment _________ Total, other centered _____

9.9 2.4 1.6 0.8

o. , .

0.7 9.1

I 01 Personal - _________________ 02 Standby ___________________

- -

2.4 1.6 0.8

, I

- 98 -

APPENDIX VI

EXAMPIES OF COMPIETED WClUITABU:S 1> 2, 3

APPENIllX V

NURSING ACTIVITY STWY

WOflK'DlBLE 1. - Da11y tally sheet of' number of' activities onthe CFD, by personnel observed and area and level of' activity HOSPITAL _--"PG.:::;H~

_ _ _ _ __ .

PERSONNEL OBSERVED

Area of' activity

A.M •

_-X

P.I".

DAY (mo.,day,yr.) OF STUDY Aug. 17, 1965 Level of' aoti vi ty

Rn -

A _ __

Total, all levels

12 _. ______ . _

11 -. -

t - --- --j- _3~ - -1- --. ---. ~O

__ . _. __ ,_ •._ ...

...- - - --

13 .... - ____ ~ 14

& I

-1

--_._0._-

- - __ 42 __ _ 1-~

--- --_. -.- -_.1 -.- .. -~.-. ( __ I

4 ... 1___ d.

- -( -'----- --~-- --I

15 ,. - ,. - - - '. ."'" 'C

,,~,

~---

r -

___ L. _ '- _p_ _ . I __ . _____ I __

23 •. , _,1-~ -.. 31 __ • _. _ •• _ ('\1

t. ~O

1 1 _

1, -1-' _'±.. ___. ___ ---. 1 ... __ _ _ • -I __

- - - - .•. - - - - - - - - - - - - - - - - ...

I· -. - g 1 L. __ 9.. -. -. ~ ~ .~{ ~ '~ 'j' _. '_ 8~ '_ -., -: __ • _ _ _ _

._ _

__ 1

_ _ _ _ _ _ 1_ _ _ _ .

_' _ _

•

-/- -, ___ . _I..

-1- - • _.

- ,- - -. -

1- - - - -

• __ • _ . _

_ ____ ,____ .1Q.

".~ 4~·-.~ --

t-:t ~-'-~ I _ ;!-O,_ ~l

.•

1_ _

Total,

areas-,

al1.

)/'

,. P.M.

HOSPI'lYIL _"jP~G;rH:-

NURSOO ACTIVITY S'roDY WORIC'.D\BLE 2. - Five-day tally sheet of number of activ1ties on the CTDby personnel observed and area and level of activity R

A..:.!:!.. Area A

__~.,...__~_ "

DA'mS OF STUDY Level of activity by day obsel'\'ed C D:lYs

PERSONNEL OBSERVED _....,.=~n~..-:-".....",rn'!::--_ _ _ __ j,u~ust 16~ 'I. lUGS , ~

ot activity

11 :

Days

N Days

H Days

. Days

1M!: If 5 da)l 1 2 3

4 5 ~: ~.n

alr ".... .:J}t>' '.91 3'1

'far

1 23 23 1 4 5 .~ Ii'-j

5 ~ays

_. -_. 1--1-- - - - -- - - - - - -- -. 12 _____. - _. ~:.. I-- 1'- - -- -t-'--- - -- . _. 2 2' 13 __.. __ . - - - -- - -1-- - - -- - _. --. 1--1--- 4 14 ______ . 2 -I-;" ---I-- - - 16 - - - - - -- 15 ______ . 1 -. :.. -_. t---1-- - - - -1-- - -1--- 1-- -~. 1-21 ______ --r' 1--1-. 1-- -- - - - - -. -- I--1-- - - - -- t-- - - - - -- 22 ______ 1--1-- - - - -. -- --I-- - - - -- - - - - -- - - - - - -- -- I-23 ------ -- 27 - - - - -- 10 26 31 ~ I~: ,.- ,.-- 31 ------ -- --I-- 1--1-- -- - - - -- -_. ~- 1-_. 01 ------. -- -I--t-- - -- - - - - -- I-- - - - - -- - - - -!-- 1--- 02 ---..:-- ...- -1-- 1-- - -- I- - - - _. r-- -- c- - - - -- - - - - -1--- 11 _______ 1-- -1-- -~-

-9 I

~. 3

o·

8 G :: 3

3 3

5 I I

1 II 5 -I 4

~~ ~6

3 7 ~

-~.

9 3 19. 6 I 9 7 4 6

1 2

46 3 9 I

19 3, 31 127

I la-Ys 1 2 ,14 5 D~ ~ ~, j 19 35 36 48 -. - t--. 1--- 41 1--' 1-- -- -- too-------- . - - - I- -I ' . . - - - ..1--- 6 r!!' ~! 15 12. .-------- I-. ~-- - - - . 5 _. _. --- -9 I 2 I 1--' 1-- --- I-- -- - - - - - -- - - _. ~---... -_. -. - (--- -. 8 6 14 12 6 46 1-":;' ~ .. ----1--' 1--- - - - - -9 I-I,!I. S 6 J}. 44 -. 1--- - - - _. 1 I - - _. --------- I-' 1--- - . . - - -- - . _. _. . --- _. 1-" 1-- --1"-' 1------4 -. !-. -- - - - - - -- - - :!.. _. 1-' (-L 1--' 1-1.. 1-2- --1--' 1------1 10 14 12 17 1 54 ~ - - - 1-' 1--- 1--' 1--' -- 1-':1-------- 1-' --- - 2- - 2- 2 6 10 ~O 74 7/J 70 364 3 :; 1 _. ~2_ ~------. 1 --1-- --.---I 1 6 17 21 16 2 71 6 17 21 16 I~. 73 1-- -- - - - - - -1--- -. ~-- -- -- I-- p..-----. 1-":;2G !. .... 4 L _ 20 a 9 -r- - - - _. 1 4 ~. 3 9 .-"-~-----1 2

U Days

Total, all levels tor each day

4 5 .-i 1 2

Total, all level d:;;

1-';'

-' -'

"1"--

Total, all areas_

, ..! '.7 .. 14 110 61

~7 Sl ?9S ~7

~o 37

~: W9

7 19 32 31 127

2 5 8 I

3'- 1lO

2 106 156 70 f15

Ins 183

859

NUl'ISINO AC'l'IVI'lY S'DJD!' ~

3. -

SUmmary

sheet of the total. llUDIber of aotivities for all dqs on the OPl), by personnel observed and area and level of aotivity. PImSONNE'L OBSERVED _--.;R;;.;a~_ __

HOSPI'lYIL X

RHr .n.'!.

P .~1.

1)Am.~ OF BTllDY

Aup;ust 16-21, 19Q2

Area 0 1: activity

Level of activity - all days N C H M U

TOtal! all al days 2 ~

level~

11 ___ _ 1 ';~

24)____ _ .----

____ • __________ _ ----~-----~

---_ ... ------____ ~§_____ J _____}§_____ • ___________ ~ __________ _ ~~ ~1

------~~-------2 )~

2 8 _____ _________ __________

10 ----------- -------------.-------------------------------------------------------_________________________________________________________ _______ _

1'0

_____ g_________ 3.Q__________

21 22 2""

_____ g__________ _____

~_____

__________________ _______ _ ____________ ___________ ___________ __________ _____ _____________ _______ _ ~~ ~~

__________ Jl ____________________ Jl____

1_____ ___________ ____________ ___________ ___________ __________ ____ ______________ _______ _ ~ ~

____ §!)_____ _____ iL____

----t----22-----

01 ____ ___________

----}~----__________

_____ :?_____ ___________ ___________ __________ _____t _____________ _______ _ ---§)}----- ___ 219_____ ___________ _ ____7_____ _ __ ~~ ____________~ _______ _ ~

___________ ___________ ___________

_____

t____

__~~l_____

_ ______ _______ _ ~

02 Total. all

days--

----r----------- .. ---------.-----------370 294 :fras , 135

....

_------- -----------.----------331 11

----.------~-~--------------1345 204

Level~A".

INote that information in this column is derived directly from the sixth subcolumn. WORKTABLE 2. A s1m11ar transfer from WORKTABLE 2 is repeated for every level. -wrived directly from the last column on l'IORKTABLE 2.

.)I

Observer's Reoord Agenoy _ _ _ _ _ _ _ _ _ __ Observer CODE PERSONNEL HN Rn Head Nurse

Daw,_____________ Page of

Person Arc2 of' ,~killTime Plaoe observed Activity LE'vel

(What is being dene) Descr1pt1on of Aot1v1ty

Na St

Registered Nurse (Staff) Nursing Attendant Student

TYPE OF ACTII,lI'I'Y

U. Patient Centred: Giving Care 12. Patient Centred: Other direct aotivities 13. Patient Centred: Teaching Patient 14. Patient Centred: Exchanging Information 15. Patient Centred: Indirect Care 21. Professional Development of Staff' 22. Personnel - Other 23. Professional Student Nursing Programme 31- Un1 t Management 01- Personal 02. standby

SKnL-LEVEL

.N. C.

H. M.

Administration Nursing Clerical Housekeeping Messenger Unclassified

-103 FIRST RIDIONAL NURSIm sruDIES SEMINAR

ANNEX III

2-30 August 1965

BIBLIOGRAPHY

Indices - General References Grandbois, M. (1964), Cumulative index to nursing literature, Glendale Sanitarium and Hospital; Glendale, 6-8, (1961-63) Henderson, V. (1963), NurSing studies index, prepared by Yale University School of NurSing Index Staff, J.B. Lippincott Co., Phila~elphia, ~, (1951-1959) International Labour Office (1958) International standard classification of occupations. Lennon, Sir Mary Isadore (1954) Teaching in the outpatient department. Matheney, Ruth V. and others (1964) nursing. ~!ndamentals

of patient-centered A survey and

Simlllons, L.W. & Henderson, V. (1964), Nursing research: assessment, Appleton-Century-Crofts, New York

Wallace, Helen M. (1962) Health services for mothers and children.

Statistics Walker, H. & Leo, J. (1958) Elementary statistical methods, New York, Henry Holt Co. Levine, E. (1959) Interpreting statistical data, Amer. J. Nurs., 230-233 Levine, E. (1959) The ABCs of statistics, Amer. J. Nurs.,

22"

22" 11-15

III.

Methods Abdellah, F. & LeVine, E. (1954) Work sampling applied to the study of nursing personnel, Nursing Resea.rch, 3, 11-16 Adams, A.O. (1951) How to study the nursing service of an outpatient department, Washington, United States Public Health SerVice, Department of Health, Education and Welfare, Publ. Hlth. Servo Publ. No. 491 Adams, Apollonia O. (1958) Nursing resources: a progress report of the program of the Division of Nursing Resources, U.S. Public Health Service Publ. No. 551. American Public Health Association (1961) Guide to a community health study. Arnstein, M.G. (1953) Guide for national studies of nursing resources, Bull. Wld. Hlth. Org., Suppl. 1, Geneva, World Health Organization.

,Ie

- 104Arnstein, Margaret G. (1956) Design for statewide nursing surveys: basis for action. U.S. Public Health Service Pub. No. 460. a

Cohart, E. & Willard, W.R. (1955) A time study method for public health, Pub!. Hlth. Rep., Wash., 70, 570. Ferguson, M. Public health nursing service to patients, (1959) Washington, United States Public Health Service, Department of Health, Education and Welfare, Pub!. Hlth.Serv.Pub!.No. 685, Pub!. Hlth. Monogr. No. 22Ferguson, M. Work measurement and performance budgeting (1959) NurSing OutlOOk, L 570-572 Ferguson, M. How to determine nurSing expenditure in small health agenCies, (1962) Washington, United States Public Health Service, Division of NurSing, Publ. Hlth. Serv.Pub!. No. 902 Florence Nightingale International Foundation (1956) International Conference on the Planning of Nursing Studies, Sen-es, london International Council of Nurses. Florence Nightingale International Foundation (1960) Learning to investigate nursing problems, london, International Council of Nurses Forehand, Garlie A. (1964) Environmental variation in studies of organization behaviour. Ps,cho. Bull. 62: 361-382. Freeman, R.H. (1961) Measuring the effectiveness of public health service, Nursing Outlook, 2.> 605-607 Good, C. V. & Scates, D. (1954) Methods of research: educational, psychological, sociologiesl, New York, Appleton Century-Crofts, Inc. Gunter, L.M. (1964) Research techniques applied to nursing, NurSing Research, 13, 230-232 Holliday, J. (1964) The exploratory study method. design, Nursins Research, 13, 1, 37-44 An aid to research

" II

" " ii ~

International:, Lebour Office (1959) Introduction to work study. International Lebour Office (1962) Job evaluation. Leeds Regional Hospital Board (1963) Work measurement as it basis for calculating nursing establishments: sn analytical study. Levine, E. (1960) Experimental design in nursing research, Nursing Research, 9, 203-213 Meyer, Burton Be Heidgerken, loretta (1962) Introduction to research in nursing, Lippincott .

Mooney, H. William (1962) Methodology in two California health surveys. Public Health Monograph No. 70. Patients and personnel speak:" a method of studying patient care in hospitals, United States Public Health Service, Division of Nursing Resources, Washington, D.C., 1957 • . Philippines. Bureau of Health (1953) Public health nursing manual.

Roberts, D. (1963) The staffing of public health and outpatient nursing services: Methods'of study, Geneva, World Health organization, Public Health Paper No. ~ Stanford, Elinor D. (1957) How to study supervisor activities in a hospital nursing service. U.S. Public Health Service Pub. No. 496. United States of America, National Organization for Public Health NurSing (1950) Cost analysis for public health nursing services, New York, National League for Nursing U.S. Govermnent Printing Office (1953) The head nurse looks at her job, Public Health Service Publication No. 227, Washington, D.C. U.S. GoverllDlent Printing Office (1954) How to study nursing activities in a patient unit, Washington, D.C. U.S. Govermnent Printing Office (1964) How to study patient progress, Public Health Service Publication No. 1169, Washington, D.C. U.S. Public Health Service (1964) Hospital outpatient services: guide to surveying clinical procedures. A method for documenting medical services and administrative procedures. U.S. Public Health Service Pub. No. 930-C-4. IV. Admin1Ertration of Services John, Audrey L. ,and others (1963) The nuree in mental health practice. Report of a Technical Conference. WHO Publ.1c Health Pal.irrs ,22. Lsmbertsen, Eleanor ·C. (1953) Nursing team organization and functioning Results of a study of the Division of Nursing Education, Teachers College, Columbia University. I6'man, K. (196l) Basic nursing education programmes: a guide to their planning, Geneva, World Health Organization, Public Health Psper, 1lI0.1 National League for Nursing (1953) The head nurse at work. United States of Americs, Nationsl League for Nursing (1961) Criteria for evaluating the administration of a public health nursing service, New York.

- 106 World Health Organization, Expert Committee on Nursing (1950) Report on the first session, Wld Hlth Org. techno Rep.Ser. No. 167 World Health Organization, Expert Committee on Public Health Administration (1952) First Report, Wld Hlth Org.techn.Rep.Ser. No. 22 World Health Organization, Expert Committee on Public Health Administration (1954) Methodology of planning an integrated health programme for rural areas, Wld Hlth Org. techn.Rep.Ser. No. 83. World Health Organization (1959) PUblic health nursing. Fourth report of the Expert Committee on Nursing. WHO Tech.Rep. Ser. No. 167. World Health Organization (1959) Public health nursing, ehron.Wld Hlth Org., 13, 225-228 World Health Organization, Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel (1961) The use and training of auxiliary personnel in medicine, nursing, midWifery and sanitation, Wld Hlth Org. techn.Rep.Ser. No. 212 World Health Organization (1961) Aspects of public health nurSing, by various contributors. WHO Public Health Papers 4 World Health Organization (1961) Public health nursing, ehron. Wld Hlth Org., 15, 79-92 World Health Organization (1962) Mental health programmes in pUblic health planning, Chron. Wld Hlth Org., ~ 306-311

Studies Abdellah, F. & Levine, E. (1958) Effect of nurse staffing on satisfactions with nursing care, Chicago, American Hospital Association, Hospital MonOgraph Series No •...!. Akin, K. (1962) Work measurement studies in small health departments, Nursing Outlook, 29, 544-546 Bennis, W. et a1. (1961) The role of the nurse in the outpatient department, New York, American Nurses Foundation Boyle, R. (1960) A study of stUdent nurse perceptions of patient attitudes, washington, D.C., U.S.P.H.S., Publ. Hlth.Serv.Publ. No. 1§2. Brown, Esther Lucile (1961) Newer dimenSions of patient care. Part I. The use of tle physical and social environment of the General Hospital for therapeutic purposes.

- .J.°1·Brown, Esther Lucile (1962) Newer dimensions of patient care. Part 2. Improving staff motivation and competence in the General Hospital Brown, Esther Lucile (1964) Newer dimensions of patient care. Part ,. Patients as people. Burling, T. et al. (1956) The give and take in hospitals: human organization, New York, G.P. Putnsm a study of

Cartwright, A. (1964) Human relations and hospital care, Lolldon, Routledge and Kegan Paul Congalton, A.A. (1962) The public image of nursing, Research Reports in NurSing, No. 1 Sydney, Australia, The New South Wales College of Nursing Congalton, A.A. (1962) Young people look at nurSing, Research Reports in Nursing, No.2, Sydney, Australia, The New South Wales College of NurSing Connor, R.J. (1961) A work sampling study of variations in nursing work load, Hospitals, '5, 40-41; 111 Daly, O.M. (1963) Ward housekeeping experiment, Nursing Times, July 5 de M. Warren, D. (1964) Ward housekeepers: authority, NurSing Times, November 20 an experiment in delegated

Elms, R. (1964) Effects of varied nursing approaches during hospital admission: an exploratory study, Nursing Research, 1" 266-267 Feyerherm, A.M. & Kirk, W.R. (1964) Effect of census variation on nursing activity patterns, Hospitals, ,s, 62-70; 74 Gordon, E.M. & Hoff'man, V.M. (1960) Evalusting an occupational health nursing program by a work sampling study, Cansd. Nurse, 56 '14-~ Hasselmeyer, Eileen G. (1961) Behavior patterns of premature infants. A study of the relationship between a specific nursing procedure and general well-being of the prematurely born intant. U.S. Public Health Service Publ. No. 840 Internationsl Labour Office (1960) Employment and conditions of work of nurses. Kellogg, W.K. Foundation (1961) The planning and operation of an intensive care unit. An experience brochure. Levine, E., Siegel, S. & Puente, J. de la (1961) Diversity of nurse staffing among general hospitals, HO!pitals, ~ 9, 42-48

Manaser, J. & Wener, A. (1964) Instruments for study of nurse-patient interaction, New York, Macmillan Co. Meyer, GeneVieve Rogge (1960) Tenderness and tecbniques. Nursing values in transition. Miller, S.J. & Bryant, W.D. (1964) How minimal can nurse staffing be1 Modern Hospital, 103, 111-113 New, Peter et al. (1959) Nursing service and patient care: experiment, Kansas City Mo. Community Studies a staffing

Rines, Alice R. (1963) Evaluating student progress in learning the practice of nursing. A Nursing Education Monograph. Roberts, D.E. (1962) Hoo effective is public health nursing? J. Publ. Hlth., g, 1077-1083 Amer.

Schwartz, D. (1960) Nursing needs of chronically ill ambulatory patients, Nursing Research, ~, 185-188 Schwartz, M.S. et a1. (1956) The nurse and the mental patient: of interpersonal relations, New York, Russell Sage Foundation. Survey Report: a study

The realities of staffing (1962) Amer.J.Nurs., 62

56-63 The Brazilian Nursing Association (1963) Survey of needs and resources of nursirg in Brazil, Trans. in English, Rio de Janeiro, Brazil.. Wright, M.J. (1963) staffing the nursing service, Hospitsls, 37, 91-99

... . ,

• WORLD HEALTH ORGANIZATION .~

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

of a

•

conducted

a.t the JOOE REfiS ~IAL

HOSPITAL

August

1.6-21, 1965

in conjunction with the FIRST RIDIONAL NURSING STUDIES SEMINAR WORLD HEAIlrR ORGANXZ..A!rION Regiooa.l Office for the Western Pacific

Ma.nila, R1ilippines

...

The members of the Group would like to thank: The Director of the Jose Reyes Memorial Hospital (North General Hospital), The Chief aud Medical Reyes Memorial Hospital, The Chief of Nursing Services aud Nursing Staff of the Jose Reyes Memorial Hospital, for their kind co-operation without which this study would not have been possible. The members of the Group also acknowledge their gratitude to:

start

of the Outpatient Department of the Jose

The driver of the vehicle provided by the Department of Health, Ibilippine Governmem; (for his careful driving and willingness to help the participants in their journeys to aud frOm the hospital). The resource persous of the Secretariat aud WHO Regional Office staff for their readily given assistance at all times during the Seminar. The Typiug Pool aud other staff of the WHO Regional Office for their willing assistance especially during the irregular hours of work activity.

CON'l'EN'l'S

1. 2.

HOW THE STUDY CAME ABOUT ••••••••••••••••••••••••••• MR'I'BOD •••••••••••••••••••••••••••••• <I • • • • • • • • • • • • • •

ANALYSIS .AND "IN'I'EE'RErATION" •••••••••••••••••••••••••

Introduction

1. 2. 3.

How are nursing service personnel spending their time in the outpatient's department? ••••• lIOwmuch of the non;;nursing wrk is done by nurses? ••••••••••••••••••••••••••••••••• ~...

20 22

How much of the total time of the nursing service personnel is spent on patieilt- . centred activities?' •....••.• <II

<I................. . by the <11.<11 •

4. How is the remaining time spent

nursing service staff? ••...••••...•..•••.•.•

27 30

5. How much of the nurses' time can each n~ins

patient expect to receive in direct care? ••......••••.. "................... is given to each patient by the nurs1"8 service personnel? ••••••••••••••

6. How much teaching

7. What part 4. StXlGESTIONS APPENDICES 1. 2.

do the nursing students plS¥ in the outpatient department? ••••••••••••••••••

........................................ ......................... .

35 42 49 53 68

Codes and Definitions Assignment of Observers ••••••••••••••••••••••••

3. Observ"er's Record •••••••••••••••••••••••••••••• 4. Information Letter .•.••.•...•...••.••.••....... 5. Cha:rts and Graphs •••••••••••••••••••••••••••••• 6. Worktables .•••••..••••.•••••••••••••.•••••••••• 7. Bi b110graphy •.•.••••••••..•••••••••••••.•••••••

54 57

108

The Group carrying out the Activity Study at the Jose Reyes Memorial Hospital were:

Dr. Vera Fry-Maillart Professor Athol Congalton Puan Hajjah Fat1mah bt. Haji Su1a1man

Director of the Seminar Temporary Adviser to the Seminar Seminar Participant, Malaysia Seminar Participant, Japan Seminar PartiCipant, Korea Seminar PartiCipant, New Zealand Seminar Participant, Philippines Seminar PartiCipant, WHO Field Staff

Miss Yukiko Inoue Miss !'yo Hi Lee Miss Shirley Lowe Mrs. J.A. Mendoza Mr. J.H. Waterer

<Of

•

CBAPl'ER I HQl THE S'l'UD'l CAME .ABOt1.r

The countries in the Western Pacific Region of the WHO are and have been facing a shortage of health personnel, particularly nurses, to _ t the rapidly increasing demand for health and medical care services.

The

shortage of nurses is most felt because of the major role they p1B¥ in delivering health services to sick and well people. Past efforts ,largely the introduction of 81!xil1ary workers to "stretch" nursing personnel, have not provided a ·solution. Problems of

staffing for nursing services continue to handicap the implementation of health and medical care services. One of the factors aggravating the shortage of nurse power in many

countries would appear to be the m18use of f'ull.y qualified nurses.

assist national health administrations to plan better use of nurse power, the WE'RO of WHO conducted a Nursing Studies Seminar for key nurses from seven countries, to train them in nursing activity study methods. Part of

their learning experience included the conduct of a nursing activity study in an outpatient department. In providing for this learning experience,

outpatient aepartments presenting problems Which migbt be considered "typical n in the countries were sougbt as a laboratory. teristics taken into consideration included: Typical charac-

large clinic attendance,

service pressures on staff, absences and/or leaves of' absence of nurses creating "gape" in staff, frequent overtime, paid or unpaid, on the part of staff, clinic services of both a preventive and curative nature, more than one category of worker in nursing service personnel and the inclusion of a student program for clinical learning experiences.

...

Toward the above purpose of the seminar, the following planning was

done in two phases: 1.

Preliminary "top" planning by the two Regional Nursing Advisers

• - 2 -

of the WPRO of WHO, with the Nursing Consul.tant, the Chief of the Office of Health, Education & Personnel Training, the Government/WHO/UNICD Liaison Officer and nurses from the Bureau of Health and Medical Services of the Department of Health, Government of the Philippines.

This preliminary planning, started 18 months prior to the Seminar, brought the full support and understanding of key personne1 in the Department of Health and facl1itated later visiting of agencies for the selection of the outpatient departments to be studied. 2. The second planning phase for the Nursing Activity Study began in

the last week in JUne preceding the seminar, with survey visits to hospita1s, outpatient departments, health centres, and other health agencies in and outside Manila. ViSits were made by one of the Seminar Directors accom-

panied by the nurse designated to serve as liaison with the Government. During each visit discussions on the purpose of the visit were held with medica1 and nursing administrative and operational staff. Conversations

were also held with patients and their families, as the occasion arose. Decision on the OUtpatient Department to serve as the field for the Nursing Activity study was reached by 15 JUly and the first definitive steps were taken to secure the participation, understanding and assistance of medical, nursing, and other personnel. On 20 July, a "Top" COmmittee composed of the chief medical and nurs-

ing administrative officers, training Officer, the chiefs of Dietetics and HOusekeeping and the agency's administrative officer met with the seminar staff. At this meeting the purposes of the Nursing Studies Seminar, the shortage of health personne1 (especially nurses), the relation of nurse utilization to shortage, the purposes, method and potentia1 contribution of nursing activity studies were discussed. Keen interest was expressed

and ful1 support was given for subsequent planning with the administrative

, - 3 and other personnel of the OPO, and for a f'ollow-up meeting to discuss the study findings and plan for needed action. Several days later, a smaller committee composed of the administrative, medical and nursing staff' of the OPO met. At this meeting the dis-

cussion included the purpose, method and potential contribution of the Nursing Activi'Cy Study; the problems of providing OPO services; the need for the study in relation to the problems expressed by the OPO staff'; the plan for orienting the OPO personnel to the study, the clinics to be studied, and the dates of the study. Decisions on other aspects of the planning essential to the smooth conduct of' the study were made with the Chief', Assistant Medical Chief of the OPO and the Supervising Nurse who served as an executive coom1ttee but were not so designated. Such aspects included the arrangement of'

space for the Director of the Study and Observer Teams, the method of orienting the nursing and other personnel in the OPO, the arracg_nts for two half days of "dry run" for the observers-in-training, the exclusion of the Dental Clinic from the activity study field, and the provision of other data from OPO records to be used with activity study findings. 1'he "executive committee" met frequently before and during the Study and made possible the efficient conduct of the Study. As part of the plan for the orientation of the nursing personnel in the outpatient Department the Supervising Nurse met twice with the total seminar group. 1'he Superv1sing NUrse met several times with the nursing A

staff of the OPD to orient them to the study and to their role in it.

mimeographed statement was also prepared to assist with the orientation of personnel. TWo half days of "dry run" for the observers served to assist in the

orientation of the OPO personnel as well as to train the obser\'ft'S in using the codes and the observation forms.

_ 4 TIME OF THE NURSIl'D ACTIVr!'Y STtJDY

•

The period selected to conduct the 5-day nursing activity study was the third week in August from 16 through 21. Althol1gh this week included

a holiday which f'ell on the 19th, it covered five work days of' 8 hours each and is normal f'or the holiday "Quezon Birthday". CLINIC SAMPLE All the clinics in the Outpatient Department, with the exception of' ~

week of' August which includes the national

the Dental CliniC, were included in the Study.

The Dental Clinic was

excluded because nursing personnel are not assigned to it. All the nursing personnel working in the OPD were included in the Study. These personnel included:

NURSING PERSONNEL

FUll Time - 8-4 P.M~ d~ily

7-3

Part Time 1 Registered Nurse

P. M.

Saturday from 2 to 4 P.M. daily except Saturday

1 Supervising Nurse

5 Registered Nurses 5 Nursing Attendants Student Nurses 10 Student Nurses

7: 30 to 12 daily except Saturday 7: 30 to 12 daily except Saturday

1 Clinical Instructor General PUrpose

The purpose of' the nursing activity study at the Jose Reyes Memorial Hospital, Outpatient Department, was to secure information on the activities of' the nursing service personnel as a basis f'or assessing staff' needs. SpeCific Objectives The specif'ic questions to be answered in the study were: 1. What are the areas of' activities performed by nursing personnel in the Outpatient Department?

- 5 2. What is the volume of nursing activities carried by the nursi08

service personnel?

3. How much patient teaching is done by the nursing service personnel? 4. Are the special skills of each category of worker in nursi08 be-

i08 used to the maximum extent possible?

5. Would a re-asstgnment

of one or more of the mrsi08 service

personnel permit nurses to spend more time in patient care activities?

..,

Do the

activities performed by nurses in the OUtpatient Depart-

ment indicate the need for other categories of workers to assist in the :functioning of the Outpatient Department? 7. What nursing service posts are budgeted by the administration

to accomplish the objectives of the outpatient Department?

.....

- 6JOSE REYES MEl«lRIAL HCBPlTAL - OI1.rPATIEl'IT IlEPARTMENT Physical Description The outpatient Department of the Jose Reyes Memorial Hospital is housed in the main building of the 430 bed general hospital. The OPD

is rectangular in shape and covers an area of 706 square meters.

narrow corridor divides the area and provides for the access of patients to the small but compact clinic consultation rooms. at the entrance to the OPD, is about tration desk and patients each. 4~

The waiting room,

meters and houses the regis-

wooden benches which seat approximately four or five

The walls of the waiting room are bare except for printed

instructions indicating the seating area for new patients and for the readmissions. Despite the limited physical space, it is usual to find

several hundred patients waiting to ....0 called into the clinic consultation rooms. The in-and ou~flow

of patients is regulated by a wooden

railing placed in the center of the corridor and traffic flows smoothly during the clinic hours. In addition to the offices, record room, accounting office and

toilets, six clinic unit areas are organized along the right side of the long corridor and two along the left side. (See floor plan) Surgical Unit which occupies an area of The

49.5

square meters includes

general surgical. cliniC, urology, plastic and proctology clinics, a treatment room and an operating room, appr'Jximately ~

x 5 meters in The Medical

size, where an average of 12 operations are done daily.

Clinic, the second largest in physical Size, adjoins the surgical unit and covers about 20 square meters. The Deru:stology, Pediatrics and the

Gynecological Obstetrical Clinics, each of which occupies a physical area of ~

x 5 meters complete the clinic units on the right side of the The Ear Eye Nose and Throat and the Dental Clinics on the

corridor.

- 7 left side ot the corridor are comparable in size to the Surgical Unit. Organization of Clinic Services The clinic services offered daily include general surgery. medicine. dermatology. pediatrics. obstetrics. gynaecology. eye. ear. nose and throat

and d.er.t1stry. ,

In addition speciality clinics including well baby, ortho-

pedic, sterility. cancer detection. endocrinology. plastic, chest. vascular, head and neck tumors. neuro-surgery. cardiovascular operate from oue to two times a week.

Hours ot Operation Clinic services are available daily, except Sundays and holidays. from

8 a.m.

to 12 noon and 2 p.m. to 4 p.m.

On Saturdays clinics close

at ::5 p.m. a week.

The normal work week ot·the Outpatient Department is six days The month of August includes a national hol1day which is cele-

brated yearly and reduces the work week to 5 days. population Served OUtpatient department services are available to anyone needing the services. In general the OPD is used by the populAt.iOt1 residing in: the

districts ot M!Lnila north ot the Pasig River and comprising 1,059.066 of the 1,32::5,000 population ot the City of Manila. E1gbty per cent ot the patients who attend the OPD are indigent and receive free services.

Of the remainder 15 per cent are classU1ed

as "part_pay" and 5 per cent as "tull pay" patients. the tees charged tor Z-ray and laboratory services.

Pa;,ment refers to

All patients, indiClear-

gent or pay. are expected to provide tor their own medications.

ance ot the economic status of patients is done by interview with oue of the two social workers in the OPD.

- 8 Volume of Services During 1964, the dally average clin1c attendance in the OPD was 647 patients. The mon~ average for the same period. was 16,843. The

apeak" month of clin1c attendance was July, 1964, with 19,033 patients. The average monthly clinic attendance for the period. January to June

1965 was 16,510.

Considering that the second six-month period of the

year has usually a higher monthly clin1c attendance, the monthly average for 1965 may be expected to su-~ss the 1964 monthly average. Since the nursing activity study was conducted during the third week of August, 1965, it is important to note the clinic attendance for the same period. in August, 1964. Dlring the flve-day..week study period,

16, 17, 18, 20 and 21 August, 1965, the average daily clinic attendance

was 782 patients as compared with 741,8 patients for the same five-day work week in August, 1964. General Health Dare - Man1la In order to view the role of the OPD within the medical care needs of the City of Man1la, it is worthwhile to examine some of the health statistics for 1964. In 1964, of the ten common l diseases in the City of Man11a, the first five are either preventable or can be controlled i f symptoms 8l.·e recognized and reported early by patients. culosis, gastro-enteritis and COlitis, tis. The 3 leading causes 2 of deaths among infants under 1 year in the ~

These diseases are: influenz~

tuber-

pne~nia,

and bronchi-

City of Manila in 1964 also point to the

Ur~rtance

of preventive measures

1 "Report, Health Statistics, City of Manila, 1964." Preventable Diseases, Department of Health, Manila 2

Division of

- 9• and patient teaching in the Well Baby, Pediatric and Obstetrical Clinics. These leading causes of death include: pneumonia, birth inJuries, as~

and infection of the newborn and gastro-enter1tis and colitis. Among the six major causes of death' in the City of Manila for

1964

are three chronic diseases, tuberculosis, heart disease and malignancies ~

and two acute debl1iting diseases, pneumonia and gastro-enter1tis and colitis. With the early discharge of patients with chronic illnesses :from hospitals to the OPD for continuing amhulatory treatment, and supportive care especially during rehabilitation, and with the increasing d1:f:ficulty of separating preventive and curative services of sidtand well children and adults, the importance of the OPD in continuity of patient care and in general improvement of the health of the community is immediately evident. Aims of OPD - Jose ReyeS Memorial Hospital

The aims of the OUtpatient Department are:

To provide immediate supportive care to ambulatory patients who

do not need hospitalization.

2. hospital. ,.

To extend further care to indigent patients after leaving the

To promote understanding between patients and community, hospi-

tal physicians and nurse.

4. To emphasize the importance of healthful living.

5. To serve as a sound laboratory for the learning experiences of medical and nursing students.

Implicit in the above aims is estension of care to "discharged"

'mm 4 "Jose R. Reyes Memorial Hospital OUtpatient Department Manual." Prepared by Staff of OPD in oo-ordination with the NUrsing Training Staff. U'Ildated

- 10 -

pat:l.ents, cont:l.nu:l.ty of care between home and hosp:l.tal and focus on vent:l.ve health teaching for the Man:l.la population served by the OPD. Outpatient Department Personne15 Medical Personnel

The medical and other services of the OPD are organized under the direction of a Medical Chief and his assistant who constitute the total t'ul.l time fixed medical persocnel. Assistance w:l.th the medical functions of the OPD is provided by: Fi.ve Reside:Its who report to the OPD au average of one to two times a week from the:l.r fixed ward assignments; Ten Internes are rotated from other services for one month of OPD semce ; Other internes, assigned full time to the hospital wards, spend one to two days a week providing service in the OPD, thus rotating into the OPD approximately 20 internes per day; A med:l.cal and speciality consultant staff assists :l.n the Dermatology and Obstetric CUnics on a daily basis end others service the speciaUty clinics on a scheduled basis, as, for example the six consultants who previde service three times a week in the Eye Ear Nose and Throat Clinic. Since the Jose Reyes Memorial Hospital is a teaching centre, medical students from three medical schools augment the medical steff of the OPD while securing the:l.r cUnical learning experiences. The fourth year medi-

r '

cal students, called Clinical Clerks, are assigned for a two-month's experience to the OPD and work from 8 a.m. to 11:30 a.m. under the supervision of the full time Medical Steff. During the period of the '11 ursing

activity

Data from conferences w:l.th the Chief of OPD and Supervieing Nurse

- 11 -

study, there were 12 clinical clerks providing medical services according

to the rules outlined in the Policy MIlnual as follows: "Allowed to dress wounds and do minor procedures under the supervision of a res1dent; Allowed to take h1stor1es and physical exam1cations subject to super-

vision of the reSident; ~

Allowed to ass1st in minor operations." NUrsing Personnel

The official budgeted posts for nursing service in the OPD are two, one of supervisory grade and one of staff grade. Recognizing the inade-

quacy of the official posting, the Chief NUrse of the Hospital has allocated four nurses from ward assignments bringing the total registered nurse staff to five and one superv;!sory nurse. To assist the registered nurse staff with such support1ng services

as setting up clinics and cleaning and sterilizing instruments, there are f'ive nursing attendants only three of' whom are regularly employed to work 1n the OPD. Although called a nursing attendant this worker has only

brief' on-the-Job training in those housekeeping activities which f'sc1li~.

tate the work of the registered nurses. Helpers There is a staff of' f'our helpers who are responsible f'or the general cleaning of' the clinics and the OPD and who are under the direction of' the Supervising NUrse. The nurSing service, like the medical service, CD..ape1"ates

with three

schools of' nurs1ng 1n providing clinical learning experiences f'or student nurses. '.c> ,

About 100 students a year are rotated through selected

6 "Jose R. Reyes Memorial Hospital OUtpatient Department MIlnual.- Prepared by StUf' in OPD 1n co-ord1cation with the NUrsing Training Staff. Undated

- 12 -

services, including the OPD, under the direct supervision of a Cl1llical Instructor who accompanies the students from each school. During the

period of the activity study, there were 10 student nurses assigned to the clillics every morning except Saturday. Job descriptions of the nursing personnel in the various categories (Supervising Staff and Nursing attendant) have specifically defined duties and are co~ehensive in nature. (Please see Appendix) Policies which affect nursing service personnel and which relate specii'ically to the nurSing ac'dvitystudy include: 7 nAll nursing personnel must report at least 15 minutes before the

time of the clillic; All nursing personnel shall wo~k

8 hours a day including 30 minutes

for meal time and 15 minutes snack time; Nurses and nursing attendants are to make all kinds of dressings from 12:30 to 1:45."

7 "Jose R. Reyes Memorial Hospital OUtpatient Department Manual. n Prepared by Staft' ot' OPD in co-ordination with the Nursing Training Staff. Undated

I II

- 13 CHAPl'ER 2 Ml!.'l'ROD

For the collection of data on the activities performed by the nursing service personnel in the OUtpatient Department, the technique of instantaneous intermittent observation at 15 minute intervals 'W8S

used.

This

technique

'W8S

developed from the work sampling method used in industry and

is based on statistical evidence that the number of times on activity is observed being performed during a whole work-day for a normal work-week correlates closely with the total amount of time spent in the performance of the activity.l The technique of instantaneous intermittent observation for the systematic collection of data because: 1. 'W8S

selected

All nursing personnel in the outpatient Department were to be included as sUbjects and the period of data collection extended over a full work week considered to be a reliable sample. 2

, i

A representative picture of the nursing activities

'W8S

needed Since

rather than the sequence or duration of the activities.

in nursing in the OUtpatient Department the performance of the same kind of activities occurs at irregular intervals, a raruiom time distribution already existed and observations could be made at fixed intervals without jeopardizing the reliability of data. 3. I

Nurse observers could be trained and definitions of activities could be made to ensure specificity in observation.

...

Procedure for collecting data: Trained observers alternated scheduled observation periods of two to

1 Abdellah, F. and Levine, E., Work Sampling Applied to the Study of Nursing Personnel, Nursing Research, Vol. 3, No.1, June 1954, pp. 11-16. 2 Arnstein, M., Time Studies of Nursing Activities in International Conference on Planning of Nursing Studies, International Council of Nurses, ltngland 1956, p. 28-29.

- 14 two and a halt hours to provide for observation of all the nursing service personnel during all the work hours of each of five consecutive wrking days. The mnximum hours of observation scheduled for an observer on any IDlen an observer was

one day were four and usually did not exceed two.

scheduled for four hours in any one day, a two-hour rest period was provided between the first two hour observation period and the second to guard against fatigue interfering with accuracy of recording. Each observer was assigned from six to ten members of the nursing personnel for observation in the daily scheduled data collect1dn period because the personnel did not always have fixed assignments and floated among the several clinics. Observers exchanged assignments of personnel

three times during the five days study period. To facilitate identification of the category of worker, nursing per-

sonnel wre a blue armband with the category code printed in black. (see Appendix-Codes) To permIt free circulation of the observer throughout

! fl

the outpatient Department and to enable him to be identified by the nursing personnel each observer wore a white laboratory coat with a badge labeled nOb server" pinned on. The observer sampled the activities of his assigned nurSing personnel, walking through the OUtpatient Department every 15 minutes and record-

I ,

I I, "

ing what the worker was doing at the instant he located her.

He continued

his tour through the OPD until each member of thenursing personnel assigned to him had had one observation recorded. If, for example, the observer started his tour through the OPD at

JI IDlen he had

7:00 a.m., he continued walking, observing and recording the activities of the nursing personnel assigned to him as he met them.

recorded one observation for each member of his personnel aSSignment, the 7:00 a.m. series of.observations was completed and a new series of observations was started. at 7:15 a.m.

- 15 The observer started each series of observations from a different place in the outpatient Department to avoid observing the same personnel in the same order. On completion of the assigned observation period, the observer edited and checked the recorded observations and conferred with the Study Director on any problems. RECORDING

A form for recording the nursing activities was developed by the observers. (See Appendix) --~-

The observer recorded the activities of the nurs-

ing service personnel on the Form and coded them using the code shown on the Definitions (Appendix p. ity he had to: 1.

Before the observer recorded the activ-

identify the activity classify the activity according to area classify the activity according to skill level

2. 3.

Generally the observer could identify the activity by what he saw or what he heard. When the purpose of the activity was not evident from the overt

behaviour of the worker observed, the observer asked the worker the purpose of what she was doing if the nurse did not immediately indicate it. When a verbal exchange took place between the nurse and a patier>t, the discussion was in Tagalog which was understood by only one of the six -~

observers. The purpose of such an exchange between.(1 nurse and a pn:hlent was arrived at through a brief explanation in English by the nurse and was accep'~ed

an accurate representation of the purpose of the activity.

T~~

recording for each 15 minute series of observations was made on The data for the five-day study period on each

a sepexl'lte Observers Form.

category of nursing personnel were tabulated from these forme.

- 16 DEFINITIONS Since the ectivit~

was the basic unit of the. study, activities were

recorded in terms of' area (functional purpose) and skill level (the training and skill required to perform the activity). Definitions developed f'or

this study are modifications of those developed for OUtpatient Department 3 and for In-patient Unit.

Areas of activity were defined as: patient, per-

sonnel, unit centred and other centred activities not directed towards the

3 preceding purposes. (See Appendix)

Skill levels of activity were defined

on·the bads of the training and skill needed to perform the activity and included administration, nursing, clerical, messenger and unclassified. (See Appendix) The definitions were tested in the trial observation period,

AugUst 9 and 10, at the OPD and modified on the basis of' minor difficulties encountered. Personnel observed in the Study were defined as: mFINITION AND CODFS OF PERSONNEL

Sup N, Hn or

Director I Supervising Nurse I Head Nurse or Ass:l.stant Head

Abn

Activities wbipb. involve planning, directing, evaluating, coordinating, review1ng,and making decisions concerning nurSing care in the department and clinics. Giving nursitig care in order to

have opportunity to observe patients, to establish rapport with patients, or to teach nurSing ste.:ff. Rn Registered Nurse (Staff) . .'Thoee nUrsing procedUres listed in the registered nurse job description. st Nursing Student A student in a professional nursing educational programme.

3 Adams, P., How to Study the Nursing Service of an outpatient Depart- . ment, Public Health Service Publication No. 497 US Govt. Printing Off. 1957 Washington, D.C. 4 HOw To study Nursing Activities in a Patient Unit. Public Health Service Publication No. 370. Revised 1964, Govt. Printing Office, Washington, D.C.

- 17 ell

Cl1n1cal Instructor

Responsible for educational programme. Na NUrBiilg Attendant Refers to all activities in bIr job description, which in-

. OBSERVERS

volve nursing skills, or are taught in courses given to this group.

The observers who comprised the study personnel were nurses :f'rom seven different countries attending the First Regional Nursing Studies Sem1nar.' Preparation for their roles as observers was an important part of the sem1nar programme and included, among others: group discussions for the clarification of the fUnctions of

nursing personnel and the definitions of areas and skill levels of activities used to classify the activities observed; discussion of observation as a research technique, purpose and method of activity study;

practice exercises in using the definitions and in coding activitie8; briefing on the physical "layout" of the OUtpatient Department; partiCipation in the construction of the Observer's Form for recording observations (See Appendix)

Prior to the initiation of the study, observers were asSigned in teams of two for 2 half days of "trial observation" in the OPD. Teams were used

to facilitate comparison of the coding of activities by observers and to clarify problema in using the definitions, and the accur:acy of recording and usiag the codes. Follow1ag the trial observation, definitions were mod11'1ed

, Held 2-30 August 196,.

Countries represented were Japan, Taiwan,

Korea, Fhil1ppiue8, New zealand, Austral1a and MIllaysia.

- 18 and the form for recording observations changed in accordance with the trial observation experienc~s.

A study team of six observers collected data for the five-day study period at the Jose Reyes Memorial Hospital Outpat:l.ent Department, (See Appendix for observation schedules), under the supervision of a Study Director. The observers and the Study Director reported at the Outpatient Department 15 minutes before the observations were scheduled to begin. nn-ing __ •

this period the nursing personlY.!l scheduled to be on duty were checked against the nursing personnel aSSigned to the observers, identifying data on the Observer's Forms were filled in and nursing personnel were surveyed to be certain they were wearing the coded armbands. Two observers were scheduled during the same observation period for

inclusion of the total nursing personnel in the study.

Personnel assigned

to each observer varied from nine to ten for the l!!Orning outpatient department hours to four to five during the af'ternoon hours. Observations began at 7:30 a.m. and finished at 4:00 p.m. with a lunch break from 12 to 12:30 for the first 1'our days of the study. day observations started at 6:30 a.m. and finished at I

I I

On the fifth

3:00 p.m. with the

. ,i

lunch break from 12 to 12:30 p.m. STUDY DlRECTOR

The Study Director, reported on duty with the observatiOn team scheduled for the opening of the Outpatient Department and left when the nursing service personnel reported off duty at the clOSing of the Outpatient Department. She supervised the collection of data by the observers and

during the study 1. circulated in the OPD periodically during observations for "spot checking" the observation techniques; 2. consulted with the observers as needed;

- 19 -

3. reviewed the observer's record for completion and accuracy as each observer completed his scheduled observations; 4. spot-checked the coding of activities for accuracy by comparing the activity described with the way it was coded;

checked schedules of nursing personnel with the Supervising BUrse of the outpatient Department to assure the accuracy of nursing personnel assigned to observers for observations;

6. planned for the assignment of observers during the study facilitated the operation of observer's assignments;

and

planned schedules for the tabulation of data collected by the observers with one of the seminar staff who directed the tabulation of data;

assisted in the interpretation of data and the preparation of the written report of the Nursing Activity Study.

- 20 - .

AN~IS AND INrERHlETATION OF DATA

Introduction In planning the presentation of this report, it was felt that there was the choice of three approaches to the analysis of the data. ,-

One, and the llIOst easily thought of approach was to analyze the data

from the po:lnt of view of. the gradE'S of personnel; to see what they were dOing, where they were: doing it and at what skill-level the task was being carried out. This approach, it was thought, would focus the study on the

personnel and perhaps obscure some of .the other pertinent aspects of the study. The second approach considered, 'JaS

to analyze the data from the point

of view of the work done;

~ilere

it was done alii what skill levels were This approach clearly would centre

required for its efficient performance.

the study on the work load and maybe obscure other important issues relevant

to the staffing patterns of an outpatient department. A third possible analysis developed after further discussion, about the pubUc health approach to patient care, which is consistent with modern trends in medical and nursing practice. SiX questions have therefore been

posed, consideration of which in'llOlves a detailed examination of the data yielded by the activity study and does not lose sight of the point of view of total patietrt; care given to the patient and how best this may be achieved. 1. How are nursing service personnel spending their time in the outpatient's department? During the five-day period of the study, 1654 observations of nursing service personnel were made representing a total of 41'.5 working hours (eee Table lA - W'.lOle ll8y). 'C

,. '

- 21 The nursing service pex-sonnel observed were:

1 Supervising nurse

5 Registered nurses 4 1 NUrsing attendants Clinical Instructor

All observed activities were claSSified according to a scheme of siX de:t1ned skill levels (see appendiX). These levels werel administration,

nurSing, clerical, housekeeping, messenger, unclasSified.

the total time spent by all nursing service personnel., the highest

proportion (28 per cent) was spent at the level of housekeeping, while the l.evel of unclassified activities accounted for 23.3 per cent of the total. SiXteen per cent of the time was used at the cl.erical level and 2.4 per cent at the messenger level (see Table lB and Figure 1). Only 17 per cent of the

total nursing service personnel time we.s spent at the level of nursing and only 13.3 per cent in the administration of the outpatient's service, Sbowing that although the hospital administration authorities were paying for 395.75 hours of nursing time, they were actuaUy receiving onl.y 125.50 hours at this l.evel. of skill, 70 hours of whIch Wel'e

devoted to nursing both direct

and indirect and 55.50 hours in the planning, organizing, directing and teaching undertaken in the aaministration of the unit. The supervising nurse's function, as stated in the job description, is that of a nursing service administrator yet only 52.6 per cent of her time was devoted to aaministration, while 3.2 per cent of her time was spent at the level of nursing. The housekeeping level cl.aimed 12.8 per cent of her

total time and clerical, messengex- and unclassified levels 4.5, 1.3 and 25.6 per cent, respectIvely. The regIstered nurses, who had all completed 3 to 5 year nursing prograDIlieS

followed by post..graduate experience, spent the highest proportion

- 22 -

of their t:l.me (29 per cent) giving direct and indirect care to patients at the level of rmrsing. Almost as much of their t:l.me (25.7 per cent), how-

ever, was used at the housekeeping level, with 10.9 per cent given to clerical skills, while 2.0 and 22.0 per cent were spent at the messenger and unclassified levelS, respectively. These graduate nurses have certain 00"

ministrative functions according to their job description and the study revealed that a total of 10.4 per cent of their time is spent in the administration of the unit. The clinical instructor is not paid by the hospital administration but accompanies students from the De Ocampo School of NurSing which is affiliated with the Jose Reyes Memorial Hospital QutpatientsDepartment for student nurse clinical instruction and experience in outpatient nursing. cal instructor spent

The clini-

63.4 per cent of her time at the administrative level,

wt1ich included teaching in the student programme and 2.8 per cent cf her t:l.me at the nursing level. The unclassified level oc:!upied 32.4 per cent

of her t:l.me and only 1.4 per cent was spent at the clerical level. The nursing attendants have a brief on-the-job training in those housekeeping duties 'Which faqilitate the work. of registered nurses, and the highest proportion of their t:l.me (37.8 per cent) was occupied at the housekeeping level, with clerical next in line with 26.6 per cent of time and only 3.5 per cent of t:l.me spent at the level of messenger. Nursing attendants spent I

I -4 ."

6.6

per cent of their time at the level of nursing direct and indirect and 1.9 per cent at the administrative level. As with the registered nurses, they

spent a high proportion of t:l.me (23.60 per cent) at the unclassified level. 2. How much of the non-rmrsing work is done by nUrses? WIllie it is inevitable that nurses will be involved in some non-nursing work, there is nothing inherent in work at the clerical, housekeeping and messenger levels which suggests that it requires the kind of preparation

which registered nurses receive during a 3 to 5 :year educational progr8IIIJII!. It may be surprising, therefore, to discover that work at tI:'.is level occupies

38.6 per cent of the registered nurses' time and 57.2 per cent of the tillle of

!!! nursing

service personnel.

If this use of time is occurring, is it

happening at the expense of not allowing the registered nurses sufficient

time to undertake their role in meeting the objectives of the outpatients' department for providing nursing care for patients, promoting understanding between the outpatient staff, the patients and the colllllllnity, giving health teaching to patients and education to nursing studentsan/l nursing attendantsT This question cannot be answered directly, but closer look should be taken at this non-nursing time 'to see how it is made up. Housekeeping is the

level occupying the highest proportion of non-nursing time for all nurses it actually occupies only 4 per cent less time than does nursing for registered nurses. Itis not known, whether this work could all be undertaken by

other staff at present employed and trained to concentrate on work at this' level. The nursing attendants spent the highest proportion of their time (37.8 per cent) in housekeeping. A very small p£rcentage of time (6.6';per cent)

was spent at the level of nursing, both direct and indirect, in spite of

their title, "nursing attendant".

The nursing attendants' job description

lists se'Ve1'81 duties which can be described as basic nursing care "under the supervision of a registered nurse~.

One wonders whether or not the registered

nurses are free to give this supervision when a high percentage of the registered nurse time (60 per cent) takes them away from level of nursing and administration. Work at the clerical level occupies 26.6 per cent of thewrsiQg attendants' time and 16 per cent of the total time of all nursing service personnel.

- 24 Work at the messenger level occupies only 2.4 per cent of the total time of the cursing service personnel of the Jose Reyes Outpatients Department and

'.5 per cent of the cursing attendants'

time is spent at this level.

The total of 46.4 per cent of time spent by all categories of nursing service personnel at the skill levels of clerical, housekeeping and messenger could be the subject of further close study to determine why this nonnursing work is undertaken by nursing service personnel. It must be remem-

bered that a higher proportion (54.8 per cent) of these non-nursing activi_ ties 11&8

undertaken during the afternoon period while in the morning

~.98

per cent of the total time is spent in this way.

The housekeeping level was T

particularly high (4,.07 per cent of the total) during the afternoon period. This work was spread over all categories of nursing staff and occupied 21.21 per cent of the supervising nurse's t~me, 4l.95 of the registered nurse's time and 50 per cent of the nursing assistants' time, between 12.3C p.m. aDd 4:00 p.m. Time at the nursing skill level was correspoudingly lowered from

19.66 per cent of the total during the morning to 1:5.28 per cent during the afternoon, as was also time spent at the administrative l.evel which was reduced from 18.20 per cent of the total for the morning to 6.9' per cent for the afternoon period. This use of time illustrates a wide variation in

the balance between nursing and non-nursing activities as related to the morning and afternoon ~eriods.

The skill level "unclassified" requires further analysis for it represents a high pro:pflrtion of total time (2'.:5 per cent) for all categories of nursing service personnel.. The clinical instructors' activities yielded the highest '"

. percentage (:52.4 per cent) of this time while the remaining 77.6 per cent was sbaredalmost evenly between the supervising nurse, the registered nurses aDd the nursing attendants. The unclassified skill level activities were

closely related to the "personal" and "standb:y" areas of activity for each

- 25 category of nursing personnel. Personal time includes snack time which is It also includes other activities of

approved in the department's policy.

a personal nature which are oormal and can be expected and even encouraged in the interests of human relations in the unit. Some standby activities

are also inevitable in a department such as this but the relatively high pro_ portion of this time should be further studied in relation to time spent at the unclassified level. 3. T

How much of the total time of the nurSing service personnel is spent

on patient-centred acttTities? Analytical Table 2A shows hours spent in each area of activity by each grade of nursing service personnel. The illlDediate interest is to see how much time was spent on patientcentred activity. The nursing service spent 83.25 hours (20.20 per cent) of

the total time on duty in an average week on patient-centred activities. Of this time, 8.50 per cent was spent in giving direct care to patients and a further 5.50 per cent in giving other direct care. These activities

were actually carried out in the presence of the patient and, with a further .. O.~

per cent of time spent on patient teaching, represent the total time Approximately 1 per cent on the time was

spent in patieot-centred care.

spent in exchanging information about the patient and 4.4 per cent on indirect nursing activities not in the preseoce of the patient. This extremely small

amount of time spent on patient care raises immediate questions as to why it is so small considering the preparation and normally-accepted role of nursing service staff. In order to attempt an answer to these questions, it will be

necessary to examine further how much time was spent by the different members of the staff in these patient-centred activities. As

might be expected, even though the smount was small, the registered JUst

nurses spent more of their total time (32.15 per cent) in this area.

- 26 over 22 per cent of this t¥oe was actually spent with the patient including the onl¥ time spent on patient-teaching in the entire un1t (0.63 per cent), wh1l.e the remain1ng time was spent in exchanging information and giving indirect care away from the patient.

The nursing attendants appear by their job-description to be prepa.red for onl¥ three patient-centred activ1ties: "He1ps the staff nurse or service nurse prepare the treatment trays, injection trays and diagnostic trays" "Prepare supplies for sterilization inc1uding linens and instruments needed" "Assists the doc1;ors in the examination room when the lUl"se is busy" The nursing attendants spent 16-1/4 hours (10 per cent) of their time in patient-centred activities of one ]>:::'nd or another. This amount of time

wou1d appear to be fair1y high considering their preparation and also in re1ation to the time spent by graduate nurses in nursing-centred activities. The supervising nurse and clinica1 instructor do not norma1ly spend a 1arge amount of time in actua1 patient-centred activity. The majorresponsi-

bility of the supervising nurse lies in the administration of the un1t and in personne1-centred activity. The clinica1 instructor's major responsibi-

•

lity lies in the personne1-centred area of activity, namely, the studentnurse training programme·. These nurses then wou1d on1y be expected to give It may be noted

patient-centred care under spec1a1 and emergency conditions.

that the supervising nurse and the clin1ca1 instructor spent approximate1y the same percentage of their tota1 time (5.6 per cent) on duty in this ac": tiv1ty, but in the case of the clinica1 instructor none of this time was spent in "direct" care. From these data it can be seen that the registered nurse spends the greater part of the time in patient-centred activity, but it must be repeated

I I

- 27 and stressed·.~that

this part is ve-ry small and certaiul.y DOt consistent with

her level of skill through preparation and would suggest that she 1s not being used to her full professional capacity nor economically. On

the other

hand, the nursing ass1stant, who is not primarily prepared for patient-centred activity is epending more time in this area than would be expected in the 11gnt of her job description. In order to discover possible reasons for this apparent nunder_use n of the registered nurse in her expectant role, it will now be necessli-ry to examine the data to find what the nursing service staff were doing with the rest and the greater part of their time. 4. How is the remaining time spent by the nursing service staff? Having demonstrated the time spent by the nursing service staff in patient-centred activity and bearing in mind that nurses are primarily prepared for car-rying out or administering this type of activity, it is essential now to examine how the rest of their time is occupied. From Analytical Tables 2A and 2B, it will be observed that 325/.75 hours (79.71 per cent) of the time on duty in an average week is spent in non-patient centred activities. For the carrying out of this study, these non-patient centred activities were divided into: Personne1-centred activities - concerned with professional growth and development of nursing service personnel and personnel management. Unit-centred activities - concerned with the running of the unit, Other-centred activities _ concerned with personal activities and standby. (see Methodology)

From a scrutiny of the tables, it can be seen clearly that the greater part of this time was spent in unit-centred activity, i.e., 215 hours (52 per cent) of the total 413.50 hours of duty in the week (see Fig. 4A). .As

- 28 this activity involves, in the main, a skill at housekeeping level, it will . be important to ex6III1ne the time spent by the different grades of nursing service personnel c:arry1ng out this activity. The registered nurse spent 87.25 hours (44.01 per cent) of her time on duty in unit-centred activ1ty. The nursing attendant spent 105.75 hours

(66.9:5. per cent) of her time on duty in unit-centred activity. The supervising nurse spent 21.50 hours (55.13 per cent) of her time on duty in unitcentred activity. The clinical instructor spent 0.50 hours (2.82 per cent)

of her time on duty in this activity. As the clinical instructor is employed for the nursing education prog1'8IIIIlS,

her time spent in unit-centred activity, being so small, has no sig-

nif'icance in relation to evaluating the stai'f'ing of the Department. The grades of nursing personnel s'-8t1ificant in examining Unit-centred activity are; SuperviSing nurse; Registered nurse; Nursing attendaLt.

For all personnel, this unit-centred activity occupied more time than "Patientcentred" activ1ty. The nursing attendant spent the greater part of her time

on duty in "unit_centred" activity as might be expected, The supervising nurse, whose major responsibility is in the areas of unit-centred activity and personnel activity spent slightly more time in unit-centred activity than in personnel-centred activity. Accounting for

the nature of the preparation and the appointment of the supervidng nurse, we might expect to find mre time spent in personnel-centred activity. is !;Iarticular~

This

important in view of the supervisory responsibility for the

professioual development of personnel and for the evaluation of the patientcare activ1ties of the nUrsing staff. On examining the table breaking down the areas of activ1ty1nto the a.m.

and p.m. periods, it is very evident that, with the exception of the nursing attendant and clinicalinstructor, much more unit-centred activity takes

..J

- 29 -

-,...

place in the afternoon (61.05 per cent) than in the morning (46.10 per cent). This may be explained by the fact that duriog the first 1-1/2 hours of the afternoon, there were no patients under treatment. duriog the afternoon was lighter. The patients r attendance

However, on studying Analytical Table 2B.

one sees: a) That the total personnel. spent the largest percentage of their time in the afternoon at the housekeepiog skil.l level.. b) The supervising nurse spent almost the same time at housekeeping skill 1evel in the morning and afternoon. c) The registered nurses spent 1-l./2 times more time at housekeepiog skill l.evel in the afternoon than in the morniog. d) The nursing attendants spent almost the same time at housekeeping skill level. in the morning as in the afternoon. In referring back to Figure 6, one sees that the period spent by the supervising nurse in the personnel.-centred area of activity is reduced in the afternoon. ThiB is found to be the main cause of her total reduced time This would also apply to a lesser deg-

spent in personnel-centred activity.

ree to the registered nurse who might alBo be spending more time on personnel. development. Data show that the period 1230 - l.4oo hours, when patients were not in attendance, was spent by the nurs10g service staff in the preparation of S\1ppUes. e.g., cotton balls and dress1ogs, and preparation of unit for the afternoon's work. The greater part of these activities do not require a

nursiog preparation and can be quite easily carr1edout by lay personnel.

The data show that:

The clinical instructor spent approximately one-

third of the time more in non-nursiog activities than the actual nursing service personnel.. Personnel-centred activity occupied 28.00 hours (6.73 per cent) of the total time of the nursing service staff.

- 3C As was to be expected, the greater amount of time in th1s area was spent by the superv1sing nurse i.e., 7.50 hours or 19.2, per cent of which 10.90 per cent of the time was spent in personnel development. Next came the cl1-

nical instructor, with 10.75 hours or 60.57 per cent of which 57.75 per cent was spent in the student development programme. The registered nurses were

obviously more occupied with patient and unit-centred activities spending 6.25 hours (,.15 per cent) of the1r time in this area. Lastly, the nursing attend-

ants spent ,.50 hours (2.22 per cent) of the1r time in this area and that mainly in "personneln matters. The next largest amount of time spent in non_nursing centred activities ~

that spent in "other-centred" activity, namely activities of a personal It is normal and inevitable that activities of a personal

nature and standby.

nature do occur and the1r extent depends on factors outside the scope of this study. Standby is also 1n.cvitable, especially when an outpatient departments'

work depends on the uumber, the times of attendance, etc. of the patients and the availabil1ty of medical staff. The nursing service staff spent 86.75 hours (20.98 per cent) of the time on duty in "other-centred" activities. Of these:

58.00 hours (14.0' per cent) were spent in personal activities. 28.75 hours (6.95 per cent) were spent in standby.

How much of the nurses' t:l.me can each patient expect to receive in direct nurSing care? Although specific data on the time patients wait in the lobby of the out-

patient·s department are not available, one can assume that in view of the fact that an average of 782 patients attended daily during the study, the waiting time was considerable. An independent, but not systematic survey, ~.

est1lm.ted that on the average patients wait from 1 to 2 hours before receiving

- 31 -

medical. and nursing care.

Assuming that many patients leave their employment

to attend clinics, and that lengthy waiting periods in the hot-crowded vaiting space are not in the best interests of the health or comfort of patients, watting time for patients might well be an aspect which would merit further study particularly in relation to the aims of the outpatient department. When the patietIt eventually arrives at the personnel qualif1ed to provide for his medical and nursing care needs, bow much of the nurses' time can he expect to receive in direct care? 'T

If the time spent by nursing service personnel1n the presence of patients

was equally distributed among the 3910 patients who attended the outpatients department during the five-day study periOd, the time available would be 42 seconds or 0.749 minutes per patient. Activities which are related to time spent in the presence of the patient are those listed under COdes ll, 12 and 13 (see appendix) and inClude direct care of patients, other direct activities in the presence of patients, and patient teaching. The question arises as to how much can be accomplished during this average nurse-patient contact of 42 seconds. Is it sufficient to make signifi-

cant progress towards the achievement of the a1mB of the outpatients' department for providing supportive care to patients, promoting understanding between the patients, the outpatients' staff and the COmmunity, for health teach. ing or even for student education in a programme which should be primarily patient-centred? In view of the fact that 5 of the 10 most common diseases in the City of M!l.nila are known to be preventable, patient contact, particularly for the purpose of health teaching, would seem to be of prime importance.

one

m\JBt

also ask whether a significant increase in this 42 seconds nurse-patient

- 32 con.tact might DOt help to prevent repeat visits to the department and thus keep down the cost both to patients in terms of work time lost, and in rela. twn to the ,departmett and hospital running costs. The mol'e the a1!ns of the

department are realized the more outpatients will be prevented :from becoming in_patients. This small amount of patient-nurse contact must also be closely studied in relation to its effect on the job satisfaction of registered nurses particularly. These nurses are prepared in 3 to 5 year programmes for nursing They elect as graduates :r'

service Which should be primarily patient-centred.

to work in nursing service units rather than in administration or teaching posts and are in a position to \.:Se their learning to the best advantage for patients. The registered nurses have six t.imes more contact (J6 seconds or

.656 minutes) per patient than do nursing attendants with 6 seconds or .115 minutes per patient. The supervising nurse yields a figure of 9 seconds or

0.15 minutes per patient spent in the presence of patien'ts. Comparison between these two :figures and the exceedingly high figures spent on llOn-nursing activities suggests the question, "Is there a place for reassignment of activities and re-education of registered nursing personnel to give priority to assuming their true function for patient-centred nursing eare?D

Consideration must also be given to the physical factors such as cramped crowded conditiOns, noise, lack of privacy and lack of air-conditioning, all

of which operate against health teaching, and the best use of nursing time spent in presence of patients, and ul.tlmately against meeting the objectives of the outpatient department. Another factor to be considered is the IUWIll number 01' budgeted posts for registered nurses in the department. There is one registered nurse PJ:e these

post budgeted for over and above the superviSing nurse's post.

- 33 sufficient to supply the cursing service needs ror an average daily attendance of 782 outpatients?

How much teaching is given to each p4111entby the nursing service personnel? Teaching is considered to be an essential activity in any outpatient

department.

In view or the current trends in medical care whl.ch combine pre_

ventive with curative care, this activity must rank high in the objectives

or the department as described in the Pollcy Book or the hospital. The study revealed that only 1.25 hours (0.30 per cent) or the total time was spent in teaching patients. Thus, each patient could only expect

11-1/2 seconds or time (0.019 minutes) ror teaching.

It was noted, as expected, that the registered nurse was the only grade

or cursing service starr ..~ provided ror patient teaching. However, when one realizes that all graduate nurse personnel are prepared ror patient teaching, it is important to examine their work in ather nan-nursing centred activities to consider their possible release from this work in order to provide fen- patient teaching. In relation to thiB problem one might also consider the time spent by patients waiting ror examination and treatment and the possible use or grad_ uate nurse personnel to carry out a teaching progra.nme during this time. This activity would be more appropriate to the preparation or the graduate nurse than the many housekeeping and clerical skill-level activities she is now required to perf'orm.

What part do the nursing students play in the OUtpatient Department? The distribution of the time spent by students in the outpatient depart-

ment in the areas and levels or activity should be c:onsidered in relatIon to certain factors which may have influenced the percentage of time spent

to the morning clinic hours. Of

in patient-centred activities and the time at the nursing skill level. During the period of data collection, there were 10 students assigned

these students, two were present on 1.-wo

mornings only for the specific purpose of making up their clinical experiences in the operating room. These students spent aJ.l of their time for

2 days assisting doctors with minor surgical operations.

Analytical Table 5A reveals that slightly less than 50 per cent of student time was spent in patient-centred activities. Direct-patient-care See

activities represented approximately 40 per cent of these activities. Fig.

ll. Only

5 per cent of the students' time, however, was spent in professional Since

staff development, i.e., receiving impromptu or planned instruction.

the students experience in the outpatient department is p:anned essentially as a learning experience, t~e

small amount of her time spent in professional

staff development might have been influenced by the fact that all the students were:l.n their senior year. Other-centred activities occupied slightly more than 25 per cent of the students' total time, with 11 per cent of this time in nstandbyn and 14 per cent in personal activities. Considering the imPortance of the rich facilities of the OUtpatient Department in the whole student education programme, re-study of the student activity in relation to the educational goals of the student programne appe8l'6 to be indicated.

-» -

BU:lGESTIONS

In studyieg the data revealed from the activity study and the eval.uation, the most outstandieg fact emerging is the m1uute proportion of time (20 per cent) the nursing staff spend in patient.;.centred activity. ltcould be said

that the aim of nurse training should be pr1lDarily directed to the produc_ tion of an efficient graduate nurse capable of giving effective patient care. The majority of nurses who graduate should remain in the position of being able to give patient-care for the rest of their careers. If amongst some nursing service stat!, the graduate nurse is spending

little of her time (32 per cent) in patient-centred activity, it is obvious that she must be spendieg a disproportionate part of her time in other activities for which she is not prepared.

The stud)' data sholl clearly that the registered nurse is spending considerable time (44 per cent) in the unit-centred area of activ1ty of which the criteria (nursing definitions) reveal that only 7.5 per cent require

nursieg s1d.ll.

In sharp contrast, she is spending 25.7 per cent of her time

1.:II!ieg housekeepieg skills and 10.9 per cent using clerical skills, neither of which can be considered to be at her level of qualification. Of the per-

sounel employed in the Outpatient Department, it would appear that the nursieg attendants who are spendieg 10 per cent of their time in nursing activitiee are functioning during this time at a level for which they are not prepared. Could the nursing attendants carry out more duties at the house-

keeping s1d.U level i f their work were re-organized? This possibility is entirely apart from the separate question of what sbould be the job respoD. J',

sibility of a group of personnel whose title is "nursieg attendant"

rt voul.d also appear that i f ma.ximum use is to be made of the specialized skills and knowledge of registered nurses, more of the clerical work now done by the graduate nurses might be aSSigned to other people who are employed at the clerical level. However, without a separate activity study which

woul.d include existing clerical staff, it is impossible to say whether or not reassignment coul.d be done with the existing staff. The field'l.'Ork records show that, within the small aJrount of time devoted to nursing procedures, very few surgical dressings were carried out by nurses.

The rul.es -tor clinical clerks (4th year medical students) as outlined in the policy manual state may be an influencing factor: "Allowed to dress wounds and do minor procedures under supervision of a resident." It is clearly regarded that the medical dressings are within the province of both medical aud IlIll'sing work. An activity study of the medical work in the out-

patient department might help to determine to .hat extent the medical/surgical dressings coul.d possibly be taken from the work load. A redistribution of

responsibility, partial or complete, woul.d provide the registered nurses with an opportunity to perform more of those functions for which they have had specialized preparation. II

In view of the large proportion of time (10 per cent) spent by registered nurses in activities which can only be described as housekeeping, it would seem that this aspect of the work of the outpatient department should be studied in detail. The object of this study voul.d be to discover the nature

of the work aud the extent to which it is a reasonable return for the time expended by personnel whose skills are at a much higher level and more expensive in terms of salary paid, than those required of the ac"tivities carried out.

- Y{ -

One item that cannot be overlooked is the standby area ot activity which

accounted tor 28.75 per cent of the total "other_centred" activity.

While

it i8 realized that no work situation can exist without the apparently nonproduct1ve activity of standby - nevertheless, it must be agreed that in an efficient organization this activity will be minimal. Accordingly, it is

suggested that a closer scrutiny be made of the extent and nature of the standby periods With a v1ew to erad1cating those which could be eliminated. In so tar as patient-teaching is clearly delineated as an area of res-

ponaibility for the nursing personnel and patient-teaching is an eseential

pEon

of preventive and curat1ve care in total medical attention, one might

expect that a substantial amount of time would be spent in the course of a week 1n this field. An examination of the detailed results at the act1vity

study reveals that the amount of time devoted to teaching was so small as to be conaidered negligible (1.25 per cent 1. One might even wonder whether or

not the teaching that did take place was accidental rather than ·planned. There are three ways ot looking at this problem. One might ask to what extent

there exists a philosophy which includes "teaching" as being an important aspect ot medical and nursing care. This question is posed, because, unless

there is an active nursing policy directed towards patient-teaching it is unlikely that any subsequent study would reveal r:.n increase in the amount of time spent in this activity. However, given the existence of a real concern

for patient-teaching, does our activity study indicate that the nursing personnel would have the available time to devote to this activity? The answer is no, but, i f studies were carried out and actiOn taken on them to redistribute the non-nursing activities now carried oat by registered nurses, available time would be tound. With careful planming by enthusiastic nurses,

supported by the medical personnel and hospital poliCies, a successful teaching programne could be devised. Even so, one must ask oneself whether,

- 38 given the combination of the desire to help the patient by this activity together with sufi'icient nurses with the time to implement and continue the programne, would the patient be able to receive the help of this ne.ture which the nurse wishes to give? The answer to this question lies in the

fact that a considerable amount of time is spent in the waiting areas before patients are called for treatment and reorgan:l.zation on the part of the administration coul.d, no doubt, make good use of some of this otherwise useless time. The proportions of time (42 seconds per patient) during which patients can expect to have direct contact with nurses is so small as to give some concern regarding its effectiveness. given to patients in direct This 42 seconds represents the time

nursing care, other direct activities in the

presence of the patient and in patient teaching. One might well questi~n

whether or not this period of contact is suffi-

cient for the nurse to make any significant contribution towards the achievement of the outpatient departments I a:!.ma, or to contribute significantly from the body of her knowledge and skill called nnursing n , towards which her , to 5 years nursing education program has been directed. It has rig):J.tly been stated that nursing service will only ever be as \1

effective as nurSing education.

Unless the t!me which graduate nurses spend

with patients can be increased by reassignment of activities so that the focus is on nursing time with patients, rather than other activities, there will be little possibility of nurses translating their learning into effective patient care directed towards the achievement of the objectives of the outpatient's department, and the needs of p~tients. I

Finally, one must ask whether or not the two regis tered nurse posts budgeted for allow for sufi'icient registered nurse-time for each patient. the nursing needs of the patients who visit each or the clinics require Do

- ?I)/40 the attendance of more registered nurses, for example, one registered nurse 1n each clinic during the periods when pat1ents are in attendance? These questions are ra1sed because the nursing activ1ty study had as its overall aim the ultimate imp'ovement of patient care, 1n part1cular the care of patients by nurses in relation to the specialized contribution they can make to the total health service. I:f any data recently collected in this activ1ty study were to become

the basis of action it would be nry 1mportant to evaluate the modified organization by conducting a further study, say, in one year's t1me.

- 41 -

1. 2. 3.

CODES AND DJllli'ill.LTIGffi - W.m3ING ACTIVITY S're);)!" ASSIGliMEm' OF ff..msnro pgl=l'3'))I;'."Er, 'ro OBSE:rJERS AT JOOE REXl!5 MEMORIAL HOSPIrAL OOT-PATIEl'IT DEPARDfEN'r OBSERVER'S RECORD

4. 5.

INFORMATION FOR OUT-PATIENT DEPARlUENT - NURSING ACl'lVI'l'Y STUDY CHARTS AND GRAPIB

6. BIAlIK FORMS AND WORKTABLJ!5 7. BIBLIOGRAPHY

......

ANNEX 1

FIRST REGIONAL NURSIID STUDIES SEMINAR -WPRO-121 2 - 30 August 1965 *CODES AND DEFINITIONS - NURSING ACTIVITY STUDY I CLASSIFICATION OF ACTIVITIES ACCORDING TO AREA

The areas of activity for this study are four; namely, patient centred, personnel centred, unit centred, and other centred. PATIENT CENTRED ACTIVITIES These activities may There are five subgroups numbers - 11, 12, 13, 14 person being observed is occur in the patient's presence or away from him. of patient-cer.tred activities with identifying code and 15. Codes 11 and 12 will be used only when the actually with patients.

Code Number 11 - Giving Care. Activities occurring in the presence of the patient, which involve the giving of care, including: Carrying out a nursing procedure. and weights. This includes measuring heights

Assisting doctors with treatment or procedures. Giving or assisting patients with personal hygiene. Code Number 12 - Other Direct Activities. Activities in the patient's presence not classified as giving care, including: Conversing or exchanging pleasantries with the patient. Evaluating the patient's need for care. Escorting patients. Listening to requests, wishes, and complaints of patients. Making interpretations to patients. Observing the phYSical condition and behaviour of patients.

*Adapted from "How to Study Nursing Activities in a Patient Unit", PUblic Health Service No. 370 Revised 1964 and Adams, A., "How to Study the Nursing Service of an Outpatient Department", PUblic Health Service PUblication No. 497, Gov't. Printing Office, Washington, D.C.

-43 Code Number 13 - "Teaching Patient" includes: Those explanations aod demonstrations in relation to health, medications, treatment, or needed follow-up which include a specific reason or answer "why" for the patient. Not a statement such as ''Because the doctor wants you to," "This is good for your health, It or "This will make you feel better." Because patient teaching is considered an important outpatient department service it is listed and coded separately. Observers will need special orientation to identify this activity from merely "telling" or giving of general information. Code Number 14 - "Patient: Excha e of Information About or With Patient", includes: (Mayor may not be done n presence of patient Exchanging verbal reports about or with a specific patient or patients with unit personnel, nursing service administration, physicians, other hospital departments, patient's family and friends, and other interested persons or agencies. Listening to or giving a.m. or p.m. report. Discussing, giving and receiving an assignment related to patient care. Scheduling patients' appointments. Referrals. Discussing/ordering drugs, supplies, or equipment by telephone for a specific patient or patients.

(It is understood that the observer will ask the reason for scrutiny of reports). Code Number 15 - "Patient: Indirect Care" means all other patient-centred activities not in the presence of the patient and not involving an exchange of information about a patient. It includes: Care of records and record forms relating to patient care. Charting of care given. Checking of doctor's orders. Errands for patients. Preparation of medications and treatment trays. Setting up and terminal care of equipment. Planning aod evaluating patient care away from the patient. (The receiving of individual drug supplies is considered part of preparation of medications.)

- 44 _

PJmSQNNEL

CENTRED P.cTTVlTIES

These activities are primarily concerned with the professional growth and development of nursing service personnel and with personnel management. Code Number 21 - Professional Development of Staff Participation in all activities conducive to improved nursing service, as well as planned and unplanned events which increase the knowledge and skill of the staff, including: Demonstrations for teaching staff members individually or collectively. Giving or receiving planned or impromptu instruction. Observing and evaluating the quality of work performed. Orienting new staff members to unit. Reading or questioning to gain more information about a drug, treatment, etc. Code Number 22 - Personnel: other

Activities having to do with personnel management (personnel centred activities) including: Staff meetings. Individual conferences on personal matters which relate to work. Maintaining personnel records and conferring about personnel matters. Code Number 23 - Nul'sing Student Programme. These activities include: Discussions about the nursing students' programme with unit personnel, physicians, clinical instructors, and others. Observing and evaluating the quality of work performed by nursing students. Planning and selecting experiences fer nursing students. Teaching nursing students, impromptu or planned. (NOTE: Activities in which nursing students are involved must be weighed carefully in terms of whether they are patient centred or ~rsonnel centred. If personnel centred, a determination must be made whether the activity is for the student or for unit staff of which the student is considered to be a part).

_ 4:- UNrl'-CENl'RED ACTIVrl'ms

Code Number

- This classification includes:

Housekeeping, maintenance of cleanliness, order, and safety on the unit. Obtaining, preparing and dispensing supplies, eqUipment and records and all discussions and exchanges of information regarding these activities. Interpreting a hospital policy or procedure to persons other than unit staff or patients. Example: Explaining hospital regulations to visitors. Serving on committees for the purpose of discussing, revising, or formulating hospital and nurSing policy and procedure. Activities related to this study. Discussions, compilation of data, and so forth, for any other research studies. Errands in search of unit personnel. Making unit records such as time sheets, leave records and daily report. Reporting on or off duty. Calling out patients' names and numbers. patients. ~-CENTRED

Routing and directing

ACTIVrl'IES

Code Number 01 - Personal These activities include: All activities of a personal nature; such as, coffee breaks, conversation about personal affairs, and the like. Code Number 02 - Stand-by Time Time spent waiting for the arrival of a person or thing prior to the start of an activity including: waiting for a doctor to arrive to assist him with a spinal puncture. Waiting for a sterile dressing tray to arrive in order to change a patient's dressing.

- l,.6 r·

II.

CLASSIFICATION OF ACTIVlTlES BY SKILL IEVEL

The skill levels for this study are six: administration, nursing, housekeeping, clerical, messenger, and unclassified. Code A. - Administration Administration includes activities requiring nursing judgment. These involve responsibility for planning and providing ef'f'ective patient care, for developing unit personnel, and for managing and operating the nursing unit. Patient care activities include: Assigning personnel to meet the individual needs of patients. Planning and participating in unit education programmes to ensure safe and effective nursing care. Assisting the physician in his plan for patient care by directing the execution of his orders and reporting to him the patients' symptoms, reactiOns, and progress. Supervising and evaluating the effectiveness of patient care. Giving nursing care f'or the purpose of observing a patient, establishing rapport wj~h a patient, or teaching a member of' members of'the nursing staf'f'. Promoting, supervising, and evaluating the education and rehabilitation programme f'or the patient and his family. Making nursing rounds to assess patient's condition, progress, and immediate environment. Development of' unit personnel includes: Planning for and partiCipating in continuous for nursing personnal. le~ning

experiences

Promoting personal growth and development of unit personnel. Written and oral evaluations of the work performance of' staff ambcr~.

Unit management activities include: Planning f'or and maintaining an environment conducive to the wellbeing of patients and personnel. Promoting good interpersonal relationships. Assisting in the development and implementation of objectives and policies of' the nursing service.

•

- 47 -

Code N - NUrsing Activities. NUrsing activities include the direct and indirect activities involved in giving nursing care to patients: Preparing a nursing care plan for direct patient care. Carrying out orders prescribed by the physician for his individual patients. Observing and reporting on patient's symptoms, reactions and progress. Code C - Clerical level activities include: Copying records, as nursing time sheets. Maintaining graphic records. Assembling chart forms on patient's admission. Directing patients to services. Filling in chart headings and recording heights and weights. Checking charts on discharge. Making out requisitions for specimens, laboratory services, x-rays, or other professional services, making appointments. Copying, routing, maintaining, and filing records and written communications that are essential in co-ordinating professional services in a department or between departments. These duties will be considered clerical, whether or not a clerk is on the service when they are performed, and regardless of who performs them. Routing patients (calling numbers or names) Code H - Housekeeping level activities such as: Cleaning floors, windows, bathrooms, and service rooms (except narcotics cabinet). Preparing supplies for the unit. Emptying wastebaskets, dusting furniture, general cleaning of head nurse station, folding linen, washing furniture. Straightening and cleaning examining rooms when patient not present. (A nurse may do the initial cleaning up when a patient spills something, or in caring for patient when she is with him. This is not considered housekeeping level.

- 48 -

Code M. - Messenger level activities include: Delivering materials and supplies, charts, records, routine requiSitions, etc. Picking up emergency orders o~

drugs and supplies. o~

Accompanying patients to other parts i~ this is established policy.

outpatient department,

(It is understood that carrying drugs be recorded as a messenger activity. It was decided that the observer should ask aQY nurse accompanying patients to other parts o~ the department the reason ~or dOing so. The reply will indicate the skill level, e.g., "nursing" or "messenger"). Code U from any Unclassi~ied

Activities.

Unclassified activities are those which are eliminated by definition o~ the preceding codes. Code U is used to identi~y those activities which re~er to the person as an individual. For example: Time 10:00 1&: :JO Person observed RNl RN2 RN3 Area 21 01 02

Level U U U

Description Reading new pamphlet on diabetes. Drinking chocolate milk. Waiting to assist physician with a dressing. .('

11:00

ASSIGNMEl'll'S OF NURSING PERSONNEL TO OBSERVERS AT NORTH GENERAL HOSPITAL, OUl'PATIENT DEPARTMENT

il DATE

16, 17, 18, 20 and 21 August 1965

OBSERVERS

ASSIGNMENT NUMBER I II II I I II

16 August

John Waterer Shirley Lowe Josie Mendoza Che Fatimah Pyo Lee

Yukiko Inoue

~ I

Beginning the 17th August observers will exchange Assignment Numbers everyday as follows: John Waterer exchange with Shirley Lowe .. tI Che Fatimah Josie Mendoza tI tI Yukiko Inoue Pyo Lee

.;,

. v

').

GROUPS* OF NURSING PERSONNEL FOR OBSERVATION AT NORTH GENERAL HOSPITAL, OUTPATIENT DEPARTMENT 16, 17, 18, 20 and 21 August 1965 Total Personnel Assignment I Assignment II SuN, Rn4 Rn5 Na 3 Na4 St 5 St6 St 7 St8 9 10

ell, Rnl Rn2 Rn3 Nal Na 2 Stl St 2 St 3 St4

S; I

*Note:

Additional staff or students will be assigned daily if personnel changes.

N.B.:

Always control the assigned list of personnel with the Supervising Nurse 10 minutes before starting Obse~vations for any last minute changes in persor.r.el.

FIRST REGIONAL NURSING S'roDIES SEMINAR 2-30 August 1965 NURSING ACTIVI'lY S'roDY North General Haspi tal Outpatient Department August 16. 17. 18. 20. 8lld 21. 1965 Observer's Schedule

Name of Observer Date Monday 16 August 'fuesday 17 August Wednesday 18 August Friday

John Waterer JOsie Mendoza Shirley Lowe Che Fat1mah Hours 7:30 - 10:00 10:00 - 12:00 2:00 12:30 7:00 4:00 2:00 9:00 Hours 10:00 - 12:00 ~

John Waterer Shirley Lowe Hours 12:30 - 2:00 2:00 _ 4:00 10:00 -12:00 7:30 -10:00 11:00 -12:00

Pyo Hi Lee Yukiko Inoue Hours 2:00 - 4:00 12:30 - 2:00 7:30 -10:00 10:00 -12:00 9:00 -11:00

7:30 - 10:00 12:30 2:00 12:30 2:00 4:00 3:00

20 August Saturday 21 August

, '>-

- 52 FIRST REGIONAL NURSING STUDIES SEMINAR 2-30 August 1965 Assignments for Tabulations 16. 17. 18. 20 and 21 August 1965 Place: Room 415. WHO Professor Congalton North General Hospital OPO. Activity Study

Resource Person:

, Date Monday 16 August Tuesday 17 August Wednesday 18 August Friday 20 August Saturday 21 August Pyo Lee Yukiko Inoue Josie Mendoza Che Fatimah Josie Mendoza Che Fat1mah Josie Mendoza Che Fat1mah ..

HOURS Morning ..

Afternoon 2:00 - 5:00 Josie Mendoza Che Fatimah Josie ).f.endoza Che Fatimah 3:00 - 5:00

. I

, !

8:00 - 10:00

10:00 - 12:00 Pyo Lee Yukiko Inoue

Pyo Lee Yukiko Inoue Josie Mendoza Pyo Lee Che Fatimah Yukiko Inoue Pyo Lee Yukiko Inoue John Waterer Shirley Lowe John Waterer Shirley Lowe

I I

FIRST RIDIONAL Nl1lWNG S'.l'llDIES SEMINAR

2-30 August 1965 Observer's Record

Asency _ _ _ _ _ _ _ _ _ _ __ Obstll"'rel' _ _ _ _ _ _ _ _ _ __ 'i'imc

Date _ _ _ _ _ _ _ __ Page of A~

hr-

SuN HN Rn

CODE PERSONNEL SUpervising NUrse Head Nurse Registered Nurse (Staff) elI Clinical Instructor ll.trsing Attendant Na Student St

Place

~ $e~

(What is being done) Description of Activity

ISk1l1Level

~~u."

AREA OF ACTIVITY ll.

12.

13. 14. 15.

21. 22. ~.

3101.

02.

Patient Centred: Giving Care Pa.tient Centred: Other direct activities Patient Centred: Teaching Patient Patient Centred: Exchanging Information Pa.tient Centred: Indirect Care Professional Development of Staff Personnel - Other Professional Student Nursing Programme Unit Centred Activities Personal Standby

SKILL-LEVEL ~

N. C.

H. M.

Administration Nursing Clerical Housekeeping Messenger Unclassified

- 54 -

FIRST REGIONAL NURSING STUDIES SEMINAR

WPR/NUffi/IB/7 30 July 1965

Manila, Philippines 2-30 August 1965 NURSING ACTIVITY STUDY Information for OPO Personnel

ENGLISH ONLY

Your Outpatient Department is co-operating with the First Nursing Studies Seminar, Western Pacific Region, W.H.O. by prov:l.ding the Seminar participants with the opportunity to learn Nursing Activity Study techniques. The Seminar participants will spend August 9 and 10 and August 16 through 20 in the various clinics of the Outpatient Department. The purpose of the Nursing Activity Study, which they will be conducting to learn the necessary techniques, is to determine what activities nursing personnel are pe!'i'onning. They will be using the technique of instantaneous, intermittent observation, i.e.; an Observer, at specified intervals will record what is being done the instant he observes a nurse. The Observer is not concerned with the quality of what is being done; only with what is being done. The data he collects provide the infonnation needed to determine the scope, range and volume of activities as performed. During the observations, an Observer may ask the nurse observed a question if the purpose of what she is doing is not immediately clear. For example, if the nurse is telephoning, and the purpose of the telephone call is not clear to the Observer, he may ask the nurse, "Would you tell me with whom you were speaking?" The nurse should reply briefly, giving the facts. She might reply (as the case may be) "Te the Chief Nurse about the assignment of nurses" or "The call was personal". The Observer may also ask the nurse where she was if she was not at her duty station when the Observer was recording. He might ask, if he notes the nurse was not in the clinic at 10:15, "Can you tell me where you were when you were out of the clinic?" Again, as the case may be, the nurse should reply, "Having a snack" or "For personal reasons" or "To X-ray to get a patient's report:' At all times, the nurse should answer briefly with the facts. Remember, the Observer is not controlling what is being done in any way, but is recording information to learn how to use observation technique.

- 55 -

Tb be able to identify quickly and accurately the personnel who function in nursing service, the nursing personnel will be asked to wear blue arm bands with a letter or symbol in black. The use of the arm band makes it easier for the Observer to pick out the nurse in the crowded clinic. Please note that the nursing personnel are not identilli~ by name during the Activity Study. Tb identify the Observers who may ask the nurse questions, each Observer will wear a badge with the inscription "OBSERVER". a laboratory coat over street clothes and carry a chart back with papers for recording. Observers will be assigned in teams to the various clinics and will rotate during the 8 hours assigned. Al though only 4 Observers will be on or ott duty at any one time, nurses may meet as many as 10 different persons during the five-day period. In addition, a Director of the learning activities of the Observers will, from time to time, appear in the clinics. She will also wear a laboratory coat and a badge with the inscription ''DIRECTOR''. Participation of the SUpervising NUrse - OPD 1) The Observers will report on duty at 7:30 a.m. or whenever the nursing attendant arrives to set up the clinics. Specific instructions on where to report at 7:30 a.m. and where the nursing attendant reports in should be given to the Director of the Study. 2) At 7:50 a.m., the Observer will report to the Office of the Supervising NUrse to check the number of personnel on duty and the clinic assignment of personnel for that day. If students are to be present that day, this information should be given to the Observer. Generally, the number and types of nursing personnel on duty for eaab day can be prepared the day before. Then at 7:50 a.m. the Observer need only confinn the schedule and malte changes where last-minute shifting of nursing personnel was necessary. A simple form will be helpful - e.g.: OPD - Jose Reyes Memorial Hospital Date Personnel SUpervising NUrse I ,

16 August 1965 Assignment SUpervision all clinics Gyn - OB and

• :

Hours on Duty

8:00 a.m. 7:45 a.m. 8:00 a.m. 10:00 a.m. 10:00 a.m. 7:30 a.m. 8:00 a.m. 8:00 a.m.

RN RN

1 1

Paediatrics ENT

4:00 p.m. 3:45 p.m. 4:00 p.m.

Student - 1 Student - 1 Helpers - 3 RN RN

Derm. & Medicine All clinics

- 12:00 noon - 12:00 noon 3:30 p.m. 4:00 p.m. 4:00 p.m.

1 1

Surg. Treat & OR SUrgery

- 56 -

3) Please note that "RN" is used instead of the nurse f s name, and should appear as many times as there are graduate nurses on duty each day. '!he same procedure holds true for the nursing attendants and the students. 4) The Supervising Nurse should inform all nursing (and medical personnel) of the Nursing Activity Study, the objectives as indicated on page 1, of the function of the Observer, of the importance of answering the Observer's questions briefly and accurately, of the purpose of the arm bands for identification of categories of nursing personnel, and of importance of not changing their usual way of working. If changes in the usual way of working are made by the nurses, the whole purpose of the study and the potential benefits of the findings will be invalidated.

5) Nurses or students who are on duty part time should be instructed to leave the arm bands with the Supervising Nurse. If these nurses or students are replaced by other part-time nurses, the Supervisor should be sure those who come on duty have the appropriate arm band. ".'

6) The distribution of the arm bands should be done by the Supervising Nurse when the nursing staff reports on duty. All arm bands should be returned to the Supervising Nurse's Office when the staff repcrts off duty. 7) The Supervising Nurse should arrange for a room or office where the Director and the Observers can rest and can summarize their recording activities.

8) If a canteen is available, the Supervising Nurse should clear with the canteen to determine if Observers can be accommodated between 12:00 noon and 12:30 p.m. for lunch. If not possible, the Director should be notified so Observers can be advised to "pack a lunch". 9) Any questions or problems which may arise should be immediately discussed with the Director. 10) Director of Study at Jose Reyes Memorial Hospital, OPO _ Dr. Vera Fry-MaUl art

...

Co-Directors of Study at Philippine General Hospital Miss Maria Tito de Moraes Dean Julie Sotejo

- 57 Figure 1

ANNEX 5

PERCENTAGE OF TD1E SPENT BY NURSING STAFF AT SKILL rEVELS OF ACTIVITY FOR THE W-llOLE DAY. NORTH GENERAL HOSPITAL. OUTPATIENT IEP[,RTMENT

o All Categories

Percent 30 40 50 60

100

Supervising Nurse

Registered Nurse

Nursing Attendant

Clinical Instructor

> LEGEND

!%J

Administration H

il ~

Housekeeping Messenger

M C

rJii;~

Clerical

- 58 -

Figure 2 PERCENTAGE OF TIME SPENT BY NURSING SERVICE STAFF AT SKILL LEVElS OF I..CTIVITY DURING A.M. AND P.i1. PERIOOO NORTH GENERkL HOSPITh.L, OUTPLTIENT DEPART}1ENT

o 10 20 30 40 50 60 . , -.. _..L-_-'-_ _ .__-'-___-'-_ _ ~

Per

100

All Categories

~'.M.

/,.M. , ~'.M.

Supervising Nurse

ft.Mo /

Registered Nurse

)PO'O /

NurSing Attendant

Clinical Instructor LEGEND

.,.j

/,droinistration

H M

~ Housekeeping 14essenger

Clerical

- 59 Figure 3

PERCENTAGE OF TIME SPENT l',.T NURSING (AIM. & NURSING) fIND NON-NURSING SKILL LEVEL OF ],CTIVITY BY NURSING SERVICE STAFF FOR THE WHOLE D/.Y NORTH GElIDl.l.L OOSPITio.L. OUTPATIENT DEPf.RTl1ENT

Percent

0 'T

50 I

70 I

100 I

All Categories

~ ~g:w.0]

Supervising Nurse

Registered Nurse

~2J'.B'/fd1

Nurse Attendant

)f&l )W~$#I1#.&J ~ Administration and Nursing Skill Levels

Clinical Instructor

LEGEND

Non - Nursing Skill Levels

- 60 ::J'igure

4-A

:Fz,~c:anlj:.3E 01"\ TII..E ':';l'EIJ'i' BY inLl~IHG In L_.·-..;j~LJ C~' J:..CTI717Y FO~: TE

;]3. :v:CE GTi;.FF LL1 1J o.!.{.r.~:z G.i~ t~:..h..:~ .:=Cl"::.?::~ '11:-'1.., OU'l'FL~.' I211i: Di!::L:\.':.'LJJ.T?

.r:c:;.!!

o All C&tegoriec

r 1'"-

i",V

e r 30

100

, ,r

Supervicing iluroe

Regictereo. lIurce

!Turtling Att en(,~.nt

Clinic~.l

Inatructor

... Pr

~ Patient ~ntrec.

tir

LEGEND: Pr Peroonnel Centrc(: O-t.:.lcr CentreL

- 61 7igure 4-B PElCEHTAGE OF 'l'11:.E GPEllT IN .tJtE8. O.li' J..CTIVITI~ BY HUL~IITG JERVICE JTJJi'F NORTH GztmP.J..L i10;::J?ITk::', OUTl'J..TIztlT D;;:Pj~-;.Ti.,EtlT

. .. .... .. .... " . ........................... . .. . .. .. .. . .. .. . .. " .... .. ~

.....•..•...•.•. ... •........•............. ..•................. ............................................... .................•.•. .. .....•..•.......•... .... .. •.•.........•..•.•.. ..... . ............•.. ....... .............. -......•...... .. .... .. .. .. .... , .......................... * .... ••••••••••••••••••••••••••• ••••••••••••••••••••••••••• ••••••••••••••••••••••••••• ..... .•..•..............•••• ,·,,·,'.L·.·, ••••••• " •• " •••••••••••••••••• ........•....•.........•..•••.• >_"0·1. ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •• ~

...... .....•..... ..........•..•.•.... .. .. .. .. • , .... '" . . . . . . . . . . . . . . :it . . . . . . . . . . . . II . . . . . . . . . . . . . . . . . . . . . ; •••••••••••••••• 0 ~ ~ ,~~

•••••••••••••••••••••

•

~.~

••• f

•••••••••••••••••••••••• ~

: :..

~~,~'!~::.-;f;,S

"'''''''''''' •••. \

......................... .. ........................ .. .. ...... •.... ••• •••• . ..... • ,'. <i'.'•.,,'7".... " , ..... .. .......... : ,'.'"•..••' .·.·.·111· .....-.-.-.-.-.....:.-.-' ....... , ..•...... ............. .. . , ... , .. ..................... , .......................... . . ..: .. ............................... .........••.•.......•••..••... .........•.•.••.• .........•• ...... ....... .... -......... .............................. . •.......••......•.."" .... ...... . .. ....•.....•...•..... ": , .. , ., ............,#, , ,•• .... , ..... , ............._,• .'.. .... ............. ............ '.', ...... , ...... , .. ,., ..... ,. .. , .... . , . .................. .................. , ..... . . .................. ,. , .... ,....... ............. " .. . " .... .'. .... ,.. ...•....•.• 4.' •, . .. , .. , ............ . .......... .. ,.:. ••••••••••••••••••••••••••••••• .••••••••••••••••••••• , " III . . . . . . . . . .

• •• , ••••••••••••••••••• 4 •••••••.

·••• , ••••••••••••• , •••••••••• #.f. ;

....... I

• • • • • • • • • • • • • ' •••••••

•

c;:~

•

.» . . . . . . . . . . ..

~: r·

; •• , . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . 'C·.''' .l. ••••••••••••••••••••••••••••••

~; t

••••• r •••••••••••••••••• • •••• ~

•••••••••

•••••

••••

•••••••

• , ; . " . " . . . . . . . . . . . . . fI" • • • • • • , • • • ~~ • • • • • • • • • • • • • • • • • • • • " • • P • • •

;~,

;

r~~ . . . . . . . . . . . . . . . , • • •

;" " , " '.,' •• ••••• " . t .................. , f ••• , ••• , , ............ " ... , ,

.•••.. t , . " " " " ' . " " " · ' " < •••••• ,

•••••••• ,

•• ,

•••••

'., " •

.. "

... ,," ." ....., , • , II; .. , ,," t

• , •• , ,

•• ,

••

- 62Figure 5 PERCENT OF TILE S?ENT BY i'JUfLIiTG JE1VICE CT1L."'P III Al'illA. OF AC'fIVl'l'Y DURIJIG A.M, .WD P.Li. }'E,HOn::; HO:L~TH Gl!'JIEBAit iiOS}-:7LL, OUTP1..7I2:l-YL' DEPJ:2./lLEI-JT

Per c e n t 10 20 30 40 50 60 7';) CO 90_ _ lCO 1. _ _---1_ _---1_ _-'-_ _-'-_ _- L_ _- ' -_ _- ' -_ _- ' -_ _

Supervicing ""'-, llurse /

""'-

A • /.I.

P.ll.

.. Clinical> Inotructor .M.

Ur..it. Ce:l. ..;jrec~ LEGEllD

-.c'

- 63 Fieure 6 PERCEllTA.GE OF TILE 3J?illlT AT llUP..JIHG (.!Jll,;. 12 lr0R.3HlG) J..tID 1I0N-lI'"JIl.JING :T.tiILL IE"V"ZL3 OF ACTIVITY BY HUR.;':!IlTG 3TAFF :F2R80NNEL nORTH GElJillJJ..L I103PITA.L, OUTPA'i'ImlT DE?J;;l';'I!.ENT

Per

c 50

n t 60 70 GO 90 100

All Ce.ter:;orien

I ~~".-~ ~b.,

:Jupervioin[; Nurse

Reei at ere(~ 1Iuroe

II;, ~j

i I

Nuraing Attenti=t

)~W~ P.M.

Clin{cn.l Instructor

>.1i. ~;1W$0l$/#~!£1 . WJ lluroinc 3:::ill Levelo II D '/ .

LEG

""-

lion-l'Tur"ing Gkill Level"

- 64 Figure 7 PERCEr:1TAGZ C'.i ~ ~w :'::?~J!"il ::iJ ::1"10'': :311':' G~:':'?.El:. ~C~ IVITY BY EACH GIIJillE OF NlJR;JIllG :JElHICE .:lTi.1'F FOP.. "';ill .!Hom lli\.Y HOi.UH GEHElU,L ao;:;pI'i'AL, OUTPATIEllT Dill'Jill.TJ:;EtlT

o ~

P e 10 __ ~

c 50

30 ~

e n 60

i:i

co ~

100

____- 2____

____-L____- L_ _ _ _-L____-L____

____

4-_~

3upervillinB Nuroe Re~illtered

Huroo NuroillB Attendant

CIL:dcal Inotructor

PERCElI'i'LGE OF TILlE ;:;PEllT III UlIIT CEU'fREll ACTIVITY BY EkCH GRi~E OF lTUf'1.3IlIG JilltVICE 8T1C.?F :;ron. ?::E JaGLE D1..Y lTOltTH GZIJEahL i~03?ITAL, OUI'T'&7IZlJT D~T1JEl»"T

Supervising Nurse Regi ot ered Nuroe lIuroing Attenda.nt Clinical 1.' t ,

•.:f..:;..'-........ 'U:.:"'Tf'+"~ "1-.·.·..... .;::·+· -,:&..,...7..r.. . + ."T"..l..C'"':">:"7T+'" .; +'.,.. .I. + .,:'>',', +' -.":.I•••-,~ o:,..'J• •I.' .•.. T . .IX.:~ + ..... ' ......... ":"' .... ~.:£...... -::;:r..:: ...:..'. ,-, ., ..................... to' to ._.", ',""

.(T •.,... •

• , •••

&.- _ ,_'-':::....

Inatructor

LEGElID

UllI'r CElITRED

- 65 Figure G

PEaCEH'1'AGE OF TIl.E ':;PElIT III PEa:::OInIEi. CEHT1UD ACTIVITY BY EA.C;J GRJillE Oir llURJIllG ZmVICE J':J>Jo"F j,'Ol'l. TIlE .lilOLE DLY IJORTH GElJl!B.h..L HO:J:l:lr:',.Ii..L, OUTPi>l.';:'IEiT? DKf'.a.:1TID!lTT

Per c e n t

100

Dupervioing Huroc

'1"'W~'++r-,.;.'k"1 0_1-+'++ ~:-:-i·r!~:+. ____________________________------____________ ~"~"~"~+~±~'~k~~~c~~.~""~'_~

Reeil:rtcrec1 Nuroe Huroing A.ttendant

• .,.

PERcZir'.~LGE OF 'rli.J~ J::Z!.JT nr PfltJOlINEL CaITIW!.I: J~cr~rlI?Y DY FACH GRIJ)E OF IJUJ.1.3:11G JE1.VICE 3rr;i&~ ~OR '~i-1E :l.~LOLE DJ...y lrOi"1.?H GEHE:iJI.L dO:::::':-ITJ... :i..s, O"JTD!..'':''IZITT DZflS.:.7L.Ei.1T

3upervioina Nurse

a,egi ct erec1 lIuroe lIuroine

Attencknt Cli:-,icel

Inotructor

"JE~f\1 LEGEIIDI

IT.';Ii!R CElITIlED

/tz2a

i;.,n;:;OIllIEL

CEir~?.ED

- 66 Figure PEaCEaITL.GE OF TIEE 3?EHT BY 37UD:clJ? HORTH GEImi.f~l.., Eo;:;?r21...L, I)

If'UP...3~

l ..T THE

DI~".lRi.EiJT

:JK!li LEV2W

Our:PLr:L~'lT

DE?lJ!TI,.:EUT

••

..... . .·. ............................ . .. .. .... . .. . . . .. .. . .. .. . . ....... . . ........ ............. . . .. . . . ... . .. , ,~ ~ ~

.•... #~ ••

....... , ... .. , •• .. ••

~._.~~.

~,~.~.~.~,~.~~~~~~~~~~~~I1i!l~ .c . . ·.•. ~ ~ ~ ••

............. .. .. . ...... .......................................... .. . ·. ................................................. .. . . . . . .. . .. . ... .. ..................... . · ...................................................... . ................................................ .. .. . .. .. .. .. . .. . . .. . . .. .. . ... .. .. . . . .. . . . . . .. .. .. . .. . .. . . . . . .. .. .. . .. .. .. .. .. . .. .................................................... .. . .. ... . . .. ... ... ..... ................... .. .. . . . .... . . . .... . . .. . .. ..... ................. .............. . . . .. ... .... . . . .................. . ................................. .. . . .. . .. . . .. ... ... . .... . .. . .. . . . . . . .. .. .. .. ... ........ . .. . .. . . . .. . .. . .................. . . . . . .. . . ... .. .. .. • .. .. .. • .. .. .. .. .. .. • ~.~ ~

_ ................. s ~ ~

••••• ., ••

...............

•

•••

• • • • • • • • • • • • • • •

. . .. . . . . . .. . .. .. .. .. •

... .......... .

. . . ... ' ......... . ~

. . .. . ...... .. r

LEGEND HUR8I11G

.. ..... ..... ..... ........" ,... ~

IJEJ:JElIG:<R - 0.00%

~ AT""'l'I~nil""IC" .ui.•1. t u~J..,.J_.... -11

5 • .L ,,,OL .... P

- 67 Fi(;ure 10 '-"

PEitCEinb.GE

O~ 'i' ILE :::~<i~!NT BY JTUDElJT rru::..::m IN DI~1?K!:;3~HT ii. .;.-U!;L:J lJORTH GEN~L ~rC3::-ITh~, ourPAri'IEiI~ DEPAl1.TLKl'IT

O!? L8'£ IVITY

....

L E

~===============

- 68 -

ANNEX 6 , , , ,

:::r '

NURSING it.GrlVITY STUDY

ANALYTICAL TABLE 11,. - Number of hours spent at different skill levels by nursing service staff HOSPITAL _ _ _ _.:::NGH~______ _ _ _..:Wh=ol=:e::....;:D~ayL-_ _ _ _ _ _ __ OPD _ _ _ _..:v''--_________ DATES OF STUDY Augllst

16_21, 1965 ~, I

Skill level of activity Personnel observed Total, all 1 levels A-

-.-

Total, all personnel---- 413.50 55.50 70.00 ~.oo 115.75 ---~-

. " II

----

0.00 96.25

Registered Nurse ------------ 198.75 20.75 57.75 21. 75 Clinical Instructor --------Nursing ;~tterrlant

51.00

4.00 43.50

17.75 11.25 0.50 0.25 -

59.75 5.00

5.75

--------------------,

158.00

3.00 10.50 42.25

5.50 37.00 0.50 10.00

Supen.tsing Nurse

39.00 20.50 1.25 1.75

... Nursing Student ----------- 153.00 7.75 81.75 9.50 13.50 1.25 39.25

1 Number of hours Nursing Students spent on levels included.

of activities are not

,HOSprrAL _.;:;NG:::.:H~._ _

- ($ -

NURSING ACTIVITY STUDY

ANAtrrICAL TABLE lAo - Number of hours spent at different skill levels by nursing service staff _ _...;,/ _ _ _ A.M. _ _ _ _...:P.M.

OPD _ _ _.;:,'_'_ _

DATES OF STUDY

August 16-21, 1965

Skill level of activity Personnel observed Total, all , levels A N C

Total, all personnel---''r

244.00 43.75 "-7·50 49.50 "-2.75

5.25

5~.25

Registered Nurse -----------Clinical Instructor --------Nursing Attendant -----------

111.75 '.1.7.50 38.25 16.25 :1-4.50 17.75 111.25 0·50 O.~5

1.75

2~.50

0.25

5·75

92.00 2.00 7·75 31.50 126.75 22.50 tt~.QO 1.00 1.;0 1.50

3.25 20.75 5.25

Supervising Nurse -----------

••

Nursing Student--------______

151.50 7·75 81.50 9·50

1~.25

1.00 ;8.50

included.

~umber of hours Nursing Students spent on levels of activities are not

- 70 NtrnSIm ACTIVITY S'l'WY ANALYTICAL TABLE lAo - Number of hours spent at different skill levels

by nursing service staff HOSPITAL _ _---'N""GwH'--_ _ _ _ __ OPO _ _ _ _ _ _""_/_ _ _ _ _ __

_ _ _ _..-:A.M. _ _:....~ _ _.P .M.

DAlES OF S'roDY

August 16-21, 1965

Skill level of activity Personnel observed Total. all levels l

Total, all personnel

169.50 11.75 22.50 16.50 73.00

4.75 41.00

Registered NUrse ___________ NUrsing Attendant __________ Supervising NUrse __________

87.00 66.00 16.50

3.25 19.50 5.50 36.50 1.00 2.75 10.75 3.3.00 7.50 0.25 0.25 3.50

2.25 20.00 2.25 16.25 0.25 4.75

-,--

lNumber of hours NUrsing Students spent on levels of activities are not included.

- 71 -

NURSOO ACTIVrry STUDY ANALYTICAL TiUlIE lB. - Percent of time spent at duferent skill levels by nursing service staff HOSPITAL NGH

Whole Day DATES OF STUDY August 16-21, 1965

OPD _ _---'V!!;..; _ _ _ _ _ __

Skill level of activity Personnel observed Total, all levels I

Total, all personnel

100.00 13.3 17.0 16.,0 28.0

2.4 23.3

! I

i 2.0 22.0

Registered Nurse

I 100.00 10.41 29 • 0 10.9 25.7 ! ---------- 100.00 63.41 2 • 8 1 1.4

Cil.P'ltcal"il:nstructor Nursing Attendant

32 •. 4

------------

100.00 1.916.6126.6 37.8 100.00 52.6 3.2

3.5 .23.6 1.3 25.6

Supervising Nurse ------------

4~51 12.8 I

Nursing Student --------------

100.00 5.1 53.4

6.2

8.8

0.8 25.6

- 72 NURSING ACTIVITY STUDY ANAUTICAL TABLE lB. - Percent of time spent at different skill levels

by nursing service staff HOOprrAL _~!'K;::!:H~ v~

_ _ __

_ _.....:./ _ _..:A.M _ _ _ _ _P,.M.

OPD _ _ _ _

_ _ _ __

DATES OF STUDY August 16-21 l 1965 Skill level of activity

Personnel observed

Total l all levels

...

Total l all personnel ------

100.00 18.20 19.61 20.71 17.36

2.19

21.86

Registered Nurse -----------Clinical Instructor --------Nursing Attendant ----------. Supervising Nurse -----------

100.00 15.60

34.oc

14.70 13.17 1.40

1.56 21.00

100.00 63.38 2.8] 100.00 2.27

32.39

8.52 35.51 28.97 6.97 6.97

3.69 21.00 1.16 20.93

100.00 59.30 4.65

...

-. 0.66 25.41

Nursing Student --------------

100.00

5.11 53.79 6.27 8.74

- 'B NURSING ACTIVITY STUDY ANALYrICAL TABLE lB. - Percent of time spent at different skill levels

by nursing service staff HOSPITAL _ _ _...;N::..;GIl:::....._ _ _ _ __ OPD _ _--"~ _ _ _ _ _ _ _ _ __ _ _ _ _ _ A.M.

P. M.

DATES OF STUDY _ _A_ugu=.;;:.:;st.:....;1;.;;6_-2;.;;;1""'"-.;:.19"",6;.,:5___ Skill level of activity

Personnel observed

Total, all A levels

Total, all personnel ------- 100.00 6.93 13.28

9.73 43.07

2.80 24.15

Registered Nurse ----------- 100.00 3.74 22.41 6.:n 41.95 Nursing Attendant Supervising Nurse

2.59 22.9€ 3.41 24.6:1 1.52 28.7€

----------

100.00 1.51 100.00 ~5.45

4.17 16.29 50.00 1.52 1.52 21.21

----------

- 74 -

NURSING ACTIVITY STUDY ANAUTICAL TABLE 2A. - Number of hours spent in areas of activities by nursing service staff HOSPIT.l.L _ _ _ _ _N_GH _ _ _ _ __ vlhole Day

OPD _ _ _ _ _ _ t/_-______ D;.TES OF STUDY August 16-21, 1965

. Category of personnel observed Area of activity Nursing Cli- NursStudent ing Sttper. Total Regis- nical AttenInsvising all Head tered truc dam Nurse person- Nurs Nurse tor nel

.. Total, all areas Total, patient centered 11

413.50 83.25

198.25 .-~~--

17.75 158.00 39.00 f---

153.00 .-.~

-----

-~-

63.75 31. 75 12.50 1.25 4.00 14.25 6.25 2.75 1.00 2.50 87.25 87.25

1.00 16.25

2.25 0.25 0.75

78.75 47.75 14.00 0.75 3.00 13.25

Giving care ----------- 35.25 22.75 1.25 5.75 18.25

0.50

3.25 9.00

12 Other Qirect activities : :

13 Teaching Patient -----Exchange of Information

0.50

0.25 3.75 3.50 0.25 3.25

1.00 0.25

, 14

15 Irxlirect Care ---------

10.75 0.50

Total, personnel centered --- ~ 28.00 21 Professional staff development ----------- 7.75 22 Personnel: 23 other 7.50

. ., 7.50 4.25 3.25 9.25 8.75 0.50

10.25

Nursing Student program ---------- - 12.75 Total, unit centered -215.00

25.00 25.00

0.5C 105.75 21.50 0.5C 105.75 21.50

31 Environment, supplies, 215.00 and equipment -----Total, other centered --- - 86.75 01 Personal ------------02 Standby -------------58.00 28.75

41.00 28.00 13.00

5.5e 32.50 4. 7~ 0.7 17.75 14.75

7.75 7.50 0.25

40.00 22.00 18.00

.ROSprrAL _---'!«}=H_ __

- 75 -

ANAUTICAL TABIE 2A. - Number of hours spent in areas of activities by nursing

service staf:f' _ _-..:.V_--.:A.M. DATES OF STUDY

_ _ _ _--'P.M.

OPD _ _.....:;v _____

August 16-21, 1965

category of personnel observed TOtal, Regisall Head tered person- NUrse NUrse ne1 239.OC 56.OC 25.2~

Area of activity

NUrsing Cll- NUrsnica1 ing Super- Student Atten- vising Instruc- dant NUrse tol' 21.50 1.25 0.25 0.50 151.50 78.25 47.50 14.00 0·75 3.00 1 '5.00 10.25 8.7'5 0.50 1.00 24.75 24.75

TOtal, all areas------TOtal, patient centered 11 Giving care ---------12 Other direct activitie

111.75 17.75 88.00 43.25 22.75 7.50 0·75 2.50 9.75 1.00 10.50

0.50

2.25 6.00

14.5<: 0.7" 3.7" 11.7~

13 Teaching Patient-----14 Exchange of Ini'ormatio 15 Indirect Care -------TOtal, personnel centered---21 Professional staff development ---------22 Personnel: other-----

0.50

0.25 2.00 0.25

0·50

5.50 3.00 2.50

•

21.5<: 5.OC 3.7"

5.00 10.75 1.50 1.00 2.50 39.75 39.75 0.50

10.25

0.25

23 NUrSing Student program -------------- 12.7" TOtal, unit centered- 110.2" 31 EnVironment, supplies, and equipment ------- 110.2" TOtal, othel' centered-----

11.50 11·50

0.50 58.50 0.50 58.50

51.2" 32.OC 19·2~

23.75 15.25 8.50

5.50 18.75 4.75 0.75

3.25 3.00 0.25

38.25 20.'50 "-

....-

01 Personal ------------02

9.00 9·75

Standby --------------

17.75

- 76 r'

NURSING ACrrVITY STUDY ANALYTICAL TABLE 2A. - Number of hours spent in areas of activities by nursing service staff HOSPITAL _ _ _.::NGH::.:-_ _ _ _ _ _ _ _ _ _ _ _ A.M. _ _'::,,/ _ _ _ P.M.

om ____-'v><-_ _ _ _ _ _ _ DATES

OF STUDY _..::A:.:ugg.;u::;:st:.::.....;1.6:::::--.2::;1"-"c...::::19:..::6:..::;5__

Category of personnel observed Area of activity Total, I Head all perscn- Nurse nel

Registered Nurse

Cliing S~p?rn1ca1 Atten Vl.Sl.ng Insdant Nurse tructor

N~'-i

, Nursing Student

Total, all areas

------

169.50

87.00 21.00 9.50 5.00 . 0.50 1.50

66.00 16.50 5.50 1.00 2.75 1.00

Total, patient centered· ll. Giving care ---------12 other direct activitie

27.50 10.50 8.00 0.50 2.00 6.50 6.00 2.25 3.75

0.25

1.3 Teaching Patient ----14 Exchange of Informat io , 15 Indirect Care --------Total, personnel centered --21 Professional staff development --------22 Personnel: other :...--23

1.75 3.25 0.25 .

0.50 0.25 2.00 1.25 0.75

4.50 0.75 0.75

-' II

3.00

Nursing Student program ----------Total, unit centered· ·10).50

4tJ.00 48.00

45.75 45.75

9.75 9.75

I II

31 Environment, suppll.es, and equipment ----103.50

Total, other centered ----Personal ------------02 Standby ------------01

! 32.50

, 3.75 3.75

23.50 -9.00

17 .25 12.75 4.50

111.50 7.00 4.50

! , ;

II ,

-77-

NURSING ACT IVITY STUDY ANALYTICAL TABLE 2B. - Peroent of time spent ;in areas of aotivities by nursing service staff ole Day HOSPITAL NGH OPD

D[,TES OF STUDY Au:mst 16-21 1965 Category of personnel observed

Area of aotivity

'11

Total, all Head "erson- Nurse nel

Regis- Cl;ini- Nurs- Supe tered oal ing visNurse Ins- Atten- ing trucdant Nurse

Nursing Student

Total, all areas ------ LOO.OO Total, patient centered Giving care Other direct activities ----------

100.00 100.00 LOO.OO 100.00 100.00 32.15 16.01 6.31 0.63 2.02 7.19 5.64 10.29 5.76 0.64 1.92 51.47 31.21 9.15 0.49 1.96 8.66 6.05 5.72 0.33

20.20 8.52 5.50 0.30

2.82

2.06 5.70

13 Teaching Patient -----

2.82

0.16 2.37 2.22 0.16 2.06

2.56 0.64 19.23 10.'( 8.33

14 Exchange of Informatior. 1.39 15 Indirect care Total, personnel centered ------

4.41 6. 73 1 -

3.15 60.57 1.39 0.50 2.82

21 Professional staff development --------

1.87 1. 78 3.08 52.00 52.00 20.98

22 Personnel: other ----23 Nursing Student program ------------Total, unit centered 31 Environment, supplies and equipment -------

1.26 57.75 44.01 44.01

55.U

16.34 16.34 26.U 14.38 11.75

2.82 66.93 2.82 66.93

55.13 19.81 19.2, 0.6.1

Total, other centered

20.78 30.98 20.56 14.12 26.76 11.23 6.56 4.22 9.33

01 Personal ------------- 14.03 02 Standby -------------6.95

- 78 -

NURSING ACTIVnY STUDY ANAUTICAL TABLE 28. - Percent of time spent in areas of activities by nursing service staff ROOPlTAL _ _:::ID::,:H::......_ _ __......:v'-__-A.M. _ _ _ _..:P.M. OPD _ _--'v ______ -

OF STUDY August 16-21, 1965

category of personnel observed ~urBing

Area of activity

Total, all Head person- NUrse Del

Regis- C11ni- NUrs- Super- Student tered cal ing vising Nurse InsAtten- Nurse truc- dant tor 100.00

Total, all areas------ 100.00 Total, patient centered 23:6 1:1- Giving care---------- le.56 12 Other direct activities ---------- 6;06 13 Teaching Patient----14 Exchange of Informatio 15 Indirect care-------Total, personnel centered-----21 Professional staff development ------22

100.00 100.00 1OO.Ot 100.00 5.60 11.80 2.50 6.80 5.60 1.20 2.20 52.80 32.40 9.30 0.50 2.00 8.60 7.40 6.00 ...

39.00 20.40 6.70 0.06 2.23 8.70 4 •.40 1.34 0.90 2.23 ..

2.80

0.33 1.56 4.91 8.98 2.09 1.56 5.33 .

2.80

0.30 2.20

2.20

60.40 2.80

14.20

0.30 25.80

66.40

Personnel:

other----

57.60

0.30 11.60

0.40 1.00

·23 NUrsing Student

program------------

53.40

Total, unit centered--. 46.10 31 Environment, supplies and equipment -------- 46.10

35.60

2.80

14.30

35.60

2.80

66 ..4c

53.40 .

14.30

Total, other centered- 21.44 01 Personal -----------02 standby --------------

21.20 13.64 7.60

31.00 26.80 4.20

21.8c 10.2C 11.60

15.20 14.00 1.20

25.40 13.60 11.80

13.38 8.06

- 'f9 -

NURSING ;.CTIV1TY STUDY

ANALYTICAL TABLE 2B. - Percent of time spent in areas of activities by nursing service staff _ _ _ _ _ _ _ _ It..M. v HOSPITi.L _ _ _~N.:;:GH:=.-_ _ _ __ Offi _________v~___________

P.M.

Did'ES OF STUDY August 16-21, 1965 Category of personnel observed

Area of activity

Total, all Head person- Nurse nel

-...

Regis- Clini tered cal Nurse Instructor

Nursing Nurs- Super Student ing vis.P. .tten ing dant Nurse

Total, all areas ------ 100.00 Total, patient centered 11

100.00

100.00 100.00 8.34 1.52 4.17 6.17

16.25 6.18 4.71 0.30 1.24 3.82 ; ..33 1.33 2.20

.24.14 10.92 5.75 0,58 1.72 5.17 0.86

Giving

care ---------

1.57

12 other direct aotivities ----------

13 Teaetting Patient ----14 Exchange of Infonn!lt io 15 Indirect care -------Total, personnel centered -----21 Professional staff development --------

2.65 4.92 0.38 4.54

3.03 1.57 12.12

0.86

22 Personnel: 23

other ----

7.58 4.54

Nursing Student program ----------Total, unit centered

61.05

55.17

69.32

59.01

31 Environment, supplies

and equipment ----- 61.05

55.17

69.32

59.01

Total, other centered

19.17 13,87 5.30

19.83 14.66

17.42 10.60 6.82

22.70 22.70

01 Personal ------------02

Standby --------------

5.17

., 80 ., NURSlNG ACI'rvTIY STlIDY

ANALYTICAL TABLE 3. - Comparison of average amount of nursing care time available per patient from each category of nursing personnel with the average amount of time spent on patient centered activities and other activities

HOSPITAL

NGH

_ _ _.......:'W:::h~o=le:::-:D~a:..!.y_ _ _ _ _ _ _ __

OPD ~_ _ _ _'-"t/~__--'-____ DATES ail' snroy August 16-21! 1965 Spent on paTotal minutes t ient centered Spent on other available activities at activities the nursing level

Type of personnel

Total, all personnel

----------

...

6.300

0.913

5.387

Registered Nurse ---------------_ Clinical Instructor ------------- . Nursing Atteooant

3.000 0..300 2.40.0 0..600

O.BOO O.OOB

2.200 0..292

0..],00 0.005

2.300 0..595 ... I

Supervising Nurse·

Nursing Student

2.30.0

1.100

1.200

- 81 -

NURSnm ACTIVITY STUDY

ANAUTICAL TlIBLE 4. - Average amount of time per patient each category of nursing personnel spent in the presence of the patient HOSPITJU, ____---.::N,:..:GH=_ Whole Day

OPD _ _ _ _ _ _ . _ / _ _ _ _ _ _ _ DJiTES OF STUDY August 1.6-21, 1965 I

TYPe of personnel

Average minutes per patient spent in presence of patient

I ~

Percent of total

Total, all personnel

-----------------------

.794

100

Registered Nurse

----------------------------------------------------------

.656 .008 .U5 .015

I , , ,

82.6 1.0

Clinical Instructor

I I , 1

Nursing r,ttendant

-----------------------------------------------------------

! ,

14.5 1.9

Supervising Nurse

Nursing Student

-------------------------------!

.920

I ,

100

_ 82 -

NURSING AGrIVTIY STUDY ANALYTICl.L Tf.BLE 5A. - Percent of time spent at each area and level of activity by each oategory of personnel during a sample workweek of 39-1/2 hours HOSPITl.L NGH PERSONNEL OBSERVED SuN "'bole Day August 16-21, 1965 -L

OPD

.,,/

Dl,TES OF STUDY

Skill level of activity ]"rea of activity Total, all levels .Ii

Total, all areas

----------- 100.00 0.64

52.57 3.20

4.48 P2.82

1.28

25.M

Total, patient centered ----II

5.76 1.92 2.56

Giving care

-------------------

o.M

-. -

12 other direct activities

1.92 0.64 1.28

13 Teaching Patients ----------14 Exchange of Infonnation ----15 Indirect Care --------------Total, personnel centered

2.56

0.64 0.64 1.28

1.28

0.64 0.64

-19.23 17.31 0.64

21 Professional staff development --------------------- --10.90 10.90

22 23

Personnel: other NurSing Student program ---Total, unit centered

8.33

6.41 0.64

1.28

4.48

------

- 55.13 33.33

3.20 12.82

31 Erwirornnent, supplies and equipment ------------------ - 55.13 Total, other centered ---- '" 19.87

33.33

3.20 12.82

1.28

4.48 19.87 19.23 0.64

01 Personal -------------------- - 19.23 02 Standby

- -

---------------------1-

0.64

- 83 NURSING ACTI'llTY STUDY

ANALYTICAL TABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of ._~3_ hours (a.m.) HOSPITAL NGH OPD"" PERSONNEL OBSERVED SuN ./ DATES OF STUDY ~

A.M. P.M. August 16-21 , 1965

Skill level of activity Area of activity Total, all levels A

C 6.90 ---~

H 6.90

Total, all areas ..... - .. ------Total, patient centered----11

100.00 59.30 4.80 6.00 1.20 2.40 2.40

1.20 20·90

Giving care

----------------

12 Other direct activities----13 Teaching Patients----------14 Exchange of Information----15 Indirect Care

4.80 1.20 2.40

1.20

1.20 1.20

--------------

61.70

59.~

6.90

Total, personnel centered--21 Professional staff development----------------------Other

2.40

13·10 1"3.70 11.70 9·30

2.40

2? Personnel: J ..

----------

23 Nursing Student program----Total, unit centered------31 Environment, supplies and eqUipment -----------------

:f).?fJ 36.:50 -

5.70

1.20

3.60

17.40

- - -

17.40

5.70

6.90

1.20

3.60

Total, other centered-----01 02 Personal Standby

14.90 13.70 1.20

--------------------------------------

14.90 13.70 1.20

_ 84 <: (

NURSm ACTIVITY STUDY AN~ICAL

TABIE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 16-1/2 brs. N1H y

BOOprrAL

PERSONNEL OBSERVED

SuN

A.M.

P.M.

OPD

DATES OF STUDY August 16-21, 1965 Slti11 level of activity

Area of activity

Total, alL levels

I N

TOtal, all areas

----------

100.00 45.42 6.04 4.53

1.5] 1.51 21.21

1.5J 28.79

Total, patient centered --11 Giving care

-_ ...-------------

12 Other direct activities 13 Teaching Patients 15 Indirect Care

1.51 1.51

.--------

14 Exchange of Information----

3.02 1.51 1.51 1.:>1 12.12 10.58 7.58 7.58 ~.02

-------------

Total, personnel centered21 Professional staff development -------------------22 Personnel: Other

1.51 - 1.51 -

I, II

---------

23 NUrsing Student Program---Total, unit centered ----31 Environment, suppUes and equipment ----.-------------

- 4.54 1.51 - - - - 59.09 30·30 - 21.21 59.09 30.30

. \I I 11

1.51 6.06

21.21

1.51 6.06

Total, other centered-----01 Personal 02

22.73 22.73

-------------------

Standby --------------______

22.73 22.73

- 85 -

NURSJNG ilCTIVITY STUDY ANALYTICAL TABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL NOH PERSONNEL OBSERVED Rn Whole Da~ om v DilTES OF STUDY August 16-21! 1 5 Skill level of activity Area of activity frotal all P.evels Ii N

Total, ell areaS ----------- tlOO.OO 10.44 29.45 Total, patient oentered 11 Giving care

p.o. 94 25.65 1.01 1.3£

2.0:3 21.89 0.53

----

32.35 .16.23 6.29 0.63 2.0:3 7.17

0.36 27.92 3.40 0.12 0.12 16.10

12 13

Other direct activities Teaching Patients -----------

4.78 1.01

0.. 53

0.12 0.12 3.18

0.63 0.88

0.12

14 Exchange of Information ----15

Indirect Care Total, personnel cen1mred

5.53

3.17

21 22 23

Professional staff development ----------------------Personnel: other

1.38 0.53 1.26

1.38 0.53 1.26 6.92 6.92

-----------

Nursing Student program -----

0.53 0.53 0.63

Total, unit centered ------- 43.89 31 ErnT;iroIllT\~nt J. .. supplies

7. 5~ 25.53 7.55 25.53

1.50 1.89 1.50 1.89

and equipment ------------------ 43.89 Total, other centered ----- 20.63

01 Personal

--------------------

14.09 6.54

02 Standby----------------------

0.63

20.00

14.-09 5.91

_86_

,NtBSING ArJrrvI!I'Y STUDY

ANALYTICAL TABLE 5A. - Percent of' time spent at each area and level of' activit.y by each cate,:ory of' persoClnel during a sample workweek of' ~3 hours (a.m.) HOSPl'rAL OPD _,

~.?"~~:~

NGH

PERSONNEL OBSERVED

RN , / A.M. P.M. DmS OF 'STUDY ,All[,ust 16-?l ,~5165.

Skill level of' activity Area of' acti '>1 ty Total, all levels A: N ~.OC

Total, all areas-----------Total. patient centered----II

100.00 15.66 ~.70

14.72 12.97

1.55 ~1.oo 0.67

0.66 32.6E 4.7B 0.22 20.;C 4.40 1.60

20.58 6.67 12 Other direct activities ---.... 66 13 TeaChing Patients .-------14 Exchange of' Inf'ormation----- 2.22 15 Indirect Care -----------_.- 8.58 Giving care

----------------

.,.66

0.22 0.66 1.~ 0.22 6.60 1.76 4.50

0.67 - - -

Total, personnel centered---

4.50 1.40 0.90 a.~

- - 0.4~

21 Professional staff development

--------------------

1.40

22 Personnel: other---------23 Nursing Student program----Total, unit centered-------

0.$0 2.20

35,65 10.:;0 0.44 .LO.20 l2.9,7 ,

0.88 0.,66 0.88 0.66

31 Environment, supplies and equipment ----------------!

35.65 10.50 21.20

10:20 12.97

Total, other centered------

O.St

20.34 13.64 6.70

01 Personal------------------02 Standby -------------------

13·64 7.58

0.88

- 87 -

NURSING AcrIVlTY STUDY ANALYTICAL TABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 16-1/2 hours(p.m.) HOSPTI'AL NGH PERSONNEL OBSERVED Rn A.M. , / P.M. OPO V DATE& OF STUDY August 16-21, 1965 Area of activity Skill level of activity

rr otal ,

all levels

Total, all areas

------------ 100.00 10.90 5.15 (i).f7

3.1' 22.41 p.3 2 41.95

2.59 22.9! 0.29

Total, patient centered ----- 22.11 II

0.86

~1.54

~.OO

0.29

Giving care

-----------------

- [.10.90 0.57

0.29

12 other direct activities -----

4.89 p.51

D 15

Teaching Patients ----------Indirect Care --------------Total, personnel cretered -

14 Exchange of Information -----

1.72 5.17 0.86

1.16 p.57 4.02 0.86 0.29

21 Professional staff development ---------------------22 Personnel: Other ----------23 Nursing Student program - -

0.86 0.86

- -

2.30

3.~

Total, unit centered ------- 55.17 2.87

0.57 ~.31 41.66 0.57 ~.31 41.66

31 Environment, supplies and equipment ----------------- 55.17

2.87

2.30 3.44

Total, other centered ------ 19.83

0.29

.19.53

Personal -------------------- 14.66

- 0.25

- it4. 66 4.89

02 Standby

--------------------

5.17

- 88 -

NURSING ACTIVITY STUDY ANALYTICAL TABLE SA. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL OPD NGH PERSONNEL OBSERVED Na Whole Day August 16-21, 1965

V Area of activity

DATES 017 STUDY

Skill level of activity Total, all levels 11.

Total, all areas ----------Total, patient centered ---11

100.00 1.91 6.64 26.74 37.81 10.28 2.06 5.70

3.48 23.42 1.27 0.16

6.17 2.21 0.47 -

Giving care ---------------Other direct activities Teaching Patients -----------

2.06

2.69 1.74

0.16 ~.36

0.16

1.27

0.16 1.90

14 Exchange of Information ----15 Indirect Care -------------Total, personnel centered -

0.47

1.26 0.47

2.22 0.32

21 Professional staff development

---------------------_. Other

0.16 0.16 :2.0& 0.16

22 Personnel,

23 Nursing Student program Total, unit centered

----

- ~6.93

1.90 ~

\' I

---

1. 5~ 0.47 24.37 37.18

2.21 1.11 2.21 1.11

31 Environment, supplies and equipment ----------------Total, other centered -----

66.93 1.59 10.47 24.37 37.18 20.57 11.23 9.34

0.16 0.16

20.25

) 01 Personal -------------------02 Standby ---------------------

! 0.16

0.16

11.23 9.02

I ,J

- 89 -

-OPD:(

NUBS ING ACTDT:rrY STUDY ANALYTICAL TABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of _23 hours H06prrAL NGH PERSONNEL OBSERVED Na ../ A.M. P.M. DATES OF STUDY AOOUST 16-21, 1965

pkill level of Activity Area of activity _ _ _ 0. _ _ _

Total, all levels 10C.00 11.90 2.60 6.80

A 2.30

Total, all areas----------Total, patient centered---11

8.50 35.50 29.00 7.98 2.60 2.26 0.28

3·70 1.42

21.00

Giving care

---------------

- - -

1.42

12 other direct activities---13 Teaching Patients---------14 Exchange of Information----15 Indirect Care

3.40 1.98

0.28 2.26

0.28

--------------

1.70 0.28 0.28

Total, personnel centered-21 .,

0.28 0.28

Professional staff development ---------------------- f--"'; Personnel: Other-----------

2.00

...

0.28 0.28

23 Nursing Student program----Total, unit centered-------31 Environment, supplies and equipment------------------

66.60

- - ~8.50

2.27 2.27

0.28

0.60 33.00 ~8.50

66.60

2.00

060 33·00

0.28

Total, other centered-------

21.28

0.28

20.·72

01 02

Personal

-------------------

lQ.22

Standby--------------------- 111.06

0.28

Q.28

10.22 10.50

- 90 -

NURSING ACrIVITY STUDY ANALYTICAL TABLE 5A. - Percent of time spent at each area an:! level of activity by each category of personnel during a sample workweek of 16-1/2 hours(p.m.) HOSPITAL NGli PERSONNEL OBSERVED Na A.M. i/- p.M. OPD , / . DATES OF STunY August 16-21, 1965

Skill level of activity Area of activity Total, all levels A

Total, -all areas

------------------

100.00 1.52 4.17 16.29 50.00 8.34 1.52 4.17

3.41 24.62 1.14 0.38

Total, patient centered

3.80 2.28 1.52 1. 52 .---.. ---

0.76

11 Giving care 12

-----------------

other direct activities

13 Teaching Patients ----------14 Exchange of Information -----

2.65 4.92 0.38 4.54

15 Indirect Care --------------_Total, personnel centered --21 22 professional staff developl!Ient- ------------~---.~-'-~-Personnel: other

0.38 0.38

:------

1.14

1.52

0.76

0.38 4.54

jl I

-----------

23 -NurSing Student program -----

2.27

4.54

2.27

Tbtal,unit centered ------- 69.32

1.14 0.38 .1.4.01 49.24

:n.

Environmen t , supplies and -equipment ------------------

69.32

1.14 0.38 .1.4.01 49.24

2.27 2.27

Total, other centered ------- 17.43 01 Personal 02

--------------------

10.61 6.82

17.43 10.61 6.82

Standby ---------------------,

- 91 -

NURSJlm ACTIVITY STUDY

ANALYTICAL T,J3LE SA. - Percent of time spent at each area and level of act iv- , ity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL NGH PERSONNEL OBSERVED Cl I .mole Day August 16-21, 1965

OPD

v'"

DATES OF STUDY

Skill level of activity Area of activity Total, all levels Total, all areas Total, patient centered 11

100.00 63.38 2.82 1.41

32.39

----

5.64

2.82 2.82

Giving care

----------------

2.82

12 other direct activities

- 2.82

l3 Teaching Patients

-----------

2.82

1A Exchange of Infomation -----

15 Indirect Care

---------------

2.82

- 2.82 - - -

Total, personnel centered---

60.56 60.56 2.B2

...

21 Professional staff development

----------------------other

22 Personnel:

57.74 2.82

23 Nursing Student program ----.., Total, unit centered

- - - 57. :4 .

-------

1.41

., -

1.41 1.41 30.9c 26.76 4.22

31 Environment, supplies and equipment Total, other centered

---------------------

2.82 30.98 25.76 4.22

- 1.41 - - -

01 Personal --------------------

02 Standby --------------------.

- 92 -

NURSING ACTIVTI'Y STUDY ANALYTICAL TABLE 5A. _ Percent o~ time spent at each area and level o~ activ-

ity by each category HOSPITAL _..:.:NG::::H~_ _

personnel during a sample vorkweek Cl I ./ DATES OF STUDY Skill level o~

of_~ __hours

PERSONNEL OBSERVED

A.M.

P.M.

OPD

August 16-21, 1965 activity H M

Area

activity

Total, all levels

N 2.80

Total, all areas

-----------

100.00 63.40

1.40

Total, patient centered -.-11 Giving care

5.60 2.80 2.80

-------------.--

2.80

12 other direct activities----13 Teaching Batients----------14 Exchange 15 o~ I~ormation-----

60.60

2.80

2.81'1 2.80

- - - - --

Indirect Care

--------------

Total, personnel centered21 Professional sta~~ development ------~--------------Other----------Nursing Student program----Total, unit centered------31 Environment, supplies and equipment-------- __________

- - 1.40

...

32.40

2.80 2.80

22 Personnel:

2.80

57.80 57.80

1.40 1.40

2.80

1.40

Total, other centered-----o. 01 02 '--_.

,1.0C 26.8e 4.2(

Personal-------____________ Standby --

------------------._--

- - -

,l.0(

26.& 4.~

-----.----~,-

- 93 NURSING ACTIVITY STUDY

ANALYTICAL ~ 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL _ _ _...:OO=H,.-_ _ PERSONNEL OBSERVED St Whole Day OPD___ .

DATES OF STUDY August 16-21, 1965 Skill level of activity .

Area of activity Total, all levels Total, all areas __________ A N

100.00 4.90 53.43 6.20 8.82 51.46 0.98 47.55 2.12 31.21 9.15 0.49

Total, patient centered ___ 11

Giving care ________________

12 Other direct activities ____ 13 Teaching Patients __________ 14 Exchange of Information ____ Indirect Care ______________ 15 Total, personnel centered __ 21 22

31.05 0.16 7.68 0.98 0.49

0.82 25.82 - 0.16

0.16

0.33 0.16

1.96 0.16 1.47 0.33

8.65 0.82 6.86 0.65 0.16 6.05 0.66 5.23

0.16

0.33

Professional staff development _____________________ Other __________

5.72 0.33 5.23 0.33 0.33

0.16

Personnel: 23 Nursing Student program _-'-__

- -

Total, unit centered .-----supplies and 31 Environment, equipment _______________ Total, other centered ______ 01 02 Personal ___________________ Standby ____________________

16.34 3.26 0.16 3.92 8.66

25.49 14.38 11.11

16.34 3.26 0.16 3.92 8.66 26.14 14.38 11.76 -

0.33

0.49 0.16

- -

0.49 0.16

- 94 -

NURSDm ACTIVITY STUDY

ANALYTICAL TABLE 5A. - Percent of time spent at each area and level of activity by each category of personnel during a sample workweek of_~? hours (a.m.) HOSPITAL OPD NGH

PERSONNEL OBSERVED

St / DATES OF STUDY ~

A.M.

P.M.

August 16-21 I 1965

Skill level of activity Area of activity Total, I all levels J.. N

-53.76 6.26 47.83 2.11·f 31.18 0.16 7.75 0.99 0.49 8.74 O.le 0.66 0.33 25 .. 56

Total, all areas

----------

100.00 4.94 51.60 0.98 31.34 9.23 c.49

Total, patient centered---II

c.16

Giving care

-----------------------

12 13 14 15

Other direct activities---Teaching Patients

0·33

0.16

Exchange of Information---Indirect Care-------------Total, personnel centered--

1.97 0.16 8.57 0.82 6.10 0.66

1. 1 18 0.33 6.93 0.66 5.28

o.lE

8.5

0.16

a 2i'

Professional staff development --------------------Personnel: Other

5.77 0.33 0·33 0·33

5.28

---------

Nursing Student program---Total, unit centered----__

16.33

0.33 0.33

0.16

16.33 3· 30

0.16 3.96

.31

Environment, supplies and equipment-----------------

3~30

0.16 3.96

8.5

Total, other cantered-----01 02 Personal------------------Standby -------------------

~5.69

0.49 0/£6

25.24 14.19 11.09

14.19 11.70

0.49 0.19

- 95 -

NURSING AGrIVITY ffi'UDY

ANALYTICAL TABLE SB. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL OPD _......!N:.;:GH~___

PERSONNEL OBSERVED

SuN

Total: Whole Day DATES OF Sl'UI1i August 16-21, 1965

Skill level of activity Area of activity Total, all levels A N

H 5.06

Total, all a--eas-------------("-

39.50 20.77 1.26 1.77 2.27 0.25 0.76 0.'(6 1.01

0.51

10.13

Total, patient centered---11

0.51

Giving

care----------------

0.25

0.51

12 Other direct activities---13 Teaching Patients---------14 Exchange of Information---115 Indirect care-------------~

0.25 0.51 t

1.01 0.25 7.59

0.2510.25

Total, personnel centered-21 Professional staff development-----------------Other----------

6.84 0.25

0.51 0.51

4.30 4.30

0.51

22 Personnel:

3.29 2.53 0.25

23 lW'eihQg Student program---Total, unit centered------31 Environment, supplies and equipment------------

1.77 1.77

21.79 13.17 21.79 13.17

1.26 5.06 1.26 5.06

Total, other centered-----01

7.85 7.60 0.25

Personal-------------------

02 Standby--------------------

- - - -

7.85 7.60 0.25

- 96 NtJRSIW ACTIVITY STUDY

ANALlTICAL TABLE 55. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 23 hours IIlSPI'mL _....;N'GH=;o--__ OPD _ _ _ _ _ 17 ____ PERSONNEL OBSERVED SuN ;/ A.M. P.M.

DA'IES OF STUDY August 16-2l, 1965 Skill level of activity

Area of activity

Total, all levels

I I

Total,

all areas ___________

Total, patient centered ____ III Giving care ____________ ___ ~

23.00 13.62 1.08 1.58 1.58 1.35 - 1.08 0.27 0.27 0.54 0.54

0.27

4.79

12 Other direct activities ____ 13 Teaching Patients __________ 14 Exchange of Information ____ 15 Indirect Care ______________ Total, personnel centered __ 2l

0.27 0.54 0.27 0.27

- -

14.17 13.62

0.55

Professional staff development __________________ Other __________

22 Personnel: 23 Nursing Student program ____ Total, unit centered _______ supplies 31 Environment, and equipment ____________ Total, other centered ______ Personal ___________________

3.15 3.15 2.68 2.13 8.34 8.34 3.98

- --

0.2_1

0.55

0.82 0.82 13.42 3.15 0.27

1.31 1.58 1.31 '1.58

.. )3,"98 ~.42

0.27

01 Standby ____________________ 02

3.15 0.27

- - - -

II , II

- 97 -

NURSING ACTIVITY STUDY ANALYTICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 16-1/2 hours(p.nn HOSPITAL _ _NG=H=---__ PERSONNEL OBSERVED SuN I,.M."/

P.M.

OPD../

DATES OF STUDY

August

16-21 ! 1965

Skill level of activity 1.rea of activity Total, all levels A

Total, all areas Total, patient centered --11

16.50 7.49 0.25 1.00 0.75

0.2~

3.50

0.25

4.75

Giving care

--------------

0.25

other direct activities --Teaching Patients

---------

14 Exchange of Information

0.50 10.25

- - - 0.25

15 Indirect Care

-------------

0.25 ! 0.25

Total, personnel centered

2.00 1. 75 0.25i 1.25 . 1.25 0.75 0.50 0_2:5

21 Professional staff development

--------------Other --------

-' -

22 Personnel:

23 Nursing Student program --Total, unit centered -----

- - ~ .50

0.25 0.25

9.75 5.00

1.00 1.00

31 Environment, supplies and equipment

----------

. 9.75 5.00

3.50

Total, other centered ---

3.75 3.75

01 02

Personal Standby -----------------~

- - - -

3.7' 3.75

- 98 -

NURSING ACrrVlTY srUDY AN~ICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of persormel during a sample workweek of 39-1/2 hours

HOSprrAL

NOH

PERSONNEL OBSERVE'D

B.N.

OPD

DATES OF STUDY

Total: Whole Day August 16-'1, 1965

Skill level of activity Area of activity Total, all levels A N C

, I 4.3~

Total, all areas --------Total, patient centered --

, 39.50 4.13 11.46 12.78 0,15 1l.0~

10.13

0.80 0.21

8.65

loy 0.05

11 Giving care --------------12 Other direct activities --13 Teaching Patients --------14 Exchange of Information---15 Indirect Care ------------Total, personnel centered

6.40 0.05 6.3E 2.48 1.89 0.4< 0.25 0.25 0.89 0.05 0.35 0,~4c 2.83 o 05 2.18 0:55 0.05

0.21

1.25 1.25 0.54 0.54 0.21 0.21 0.50 0.50

'--

21 Professional staff development ----------------Other --------23 Nursing Student program --Total, unit centered ----22 Personnel:

- I

0.59 0.59

0.75 0.75 7.90 5.57 2.33

17.34 2.73, 0.2,1 2.Q8 10.08 17.34 2.73 0.21 2.98 10.08 8.14 5.57 2.57

31 EnVironment, supplies and equipment ------------

Total, other centered

0.24

Personal ------------------

0.24

02 Standby -------------------~

I I

•

HCX':lPl'1'AL --:-..:;N;;:;G""H__ OPD /

- 99 NURSIl'lG ACrlvrl'! STUDY

ANA!.'lTICAL TABLE 5B. - Average number of' hours spent at each area and level of' activity by each category of' personnel during a sample workweek of' 2~ hours PERSONNEL OBSERVED Rn .A.M. DATES OF STUDY August P.M.

16-21 ! 1965

Skill level of' activity Area of' activity -

Total, all l~ve;Ui

N ...

C ~.3A

Total,

all·areas-----..:~---

2~.OO

~.60

Total, patient centered--11 Giving care----------------

8.90 0.15 7·52 1.08 _O.O~

7.82

2.98 ~'

0.35 0.15

4.83

~- -.~

6.79

12 other direct activities----

};:5~, _'O.

13 Teaching Patlents---------- 0.15 14 Exchange of' In:formation---- a.51 15 Indirect Care

O~9~

-------------

1.97

I.i.O~

Total, personnel centered- 1.03

1.Q~

- 1.01 0.'5.1 - 0.15 - 0.15 0.3:\. 1.52 0.40 -, - 4.68

- ---.

.- ~~0.15

~:--.-

21 Prof'esaional staf'f' development------------------22 O.~

0.32

Personnel:

Other---------- 0.21 program---~

0.2' 0.5 .. ~;4~

23 Nursing Student

a.51 8.19 . 8.19

'0.10

- - - 2.~

0.20 0.20

-.0.15 0.15

Total, unit centered------,.

2.98

31 Environment, supplies aod

equipment-----------------

2.42 0.10 2.30 2.98

---Total, other centered-----

4.88 3.14

01 Personal-------------------

0.20

- -. -

0.20

02 Standby------------------- _:1:.7.4

- -

4.68 3.14 1.54

- 100 -

NURSING ACTIVITY STUDY ANALYTICAL TABIB 5B. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 16-1/2 h6urs(p.m.) HOSPITAL _....;N::.;GH:::..-_ _ PERSONNEL OBSERVED Rn _

A.M.

P.M.

OPD

1/ Area of activity

DATES OF STUDY

August 16-21 I 1965

Skill level of activity Total, all levels A

Total, all areas ---------Total, patient centered --11 Giving care

16.50 0.62 3.70 1.04 6.92 3.98 LBO .

0.43 0.05

3.79

3.55 0.33 0.05 1.80

---------------

12 Other direct activities ---

0.96 0.09 0;28 0.85

Teaching Patients --------14 Exchange of Information -15 Irxiirect Care -------------Total, personnel centered-

p.81 0.09 0.09

0.05 i

0.19 0,09 Kl.66 0.14 0.05

- I

0.14 0.14 0.14 0.14

- -

0.38 0.38

21 Professional staff development ----------------22 Personnel: other ---------23 Nursing Student program ---Total, unit centered -----31 Enviromnent , supplies and equipment -------~---_

- - -

- ~.87

9.10 0.47 p.W 0.71.

0.57 0.57

9.10 0.47 p.09 0.71 p.87

Total, other centered ----

3.27 2.42 0.85

p.G5

01 Personal -----------------__ 02

p.05 '

Standby --------____________

- -

3.22 2.42 0.81

- 101 -

NURSJNG ACl'IVJTY STUDY ANALYTICAL TABLE SB. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPITAL -::..:.N""G... H_~---,PERSONNEL OBSERVED OPD _ _.....:.:.X_ _ _ __ Cl J Total: DATES OF STUDY Whole Day August 16-21, 1965

Skill level of activity Area of activity Total, all levels 39.5 2.23 I

; M

I I

C I

Tota~

all areas-----------

25.0~

loll 0.56 -

Total, patient centered--11

loll loll

Giving care---------------

loll

12 Other direct activities--13 Teaching Patients--------14 Exchange of Information---

loll

15 Indirect Care-------------Total, personnel centered 21 22 Professional staff development-----------------Personnel:

23.92 loll

23.9~

- - - loll loll - loll

12.79

0.56

Other --------23 NurSing Student program--Total, unit centered-----31 Environment, supplies and equipment-----------Total, other centered-----01 02 Personal------------------Standby--------------------

22.81 loll

- - - -

I I

22.81

0.56

loll 12.24 10.57 1.67

0.56

0.56 12.24 10.57 1.67

- -

I I

· - 102 -

ANALYTICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of~hours liOOprrAL OPD ,/

IDH

PERSONNEL eBSERVED

Cl I

A.M.

P.M.

OF STUDY August 16-21, 1965

Skill level of activity Area of activity Total, all levels A N C H M

Total, all areas----------Total, patient centered----

23.00 14.58 0.64 0.32 1.27 0.6~

0.64

11 Giving care

---------------

0.64

0.64 0.64

12 Other direct activities---13 Teaching. Patients--------14 Exchange of Information---15 Indirect Care------------Total, personnel centered..

0.64

- -

0.64

13.94 13.9

- - - - - - ,

7.45

0.32 0.32

21 Professiopal staff development----- _______________ 22

0.61

Personnel:

Other

--------

13·29 0.61;0.64

13·~

- - 0.32 0.32

23 Nursing Student program--Total, unit centered-----_

31 Environment, supplies and equipment

-----------

Total, other centered----_

7.1 6.1< 0.9~

01 02

Personal--- _______________ Standby _________________ ~

- - - .. - - -

1.1'5

6.16 0.97

- 103 -

NtlRSmG AcrlVTI'Y STUI1i

ANALYTICAL TABLE 5B. - AVerage number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPlTAL __N'-;GH"..;-_ _ _ PERSONNEL OBSERVED Na Total: Whole Day OPD X DATES OF STUDY August 16-21. 1965

, Skill level of activity Area of activity Total. all levels

IA I

I I I

! Total, all areas---------Total, patient centered---

39.50 0.')'5 2.62 10.56 4.93 .. 4.06

---

2.44 0.87 1.19 0.81 1.06 0.69

11 •37

9.<5

0.50

0.06

Giving care---------------

12. Other direct activities--13 Teaching Patients--------14 Exchange of Inf'ormation--15 Indirect Care------------Total, personnel centered-

0.81 2.25

0.06 0.93 0.88 0.13

0.06 0.50 1.19 1.19

0.50

0.06 0.75

21 Professional staff development-----------------

0.06 0.06 0.81 0.06

22 Personnel:

Other---------

23 Nursing student Program--Total, unit centered------

0.87

0.75

0.44

26.44 0.63 1.19 9.63 4.69

31 Environment, supplies and equipment-----------

26.44 0.631 1.19 9.63 4.69

0.87

0.44

! Total, crth~i· c0nter~d--~~.: ! OJ. Personal------------------

I ,

I , I

8.12 4.43

0.06 10.06 I I

8.00

, I

02 Standby-------------------

I !

3.69

- -. I - ! I , I 0.06 iO.06 - I I I

4.43

! !

i 3.56

- 104 -

NURSIm AC'rIvl'lY S'ltlDY

ANALYTICAL TABLE 513. - Av~rage number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 2) hours HJSPITAL _-=.:NG::H"--_ _ OPD _ _ _--=v_.__

PERSONNEL OBSERVED

A.M.

P.M. I

DA'lES OF SWDY

August 16-21, 1965

Skill level of activity Area of activity Total, all levels 2).00

Total, all

areas __________

0.53 1.96

8.16 6.67

0.85 0.33

4.83

Total, patient centered.. ___ 11

2.74 0.60

1.82 0.57 0.06 0.59

Giving care ______________

12 Other direct activities ___ 13 Teaching Patients ________ 14 Exchange of Information __ Indirect Care ____________ 15 Total, personnel centered2l

1.56

0.78 0.45

0.06 0.52

0.06 0.39

0.33

0.52 0.52

0.06 0.06 -

0.06 0.06

0.06 0.06 4.77 2.35 2.42 !

Professional staff deve"lopment _________________ Other ________

0.06

22 Personnel: 2)

Nursing· Student program ___ .. .. Total, unit centered ____

- -

15.32 0.46 0.14 15.32 0.46 0.14 4.89 2.35 2.55

7.59 6.55 7.59 6.55 0.06 0.06

31 Environment, supplies and equipment __________ Total, other centered ___ 01 02 Personal ----------------Standby __________________

- -

- 0~06

0.06

- 105 -

NURSING ACTIVITY STUDY .~NALITICAL TABLE 5B. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 16-1/2 hours(p.m.)

HOSPITAL

NOH

PERSONNEL OBSERVED_ _-,N",a;...

OPD

. OF STUDY August 16-21 I 1965 DlTES ·Skill level of activity Total all levels

.\.M.!/

P.M.-

Area of activity

IA -

Total, all areas

----------

16.50 0.25 0.69 2.69 8.25 1.38 0.25 0.69 0.63 0.25 0.38 0.12

0.56 0.19

4.02

Total, patient centered 11

0.06

Giving care

12 Other

--------------direct activities ---

13 'Teaching Patients -------14 Exchange of Information --15 Indirect Care ------------Total, personnel centered

0.44

- 0.25 0.25 - - - -

0.19

0,06 0.75

- -

0.12 0.12 0.12

0.81 0,06 0.06 0.06 0.75

21 Professional staff deve22 23 lopment ----------------Personnel: Other --------Nursing Student program --Total, unit centered ----31 Environment, supplies and equipment -----------

- -

0.~5

-- -

- - -

- -

11.44 1. 813 0.06 2.31 8.12 11.44 1.88 0.06 2.31 8.~

0.37 0.37 0.37 0.37

Total, other centered

2.88 1. 75 1.13

- - - -

2.88 1.75 1.13

01 Personal -----------------02 Standby

-------------------

- w6NURSlNG AGrIVTI'Y STUDY

'ANALYTICAL TABLE 58. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of 39-1/2 hours HOSPTIAL _----'-N!:.GH:!!-___ PERSONNEL OB'3ERVED OPD X _~S.::.t

___ Total: Whole Day DATES OF STt'DY August 16-21, 19E:5

Skill level of activity Area of activity Total, all levels I

-: H M

i , !

I 3.48 0.32 10.20

, ,

Total, all areas--------Total, patient centered-11

39·50 1.94 21.11 2.45 20.33 0.39 12.34 3.61 0.19 }~42 I

18.78 0.84 12.26 0.06 3.03 0.39 0.19

o.oE

Giving

care--------------

12 13 14 15

other direct activities-Teaching Patients-------Exchange of Information-Indirect Care-----------Total, personnel centered

0.32

0.13

0.06

0.77 0.06

0.58 0.13

0.06

2.71 0.26 0.06 2.07 2.07

O.oG 0.0(, ) I

2.39 0.26 '2;26 0.13

3.42 J

21 22 ~3

Professional staff development---------------Personnel: Other Nursing Student program-Total, unit centered-;'---

0.13 0.13

6.45 6.45 ..

1.29 1.29

- - -

0.13 0.13

II II J.. , ,

0.06 1.55 0.06 1.55

Environment, supplies and equipment----------

3.42

II ..

! I! II 'I

Total, other centered---01 02 Personal----------------Standby----------------;.-

10.33 5.68

I 0.19 0.061

. ~

I ,

10.07 5.68 4.39 i

4.65

0.19 0.06

i ,

I I

- 107 NURSING AC'LTVI'lY S'roDY

ANALYTICAL TNBLE 58. - Average number of hours spent at each area and level of activity by each category of personnel during a sample workweek of ~ hours HOSPI'DIL __ Nl::;;;H _____ PERSONNEL OBSERVED St V'/ A.M. _ _-,P.M. OPD _ _...t<~_ __

DA'lES OF S'roDY August 11>-21, 1965 Skill level of activity

Area of activity

Total, all levels 23.00 11.86 7.21 2.12 0.11 0.45 1.97 1.40 1.32 0.08

M 0.08

Total,

all areas _________

1.12 12.36 1.44 2.0' 0.22 11.00 0.49 0.04

5.88

Total, patient centered __ 11 Giving care ______________

0.08 0.04

12 Other direct activities __ 13 Teaching Patients ________ 14 Exchange of Information __ Indirect Care ____________ 15 Total, personnel centeredL 21 22 ~

7·17 0.04 1.78 O.~ 0.11

0.08 0.04

0.04 0.24 0.08

0.19 1.59 0.15 0.04 0.15 1.21 0.08 1.21 0.08

0.04

Professional staff development ________________ Personnel: Other ________

""-

NUrsing Studdent program _ Total, unit centered ____

...

3.67 3.67 5.95 3.26

0.75 0.04 0.91 1.97 0.75 0.04 0.91 1.97

- 0.04 - - - -

Environment, supplies and equipment _________

01 02

Total, other centered ____ Personal _________________ Standby __________________

2.69

0.11 0.04

0.1110.04 I

5.80 3.26

2.54

- 108 -

FIRST REGIONAL NURSING STUDIES SEMINAR 2-30 August 1965

BIBLIOGRAPHY

Indices - General References Grandbois, M. (1964), Cumulative index to nursing literature, Glendalc Sanitarium and Hospital; Glendale, 6-8, (1961-63) Henderson, V. (1963), Nursing studies index, prepared by Yale University School of Nursing Index Staff, J.B. Lippincott Co., Philadelphia, IV,

(1957-1959)

International Labour Office (1958) International standard classification of occupations. Lennon, Sir Mary Isadore (1954) Teaching in the outpatient department. Matheney, Ruth V. and others (1964) Fundamentals of patient-centered nursing. Simmons, L.W. & Henderson, V. (l~64), Nursing research: assessment, Appleton-Century-Crofts, New York A survey and

Wallace, Helen M. (1962) Health services for mothers and children. lI. Statistics Walker, H. & Leo, J. (1958) Elementary statistical methods, New York, Henry Holt Co. Levine, E. (1959) Interpreting Etatistical data, Amer. J. Nurs., ~,

230-233 Levine, E. (1959) The ABCs of statistics, Amer. J. Nurs., 59, 71-75 III. Methods Abdellah, F. & Levine, E. (1954) Work sampling applied to the study of nursing personnel, Nursing Research, 3, 11-16 Adams, A.O. (1957) How to study the nursing service of an outpatient department, Washington, United States Public Health Service, Department of Health, Education and ,,relfare, Publ. Hlth. Servo Publ. No. 497 Adams, Apollonia O. (1958) NurSing reso~ces: a progress report of the program of the Division of Nursing Resources, U.S. Public Health Service Publ. No. 551. American Public Health Association (1961) Guide to a community health study. Arnstein, M.G. (1953) Guide for national studies of nursing resources, Bull. Wld. Hlth. Org., Suppl. 7, Geneva, World Health Organization.

- 100l -

Arnstein, Margaret G. (1956) Design for statewide nursing surveys: basis for action. U.S. Public Health Service Pub. No. 460.

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.-("

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Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1965

Source Organisation mondiale de la santé