*3.4.3 Survey*

At the patient level, the 15-Item Single-Factor Patient Perception of Hospital Experience with Nursing (PPHEN) [3] tool was used. The tool was developed in the English language, and was translated into Slovenian according to standard

*Congruence of Nurse Staffing and Activities with Patient Needs DOI: http://dx.doi.org/10.5772/intechopen.96589*

procedures for forward and backward translation [41]. The tool was piloted in a preliminary way in a group of 15 patients (not involved in this study) to test its comprehensibility and feasibility. The Cronbach's alpha for the PPHEN questionnaire in the Slovenian language was 0.905 (n = 15).

Patients' satisfaction was reported using a five-point Likert scale (1 = strongly disagree/not at all satisfied, 5 = strongly agree/completely satisfied). The responses to this were then turned into a patient satisfaction index including all the variables and ranging from 1 to 5, with higher scores indicating a higher degree of satisfaction with nursing care. Patients also answered some questions exploring demographic variables (e.g., age and gender) as well as data regarding whether the respondent was the patient or one of their relatives.

The questionnaires were distributed by nine third-year nursing students, who were not included in direct observations or in nursing care. On the research days, nursing activities were observed, and the patients included in the study (or their relatives) were invited to complete the questionnaire.

#### **3.5 Ethics**

Institutional review board approval was obtained from the Faculty of Health Sciences, University of Primorska, Slovenia, and from the hospital administration prior the start of the study. The study was conducted following the Code of Ethics for Nurses and Nurse Assistants, as well as the Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [42]. Patient and nurse consent was obtained on-site.

#### **3.6 Statistical methods**

Reliability was reached in the data analysis, with the exclusion of three of the nine (i.e., 30%) previously selected observational days. These days were selected casually in advance before the data collection phase. Only the principal investigator was aware of which days were chosen. Therefore, a total of 7,732 (78.4%) out of 9,866 observed nursing activities were used in the final analysis. As a consequence, 149 (68.4%) out of the total of 218 gathered questionnaires were used.

Exploratory data analyses were performed to inspect the data and identify inconsistencies. IBM SPSS Statistics, version 21.0 (IBM Corp., Group NY, USA) was used for data analysis to consider the three levels of analyses, namely: the hospital unit, the individual nurse, and the patient. Preliminary data analyses were completed using descriptive and bivariate analysis techniques.

Quantitative data analysis was performed using descriptive methods: mean (M), standard deviation (SD), frequency (n), percentage (%), Pearson's correlation (r), and Spearman's correlation (R). Correlation strengths were set as follows: 0–0.09 not correlated, 0.1–0.3 weak, 0.31–0.6 medium, and 0.61–1 strong correlation [43]. The significance was set at p < 0.05.

#### **4. Results**

#### **4.1 Nursing structure**

Seven registered nurses worked regularly across the observed medical ward, aided by 36 nursing technicians. Therefore, a total of 43 individuals participated in this study, representing 95.6% of the nursing population.

In the 94 available beds there were, on average, 80 patients/day. The nursing teams consisted mostly of nursing technicians (64%), which delivered 61.3% of nursing care. Each member of nursing staff cared for an average of three patients/ day, and every registered nurse was responsible for an average of 8.5 patients/day.

The mean number of nursing staff hours per patient day was 3.64 hours, of which 1.41 hours were provided by registered nurses. The average percentage of registered nurse hours was 38.74%, ranging from 38.05% to 39.9% of total nursing staff hours (**Table 1**).

#### **4.2 Nursing care process**

About 36.8% (n = 2,842) of all nursing staff activities involved direct contact with patients, and hands-on care represented 27.5% of all recorded nursing activities. One-to-one observation was identified 336 times (4.2%), direct communication with patients 294 times (3.8%), and support being given to patients 98 times (1.3%).

About 18.5% of all nursing activities were indirect patient care. A large number of these were represented by dealing with patient documentation, professional discussion to plan patients' care, discharge planning, and communication with patients' relatives and friends (n = 538, 6.9%). Shift handovers were identified 469 times (6.1%) and ordering investigations and preparing for medical/technical procedures performed independently by nursing staff were recorded 425 times (5.5%).

Other nursing activities were recorded 2,013 times (26%): patient-focused activities 1,470 times (19%), ward-focused activities 446 times (5.8%), and stafffocused activities 97 times (1.2%). Unproductive time represented 9.5% (n = 735) of all observed activities, including personal staff time (n = 729, 9.4%) and wasted time (n = 6, 0.1%). Information was missing with regard to staff activities for 9.2% of the observations (n = 710) (**Table 2**).


*1 Summary for 6 research days, 2 day shifts.*

*2 patients classified using the Slovenian patient classification system; RN = graduated (registered) nurse;* 

*NT = nursing technician; nursing staff = RN and NT; Average nursing care hours/patient day = (((total nursing care staff on duty, 6 research days, 2 shifts) x no. hours worked per day) x 1,5) /No. hospitalized patients.*

#### **Table 1.**

*Independent variable characteristics.*


*%, percent; n, number; a includes: patient documentation, professional discussion to plan patients' care, discharge planning, and communication with patient's relatives and friends; b includes individual medical–technical procedures done independently by nursing staff; <sup>c</sup> nursing activities that could not be observed, as the RN or the NA was not in the medical ward.*

#### **Table 2.**

*Proportions of nursing care activities.*
