**2. Method**

yield highly reliable results concerning the amounts of work time expended. They are there‐ fore widely used not only in fields related to nursing but also in clinical locations where doc‐ tors and other co-medicals work (Vinson et al., 1996; Langlois et al., 1999; Magnusson et al., 1998). They are carried out in various forms (Thomas et al., 2000; Caughey & Chang, 1998) and in the course of this study also we have used time study to elucidate the actual state of

In most such studies, however, the analyses of the time study data do not go beyond factual descriptions of the actual state of affairs. So far, almost no methodology has been established for the purpose of linking the data to the calculation of quantities of nursing care required or to nursing care management. The following points may be cited as contributing factors:

With regard to point 1)→1, for example, researcher-administered time studies (see 2.2.1.1. below) produce what are regarded as the most reliable data, but the outlay in terms of staff‐ ing and financial costs, from the pre-survey preparation stage to the results analysis, as well as the high burden on the clinical location concerned, make it difficult to carry out such

With regard to point 2)→2, where nursing care management matters such as appropriate staff allocation are concerned, inconsistencies in shift conditions will arise (there will be days when shifts have crowded schedules and days when they do not), so it will be necessary to obtain an over-all picture of tasks on the ward based on the evidence of frequent or long-term surveys. For the reason given above, however, time studies are restricted, in almost all cases, to short survey periods. The results obtained therefore provide an interpretation only of the period

With regard to point 3)→3, having obtained an over-all picture of the tasks on the ward, the next step in nursing care management is to formulate a concrete plan that takes into consid‐ eration changes in working hours when there is a shortage of nursing staff or when there is an increase in the number of patients admitted. In practice, however, it is difficult to carry out the formulated plan in the actual ward environment because such plans are accompa‐ nied by risks and involve many ethical problems. This means that an investigation of a new

Considering the above adverse factors, it would be effective, for the purposes of time-study

ward nursing care from a variety of perspectives.

214 Advances in Discrete Time Systems

**1.** It is difficult to carry out long-term time studies

**2.** It is difficult to obtain an overall picture of tasks in hospital wards

**3.** There is no place for trial and error in the actual execution of the plan devised.

studies with any great frequency, and the survey periods must also be kept short.

when the survey was conducted and are confined to the realm of factual description.

method of work management is in fact impossible. This has been a major barrier.

based management of ward tasks, to establish a methodology of the following kind:

**•** Creation of a computer-based virtual ward environment using the estimated values

**•** Test experiment on a plan for work management using the virtual ward environment

**•** Estimates of ward task times based on time study data

The procedure followed was:


#### **2.1. Framing a plan for the creation of a virtual environment**

First of all, in order to establish a way of thinking about how to simulate an actual ward en‐ vironment, we drew up a diagram showing what kinds of factors would have a bearing on the time devoted to nursing tasks (Fig. 1).

We assumed that the tasks carried out by a given nurse during one shift would comprise (i) tasks relating to patients for whom the nurse is responsible, (ii) tasks relating to other patients, (iii) other tasks, such as those relating to the running of the ward, and (iv) rest time. Task times devoted to these four items would be interdependent and would vary, but we thought that 'task times devoted to patients for whom the nurse is responsible' would have particularly high priority, and would affect 'time devoted to other patients,' 'time devoted to other tasks' and 'rest time.' We also assumed, first, that the number of patients for whom a given nurse is responsible, and the severity of their conditions, would affect 'task times devoted to patients for whom the nurse is responsible'; second, that 'number of patients' in the nurse's charge and 'severity of their conditions' would be affected by 'number of patients by severity of condition' who were on the ward at a given time and 'number of nurses' actually available to carry out pa‐ tient care; and third, that 'number of patients by intensity of nursing care' would be affected by 'patient outcomes' and 'number of patients admitted.

ing,' and 'non-nursing tasks.' At the most detailed level, there were 92 headings altogether.

Investigation of a Methodology for the Quantitative Estimation of Nursing Tasks on the Basis of Time Study Data

http://dx.doi.org/10.5772/51014

217

Patient condition information for each patient on the ward was collected and recorded daily throughout the fifteen days of the time study period. 'Patient condition information' means information that indicates a hospital patient's condition, such as how many times in the course of the day vital signs are checked, whether an artificial respirator is in use, or wheth‐ er there is any fever or bleeding. About 70 items are covered. Information collected during the day shift, at about 10 a.m., served as the base, and was incrementally updated for any patient who underwent an operation or other invasive procedure during the day shift and whose nursing intensity changed. The information recorded was entered into a database.

Nursing intensity, assessed daily by an experienced nurse, was included in patient condi‐ tion information. Nursing intensity is a method of classifying patient severity from two points of view – 'level of observation' and 'freedom of life' – that was proposed in 1984 in a report by the Study Group on Nursing Systems set up by the Ministry of Health, Labor and Welfare (formerly the Ministry of Health and Welfare) (Table 2). In the process of the present study, it was suggested that patient severity observations collected on the ward be‐ ing studied could be regarded as 'level of observation' for the purpose of assessing nursing

By integrating the time study database and the patient condition information database on the basis of 'day of survey,' 'shift,' 'nurse ID' and 'patient ID,' we created a data set that made it possible to tell which nurse had spent how much time performing what tasks for patients in what condition. We assumed that among the task actions, subject patients would

The names of nurses and patients included in the survey records, as well as any other items of information from which it would be possible to identify individuals, were all coded and

The overall number of individual task action-units recorded was 46,775.

Ultimately, the overall number of patient-shift units recorded was 2,015.

intensity and these were used in carrying out our analysis.

be available for nursing task classifications from 10101 to 301T1.

only if this used for analysis after the information had been made secure.

**Figure 2.** Module system and primary nursing model.

*2.2.1.2. Patient condition information*

#### **2.2. Computation of basic data required for a virtual environment based on short-term research and long-term cumulative information**
