**1. Background and goals**

Estimation of the quantity of nursing care required is regarded as a pressing need from the point of view of the investigation of both patient safety and care provision that meets pa‐ tient for view of demand. Nursing is a very busy job, and up to now, much attention has been paid to problems arising from the physical and psychological effects of busyness on nurses, and to consequent problems relating to patient safety and quality of care. Because a large part of any estimates of whether a nurse is busy or not depends on subjective judg‐ ment, however, it is difficult both to define busyness and to formulate methods of measur‐ ing and assessing busyness. It is also true that merely demonstrating busyness will not have a significant effect in solving problems. Consequently, ways of estimating nursing care quantity itself have been sought. If it were possible to make quantitative estimates of neces‐ sary nursing care, we could expect to improve patient safety and achieve a better quality of patient care through such elements of nursing care management as appropriate allocation of nursing staff and effective distribution of tasks.

In studies of the measurement of work quantity for the purposes of nursing care manage‐ ment, a typical approach has been to conduct work quantity surveys based on time study (Meyers & Stewart, 2002). Various techniques for calculating work quantity have been used, some of which focus on patient condition (Fagerstom & Rainio, 1999) and others on patient outcomes (Hall et al., 2004), but methods based on time study have the particular advantage that they make it possible to obtain clear quantitative results in the form of work times. Time studies quantitatively examine how much time is spent on what sort of work activities, and

© 2012 Ishii et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 Ishii et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 ward nursing care from a variety of perspectives.

The goal of this study is therefore the formulation of a methodology, based on data from a short-term time study, for estimating ward task times and for creating a virtual ward envi‐

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

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**2.** Computation of basic data required for a virtual environment based on short-term re‐

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

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

**3.** Construction of a procedure for the creation of a virtual ward environment

ronment relating to job times.

The procedure followed was:

**1.** Framing a plan for the creation of a virtual environment

search and long-term cumulative information

**4.** Trial experiment using the virtual ward environment

the time devoted to nursing tasks (Fig. 1).

**Figure 1.** Constituent factors in nursing tasks.

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

**2. Method**

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

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

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

Considering the above adverse factors, it would be effective, for the purposes of time-study based management of ward tasks, to establish a methodology of the following kind:


The goal of this study is therefore the formulation of a methodology, based on data from a short-term time study, for estimating ward task times and for creating a virtual ward envi‐ ronment relating to job times.
