http://doi.org/10.33698/NRF0019 Saritha TS, Jogindra Vati
Abstract: A descriptive study was conducted in four selected wards of Nehru hospital of PGIMER Chandigarh during the year 2002, with the objectives to describe the nursing care activitilies carried out by the nurses and also to measure the dimensions of satisfaction of nurses, designated as sister Grade II, towards those activities. A total forty three nurses available during the time of data collection were observed by using intermittent non participatory observation method. The observations were made at the interval of 10 minutes for 6 hours each day for 6 days in the morning and evening shifts in each ward. A ‘Nursing Activities Satisfaction Scale (NASS)’, after checking its validity and reliability was administered to them. Out of 2304 observations, maximum, 1482 (64.32%) were complex patients care activities, 233 (10.11) were of basic patient care activities and remaining 589 (25.56%) of other miscellaneous activities. Rank wise, technical procedure activity was first and hygiene care was tenth in order. Activities like nutrition of the patents, care of body waste and sample health teachings were not carried out by the nurses in any of the wards. Majority of the subjects carried out complex patent care activities one form or the other but basic care related activities were carried out only by few nurses. The nurses expressed moderate to highly satisfied dimensions for both basic and complex patient care. No significant relationship was observed among the satisfaction of nurses, who carried out or not carried out the activities. Bio-demographic variables also had low associations with satisfaction and activity carried out or not carried out, except for their gender and in-service education profile, which showed positive association.
Key Words: Nursing care activities, dimensions of satisfaction, nurses, perception, wards.
Correspondence at:
Or (Mrs.) Jogindra Vati
Lecturer,
National Institute of Nursing Education,
PGIMER Chandigarh, India.
Introduction
Nursing is compassion personified and a caring discipline. The values of our profession are rooted in helping individuals to regain, maintain or improve their health, prevent illness, find comfort and retain their individuality and dignity. Since the era of Florence Nightingale, nursing has always valued commitment and compassion for people in care. The fundamental goal of nursing profession is to provide patients with the best possible nursing care.
`Nursing care activity’ is the sum of interventions by nursing personnel for the purpose of achieving the optimum health status of individuals, groups and communities. It ranges from promotion of self care to meeting needs of the totally dependent. It is providing direct care and guidance to the clients, as well as cooperating with partners in the care process1. Nurses are the hospital’s goodwill ambassadors and frontline representatives. In the hospital setting, the role of nurse as a health functionary is of singular importance, as she is the coordinator, mediator and observer for all the patient services. Increasing patient acuity, economic rationalization, the explosion of medical technology and other forces have impacted on the roles and the responsibilities of all practicing nurses. Recent socio-economic trends have impacted the health care industry and have forced changes in the work pattern of care givers.
Studies on patient care activities have been carried out globally and in India from time to time. Most of these studies revealed that nurses render nursing care activities and these activities are categorized as direct and indirect or other activities. Direct care activities are illustrated as nursing activities that are patient centered and performed in presence of patient or family. Whereas indirect care included all those activities performed away from the patient but in preparation for or in completion of direct nursing care. Urden and Roode had categorized the activities as direct care, indirect care, unit related activities, personnel activities and documentation2.
Studies also reported that nurses carry out more of indirect care activities than direct nursing care 3,4.0ther studies reported that nursing personnel do more of direct nursing care than indirect nursing care activities”’. Whereas in Indian scenario, it is observed that nurses carry out basic and complex patient care and other activities include clerical, administrative, nonproductive and housekeeping etc. These activities are also described under nursing and non nursing activities5-7.
Numerous researchers have found job satisfaction of nurses with their job related variables, but little has been done in the field of satisfaction of nurses related to nursing care activities. Furthermore, a measure of nurses’ satisfaction with nursing care activities can be a useful tool in management. Hence the study has been carried out with the following objectives:
Objectives
- To describe the nursing care activities carried out by the nurses.
- To measure the perceived dimensions of satisfaction of nurses.
Materials and methods
The present study was conducted at Nehru hospital of Postgraduate Institute of Medical Education and Research at Chandigarh, UT. It is a major referral hospital in North India providing diagnostic, therapeutic and rehabilitative services in various specialties and super specialties. The hospitals bed capacity is about 1200 and about 1100 nurses, who work round the clock in the hospital. They are posted in different wards. Whereas for the purpose of study, all the nurses designated as Sister Grade II working in four wards i.e. male medical, female medical, male surgical and female surgical, were taken as study population and the nurses available in morning and evening shifts during data collection and also who gave the consent to participate in the study were included as study subjects.
The conceptual frame work of study is based on Roy’s Adaptation Model, Henderson’s Basic Needs and WHO Grouping and Description of Activities of health personnel5,8-9 to describe the role performance of the nurses and their satisfaction. The data was collected by questioning and observation using intermittent non participatory at the interval of 10 minutes in the morning and evening hours for consecutive six working days of a week during the month of January and February, 2002.
An observation guide was developed, in which basic as well as complex patients care activities and codes were assigned to each activity and group of activities. Under Basic’ patient care, six activities were included, were on personal hygiene, comforting the patient, nutrition, caring body waste, social aspect and conducting simple health teachings. Whereas under ‘Complex’ patient care activities, eight activities were included that were on noting the patients health status, giving special care, preparing for a procedure, carrying out and assisting in technical procedures, giving health teachings, providing supportive care and recording the care given.
To record the duties of subjects, a staff duty roster proforma was developed. Whereas an observation sheet was also developed to record the observed nursing care activities carried out by the nurses. The information regarding perceived dimensions of satisfaction of nurses related to nursing care activities were gathered with the help of self-developed `Nursing Activities Satisfaction Scale (NASS). `Profile data sheet’ was administered to the subjects to seek the information related to biodemographic variables. The tools were checked for validity and reliability of NASS was checked by split half method. A pilot study was also conducted to check the feasibility of the study.
A written permission was sought from the competent authority. The list of nurses working in morning and evening shifts in the selected wards was obtained from sister- in charge of each ward. All the subjects were informed and verbal consent was taken from them to participate in the study. The subjects were asked to wear the identification tags made from plain cards of size 3″X2″. Each respondent was assigned a code number 1, 2, 3 and so on. The observer started the observation with the first subject she met in the ward and simultaneously recorded the activity they did. Thus a total 2304observations were made. Later collected data as analysed by using both descriptive and inferential statistics.
Results
Characteristics of subjects
Of 43 nurses, majority of them (n 16)were from male surgical wards. Their age was ranging between 22 to 44 years with an average age 30.63 ± 5.9 years. Gender wise, majority of them (n=41) were females. More than half (62.79%) of subjects were married. About half (n=24) were undergraduate and31 (72.1 %) were holding a diploma in nursing and midwifery. Their tenure in the profession as ranging from one to 24 years with an average tenure of 7.5 ±5.2 years. Majority of them (n=28) had an experience of 2-5 years in the present ward. Thirty one nurses had attended an in-service education programme. Ward wise, there was no significance difference in their socio-demographic variables.
Nursing care activities carried out
Basic care activities
Table 1 revealed that out of 2304observations made, 233(10.1%) were on basic patient care. Maximum these types of activities (210/233) were performed by the subjects during the morning shift. It was also observed that maximum times (210/233), they were found making a comfortable bed to the patients in all the wards followed by social aspect of the care (22/233), when they were assisting their patients in shifting from bed to trolley and receiving them on admission. Only once, it was observed that the nurse, was attending to hygiene care during the entire study period and that was carried out in male medical ward. This activity was the least carried out activity. Other activities which were not carried out during the study period were nutrition of the patients, care of body waste and giving simple health talks. Maximum basic patient care activities were carried out by nurses in male surgical ward (67/233) andleast in male medical ward (43/233) andalmost same in other two wards.
Complex patient care activities
It was observed during 1482 (64.32%)observations, made on complex patient care, the nurses were carrying out more of technical procedures (765/1482) in all the wards during morning and evening hours. This included the activities on administration of medication, measuring vital signs etc. Rank- wise this activity was maximum carried out in the wards. Recording the care given or charting was the second (13.06%) in order, followed by preparing the patients for procedures (12.3%) (Table).
Maximum these activities were carried out in male surgical ward (444/1482), followed by in male medical ward (407/1482), female medical ward (377/1482) and minimum (254/1482) in female surgical ward.
Among the activities observed and ranked in descending order, carrying out technical procedures was ranked first and hygiene care was ranked tenth. Social aspects and assisting in technical procedures were ranked seventh in order.
Table 1: Number of activities carried out by the nurses
| Activities | No. of activities carried out | ||||
| Morning | Evening | Total (%) | |||
| A. | Basic patient care
Hygiene care Comfort of patient Nutrition of patient Care of body waste Social aspects Simple health teaching Sub total |
– 205 – – 05 – 210 |
01 05 – – 17 – 23 |
01 210 – – 22 – 233 |
(0.04) (9.1)
(0.95)
(10.1) |
| B. | Complex patient care
Noting patients health status Giving special care Preparing for a procedure Carrying out technical procedures Assisting in technical procedures Conducting health teachings Providing supportive care Charting Sub Total |
08 02 185 394 15 – 15 169 790 |
36 06 99 371 08 09 34 132 692 |
44 08 284 765 22 09 49 301 1482 |
(1.9) (0.35) (12.3) (33.2) (0.95) (0.39) (2.1) (13.06) (64.32) |
| C. | Other activities* | 206 | 383 | 589 | (25.56) |
| Grand Total | 1206 | 1098 | 2304 | (100) | |
*Not included in the study
Number of nurses carried out various activities
The data revealed that all the complex patient care activities were carried out by the nurses. Out of these activities, all (100%) nurses carried out technical procedures in one form or another like giving medications, measuring vital signs and also all of them were documenting the care given by them. Majority, 40 (93.02%) of subjects were found to be preparing for procedures. Supportive care was given by more than half, 28 (65.12%) of subjects. They were found to be talking to the patients ‘relatives and clarifying their doubts. About half of the subjects, 23 (53.49%) were noticed in observing patients’ health status. This was mainly by reading the report books or case sheets. Only 11 (25.58%) were helping the doctor or a nursing colleague whenever needed. Only 5 (11.63%) subjects were observed providing health teaching at the time of discharge, regarding medication regime and follow up. Whereas special care was provided by 4 (9.3%) subjects when needed which was the last office care(Table 3).
Out of six basic care activities were carried out by the nurses. More than half of the subjects, 29 (67.44%) had taken care of comfort needs of the patients. The activity which was carried out maximum was making a comfortable bed for the patients. Among 13 (30.23%) who were found to be carrying out ‘social aspect’, most of the subjects assisted their patients to shift from bed to wheel chair. The only activity carried out by one subject (2.33%) was to assist the patient to dress or undress under ‘hygiene care’. X2 test showed a statistical significance of the activities carried out and not carried out for noting the patients’ health status and supportive care (P<0.05 and <0.01 respectively).
Perceived dimensions of satisfaction ofnurses
Overall, the nurses were satisfied with both basic and complex patient care activities. The mean score rated for basic care activities is slightly less (4.35/5) as compared with the scores rated for the complex patient care activities (4.6/5). Among the basic care activities, the lowest satisfaction mean scores were rated for ‘care of body waste’ activity followed by scores rated for ‘hygiene care’ (3.98/5) and the highest for ‘delivery of health teachings’ (4.88/5). Whereas regarding the complex patient care activities, the satisfaction mean score varied from 4.5 to 4.8, out of maximum 5 scores for all the activities. The highest satisfaction mean scores were rated for ‘charting’ (Table 2).
Table 2: Mean satisfaction score of nurses for their activities
| Activities | No. of items | Rated mean scores | |
| A. | Basic patient care
Hygiene care Comfort of patient Nutrition of patient Care of body waste Social aspects Simple health teaching Total (Basic) |
9 6 1 4 6 1 27 |
3.98 4.6 4.49 3.68 4.47 4.88 4.35 |
| B. | Complex patient care
Noting patients health status Giving special care Preparing for a procedure Carrying out technical procedures Assisting in technical procedures Conducting health teachings Providing supportive care Charting Total (Complex) |
3 7 6 25 2 1 4 5 53 |
4.6 4.58 4.5 4.65 4.67 4.6 4.6 4.8 4.64 |
N=43 Maximum mean score: 5
Ward wise’t’ statistics revealed that there is a significant difference in satisfaction among the nurses towards both basic and complex patients care activities. The nurses working in medical wards rated higher satisfaction than the nurses working in surgical wards for the activities on ‘care of body waste’, giving special care’, ‘preparing for procedures’ and ‘carrying out technical procedures’ and also showed a statistical difference in their ratings. It was also observed that the nurses working in female wards expressed slightly higher satisfaction scores towards both types of activities as compare to the nurses working in male wards.
Level of satisfaction for the activities they carried out or not carried out
The data revealed that the only nursing personnel who had carried out hygiene care activity, expressed moderate level of satisfaction and for the rest of activities both basic and complex, majority of them had expressed very high level of satisfaction (Table3). The findings also revealed that among the nurses who were not observed carrying out these activities; majority of them also found to be very satisfied (Table 4).
Table 3: Nurses’ satisfaction towards the activities carried out by them
N=43
| No. of Subjects | |||||||
| Activities | Who carried out activity | Perceived dimension of satisfaction* | |||||
| 5 | 4 | 3 | 2 | 1 | |||
| A. | Basic patient care
Hygiene care Comfort of patient Nutrition of patient Care of body waste Social aspects Simple health teaching |
1 29 – – 13 – |
– 23 – – 10 – |
1 6 – – 3 – |
– – – – – – |
– – – – – – |
– – – – – – |
| B. | Complex patient care
Noting patients health status Giving special care Preparing for a procedure Carrying out technical procedures Assisting in technical procedures Conducting health teachings Providing supportive care Charting |
23 4 40 43 11 5 28 43 |
20 4 32 41 10 2 24 42 |
2 – 7 2 1 1 4 1 |
1 – 1 – – 2 – – |
– – – – – – – – |
– – – – – – – – |
*Satisfaction dimensions: 5=Very satisfied, 4=Moderately satisfied, 3=neither satisfied nor dissatisfied, 2= Moderately dissatisfied, 1=Very dissatisfied
It was also observed that all the variables related to bio-demographic profile of the nurses except gender and in-services education program attended by nurses had a very low association with the activities they carried out or not carried out and also with their level of satisfaction towards those activities (CAB=0.49), whereas gender wise and in-service education programs attended by nurses had a positive association (QAB > 0).
Discussion
Out of 2304 observations made on 43 Sister Grade Ii nurses in four different wards during morning and evening shifts for six days in each ward in the present study, revealed that maximum 1715 (74.43%) activities were related to patient care (which included 1482 (64.32%) complex patient care and 233 (10.11%) basic patient care activities) and rest 589 (25.56%) were on other miscellaneous activities (activities like clerical, off station housekeeping, non- productive) which were carried out by the nurses. Similar findings were also reported by the studies conducted by Darbyshire5 and Bobdey10, where nonproductive activities were observed less than the patient care activities.
In the present study, the basic patient care activities were also carried out less in number as compare to other miscellaneous activities.
Table 4: Nurses’ satisfaction towards the activities that were not carried out by them
N=43
| No. of Subjects | |||||||
| Activities | Who did not carry out activity | Perceived dimension of satisfaction* | |||||
| 5 | 4 | 3 | 2 | 1 | |||
| A. | Basic patient care
Hygiene care Comfort of patient Nutrition of patient Care of body waste Social aspects Simple health teaching |
42 14 43 43 30 43 |
32 13 28 12 22 38 |
8 1 10 20 7 5 |
2 – 3 8 1 – |
– – 2 3 – – |
– – – – – – |
| B. | Complex patient care
Noting patients health status Giving special care Preparing for a procedure Carrying out technical procedures Assisting in technical procedures Conducting health teachings Providing supportive care Charting |
20 39 3 – 32 38 15 – |
17 36 3 – 25 27 13 – |
3 2 – – 6 10 2 – |
– 1 – – 1 1 – – |
– – – – – – – – |
– – – – – – – – |
*Satisfaction dimensions: 5=Very satisfied, 4=Moderately satisfied, 3=neither satisfied nor dissatisfied, 2= Moderately dissatisfied, 1=Very dissatisfied
The findings of the studies conducted by Linden and English3, Hendrickson4 and Sharma11 also supported the same, that nurses carried more of indirect patient care than direct patient care activities. Whereas on the contrary, study conducted by Urden and Roode reported that nurses carried out more of direct care as compare to indirect care activities2.
A study conducted in the same hospital reported that nurses carried out more of complex patient care related activities (59.5%), compared to basic patient care (6.4%) 11. The similar findings were also observed in the present study. Out of the complex patient care activities carried out by the nurses, technical procedures were carried out maximum number of times (51.62%). Preparing the patient for procedures 19.16% times and assisting in technical procedures by the nurses was observed only 0.95% times, whereas Bobdey recorded these activities up to 13.51% and 10.14% respectively10.
The study findings revealed that under basic care activities, comfort needs were met to a maximum (9.1%), followed by social aspect (.095%) and nutrition of the patients were not attended by nurses, whereas the studies conducted in the same hospital and other hospitals reported that nurses were observed carrying out 3.38% times the nutritional needs of the patients1018 and providing the comfort to the patients11.
It was found that carrying out technical procedures (33.2%) ranked first followed by charting (13.6%). Hygiene care (.04%) ranked the lowest. Basic care activities were carried out maximum during the morning hours and complex patient care activities were carried out both morning and evening shifts almost in equal proportion. Basic care activities like nutrition of the patients, care of body waste and simple health teachings were not given by the nurses at all during the entire study period. The only one subject carried out hygiene care related activity once, 20 (47.44%) of subjects met comfort needs of the patients and 13 (30.23%) carried out activities related to social aspect. Among the complex care activities, all the subjects carried out technical procedures and recorded the care given. Majority of subjects also carried out other complex care activities e.g. preparing the patients for procedures, providing the supportive care and noting patient’s health status(Table-3). This seems that nurses were carrying out the activities which were mandatory and related to the medical care or cure as the activities related to the caring were carried out by les-s number of subjects
Majority of subjects were very satisfied with the patient care activity carried out either complex or basic. The highest satisfaction mean score was rated for recording the care given and giving simple health teachings and the least for hygiene care and care of body waste (Table2). Studies conducted by Malhotra and Joiner also revealed that nurses were highly satisfied with the nature of work they do12,13.1n Netherlands also high scores were obtained1884 but Janeson found even less satisfaction scores (3.55/5) were rated by the nurses for the care they provided 14 and other studies also reported that only few nurses were satisfied with nursing15,16.
There were number of nurses who did not carry out various both basic and complex patient care activities, but expressed a high level of satisfaction towards those activities. This demonstrates that the role performance i.e. the activities to be carried out or not to be carried out is not directly linked with their satisfaction as the findings of the study revealed a very low association of levels of satisfaction and activities carried out or not (Table3). Except for gender and in-service education profile, the study revealed a low association between levels of satisfaction of nurses and their bio-demographic profile. Other studies also reported no significant difference of satisfaction with age17, marital status18, professional qualification and activity19. Unlike the findings of our study, the study conducted Burz and Molony found that older nurses were more satisfied20, Atwood and Hageman had documented an association between nurses’ education and their satisfaction21 and also with in-service education”, and experience of nurses15,22’23.
Thus the study concluded that nurses carried out maximum complex patients care activities and also expressed the highest satisfaction level towards those activities. Only a few nurses carried out basic patient care activities. Fifty percent activities related to basic care were not carried out at all. A significant difference in nurses’ satisfaction with the activities carried out or not carried out could not be elicited in the study. Hence further studies are needed to reason out factors which made them satisfied without performing the activities and the causative factors that did not motivate nurses to carry out basic patient care activities. Further there is also a need to develop guidelines for the supervisors to streamline the work expected from Sister Grade H and required to evaluate them periodically. In-service education programs should also stress on the value of `caring’ of patients which is the ultimate objective of nursing services.
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