Time spent by nurses on nursing care activities in a medical unit of a tertiary care center

 Corresponding author: Nirmala M. Emmanuel Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Time spent by nurses on nursing care activities in a medical unit of a tertiary care center Nirmala M. Emmanuel * and Premila Lee College of Nursing, Christian Medical College Vellore, South India. World Journal of Advanced Research and Reviews, 2025, 26(02), 963-967 Publication history: Received on 28 March 2025; revised on 05 May 2025; accepted on 08 May 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.2.1713 Abstract Background: Nurses dedicate a substantially greater amount of time to patient care than other healthcare professionals. Their responsibilities encompass a broad spectrum of tasks, including offering personal and emotional support to patients, evaluating and recording patient conditions, as well as performing indirect duties such as managing units and coordinating care activities with other members of the healthcare team Nurses spend significantly more time in providing patient care compared to the other health care workers. Materials and Methods: A descriptive study was done in the medical wards, high dependency unit and intensive care unit of a tertiary care hospital to observe the nursing care activities of the registered nurses. One hundred patients were chosen using convenience judgmental sampling technique and nursing care activities performed for the patient over 24 hours was captured using a selfreporting proforma. The activities were analysed and categorized into 8 major domains. Results: The study found that 85.44% of nursing activities were dedicated to direct patient care, while 14.56% involved indirect care tasks. The majority of the direct care activities focused on therapeutic interventions (59.32%), with only a small portion of time allocated to patient counselling and education (1.3%). Conclusion: Patient assessment and medication administration were prioritized, with nurses dedicating the majority of their time to these tasks. In contrast, psychological support and preparation for home care received the least attention. To enhance the quality of life for patients, it is essential for nurses to allocate more time to emotional care and home care readiness. Keywords: Nursing Care Activities; Self-Reporting; Direct Patient Care; Quality of Life; Quality Nursing Care 1. Introduction Nursing care activities are those actions performed by a nurse during the duty hours. It includes planning, assessment, performing procedures and teaching to ensure comfort and health of the patient1. The three types of nursing care activities are independent, dependent and collaborative2. According to Eustace et al. nursing interventions are classified as family, behavioural, basic physiological, complex physiological, community, safety and health system related nursing interventions3. Nurses spend more time in providing direct patient care than other health care professionals4. Effective time spent by nurses with patient improves the patient outcomes and results with fewer errors5. Assessing time spent by nurses on the various activities will reveal the nurses’ time management, identify gaps in nursing care, and help in recommending ways to improve the nursing care activities in order to gain good patient outcomes6. Examining how time is allocated across nursing care activities can guide staffing strategies, alleviate burnout, and enhance the quality World Journal of Advanced Research and Reviews, 2025, 26(02), 963-967 964 of care. This study seeks to conduct a thorough evaluation of time distribution among various nursing tasks in a tertiary care medical unit, with the goal of pinpointing opportunities for improvement. 2. Material and Methods A cross-sectional descriptive study was done in the medical wards, medical high dependency unit (MHDU) and medical intensive care unit (MICU) of a tertiary care hospital in South India to quantify the time spent on nursing care activities and to evaluate the time spent on direct and indirect nursing care activities. The nurse patient ratio was 1:4 to 1:8 in the general wards and 1: 1 to 1:2 in the HDU and ICU. The registered nurses including the Charge Nurse and the Nurse Manager working in the unit were explained about the study. Informed consent was obtained from the Nurses willing to provide self-reporting of the nursing care activities. Patients were selected using judgmental sampling to ensure proportionate representation of medical conditions. Patients who were expected to stay over 24 hours were included in the study. The selected patients were explained about the procedure and informed consent was obtained. A selfreporting proforma was placed in the chart of the selected patient. Nursing care rendered to the patients were captured on the self-reporting proforma for 24 hours. The nursing activity, time of starting and ending the activity and the signature of the staff were captured on the self-reporting proforma. Patient details such as diagnosis, age, and sex were also noted. 3. Data analysis The collected data were analyzed to determine the actual time spent on each nursing activity, as well as the frequency of each activity. The average time allocated to each task was also calculated. A total of 54 nursing care activities were documented using self-reporting forms. These activities were grouped into eight distinct categories, including admission, discharge, and transfer; assessment and planning; assisting with diagnostic procedures; comfort care; health education and counselling; hygienic care; recording and reporting; and therapeutic nursing care. The data were processed using SPSS version 20 (SPSS Inc., Chicago, IL), with frequency and percentage calculations used to illustrate the proportion of time dedicated to each activity. 4. Results The study included 100 patients with 40 different medical conditions grouped under 7 major disorders admitted in the ward, HDU and ICU of the medical unit. Table 1 gives the patient information. Majority of the patients belong to the age group of older adults (39%), were male (60%) and predominantly had metabolic and respiratory disorders (42%). Table 1 Demographic profile of the patients S.no Characteristics No. % 1 Age 18 – 39 30 30 40 – 59 31 31 60 & above 39 39 2 Sex Male 60 60 Female 40 40 3 Unit Ward 80 80 HDU 10 10 ICU 10 10 4 Disease condition Cardiac and blood disorders 16 16 World Journal of Advanced Research and Reviews, 2025, 26(02), 963-967 965 Metabolic disorders 22 22 Respiratory disorders 20 20 Infectious diseases 21 21 Electrolyte imbalance 5 5 Neurological disorders 5 5 Poisoning 11 11 The study revealed that the maximum time was spent for the direct nursing care activities (85.44%) (see Figure 1). Major proportion of the time was used for therapeutic nursing care (59.32%) and minimal time was spent on educating and counselling (1.35%) the patients (see Figure 2). Figure 1 Time spent on direct and indirect nursing care activities Figure 2 Time spent on various nursing care activities World Journal of Advanced Research and Reviews, 2025, 26(02), 963-967 966 5. Discussion The proportion of time nurses spend on direct patient care versus indirect care activities can vary based on factors such as the healthcare environment, the specific nursing role, and patient requirements. However, research consistently indicates that direct patient care typically accounts for a smaller share of nursing time compared to indirect tasks like documentation, coordination, and administrative duties. Contrary to these findings, this study revealed that 85.44% of nursing time was spent on direct patient care activities, which diverges from existing literature. For instance, a study by Aiken et al. (2019) found that only 30% to 40% of nursing time in hospital settings was dedicated to direct patient care, with the remaining 60% to 70% allocated to indirect tasks such as administrative work, documentation, care coordination, and communication with other healthcare providers7. Similarly, Esteban et al. (2017) observed that in intensive care units (ICUs), where care is more hands-on, 45% of nursing time involved direct patient care, while 55% was spent on indirect activities like documentation, interdisciplinary communication, and managing critical care equipment and supplies8. It is important to note that the current study did not account for certain indirect activities, such as care coordination and administrative tasks, as it focused solely on nursing activities involving direct and indirect patient interactions. Additionally, many studies classify only therapeutic nursing care as direct care, and in this context, the findings of this study (59.32%) align with existing research. Studies by Lake and Friese, McHugh et al., and others in general hospital settings and ICUs have shown that nurses typically spend approximately 30% to 50% of their time on direct care activities7,8,9,10. 6. Conclusion Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the content of the article. Compliance with ethical standards Disclosure of conflict of interest This article is part of the Ph.D study which was approved by the IRB (min. No. 15106 (OBSERVE) dated 21.12.2022) Statement of informed consent Informed consent was obtained from all individual participants included in the study. References [1] Nursing Intervention. (n.d.) Medical Dictionary. (2009). Retrieved April 22 2024, https://medicaldictionary.thefreedictionary.com/nursing+intervention)) [2] RN speak. Nursing Interventions -The Core of Nursing Process. (2019). Retrieved May 22, 2024, https://rnspeak.com/nursing-interventions/ [3] Eustace, R. W., Gray, B., & Curry, D. M. (2015). The meaning of family nursing intervention: what do acute care nurses think?. Research and theory for nursing practice, 29(2), 125–142. https://doi.org/10.1891/15416577.29.2.125) [4] Butler R, Monsalve M, Thomas GW, Herman T, Segre AM, Polgreen PM, Suneja M. Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network. Am J Med. 2018 Aug;131(8):972.e9-972.e15. doi: 10.1016/j.amjmed.2018.03.015. Epub 2018 Apr 9. PMID: 29649458. [5] Duffield C, Diers D, O'Brien-Pallas L, Aisbett C, Roche M, King M, Aisbett K: Nursing, the work environment and patient outcomes. App Nurs Res. 2011. [6] Nurse Time Management: Tips and Techniques for Nurses and Nursing Students. Retrieved May 22, 2024, https://www.nursingworld.org/content-hub/resources/workplace/time-management-tips-for-nurses/ World Journal of Advanced Research and Reviews, 2025, 26(02), 963-967 967 [7] Aiken LH, Clarke SP, Sloane DM. Hospital nurse staffing and patient outcomes: A meta-analysis. J Nurs Adm. 2019;49(3):137-44. [8] Esteban A, Soriano JB. Time spent on direct patient care in intensive care units: A multi-center study. Crit Care Med. 2017;45(5):884-90. [9] Lake ET, Friese C. Nurse staffing, quality of care, and patient outcomes in hospitals. Nur Res 2020, 69(3), 214221. [10] McHugh MD, Stimpfel AW. Nurse staffing, nursing workload, and the quality of care in hospitals. JONA 2016, 46(1), 43-48.