Nursing work activities in Australian residential aged care homes

Background Australian residential aged care (RAC) homes are facing challenges of an increasing number of older people with complex care needs and a chronic shortage of skilled nursing staff to provide quality and efficient aged care services to these older people. Strategies like task re-allocation, process management and introduction of electronic information systems can be promising to overcome these challenges; however development of these strategies requires knowledge of nursing work activities and associate problems. Two important aged care services provided by nursing staff are personal care and nursing care. To date, there is little research on nursing work activities of providing these two types of care services and the challenges in the delivery of these services in RAC homes. Aims This research aimed to explore and describe nursing work activities of providing personal care and nursing care, identify the associated problems and explain the causes of these problems and their potential impacts in Australian RAC homes. Methods This research used time-motion observation method as the predominant data collection method. Structured and unstructured field notes, review of organisational documents and informal conversation with study participants were also used. Two types of data were collected. One was personal care activities collected in two high-care units in two separate RAC homes in two cities. The other was nursing care activities collected in another two high-care units in one RAC home in a third city. Cultural-historical activity theory was used to conceptualise nursing work activities and the identified problems. Both quantitative and qualitative data analyses were performed. Results There were common work patterns of nursing staff in conducting personal care or nursing care activities in terms of their work processes and time usage. For personal care provision, no significant difference was found between the two units in 70% of the nursing staff’s time. Significant differences between the two units were found in the time nursing staff spent on verbal communication, documentation and transit. For nursing care provision, no significant difference was found between the two units in all of the nursing staff’s time. Conclusion Providing quality and efficient aged care services requires solutions to the contradictions in the nursing activity system both within and outside RAC homes. This requires collaboration among RAC homes, pharmacies and IT companies in nursing work redesign, organisational process change and introduction of innovative information technology solutions that really support aged care services. These are the future directions of research with high potential to improve RAC services in Australia and over the world