The Concept of Home Care Nursing Workload: Analysis and Significance

The concept of home care nursing workload has not been widely studied and no evidence was found that an analysis of the concept had been undertaken. Consequently, there was a knowledge gap regarding the definition and attributes for the concept of home care nursing workload as it is currently experienced. To address that gap, a descriptive, three-phase, mixed methods (quantitative and qualitative) study was conducted. In Phase One, Rodgers’ (2000) evolutionary method was used to analyze the concept of home care nursing workload based on the empirical literature. Phase Two was situated within the naturalistic inquiry paradigm and involved observation of ten home care registered nurses during their visits to 61 patients. In Phase three a questionnaire was administered to validate the draft definition and attributes for the concept of home care nursing workload. It was completed by 88 home care nursing experts from clinical practice, education, management and research. Qualitative findings were analyzed using inductive content analysis. Quantitative data were analyzed descriptively using SPSS. Data triangulation was used extensively within and between the study phases. Of 14 attributes in the phase three draft concept definition, respondents assigned the highest level of relevance to the attribute of cognitive effort and the lowest to physical effort. The final definition contained 20 attributes and includes the following excerpt: “Home care nursing workload is the totality of the cognitive, emotional and physical effort home care nurses expend to meet the expectations of all stakeholders in providing holistic, outcome directed and patient/family focused care within the context of a short or long-term therapeutic relationship.” Respondents reported high levels of agreement with the accuracy and completeness of the definition and the majority indicated the definition would be useful or very useful in their day-to-day work. The comprehensive concept exemplar that emerged from the study includes each of the identified attributes. The study findings provided evidence of the complexity and challenge inherent in quantitatively measuring home care nursing workload. Accordingly, implications of the findings are shared for the management and monitoring of workload and associated outcomes, as well as for nursing practice, education and research.Ph