A recent article titled “Observing How RNs Use Clinical Time in a Nursing Home: A Pilot Study” observes how RNs allocate their time between direct and indirect care of their patients. While direct care generally involves physical and psychological care and the administration of treatments, indirect care is more administrative, including documentation and reading of medical records and care supervision and management of nursing aides and certified nursing assistants.
The results of the study showed that RNs spent 59% of their time in indirect care, and only 31% in direct care. The remaining 10% was classified as unproductive time, including breaks and mealtimes. Of the time spent in direct care, the majority, 94.6%, was spent in executing general care procedures. The remaining 5.4% was spent in clinical care, which involves the direct care of pressure ulcers, pain management, and nutrition and weight loss. Because direct care from RNs is so valuable, the study encouraged RNs in skilled nursing facilities to allocate their time between direct and indirect care more wisely.
Despite common misconceptions that direct care is more beneficial than indirect care, previous studies have actually shown that both types of care are important. One study has proven that poor supervision, which is a type of indirect care, is actually related to an increase in cases of pressure ulcers, as well as job dissatisfaction and turnover. On the other hand, direct care is also associated with reduced pressure ulcers, as well as a decline in other adverse outcomes including urinary tract infections, catheterization, and weight loss, while improving the use of nutritional supplements and the maintenance of activities of daily living.
While the implementation of direct versus indirect care each has its own results, under both types of care, the development of pressure ulcers is affected. This is due to the fact that prevention of pressure ulcers is highly dependent on RN staffing levels and quality of care. In fact, pressure sore prevention is so reliant upon the nursing staff, especially RNs, that the prevalence of cases of pressure sores is actually considered to be an indicator of quality of care that a nursing home provides.
Not only does there have to be an adequate amount of staff, however, but this staff must also be well-trained on how to prevent, diagnose, and treat pressure ulcers. While prevention is a completely feasible and necessary part of patient care plans, when pressure sores do begin to form, it is key for nurses to be able to recognize these wounds in their early <a href="stages of development before they progress into more serious stages that can often result in death.