Differences in the working pattern among wound, ostomy, and continence nurses with and without conducting the specified medical act: a multicenter time and motion study

Abstract

Background: To overcome the shortage of medical care delivery in the rapidly aging Japanese society, the Ministry of Health, Labour and Welfare in 2010 started to train the nurses to be able to conduct the specified medical acts. The Japanese Nursing Association conducted the educational program to train the wound, ostomy, and continence nurses for the specified medical act of wound care. However, the difference between wound, ostomy, and continence nurses who conducted the medical act and those who did not was not clear. The aim of this study was to determine how trained wound, ostomy, and continence nurses spend their time during their entire shift in an acute hospital setting.

Methods: In this prospective observational study, we selected those wound, ostomy, and continence nurses who received advanced training in the wound management program (T-WN) in 2011-2012. Wound, ostomy, and continence nurses who did not receive the training (N-WN) were also recruited as controls. We conducted a time and motion study during subject's day shifts for 1 week. We calculated the time spent on tasks based on a task classification code that was created to facilitate a two-group comparison.

Results: Six T-WNs and five N-WNs were our analysis subjects. T-WNs spent significantly more time on direct care than did N-WNs (p = 0.00). Moreover, in the sub-categories s of direct care, T-WN spent significantly more time on "treatment" than did N-WN (p = 0.01). T-WN spent significantly more time on treatment with (p = 0.03) or without (p = 0.01) physicians than did N-WN. In the treatment activities, T-WN performed significantly more time on foot care (p = 0.01), wound cleansing (p = 0.01) and conservative sharp wound debridement (p = 0.01) than did N-WN. Frequencies of direct care interventions for the patients was significantly different between T-WN and N-WN (p = 0.04).

Conclusions: T-WNs frequently engaged in direct care provided treatment for patients with chronic wounds.

Keywords: Advanced nursing; Advanced practice; Inter-professional practice; Nursing intervention; Nursing process; Nursing workforce; Wound care.

Fig. 1

The process to become a WOCN conducting specified medical act in Japan. ^a Registered nurse, ^b Wound, ostomy and continence nurse. It is necessary to complete the advanced course and over five years WOCN experience and so WOCN can conduct the specified medical act

Fig. 2

Flowchart of participants. ^a wound, ostomy, and continence nurse, ^b Japanese Nursing Association, ^c trained wound, ostomy, and continence nurse, ^dnon-trained wound, ostomy, and continence nurse