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| Author | Joseph Schembri |
| Abstract | There exists no objective nursing allocation system in the Maltese Public Health Care Sector that enables nursing managers/administrators to make cost-efficient and cost effective use of nursing labour. Through this study, the researcher attempted to develop a system through a bottom-up approach method, by which nursing managers can make informed decisions regarding the use of nursing staff. Utilising a methodological/action research and a needs assessment approach, the study was carried out in one male general surgical ward, which was found to be representative of the whole general surgical department. Ten clinical nurses, five nursing and five management experts participated in the development of the system, while three hundred and thirty-two patients were assessed throughout the study. The commitment of prospective system's users was acquired; fifteen factors influencing nursing workload and sixty-five nursing activities were identified. Nursing activities were mainly grouped into `Activities of daily livings' (ALs) and `Therapeutic Activities' (TAs). Activities of Living Index scales were examined; five categories of care were established and defined for clarity. Initially, two separate instruments were developed but later amalgamated through mathematical calculations to produce a one whole final `Patient Dependency Assessment Instrument'. Guidelines and scores were formulated. Nurses were trained how to use the system, and tested for inter-rater reliability thereafter. The newly developed tool was then tested for its internal consistency. An r of 0.876 was found between raters, and an r of 0.85 both with a p value of <0.01 when two presumably parallel tools were correlated. The Patient Dependency Tool was found statistically valid and reliable. For the implementation of the system, certain issues such as deploying staff, changing rosters and changing old patterns of behaviour would need to be addressed. |
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| Key words | Health Services Management, Thesis, Nursing Workload, Surgery |