Relationships among nursing care requirements, selected patient factors, selected nurse factors, and nursing resource consumption in home health care

Nursing care requirements and nursing resource consumption are essential data for programming and staffing decisions made by nurse administrators in home health care. However, it is not known how nursing needs of home health care patients relate to the amount of nursing care consumed. This retrospective exploratory study examined nursing care requirements and nursing resource consumption within a systems framework in the home health setting. The input variable of interest was nurse expertise. Throughout was the identification of nursing care requirements and was assessed using two measures: (a) patient classification, and (b) patient factors that do not produce a classification. The output measure was hours of direct care provided by the nurse and the home health aide. The findings indicate that nursing care requirements explained a significant but limited amount of variation in hours of direct nursing care but not in hours of direct care by the home health aide. Nursing diagnosis as a patient factor explained a significant amount of variation in hours of direct nursing care provided. The patient factors referral source and initial payment source did not add to the variation explained. The test of whether patient factors explain variatio n in hours of home health aide care was not significant but lacked sufficient power to be an adequate test. Nursing diagnosis explained a significant amount of variation in the nursing care requirements. The nurse factor expertise did not relate significantly to either nursing care requirements or nursing resource consumption. The findings support the importance of the nurse-patient interaction in home health care but indicate that further study is needed to refine measures of nursing care requirements. The use of nursing diagnosis holds promise as a means for predicting nursing resource consumption, with further work needed to develop techniques for grouping and weighting the various diagnoses. Additional work is needed in defining measures of resource consumption both for use in agency management and for reimbursement. Further work is also needed to understand what nurse factors influence the nurse-patient interaction in regard to nursing care requirements and nursing resource consumption.