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Created: Jan 20, 2018
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Week 2-Length of Home Visits
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Introduction: Home care nursing agencies are often understaffed and overwhelmed with large volumes of patients. Because of this, nurses find that they must be effecient when providing home visits in order to see all patients requiring services in a given work day. As suggested by Mauritus, de Veer, van der Hoek, and Francke, home care nurses who are given more autonomy and liberal time constraints for home visits are less likely to leave the profession, which will help decrease the shortage of home care nurses (Mauritus, de Veer, van der Hoek, & Francke 2015). This study looks at a sample of 80 nurses to determine if its nurses average less than half an hour (30 minutes) per visit.

Methods: A normal day for the agency in consideration includes 10 nurses on staff to serve 100 patients in 8 hours. In order to meet this high volume of patients, nurses would need to spend an average of 0.8 hours or less (including transportation time) at each home visit. We obtained a sample of 80 nurses performing home visits, and recorded the amount of time each visit required, not including transportation time. By using a one-sample T test, this data allows us to determine if the average home visit was less than 30 minutes. A 95% confidence interval was used to estimate the value of our population parameter. A histogram was included to help the reader visualize the distribution of the interval/ratio data.

Analysis: The one-sample T test below indicates that the mean visit length was 33.0375 minutes, which is higher than 30 minutes. 

Result 1: Week 2 one sample T hypothesis test   [Info]
One sample T hypothesis test:
μ : Mean of variable
H0 : μ = 30
HA : μ ≠ 30

Hypothesis test results:
VariableSample MeanStd. Err.DFT-StatP-value
Visit length33.03751.3175355792.30544060.0238

The 95% confidence interval suggests that the average visit length is between 30.415011 and 35.659989 minutes.

Result 2: Week 2 One sample T confidence interval   [Info]
One sample T confidence interval:
μ : Mean of variable

95% confidence interval results:
VariableSample MeanStd. Err.DFL. LimitU. Limit
Visit length33.03751.31753557930.41501135.659989

The data from the nurses surveyed supports the empirical rule, which suggests that 95% of the values (visit length) will fall within 2 standard deviations of the mean. As indicated above, the average visit length is 33.0375 minutes, and the standard deviation is 1.3175355 minutes (less than 2). 

The histogram below allows the reader to visualize the distribution of home length visit times.

Result 3: Visit Length Histogram   [Info]
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Conclusions: The statistics depicted above indicates that the average home visit is greater than 30 minutes in length. Many factors are involved in the visit length, such as patient acuity and educational needs. Unfortunately, transportation time between visits can vary greatly and was not incorporated into our research. If budget constraints are not an issue, an obvious solution for the coordinator of home care nurses would be to hire additional nurses. However, as this is likely not an option, the coordinator can do several things to promote efficiency. First, he/she could group home visits together by geographic area, so that each home visit nurse has a territory they cover (i.e. north of the city, south of the city), in order to minimize travel time in between visits. The coordinator could also provide staff education regarding the suggested structure of home visits and the importance of staying on task during visits. Patients may be more conversational in their own homes and seek advice of the nurse on healthcare needs unrelated to the reason for the home visit. Nurses must be trained to redirect to in order to accomplish the specific goals for the visit. The agency could also bill its clients (via private pay or insurance companies) for nursing care provided down to the minute, as opposed to rounding time spent on each visit. This would ideally encourage patients to promote efficiency in visits as well. 

References:

Maurits, E. M., de Veer, A. E., van der Hoek, L. S., & Francke, A. L. (2015). Autonomous home-care nursing staff are more engaged in their work and less likely to consider leaving the healthcare sector: a questionnaire survey. International Journal of Nursing Studies, 52(12), 1816-1823. doi:10.1016/j.ijnurstu.2015.07.006

 

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By nku.dr.nolan
Jan 24, 2018

Hi Rosemary - some comments to help:

1. Test "greater than" 30 here, as your research hypothesis is one-sided.
2. The sample mean doesn't deserve mention - need to use the p-value to interpret the hypothesis test. Your statement of confidence is well written (and really that is all we need to make a good decision).
3. Note that standard deviation and standard error are not the same thing. The standard deviation will be quite a bit larger than the standard error, and you can get it by asking statcrunch for summary statistics. Using the empirical rule (or just looking at the histogram, since it is a fairly large sample) is a good way to understand what is typical for individual values.
4. Well written conclusion!

Hope this helps!
By julie.graessle
Jan 22, 2018

The one piece of data that I found interesting within your report was in the histogram. It appears as though one home care visit lasted greater than 100 minutes while the majority of other visits fell near the appropriate 30 minute timeline. This could have occurred for a number of different reasons including travel time as you appropriately mentioned. That one visit of greater than 100 minutes could have made a great difference in the statistical results. Due to this outlier, the data could have potentially been skewed to reflect the greater length of visit time. I can't help but wonder what the data would have looked like without this visit present.
By kyleigh.odom711
Jan 18, 2018

As a home health nurse, looking at your report I can see that most of my visits fall within your confidence interval. I have a large territory that I cover and I am unable to make 8 30 minute visits in an 8 hour day, travel, and keep my communications and charts up to date. This information could be beneficial to an agency when they plan for coverage of their patients. Thank you for making the report concise and easy to read.

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