May 16, 2023Open Access
Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study
Key Result
Nurses using the Simple digital app spent significantly less median time on indirect hypertension activities per day (15 minutes) compared to those using paper-based records (39 minutes).
Study Design
Type
Cross-Sectional (n=6)
Multicenter
Yes
Structured PICO
Does a mobile device-based app reduce the time spent by staff nurses on indirect hypertension activities compared to paper-based records in primary care facilities?
P
Population
6 staff nurses in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh, India
I
Intervention
Simple mobile device-based app (open-source software) for records
C
Comparator
Paper-based records
O
Outcome
Proportion of time spent on direct and indirect hypertension activities
Digital systems like the Simple app can significantly reduce the time nurses spend on indirect hypertension activities compared to paper records.
Main Result
Absolute Event Rate: 15% vs 39%
p-value: p=<0.001
Limitations
- Potential Hawthorne effect as staff nurses may change their behavior when observed
- The ease of managing the NCD clinic and the Simple app depended on the staff nurses' varying experience and training
- Conducted in only 6 facilities across 2 states, which may not represent variations in health system functioning in other states
- Included only facilities participating in the IHCI program, limiting generalizability to non-IHCI districts
Abstract
INTRODUCTION: India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS: We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS: Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 IQR, 26-62 minutes) for indirect hypertension activities than those using the Simple app (15 IQR, 11-19 minutes; P < .001). CONCLUSION: Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.