Factors influencing community nursing: a pilot study shedding light over the feasibility

Abstract In Italy, there is a need to strengthen home care and to adjust the allocated resources in response to increased service utilisation. No tools have been identified to better allocate care resources according to the real needs of the population. Among the studies that have examined resource utilisation in home care, time of visits has emerged as the most used parameter to estimate the cost of this service. The aims of this study were to identify the variables that characterise the work of home care nurses and influence the time spent caring for patients, to better allocate nursing resources, and to assess the feasibility of a larger data collection. A mixed-methods approach was used. A descriptive qualitative approach was used to identify the variables that characterise the work of home care nurses through literature review, interviews, focus groups, and the Delphi method, leading to the selection of a core set of variables. A prospective longitudinal study was then conducted to measure travel, times, and the core variables at each home visit. Data were analysed using a gamma model regression and presented using the Local Interpretable Model-Agnostic Explanations (LIME) technique; sample size estimation was also performed. The analysis included 368 observations of 231 patients. Most of them lived with their families, had chronic disorders, and had informal caregivers, often present during service delivery and collaborating with the nurse. Variables significantly associated with overall home care time (travel time & service time) are the distance travelled (Average Marginal Effect -AME- 1.434), the number of services provided (AME 7.058), and the number of patients’ skin lesions (AME 2.142). This study provides a detailed description of home care nursing. A larger study, in different contexts (e.g. rural and urban), would allow an improved prediction of nursing time and, consequently, a better allocation of nursing resources. Key messages • A core set of variables influencing home care nursing resources consumption has been described. • This study provide information for a better time planning of home care nurses.