Development of a nursing workload calculation model, productivity assessment, and mothers’ opinion on nursing workloads at a lactation clinic: A participatory action research study

Abstract

Lactation clinics are crucial in implementing the Ten Steps to Breastfeeding Success. This participatory action research aimed to develop a model for calculating nursing workloads, assessing clinical nursing productivity, and understanding postpartum mothers' opinions about nursing workloads at a lactation clinic. The study involved service providers at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), including nurses, nurse aides, and obstetricians, who participated in focus groups, reviews, and discussions. The actual work conditions were assessed using a nursing workload calculation method, and mothers' opinions about nursing workloads were surveyed. The collected data were synthesized to develop a model for calculating nursing workloads and clinical nursing productivity. Additionally, 150 postpartum mothers attending the lactation clinic participated in testing the nursing workload and clinical nursing productivity calculation, as well as providing feedback on nursing workloads. The results revealed that nursing workload could be determined by setting direct and indirect standards for nursing duration. For direct nursing duration, patients were categorized into five types: Type 1 (1-10 minutes), Type 2 (10-45 minutes), Type 3 (45-120 minutes), Type 4 (120-150 minutes), and Type 5 (more than 150 minutes). Clinical nursing productivity was calculated as the percentage of nursing workload managed by nurses compared to the standard workload for one nurse. Mothers expressed strong agreement with statements such as, “The nurses who provide services have heavy workloads,” “The number of nurses is insufficient for the nursing workload,” and “Nurses’ services are not fully appropriate due to excessive nursing workload.” Based on the lactation clinic's data, the nursing workload was calculated at 178.79%. The required personnel for adequate care was 5.78 full-time equivalents, but the clinic had only 1 nurse and 2 nurse aides. In conclusion, the nursing workload and clinical nursing productivity calculation method for the lactation clinic was developed and aligned with mothers’ feedback.