The relationship of diagnostic-related groups, nursing diagnoses, and time spent in direct nursing care: A descriptive stud

The purpose of the study was to explore and describe the relationship of diagnostic-related groups (DRGs), nursing diagnoses, nursing interventions, and time spent in direct nursing care. The methodology chosen to investigate the research questions was a field study. Data were collected over a seven-month period in a coronary unit and a general surgery unit staffed exclusively by registered nurses. The primary method of data collection was self-report by the nurses.;The units of analysis in this research were nursing activities associated with hospitalized patients categorized into DRGs. The total number of activities which were the observations collected in the study was 2054. A sample of convenience was used consisting of 16 subjects representing four DRGs within the Major Diagnostic Category, Diseases of the Circulatory System. Because of the similarity of patient treatment and for purposes of comparison, observations for the two medically treated DRGs were grouped together as were observations for the two surgically treated DRGs. Descriptive and nonparametric statistics were used to analyze the data.;One finding was the patterning of nursing diagnoses within DRGs was a function of: (1) nursing diagnoses generic to all acutely ill, hospitalized patients; (2) the nature of the disease resulting in hospitalization; and (3) the nature of the medical treatment selected for the disease. A pattern of commonality and occurrence of the nursing interventions performed to treat a given nursing diagnosis was demonstrated. The nursing time consumed by the treatment of six nursing diagnoses common to both DRG sample groups was significantly different (p $<$.05) across the DRGs. These differences in nursing time were attributable to the: (1) medical management selected to treat the patients' disease; (2) stage of the patients' disease process; and (3) resulting rate of progression chosen by the nurses to move patients toward independence in meeting self-care needs.;The impetus prompting this study was an interest in exploring the feasibility of using nursing diagnoses as the allocation base for nursing care costs. These findings support further investigation into the use of nursing diagnoses as the framework for a nursing work load intensity measurement system capable of reflecting variable nursing costs across DRGs.