Nursing tasks and strain development among German home care nurses: results from an observational field study

Despite the central role of home care in aging societies, little is known about the daily work processes and short-term strain experienced by home care nurses. This observational field study addresses this critical research gap by investigating the nursing tasks and short-term strain reported by home care nurses and nursing assistants in Germany. Using workplace observations and short surveys in combination, this study observed 46 German home care nurses from 25 organizations. Nursing tasks were coded in five-minute intervals, and strain outcomes (fatigue, engagement, monotony, mental satiation) were assessed at three points during each shift (i.e. start, three hours after start, and end). The results showed that most working time was spent on direct care (45%), with significant portions dedicated to travel (25%), administration, and documentation. Personal hygiene and medication administration accounted for the largest shares of direct care. Registered nurses performed more clinical nursing whereas nursing assistants focused on basic care activities. Shift type influenced nursing task patterns. Work intensity was significantly related to task allocation. Engagement declined significantly over the shift, whereas mental exhaustion showed a u-shaped pattern. Specific tasks, such as personal hygiene and contact with relatives, were associated with higher exhaustion, whereas rest breaks correlated with lower mental satiation. The results point to the high work intensity and multitasking demands in home care and the necessity for qualification-based task delegation as well as structured breaks. This study contributes observational insights on how nurse tasks and strain evolve over home care shifts. Practical implications for strain prevention highlight the need for supportive structures (e.g. staffing, task delegation, and regular breaks) as well as preventive measures to ensure both the quality of care for older adults and the health of home care nurses.