Determination of daily schedules of home health care nurses under ergonomic conditions

Home healthcare includes the services for examination, diagnostics, tests, treatment, medical care, and rehabilitation to patients in their own home environments during illness, injury, and recovery processes after an operation. Home healthcare services allow patients to get their treatment at their home with their loved ones, protect them from risk of infections in hospital environments, and contribute to the more efficient and cost-effective delivery of healthcare services by reducing hospital burdens. This service particularly provides significant convenience for bedridden, elderly, or chronic patients. The increasing elderly population and advancements in medical devices are leading to the growing prevalence of home healthcare services. To enhance the quality and reduce the costs of home healthcare services, numerous decisions need to be made at both operational and strategic levels. At the operational level, it is necessary to assign nurses according to patients' treatment needs and to determine visit schedules. This problem is referred to as the Home Healthcare Services Routing and Scheduling Problem (ESHRCP). ESHRCP is a multidimensional problem that encompasses various constraints related to specific requirements of patients, visit frequency, visit intervals, nurse skills, breaks, and service quality. One of the important dimensions to be considered in ESHRCP is workload. It is essential to distribute workloads among nurses in a balanced manner when planning patient visits. In the literature, workload is typically determined using quantities such as working hours and the number of patients visited. In this study, the definition of workload has been extended to include ergonomic risks. Home health nurses provide a wide range of health services in various environments and encounter numerous ergonomic risks. These risks can adversely affect their health and lead to serious physical and mental health problems in the long term, such as musculoskeletal disorders and burnout syndrome. Patient visits should be planned in a way that does not jeopardize the health of nurses. For this purpose, in this study, a new constraint has been added to ESHRCP to keep nurse workloads resulting from ergonomic risks below a certain level. Determining the workload of home health nurses resulting from ergonomic risks is quite challenging, since they constantly travel and provide various services in different environments. Therefore, subjective assessment methods reflecting nurses' own evaluations and experiences can be used to identify these risks. In this study, a subjective assessment method is proposed. For this purpose, a post-task questioner that nurses express their perceived ergonomic risks during patient visits using linguistic variables may be conducted, and a Fuzzy Inference System (FIS) may be proposed to evaluate this survey. Additionally, perceived workloads of nurses may change over time depending on their familiarity with patients and the environment, as well as the level of treatment. Therefore, a Multi-State Markov (MSM) model is proposed to predict workload for the next visit. A mixed integer programming and a goal programming (GP) model is developed to maximize the number of patient visits while simultaneously reducing nurse workloads. To test the performance of these models, problem instances are generated. Experimental results demonstrate that the proposed models can reduce nurses' workload without degrading service quality, thereby enabling the creation of more balanced work schedules. In conclusion, applying this theoretical study to real-life problems is crucial for nurse health, which, in turn, allows them to offer better services to patients.