Abstract
Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.
Highlights
IntroductionPatient Classification System (PCS) and nursing intensity (NI) instruments were first developed in the USA in the 1940s for use in hospital settings; similar development and research in the Nordic countries started first in the early 1970s
We found several tools: Clinical Care Classification (CCC) [24], Resident Assessment Instrument, Resource Utilization Groups (RUG III) [5], Community Health Intensity Rating scale (CHIRS), Easely-Storefjell Patient Classification Instrument (R-ESPCI) [3] and Caseload Intensity Tool (CIT) [6]
The questionnaire used in a study in Finnish primary health care for older people [4] showed a reliability of 0.89 (Cronbach’s Alpha), while the questionnaire used in this study showed a reliability of 0.96 (Cronbach’s Alpha)
Summary
PCS and NI instruments were first developed in the USA in the 1940s for use in hospital settings; similar development and research in the Nordic countries started first in the early 1970s Of those designed for use with older patients in HHC settings, the majority have been developed in the USA. In Norway the Individbasert statistikk for pleie-og omsorgstjenesten i kommunene (IPLOS) register, a central health register that forms the basis for national statistics for the nursing and care services, is used in Norwegian municipalities to catalogue individual patient’s resources and need for assistance [28]. The IPLOS register is not all-encompassing and mainly classifies functional capacity; it does not register sociocultural or spiritual needs Norwegian nurses consider it to be a technology-driven register whereby interpersonal skills are diminished [29]. The need exits to test an instrument that captures all dimensions of nursing care, such as the RAFAELA system, which is the most commonly used system in the Nordic countries [14] [22] [30] [31]
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