Abstract
Objective: To study reliability and validity of the Finnish Oulu Patient Classification instrument in Norway. Background: The Finnish patient classification system RAFAELA consists of three parts: 1) daily patient classification of nursing intensity using the Oulu Patient Classification instrument, 2) calculation of nursing resources providing bed side care per 24 hours, and 3) Professional Assessment of Optimal Nursing Care Intensity Level. The RAFAELA system has not been tested outside of Finland. Methods: A prospective, descriptive study was performed at 5 clinical units at Oslo University Hospital during 2011-2012. The interrater reliability of the Oulu Patient Classification instrument was tested by parallel classification including 100-167 patient classifications pr. unit, and analyzed by consensus in % and using Cohen’s Kappa. Convergent validity was tested by using the average Oulu Patient Classification instrument value to predict the average Professional Assessment of Optimal Nursing Care Intensity Level for the same calendar day by linear regression analysis. Results: The Oulu Patient Classification instrument consensus of parallel classifications varied between 70.1%-89%. Cohen’s Kappa within patient classes varied between 0.57 and 0.81, representing substantial interrater reliability. The Oulu Patient Classification instrument was valid as the instrument in average explained about 38% of the variation of the Professional Assessment of Optimal Nursing Care Intensity Level. Conclusions: Patient classification systems tested for psychometric properties are needed and this study provides evidence of satisfactory reliability and validity of the Oulu Patient Classification instrument as tested outside Finland, demonstrating that this instrument has international relevance within nursing.
Highlights
Lack of appropriate staff is a stumbling block to the provision of effective nursing care
The purpose of the RAFAELA system is to create a work situation where the needs and amount of patient care is in balance with personnel resources
The interrater reliability of the patient classes varied between 0.59 - 0.81, and of the sub areas between 0.45 and 0.90, which indicate satisfactory reliability
Summary
Lack of appropriate staff is a stumbling block to the provision of effective nursing care. According to the Norwegian Parliament’s Coordination Reform of 2009, lack of appropriate systems for resource allocation may be one of the reasons why proper patient care is insufficient [7]. Reliable and valid systems are crucial in order to secure responsible decision making within professional nursing practice [9]. This includes balancing appropriate patient care with optimal workload. The aim is to allocate resources in accordance with the optimal nursing care level. The two first parts, consisting of a patient’s NI, which is measured daily by the OPCq, and the daily nursing resources allocated to the patient’s nursing care, are used to calculate the nurses’ actual patient-related workload. Assessment of optimal workload per nurse is established for each unit by running a test over a period of at least 3 - 4 weeks where the PAONCIL instrument is used [10]
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