Patient Classification Instrument Research Articles

Validation of an instrument for patient classification to support obstetric nursing care.

to develop and validate an instrument for the classification of pregnant and postpartum women according to the demand for nursing care. a methodological study conducted in three stages: 1) construction of the instrument based on literature review; 2) content validation using the Delphi technique with 12 experts; and 3) Evaluation of the convergent construct validity through the correlation between the scores of the constructed instrument and the Fugulin instrument. an instrument with ten indicators of specific care for pregnant and postpartum women was developed. A content validity index higher than 0.9 was obtained, requiring only one round of the Delphi technique. The Spearman coefficient was 0.64 between the instruments, indicating a strong correlation. the classification instrument specifically constructed for pregnant and postpartum women showed evidence of content validity and convergent construct validity with a widely used instrument in the national territory.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

Adaptation of an instrument to classify neonatal patients into care categories

To adapt and validate a patient classification instrument for neonatal units. Methodological study, with adaptation of the Pediatric Patients Classification Instrument for neonatal patients. After content validation by judges, the instrument was tested for reliability, applied to 33 neonates by two nurses, simultaneously. To assess the agreement among nurses regarding the scores of each patient on the classification scale, an intraclass agreement coefficient was applied. To assess the agreement regarding the classification in care categories, the weighted Kappa coefficient was calculated. The adapted instrument consisted of a total of nine indicators, with three care categories: high dependence on care, semi-intensive care and intensive care. The Content Validity Index varied between 0.85 and 0.92 for items of the instrument. The intraclass agreement was 0.87 and the weighted Kappa for care categories was 0.56. An instrument that allows neonatal patients to be classified into care categories, with satisfactory reliability was validated to support the dimensioning of the nursing team.

The transcultural adaptation and the validity and reliability of the Turkish Version of Perroca's Patient Classification Instrument.

This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument. Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads. This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa. Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826. The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care. This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload.

Using a new interrater reliability method to test the modified Oulu Patient Classification instrument in home health care: Common mistakes and methodological issue.

Using a new interrater reliability method to test the modified Oulu Patient Classification instrument in home health care: Common mistakes and methodological issue.

Nurses’ experiences of measuring nursing intensity in home healthcare: A qualitative study

This study was a part of a municipal research and development programme in home healthcare (HHC). The Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system, was used to measure nursing intensity (NI) for the first time in HHC in Norway. The aim was to describe nurses’ work experiences and perceptions of the usability of the OPCq instrument when classifying NI in HHC. Twenty-two members of staff participated in four focus-group interviews. Content analyses were used to analyze and interpret the data. Three themes emerged: 1) Classifying the modified OPCq levels correctly; 2) Technological problems hinder use of the instrument; 3) Classifying NI when time pressure dominates. The OPCq instrument is useful in classifying NI, although some minor adjustments might be needed for its use in HHC. The nurses considered the OPCq instrument useful in illuminating the actual work situation in HHC and the time pressure they experience.

Using a new interrater reliability method to test the modified Oulu Patient Classification instrument in home health care.

AimTo test the interrater reliability of the modified Oulu Patient Classification instrument, using a multiple parallel classification method based on oral case presentations in home health care in Norway.DesignReliability study.MethodsData were collected at two municipal home healthcare units during 2013–2014. The reliability of the modified OPCq instrument was tested using a new multiple parallel classification method. The data material consisted of 2 010 parallel classifications, analysed using consensus in per cent and Cohen's kappa. Cronbach's alpha was used to measure internal consistency.ResultsFor parallel classifications, consensus varied between 64.78–77.61%. Interrater reliability varied between 0.49–0.69 (Cohen's kappa), the internal consistency between 0.81–0.94 (Cronbach's alpha). Analysis of the raw scores showed 27.2% classifications had the same points, 39.1% differed one point, 17.9% differed two points and 16.5% differed ≥3 points.

Nursing intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver vs. kidney transplant recipients.

To compare nursing intensity and nurse staffing costs for liver transplant (LTx) vs. kidney transplant (KTx) patients through the use of the RAFAELA system (the OPCq instrument). High-quality patient care correlates with the correct allocation of nursing staff. Valid systems for obtaining data on nursing intensity, in relation to actual patient care needs, are needed to ensure correct staffing. A prospective, comparative study of 85 liver and 85 kidney transplant patients. Nursing intensity was calculated using the Oulu Patient Classification (OPCq) instrument. The cost per nursing intensity point was calculated by dividing annual total nursing wage costs with annual total nursing intensity points. The results showed significantly higher nursing intensity per day for liver transplant patients compared to kidney transplant patients. The length of stay was the most important variable in relation to nursing intensity points per day. The study demonstrated differences in nursing intensity and nurse staffing costs between the two patient groups. When defending nurse staffing decisions, it is essential that nurse managers have evidence-based knowledge of nursing intensity and nurse staffing costs.

Testing of the Content Validity of a Modified OPCq Instrument—A Pilot Study in Norwegian Home Health Care

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.

Care management: agreement between nursing prescriptions and patients' care needs.

ABSTRACTObjectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended.

Identification of care needs of patients with and without the use of a classification instrument

To analyze the agreement and disagreement between the assessments by applying or not a patient classification instrument, and to investigate the association between the agreement and personal and professional characteristics of the evaluators. This is a descriptive exploratory study. 105 patients were hospitalized in a teaching hospital in the state of Sao Paulo, using the kappa statistic (weighted) and the Bootstrap method. The agreement between the assessments were​​: k(w) 0.87 (instrument x internal evaluator), k(w) 0.78 (instrument x external evaluator) and k(w) 0.76 (between evaluators) and the influence of some personal and professional characteristics. The assessments conducted through the use of an instrument contemplated a greater number of areas of care in relation to when the instrument was not applied. The use of this instrument is recommended in order to more effectively identify care needs of patients.

Validity and reliability of a pediatric patient classification instrument.

OBJECTIVES: to assess the construct validity and reliability of the Pediatric Patient Classification Instrument. METHODS: correlation study developed at a teaching hospital. The classification involved 227 patients, using the pediatric patient classification instrument. The construct validity was assessed through the factor analysis approach and reliability through internal consistency. RESULTS: the Exploratory Factor Analysis identified three constructs with 67.5% of variance explanation and, in the reliability assessment, the following Cronbach's alpha coefficients were found: 0.92 for the instrument as a whole; 0.88 for the Patient domain; 0.81 for the Family domain; 0.44 for the Therapeutic procedures domain. CONCLUSIONS: the instrument evidenced its construct validity and reliability, and these analyses indicate the feasibility of the instrument. The validation of the Pediatric Patient Classification Instrument still represents a challenge, due to its relevance for a closer look at pediatric nursing care and management. Further research should be considered to explore its dimensionality and content validity.

The RAFAELA system: a workforce planning tool for nurse staffing and human resource management.

The RAFAELA system was developed in Finland during the 1990s to help with the systematic and daily measurement of nursing intensity (NI) and allocation of nursing staff. The system has now been rolled out across almost all hospitals in Finland, and implementation has started elsewhere in Europe and Asia. This article describes the system, which aims to uphold staffing levels in accordance with patients' care needs, and its structure, which consists of three parts: the Oulu Patient Classification instrument; registration of available nursing resources; and the Professional Assessment of Optimal Nursing Care Intensity Level method, as an alternative to classical time studies. The article also highlights the benefits of using a systematic measurement of NI.

Testing Reliability and Validity of the Oulu Patient Classification Instrument—The First Step in Evaluating the RAFAELA System in Norway

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.

The new version of a patient classification instrument: assessment of psychometric properties

This paper assessed the reliability and construct validity of the new version of a patient classification instrument. In the development of patient classification instruments, monitoring validity and reliability is essential to assure that patient care requirements and nursing staff workload are appropriately measured. The sample included 194 patients (construct validity test) and 60 patients (inter-rater reliability test) at medical, surgical, and specialized wards of a teaching hospital in the south east of Brazil. The study was conducted in 2009-2010. For analysis purposes, Spearman's correlation and Cronbach's alpha (internal consistency) were used, and weighted kappa (inter-rater reliability), factor analysis with principal axis factoring extraction method (construct validity) and ordinal regression (instrument's predictive ability). A high level of inter-rater agreement was found. The importance of all care areas and their contribution to distinguish patient care needs and category in the new instrument were demonstrated. Results also showed the instrument's high predictive ability (99·6%). The findings give the evidence that the new scale is a reliable and valid tool to assess patient care needs and care category and that it can be used to guide nursing management practice in determining the nursing staff workload.

Avaliação de um instrumento para classificação de pacientes pediátricos oncológicos

Este estudo teve como objetivos avaliar a reprodutibilidade interavaliadores do instrumento para a classificação de pacientes pediátricos portadores de câncer; verificar se o instrumento de classificação de pacientes é adequado a pacientes pediátricos portadores de câncer e elaborar uma proposta de modificação do instrumento, permitindo a adaptação para pacientes pediátricos oncológicos. Foram avaliados, na unidade de internação pediátrica de um Hospital de câncer, 34 pacientes pelas equipes de médicos, enfermeiros e técnicos de enfermagem. Para a avaliação do grau de concordância entre os escores obtidos pelos avaliadores foi utilizado o coeficiente Kappa, que revelou um valor intermediário/alto nas classificações objetivas, e um valor baixo nas subjetivas. Conclui-se que o instrumento é confiável e reprodutível, porém, para classificação do paciente pediátrico oncológico, sugere-se a complementação de itens para atingir um resultado mais compatível com a realidade dessa população.

Vårdtyngdsmätning inom anestesiologisk omvårdnad — Test av validitet och reliabilitet

Purpose:The purpose of this study was to test the reliability and validity of an existing patient classification instrument in anaesthetic nursing in a new context. Background:A patient classification system has to be used by many nurses, so consistency in how it is used is important. Methods: The study was divided into three parts. The first part was intended to measure interreliability using double assessments of 150 anaesthesia cases. In the second part, the anaesthetic nurses carried out the workload and, in part three, content validity was examined using a questionnaire and meetings. Results:The result showed good to very good consistency across the board in the nurses' assessments, which also included an overall assessment of the workload (r 0,85). The workload showed the highest mean care level for the indicator preparations/surgical position and the lowest for respiration. The questionnaire replies showed that the nurses were positive about workload, but 43.3 per cent thought that the instrument only described part of their work. Conclusion:The instrument was shown to be of use in different contexts, but the reliability and validation process should continue so as to increase reliability. Clarifying the progression between the different care levels for each indicator in the instrument can be a way of increasing its usefulness in different services. In terms of clinical work, the measurement of workload has started a valuable process of reflection on anaesthetic nursing that helps to enable the nurses to show what they do and why.

Development and content validity of the new version of a patient classification instrument

The purpose of this study was to reconstruct Perroca's patient classification instrument; and to assess the content validity of the new version. A group of experts comprising ten nurses appraised the instrument, using the Delphi technique. Data collection took place from March 2008 to February 2009 by means of structured questionnaires sent by electronic mail. The new version contained nine nursing care areas. Agreement levels on the instrument structure amounted to > 90%, and ranged between 80 and 96% in the nursing care areas. The refinement of classification instruments is of great importance to generate valid and reliable data, supporting management decision making on nursing care planning as well as nursing workload measurement.

Validity and reliability testing of the Oulu patient classification: instrument within primary health care for the older people

Aim. The aim of the study was to evaluate the reliability and validity of The Oulu Patient Classification (OPC) instrument to see whether the instrument that has been developed for hospital care is valid and useful within primary health care for older people. Background. Although different patient classification instruments have been under development since the 1960s, this is still a very important research area today. Method. Inter-rater reliability testing of the OPC instrument was undertaken. The inter-rater reliability was tested through parallel classification (n = 1722). Validity testing was conducted as an expert validation of the manual for the OPC instrument, using a questionnaire during June and July of 2005 (n = 61). Results. The inter-rater reliability testing achieved over 70% consensus, Cohen's Kappa showed a strong consensus for OPC classifications (0.65). The reliability measured with Cronbach's Alpha was also acceptable. Conclusion. The results show that the OPC instrument provides a good overview of the patient's care needs and is a reliable instrument within primary health care for older people.

Caracterização do perfil assistencial dos pacientes adultos de um pronto socorro

Foi desenvolvida uma pesquisa exploratória, método estudo de caso, objetivando caracterizar o perfil assistencial dos pacientes adultos internados no pronto-socorro clínico e cirúrgico de um hospital geral público no município de São Paulo como subsídio para o dimensionamento da equipe de enfermagem. Os sujeitos foram pacientes internados durante um período de trinta dias. Os dados foram coletados por meio da aplicação do instrumento de classificação de pacientes de Fugulin. O presente estudo permitiu verificar pacientes na categoria de cuidados intensivos, semi-intensivos, alta dependência, intermediária e mínima e taxa de ocupação de leitos acima da previsão oficial tornando a planta física inadequada para pacientes e profissionais, reflexo da falta de um serviço de regulação.