Inpatient progress is monitored mostly via the observation conducted by nursing staff. These tend to be unstructured, vary in reliability between different staff members, and be dependent on what has been written in nursing notes. The Nursing Observed Illness Intensity Scale (NOIIS) was devised to provide a more objective measure of behavioural improvement and symptom reduction. The scale is completed by qualified nurses at the end of every shift, based on everyday nursing observation and interaction with patients, and scores are entered on a NOIIS 'temperature' chart. In this study, more than 6000 ratings were captured on 106 admissions to a psychiatric intensive care unit. Inter-rater reliability of the scale was found to be satisfactory, and validity against the Brief Psychiatric Rating Scale good. Scores were shown to relate to the social organization and treatment methods of the unit. Recovery curves differed significantly by diagnosis, with patients having schizophrenia showing the slowest improvement. From a clinical point of view, the NOIIS can be used to track progress, response to changes in treatment and readiness of the patient for discharge; aids staff deployment; and can be used for clinical audit. For research, the scale can be used in clinical trials of treatment outcomes.
Accurate evaluation of patients' psychotic state is essential to decrease psychotic symptoms and protect the patient and others. The aim of this paper is to conduct a literature review in order to access the utility, reliability and validity of current rating scales that are purported to measure psychotic acuity of inpatient population. A search of a number of electronic databases was undertaken to retrieve potential articles that focus on the measurement of acute psychosis. We identified some conceptual and theoretical problems when using a scale that is monitoring the progress of discharge and assesses the outcome of treatments. The findings revealed a difficulty in finding a commonly agreed definition of acute psychosis and a problem of obtaining frequent measures, and the frequency of measurement and fluctuation in psychosis. The most dominant scales in assessing psychosis were reviewed: the Global Assessment of Functioning Scale, the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Several issues related to the scales' inter-rater reliability and construct validity remain unexplored. None of these scales addressed the conceptual and theoretical problems that we identified. A new scale that will measure acuity of symptoms in inpatient settings needs to be created.
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