Assessing patient's care requirements: a comparison of instruments

Abstract

The purpose of this study was to compare two patient classification instruments developed in different countries, Perroca's (Brazil) and the Beakta (Sweden) systems and to investigate if both instruments equally assess patients' care requirements. The survey sample comprised 85 patients from a university hospital in southeast Sweden. Statistical analysis used Spearman's correlation and Kappa. The Spearman's correlation coefficient for total scores and classifications were 0.83 and 0.80, respectively (P-value < 0.01). The level of agreement between the instruments related to the different care categories pointed to an overall kw of 0.60 (95% CI: 0.50-0.71). The findings indicate a high degree of association between the total scores and patient classification assessment using the Beakta and Perroca systems and also a moderate level of agreement between the two instruments in the different care categories. There are few surveys that compare classification instruments between countries making it difficult to know to what extent cultural differences influence measurement approaches.

Use of patients’ classification instruments: analysis of the brazilian production of knowledge

“…Content validity (2,(7)(8)(9)22) Delphi technic (2,(7)(8)(9)22) Agreement level ≥ 70% (2,(7)(8)(9)22) Neonatology (7) Psychiatry (9) Pediatrics (8,22) Perroca new version (2) 16 areas/ 3 categories (7) ; 11 areas (8) ; 11 areas/3 categories (9) ; 5 categories (22) ; Relevance, clarity and increasing level of complexity (7) Agreement: 86-100% (9) ; 85-100 (21) ; ≥ 90 (structure) and 80-96 (care areas) (2) . Construct validity (10,(20)(21)23) Principal components (21,23) Analysis of Variance (23) Discriminant analysis (21) Pearson (22) Spearman (10) Factor analysis (20) Perroca original (21,23) Psychiatry (10) Perroca new Version (20) First two factors explained 75% of the total variation (23) Discrimination: 89.1 -95.6% (21) Importance of all areas of care (20) Agreement between instruments (24) Spearman and Weighted Kappa …”

“…The original PCI and its new version were the most subjected to a validation process (2,6,(20)(21)(23)(24) . The psychometric properties of the PCI allows the generation of legitimate and reliable data, allowing its use in clinical practice to measure the workload of the nursing staff and to guide management decisions (20) .…”

Nursing activities and factors influential to nurse staffing decision-making

“…Unit characteristics included unit type, census, bed capacity, average nursing hours per patient day, skill mix (the proportion of RN to non-RN staff for each shift), average length of stay, and the frequency of nursing staffing decision-making. [11] Jones Dependency Tool (PCS -1) 2 Malloch et al, 1999 [12] Third-generation PCS (3PCS) (PCS -2) 3 Perroca & Ek, 2007 [13] Perroca (PCS -3) 4 Davidhizar et al, 1998 [26] Psychiatric PCS (NW -1) [14] Simplified Therapeutic Intervention Scoring System (TISS-28) (NW -2) 6 Miranda et al, 1997 [15] Nine Equivalents of Nursing Manpower Use Score (NEMS) (NW -3) 7 Miranda et al, 2003 [16] Nursing Activities Score (NAS) (NW -4) 8 Mullinax & Lawley, 2002 [5] Neonatal Acuity Score (NW -5) 9 Pyykko et al, 2004 [17] Intensive Care Nursing Scoring System (ICNSS) (NW -6) 10 Sawatzky-Dickson & Bodnaryk, 2009 [18] Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) (NW -7)…”

“…Seventeen of the instruments had been used in an acute care setting, [5,9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] followed by one used in a psychiatric setting [26] and two in outpatient settings. [27,28] Few instruments in the studies had been designed based on a theoretical framework; three (15%) of the 20 instruments were based upon, respectively, Benner's NoviceExpert, the NIC, and Nursing Outcome Classification; [12] Horta's Basic Needs Theory; [13] and the Nursing Process Model. [26] In total, 1,438 nursing activities from 20 instruments were extracted and sorted according to the NIC.…”

“…Walthier et al, 2004 [20] Modified Nursing Care Recording System (NCR11) (NW -9) 13 Yamase, 2003 [21] Comprehensive Nursing Intervention Score (CNIS) (NW -10)…”