ABSTRACT
The psychometric assessment of a new measure of nursing intensity, The Patient Intensity for Nursing Index (PINI) is reported. Four dimensions of nursing intensity are measured by the PINI: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. There are 10 items rated on a 5-point ordinal scale. A purposively drawn sample of 6,445 patients was obtained from five hospitals, with 487 registered nurses (RNs) providing daily patient ratings from 29 medical-surgical and intensive care units. Substantial interrater reliability was demonstrated. Validity testing included confirmatory factor analysis, hypothesis-testing, contrasted groups, and an observational study of time. The factor structure confirmed specified components of severity, dependency, and complexity, with time loading on all three factors. PINI scores were significantly related to medical severity of illness, length of hospital stay, disposition at discharge, number of secondary medical diagnoses and specialty consults, and scores on three different hospital classification systems used for staffing. PINI scores were significantly different for high- and low-intensity DRGs. Observed time spent delivering nursing care to specific patients was significantly correlated with nurse estimates of time.
Subject(s)
Nursing Staff, Hospital/supply & distribution , Patients/classification , Personnel Staffing and Scheduling/standards , Dependency, Psychological , Diagnosis-Related Groups , Evaluation Studies as Topic , Factor Analysis, Statistical , Humans , Length of Stay/statistics & numerical data , Nursing Care/standards , Observer Variation , Patient Discharge , Psychometrics , Referral and Consultation/statistics & numerical data , Reproducibility of Results , Severity of Illness Index , Time FactorsABSTRACT
The results of work sampling studies are used to examine how nurses spend their time and to relate nurses' time to the shortage of nursing practice in hospitals. Four types of proposals for improving the delivery of nursing care in hospitals are discussed. The likely impact of these proposals on how nurses spend their time and the consequences of increasing the effectiveness of professional nursing practice are explored.
Subject(s)
Job Description , Nursing Care/organization & administration , Nursing Staff, Hospital/supply & distribution , Task Performance and Analysis , Career Mobility , Humans , Nursing Care/methods , Nursing Care/standards , Nursing Staff, Hospital/statistics & numerical data , Organizational Innovation , Salaries and Fringe Benefits , Time FactorsABSTRACT
Although the process of rater training is important for establishing interrater reliability of observational instruments, there is little information available in current literature to guide the researcher. In this article, principles and procedures that can be used when rater performance is a critical element of reliability assessment are described. Three phases of the process of rater training are presented: (a) training raters to use the instrument; (b) evaluating rater performance at the end of training; and (c) determining the extent to which rater training is maintained during a reliability study. An example is presented to illustrate how these phases were incorporated in a study to examine the reliability of a measure of patient intensity called the Patient Intensity for Nursing Index (PINI).
