The reliability and validity of two health status measures for evaluating outcomes of home care nursing.

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the client's nursing condition and skill mix.

Nursing workload associated with adverse events in the postanesthesia care unit.

BACKGROUND: The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). METHODS: Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU. RESULTS: The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU. CONCLUSIONS: Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.

Factors influencing job satisfaction on specialty nursing units.

In the midst of downsizing, restructuring, layoffs, hospital closures, mergers, and the beginning cycle of shortages in specialty units, nursing administrators must extend their understanding of the factors influencing job satisfaction and the implications these findings may have for nursing practice, in order to enhance the quality of worklife for nurses in a hospital setting and create competitive work environments. The Causal Model of Job Satisfaction for Nurses (Blegen & Mueller, 1987), including Leatt and Schneck's (1981) technology variable, was the conceptual framework used to look at the effect of the 14 variables (opportunity, routinization, autonomy, job communication, social integration, distributive justice, promotional opportunity, motivation, pay, workload, general training, kinship responsibility, unit size, technology) on job satisfaction. This study demonstrated a statistically significant positive correlation between autonomy, motivation and job satisfaction and a statistically significant negative correlation between routinization and job satisfaction.

Validity and reliability of nursing workload measurement systems: strategies for nursing administrators.

In Part One, an overview of the theory related to validity and reliability of workload measurement systems (WMSs) was reviewed. In this article, the MEDICUS WMS is used to provide a concrete example of the type of comprehensive validity and reliability programs that can be established, in an inpatient setting, on the basis of this theory. Practical strategies for monitoring validity and reliability are identified. Administrators can adapt the approaches specified to fit the methodology underpinning other WMSs.

Validity and reliability of nursing workload measurement systems: review of validity and reliability theory.

Nursing workload measurement systems (WMSs) are used in inpatient and outpatient settings for staffing, scheduling, and budgeting. The nurse administrator can use WMS data to make wise decisions in these key areas providing the data are reliable and valid. Unfortunately, in most institutions, attention to issues of reliability and validity occurs only at system implementation and then the systems are left unattended. This article provides an overview of validity and reliability as it relates to WMSs. Part Two of this article will demonstrate how validity and reliability theory can be operationalized in an ongoing program for maintaining WMS reliability and validity.

Issues in the use of the Alberta Patient Classification System to fund Ontario long term care.

The purpose of this paper is to assess some of the issues surrounding the use of the Alberta Patient Classification System for Long Term Care Facilities (APCS) to fund Ontario long term care by attempting to answer the following questions: 1) Is the APCS valid for classifying Ontario long term care patients?; 2) Is it appropriate to use the APCS to fund Ontario long term care?, and; 3) What is required to develop a valid long term care patient classification and funding system appropriate for Ontario? The paper discusses why it may be inappropriate to use the APCS to classify Ontario long term care patients, some of the important financial consequences to a long term care facility if the APCS is inappropriate, and what might be necessary for a better patient classification and funding strategy. The potential and pitfalls of adopting patient classification systems developed in a different health system should be of interest to nurse managers in all provinces.

Work sampling revisited: a technique for understanding nursing work.

This article describes the work sampling methodology as a technique to provide direct observational data for the analysis of nursing job design. Work sampling has previously been used to examine the actual work of hospital nurses under the broad categories of direct and indirect care. We assert that work sampling can also be used to examine a specific type of nursing care, and use the example of intrapartum support to illustrate this. The purpose is to discuss the potential for using work sampling as a technique to examine the actual work nurses do and provide data for analysis of nurse job design.

Supporting women in labor: a work sampling study of the activities of labor and delivery nurses.

Studies demonstrated that support during labor and birth has a positive impact on childbirth outcomes, and that women reported they received little supportive care from nurses during parturition. This study piloted a work sampling method that was adapted to determine the proportion of time the average intrapartum nurse at a Toronto teaching hospital spends in supportive care activities. Supportive care was operationally defined within four categories of activities: emotional support, physical comfort measures, instruction/information, and advocacy. Work sampling was an effective method of measuring support as a specific aspect of direct intrapartum care. The proportion of time that nurses spent in supportive versus all other activities was 9.9 percent (95% confidence interval 7.5% and 12%), based on a sample of 616 random observations of 18 nurses. Findings are discussed in terms of the social and political factors that affect the meaning and value of the supportive activities of work by obstetric nurses.

Satisfaction with nursing workload systems: report of a survey of Canadian hospitals. Part A.

Senior nursing executives from a representative sample of Canadian hospitals were surveyed on their attitudes and views of nursing workload measurement systems. In terms of a profile of users and their satisfaction, the survey found that about 50% of hospitals were using a system, and that among those using a system, 70% used information from the system frequently or all the time. The senior nurse respondents were generally satisfied with their current systems; slightly lower levels of satisfaction were reported for staff nurses, with the most common objection being the perception that the systems do not reflect true workload. A subsequent article--Part B--explores senior nurse executives' needs and expectations for nursing workload systems.