Dependency scoring in a critical care area: a direct nursing assessment method

Cross-validation of the Care Dependency Scale in intensive care unit (ICU-CDS)

OBJECTIVES

The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients' dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units.

RESEARCH METHODOLOGY/DESIGN

A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation.

SETTING

Adult patients admitted to intensive care units of four Italian hospitals.

RESULTS

The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate.

CONCLUSION

The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care.

Between violation and competent care--lived experiences of dependency on care in the ICU

This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical interpretation theory. The study has found that dependency is experienced as difficult, and the relationship with the nurses seems to be ambivalent. The good relationship is experienced to make dependency easier, whereas negative experiences make it harder to cope with dependency. The participants deal with dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.

A threat to the understanding of oneself: intensive care patients' experiences of dependency

This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.

Intensive Care Nursing Scoring System Part 2: nursing interventions and nursing outcomes

Different medical classifications and scoring systems have been developed to measure and compare intensive care outcomes in international contexts. Many of them, however, do not include outcome variables to describe autonomous nursing and its effects on the patient's experiences and restrictions as a result of the onset and process of illness, or relatives' or significant others' distress in the intensive care environment. The Intensive Care Nursing Scoring System (ICNSS) is a new instrument to describe and highlight nurses' work and its effects on the patients and their relatives in a way not allowed by medical classifications and scoring systems. ICNSS can be used to evaluate a single intensive care nursing process from admission to discharge or to compare patients in different intensive care units for certain variables. ICNSS can also be used to measure nurses' workload. The classification of nursing diagnoses was described in a previous article. This paper describes nursing outcomes and nursing interventions as well as the use of ICNSS in a computer-based information management system in three adult intensive care units in the Oulu University Hospital.