A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study

Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system - case study from the general wards of one central hospital

BACKGROUND

RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe.

AIMS AND OBJECTIVES

The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification.

METHODS

The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses.

RESULTS

In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards.

CONCLUSIONS

RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care.

RELEVANCE TO CLINICAL PRACTICE

Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.

Patient-centered Needs Assessment

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Influence of quality of care on quality of life in inflammatory bowel disease (IBD): literature review and studies planned

Inflammatory bowel disease (IBD) is a chronic disorder with an early onset in life. Therefore, it is reasonable to assume that IBD patients are in considerable need of health care. The quality of life of IBD patients is reported to be impaired. Whether optimizing the quality of health care for these patients may positively influence their quality of life is a question that has been raised often during recent years. This review of the literature on health care research discusses different concepts regarding the quality of care assessment in chronic disease, stresses the need to see things from the patient's perspective, and provides recommendations to optimize health care research. The two most important conclusions that can be drawn are that: (1) the relationship between quality of health care and quality of life in IBD is one that is certainly worth studying; and (2) when developing a means to assess patient data on quality of care, it is essential to involve patients from the very start.

Detecting nurse-perceived patient treatment difficulty of psychiatric patients in hospital: an evaluation of a patient assessment sheet

Many changes have occurred in hospital psychiatric care, including decreased length of hospital stay and increased patient acuity. These changes highlight the need for nurses to adequately assess and formally document patient treatment difficulties. The purposes of this study were to determine the ability of the Patient Assessment Sheet (PAS) to predict patient 'problems' that psychiatric nurses perceived as associated with patient treatment difficulty, and to identify the patient problems missing from the PAS. These purposes were accomplished by comparing the PAS to the Hospital Treatment Rating Scale (HTRS). A correlational design and multiple linear regression technique were used. Eight psychiatric registered nurses assessed a total of 110 patients, admitted consecutively to one inpatient psychiatric unit. The HTRS and the PAS were used independently for each patient. Four PAS items (active affect, passive affect, aggression toward self, and patient confusion) significantly predicted 38% of the variance from the HTRS; and three HTRS items (isolation and withdrawal from relationships, noninvolvement in treatment, and wide variability in mood) significantly predicted 22% of the residual variance from the HTRS. The identified PAS and HTRS items help to make visible patient problems associated with nurse-perceived patient treatment difficulty. This identification is potentially important for both clinical and political purposes.

Validation of a new method for patient classification, the Oulu Patient Classification

At Vasa Central Hospital in Western Finland a further development of the Oulu Patient Classification (OPC) has been made by the development of weight coefficients and by estimating the nursing care intensity per nurse. The daily level of nursing care intensity of a ward is expressed by the number of nursing care intensity points per nurse. This article presents results from a validity test of the OPC at Vasa Central Hospital. The test was carried out by comparing the daily patient classifications by means of the OPC against measurements made by means of a new measuring instrument, the 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL) developed at the Vasa Central Hospital. The study was implemented in eight wards during a period of 3 months. The data material consisted of two parts, the daily patient classifications based on the OPC (n = 19 324) and the measurements by means of the PAONCIL forms (n = 8458). Simple and multiple linear regression analyses were used as statistical methods in quantifying the linear relationship between the two interval-scaled variables. In the test of concurrent validity the coefficient of determination was 0.366, i.e. the association between these two indicators is fairly strong (36.6%). The testing of construct validity showed that the construct validity of the indicator hardly deteriorates as a result of the patients being placed in separate nursing care intensity categories. There was a clear correlation between the scores allotted by the indicator to the six different sub-areas of nursing care. When examining the construct validity of the OPC, no factors with independent explanatory power in predicting PAONCIL values were discovered other than those of the OPC. The OPC proved on the basis of this research material and these statistical methods to possess fairly adequate validity, and thus there is a good basis for further research and a development of nursing care.

Professional assessment of optimal nursing care intensity level: a new method of assessing personnel resources for nursing care

The primary aim of patient classification is to be able to respond to the constant variation in patients' caring needs. Systems of patient classification usually include some form of time study, e.g. work sampling or time-and-motion studies. This article deals with the pros and cons of traditional time studies and with the theoretical bases of a new method of assessing the need for staff resources for nursing, a method termed 'Professional Assessment of Optimal Nursing Care Intensity Level'. The main idea of the method is to arrive at an optimal level of nursing care intensity for a ward by means of professional assessment and daily patient classification. The optimal level of nursing care intensity is supposed to prevail when there is a balance between the patients' need for care and the hospital's staff resources. The development of this new method and an account of a pilot study carried out in two wards are presented. The results of the pilot study established that the development of the method is worth continuing in order to create an administrative tool which, by its nature, is more compatible than traditional time studies with the idea of caring from the perspective of caring science.