Development of an instrument to measure the quality of documented nursing diagnoses,interventions and outcomes: the Q‐DIO

Aims and objectives. This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research‐based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q‐DIO) was developed. Background. Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. Design. A qualitative design was used for instrument development. Methods. Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalised into items and eight experts assessed face and content validity of the Q‐DIO. Results. Criteria were developed and operationalised into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88·25% agreement for the scores assigned to the 29 items of the Q‐DIO. Conclusions. The Q‐DIO provides a literature‐based audit instrument for nursing documentation. The strength of Q‐DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing‐sensitive patient outcomes. Further testing of Q‐DIO is recommended. Relevance to clinical practice. Based on the results of this study, the Q‐DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records.     

Testing the Q-DIO as an instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes.

PURPOSE: To describe pilot testing of Quality of Diagnoses, Interventions and Outcomes (Q-DIO), an instrument to measure quality of nursing documentation. DESIGN: Instrument testing was performed using a random, stratified sample of 60 nursing documentations representing hospital nursing with and without implementation of standardized nursing language (30 for both strata) in a Swiss General Acute Hospital. METHODS: Internal consistency and intrarater and interrater reliabilities were tested. Through item analyses, the grades of difficulty and the discrimination validity of items were evaluated. FINDINGS: Internal consistency of nursing diagnoses as process produced Cronbach's alpha .83; nursing diagnoses as product .98; nursing interventions .90; and nursing-sensitive patient outcomes .99. With Kappas of .95, the intrarater and interrater reliabilities were good. Criteria for the grades of difficulty of items and discrimination validity were well met. The results of this study suggest that Q-DIO is a reliable instrument to measure the documentation quality of nursing diagnoses, interventions, and outcomes. Further testing of Q-DIO in other settings is recommended.     

Development and psychometric evaluation of workplace psychologically violent behaviours instrument

Aim. To develop an instrument to determine nurses’ perceptions of psychologically violent behaviours that they are exposed to in the workplace. Background. According to Leymann, psychological terror or mobbing in work life involves hostile and unethical communication, which is directed in a systematic way towards one individual who, due to mobbing, is pushed into a helpless and defenceless position, and being held there by means of continuing mobbing activities. Design. Survey. Methods. Because nurses who work in hospitals are generally the principle victims of physical, emotional and verbal violence due to the nature of their work environment, the research sample comprised 476 hospital nurses. Data were collected via self‐administered questionnaires. Results. The instrument to determine the perception of workplace psychologically violent behaviours contains 33 items and four factors (individual’s isolation from work, attack on professional status, attack on personality and direct attack). All items have shown statistically significant correlation (p < 0·01); the instrument’s total Cronbach’s α internal consistency coefficient was found to be 0·93. Conclusions. The findings show that the instrument’s validity and reliability are within the limits of an acceptable level and that it is an instrument that will encourage more studies on this subject. Relevance to practice. Defining the psychological pressure that nurses are exposed to in the workplace and determining its negative effects on the victim of workplace psychological pressure and on the institution will make it possible to protect individuals and the institution from psychological violence with both individual and institutional practices.     

The Community Client Need Classification System - a dependency system for community nurses

AIM: The aim of this paper was to discuss the predictive validity and reliability of the Community Client Need Classification System (CCNCS), the results of using this tool and public health nurses' satisfaction with the system. BACKGROUND: Public health nurses provide the majority of community nursing services in Ireland. The traditional method of measuring workload in the community is based on recording the number of visits. The revised Easley-Storfjell instrument for Caseload/Workload Analysis was modified for the Irish context and permission from the authors was sought to use it in this study and was thus named the CCNCS. METHODS: A convenience sample of 29 public health nurses used the CCNCS to classify 1352 clients for 2 weeks. RESULTS: The elderly and child health groups accounted for the majority of the nurses' direct and indirect time. Predictive validity analysis demonstrated a positive relationship between needs level and nursing time. Nurses reported that the CCNCS was useful in predicting the needs of new and existing clients. CONCLUSIONS: This classification system, albeit in the first draft of its revised form, was perceived by the chosen sample of public health nurses as useful in measuring their workload. Further research is required to ascertain the reliability of the modified classification system with a larger sample size.     

精神科病人跌倒危险评估及早期护理干预的方法与效果

目的 探讨精神科病人跌倒评估方法及早期护理干预的措施.方法 采用HendrichⅡ跌倒风险模型评估住院精神科病人的跌倒风险,并对病人进行早期护理干预.结果 降低了病人跌倒发生率,差异具有统计学意义(P＜0.05).结论 通过对住院精神病人跌倒危险评估和早期实施护理干预措施可以减少病人跌倒的发生.     

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.