TITLE:
Testing Reliability and Validity of the Oulu Patient Classification Instrument—The First Step in Evaluating the RAFAELA System in Norway
AUTHORS:
Marit Helen Andersen, Kjersti Lønning, Lisbeth Fagerström
KEYWORDS:
Nursing Intensity; Staffing; RAFAELA System; Oulu Patient Classification Instrument; Reliability; Validity
JOURNAL NAME:
Open Journal of Nursing,
Vol.4 No.4,
April
18,
2014
ABSTRACT: Objective: To study reliability
and validity of the Finnish Oulu Patient Classification instrument in Norway.
Background: The Finnish patient classification system RAFAELA consists of three
parts: 1) daily patient classification of nursing intensity using the Oulu Patient
Classification instrument, 2) calculation of nursing resources providing bed
side care per 24 hours, and 3) Professional Assessment of Optimal Nursing Care
Intensity Level. The RAFAELA system has not been tested outside of Finland.
Methods: A prospective, descriptive study was performed at 5 clinical units at Oslo University Hospital during
2011-2012. The interrater reliability of the Oulu Patient Classification
instrument was tested by parallel classification including 100-167 patient
classifications pr. unit, and analyzed by consensus in % and using Cohen’s
Kappa. Convergent validity was tested by using the average Oulu Patient
Classification instrument value to predict the average Professional Assessment
of Optimal Nursing Care Intensity Level for the same calendar day by linear
regression analysis. Results: The Oulu Patient Classification instrument
consensus of parallel classifications varied between 70.1%-89%. Cohen’s Kappa
within patient classes varied between 0.57 and 0.81, representing substantial
interrater reliability. The Oulu Patient Classification instrument was valid as
the instrument in average explained about 38% of the variation of the
Professional Assessment of Optimal Nursing Care Intensity Level. Conclusions:
Patient classification systems tested for psychometric properties are needed
and this study provides evidence of satisfactory reliability and validity of
the Oulu Patient Classification instrument as tested outside Finland,
demonstrating that this instrument has international relevance within nursing.