A brief nursing workload scale: Development and evaluation
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Dr Eve Lynn Layman, PhD, RN, NEA-BC
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Growth of price competition among hospitals has renewed interest in nursing workload measures as administrative aids to control personnel costs. Nurse administrators use workload estimates primarily to justify daily staffing decisions across hospital units. The Individual Care Requirement Scale (ICRS) was designed as a brief generic direct nursing care workload scale for hospitals not currently using other standardized workload measures. The ICRS consists of three items, rated on 4-point response scale, that assess distinct aspects of care, assistance with activities of daily living, assessment of health status, and implementation of interventions. The total nursing workload (sum of the three items) was designed to represent the time and intellectual effort expended by nursing personnel to promote positive patient outcomes. Reliability and validity of the ICRS were examined in a correlational, observation study conducted on seven medical and surgical units. The time nurses spent in interactions with patients was recorded for each nurse-patient interaction occurring during five 2-hour observation periods each day for 7 days. The nurse rated the complexity of care performed. From these discrete interaction data, total nursing time per day and average complexity of care per day were estimated. Intensity of care received by patients was then estimated by multiplying the 24-hour level values for nursing time and complexity of care. The validity of the ICRS was evaluated by examining relationships between the nursing workload (ICRS scores) and nursing time, complexity of care, intensity of care delivered to patients, and severity of illness. The inter-rater reliability of the ICRS examined in preliminary studies was acceptable. Significant low-to-moderate correlations between the ICRS scores and the nurse-patient interaction characteristics were found across units and when unit data were analyzed together; correlations at the unit-level ranged from non-significant and low (r = .01) to significant and strong (r = .72). The 16 items on the APACHE III Acute Physiology Scale explained 31% of the variance in the ICRS scores. The findings were positive indicators that the ICRS is a reliable measure of direct nursing care workload. However, conclusions about the validity of the ICRS cannot be made without further research.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 9938175; ProQuest document ID: 304528859. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Cross-Sectional |
Research Approach | Quantitative Research |
Keywords | Health Care; Management; Nursing Workloads |
Grantor | The University of North Carolina at Chapel Hill |
Advisor | Lynn, Mary R. |
Level | PhD |
Year | 1999 |
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