Figure 8 - uploaded by Auvo Rauhala
Content may be subject to copyright.
Histogram illustrating the distribution of optimal nursing intensity per nurse (in weight coefficient points) in 32 wards.
Contexts in source publication
Context 1
... between explanatory power and point of optimal nursing intensity (in weight coefficient points), a scattergram of the optimal nursing intensity analyses of 48 wards Figure 8. ...
Similar publications
The notion of a global public service has been put forth in the literature as a means of addressing a number of policy issues that can no longer be addressed by a nation-state in isolation. This article sets out to address whether it is possible to formulate and implement a leadership competency model that could be used to select, develop and rewar...
Human resource management (HRM) often appears as an instrumental science, defining and analysing management practices while ignoring the power games and conflicts of interest, which those same practices may induce. From this perspective, HRM takes its cue from the rationale of management whose aim is to optimize a company’s financial performance. T...
Citations
... Research has shown that high NI level under a long period not only will be a risk for the quality of care but also a health risk for the caregivers. , Sung et al., 2005, Rauhala, 2008 Ethical consensus is thereby critical for the unit's criteria of good ethically care. Are the criteria of good care in accordance with the ideals as dignity, caring relationship, closeness and distance, safety, autonomy and participation? ...
Purpose: The study's purpose is to argue from a theoretical perspective, the importance of an ethical foundation or ontology in rehabilitation. The study aims to create a theoretical model where ethics and rehabilitation form a synthesis. Method: The study is theoretical in the fields of rehabilitation and Caring Science. It follows a hermeneutic approach where the text is interpreted and analysed concerning context. Findings: A common opinion, based on our material, is that rehabilitation is a relationship rather than a separate activity area. No professional group can invoke a monopoly on rehabilitation. Who formulates clinical practice goals and determines the patients' needs? How is the rehabilitation process tailored to the theme of "what is right "and "what is best for the patient"? Conclusion: The theoretical model as it describes in this paper has opportunities to guide the ReHabilitering team against excellent ethical rehabilitation independent of clinical context.
... 27,28,38 For further information see previous works. 39 Aim The aim of this study was to describe nurses' work experiences and perception of the usability of the OPCq instrument when classifying NI in HHC. ...
This study was a part of a municipal research and development programme in home healthcare (HHC). The Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system, was used to measure nursing intensity (NI) for the first time in HHC in Norway. The aim was to describe nurses’ work experiences and perceptions of the usability of the OPCq instrument when classifying NI in HHC. Twenty-two members of staff participated in four focus-group interviews. Content analyses were used to analyze and interpret the data. Three themes emerged: 1) Classifying the modified OPCq levels correctly; 2) Technological problems hinder use of the instrument; 3) Classifying NI when time pressure dominates. The OPCq instrument is useful in classifying NI, although some minor adjustments might be needed for its use in HHC. The nurses considered the OPCq instrument useful in illuminating the actual work situation in HHC and the time pressure they experience.
... Research has shown that high NI level under a long period not only will be a risk for the quality of care but also a health risk for the caregivers. , Sung et al., 2005, Rauhala, 2008 Ethical consensus is thereby critical for the unit's criteria of good ethically care. Are the criteria of good care in accordance with the ideals as dignity, caring relationship, closeness and distance, safety, autonomy and participation? ...
... 8 16 17 In an attempt to accommodate some of these issues, the RAFAELA patient classification system was developed in the 1990s in Finland. 16 18 19 As compared with most other patient classification systems that use fixed patient-to-nurse ratios, the RAFAELA system use daily data on patients' care needs and the workload per nurse. The main purpose of the RAFAELA system is to ensure an appropriate allocation of nurse staff resources and, thus, a preferable NWL, which has been labelled as an optimal NWL. ...
... In the RAFAELA system, NWL is based on daily assessments of patients' care needs and the registration of the nursing staff resources. 16 The PAONCIL method ('Professional Assessment of Optimal Nursing Care Intensity Level') is used to establish an assumed optimal NWL for a specific ward. Daily measurements of NWL (Oulu Patient Classification (OPC)/nurse) are subsequently compared with this level, and resources are considered to be appropriately allocated when the actual NWL is at this level. ...
... 16 19 The feasibility, validity and reliability of the RAFAELA have been tested with good results. 16 18 21 22 It is now used in about 90% of the hospitals in Finland, and has lately been implemented in Iceland, the Netherlands, Sweden and Norway. 22 A requirement for users of the RAFAELA system is that the inter-rater reliability for nursing intensity measurements should be tested yearly. ...
Objective
To investigate whether the daily workload per nurse (Oulu Patient Classification (OPCq)/nurse) as measured by the RAFAELA system correlates with different types of patient safety incidents and with patient mortality, and to compare the results with regressions based on the standard patients/nurse measure.
Setting
We obtained data from 36 units from four Finnish hospitals. One was a tertiary acute care hospital, and the three others were secondary acute care hospitals.
Participants
Patients’ nursing intensity (249 123 classifications), nursing resources, patient safety incidents and patient mortality were collected on a daily basis during 1 year, corresponding to 12 475 data points. Associations between OPC/nurse and patient safety incidents or mortality were estimated using unadjusted logistic regression models, and models that adjusted for ward-specific effects, and effects of day of the week, holiday and season.
Primary and secondary outcome measures
Main outcome measures were patient safety incidents and death of a patient.
Results
When OPC/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 (95% CI 1.08 to 1.42) that of the assumed optimal level, and 0.79 (95% CI 0.67 to 0.93) if it was below the assumed optimal level. Corresponding estimates for patient mortality were 1.43 (95% CI 1.18 to 1.73) and 0.78 (95% CI 0.60 to 1.00), respectively. As compared with the patients/nurse classification, models estimated on basis of the RAFAELA classification system generally provided larger effect sizes, greater statistical power and better model fit, although the difference was not very large. Net benefits as calculated on the basis of decision analysis did not provide any clear evidence on which measure to prefer.
Conclusions
We have demonstrated an association between daily workload per nurse and patient safety incidents and mortality. Current findings need to be replicated by future studies.
... In the Nordic countries, the RAFAELA system is the most commonly used PCS. Used to measure NI and nurse staffing in hospital settings, the RAFAELA system is based on a holistic and person-centred perspective, where balance is sought between each patient's individual care needs and the nursing resources needed to thereby guarantee good care for patients and good working conditions for staff Fagerström, 1999;Frilund, 2013;Pusa, 2007;Rauhala, 2008). Nurse managers can use the RAFAELA system to assure nursing quality, good patient outcomes and good working conditions for staff and to reduce sick leave among nurses (Junttila et al., 2016;. ...
Aim
To test the interrater reliability of the modified Oulu Patient Classification instrument, using a multiple parallel classification method based on oral case presentations in home health care in Norway.
Design
Reliability study.
Methods
Data were collected at two municipal home healthcare units during 2013–2014. The reliability of the modified OPCq instrument was tested using a new multiple parallel classification method. The data material consisted of 2 010 parallel classifications, analysed using consensus in per cent and Cohen's kappa. Cronbach's alpha was used to measure internal consistency.
Results
For parallel classifications, consensus varied between 64.78–77.61%. Interrater reliability varied between 0.49–0.69 (Cohen's kappa), the internal consistency between 0.81–0.94 (Cronbach's alpha). Analysis of the raw scores showed 27.2% classifications had the same points, 39.1% differed one point, 17.9% differed two points and 16.5% differed ≥3 points.
... The main idea is that the workload per nurse (expressed in NI points per nurse) should be on the optimal NI level, and thereby assure the quality of nursing, patient outcomes, good working conditions for staff and an effective use of available resources. The validity of the RAFAELA ® system's measurement tools and the system's feasibility for human resource management in nursing has been assessed in several studies, including four PhD theses (Fagerström, 1999;Pusa, 2007;Rauhala, 2008;Frilund, 2013). The RAFAELA ® system has been developed based on a person-centred perspective, where each individual's care needs constitute the starting point for care and a clear focus is placed on the work situation for care staff and nursing intensity (NI; Fagerström, Lønning and Andersen, 2014) The driving force behind the development of the RAFAELA ® system has been and still is the promotion of fundamental care tasks, such as guaranteeing good and safe care and contributing to 'making good care possible'. ...
... By means of the scientifically tested RAFAELA ® system, a nurse manager is able to balance patients' care needs and the nursing resources needed to fulfil these needs in a manner that equates to optimal nurse staffing (Fagerström, 1999;Rauhala, 2008;. The RAFAELA ® system currently consists of the following components (see Figure 9.1): ...
... After the implementation and testing the reliability of the OPCq classifications, the Professional Assessment of Optimal Care Intensity Level (PAONCIL) study can begin. The PAONCIL method is an alternative to classical time studies and can be described as nurses' professional assessment of the sufficiency of resources in relation to the actual NI of patients during a shift (Fagerström et al., 2000b;Rauhala andFagerström, 2004, 2007). The validity and credibility of the PAONCIL method, including the manual, has been evaluated in several studies (Fagerström and Rainio, 1999;Fagerström et al., 2000b;Fagerström, Nojonen and Åkers, 2002;Fagerström and Vainikainen, 2014). ...
... Vento 2014) tai etsitty tunnusluku ja henkilöstöresurssien määrittämiseen (esim. Rauhala 2008). Henkilöstön ja asiakkaiden määrän keskinäistä suhdetta kuvaava tunnus luku ei välttämättä huomioi asiakkaiden yksi löllistä hoidon tarvetta eikä hoitotyöntekijöil tä vaadittavaa osaamista (Ruontimo 2012, 37), mutta se ohjaa resurssien jakoa. ...
Hoitajien toiminta on vanhusten hoivatyössä tärkeää asiakkaan kokemalle elämänlaadulle. Koska hoitajan antaman ajan pituus ei ratkaise vaan sen sisältö (Räsänen 2011), tarkastelen hoitajien työajan kohdentumisen merkitystä asiakkaiden kokemaan elämänlaatuun. Tulosten mukaan hoitajien asiakkaalle antama aika on huventunut muuhun kuin suoraan asiakkaan hyvinvoinnin tukemiseen. Silti se oli kokonaisuutena tärkeää asiakkaan elämänlaadulle, vaikkakin toistuvien, eriytyneiden ja sairauspainotteisten rutiinitehtävien ohella paneutuminen hoitotyössä erityisesti elämänlaadun kannalta tärkeisiin asioihin oli niukkaa. Taustalla voi olla hoitohenkilöstön asenteeseen, määrään ja kustannuksiin liittyviä tekijöitä. Aihetta ei ole aiemmin tutkittu vanhuspalveluissa, vaikka palvelujärjestelmän odotetaankin vastaavan ikääntyneiden asiakkaiden hyvän elämänlaadun tuottamisesta. Organisaatio rakentuu tehtäväänsä suorittavista yksilöistä ja asiakkaan hyvää elämänlaatua voidaan pitää myös työntekijän näkökulmasta tavoiteltavana tuloksena omasta työstä. Tutkimus tehtiin neljän keskisuomalaisen kunnan kuudessa vanhusten ympärivuorokautisen hoidon organisaatiossa vuonna 2013. Hoitoyksiköistä löytyi eroja käytännön hoito- ja palvelutyön kohdentumisessa antaen viitteitä asiakkaan elämänlaadulle tärkeistä ammattityön menetelmistä ja niiden vaikutuksesta resurssien kohdentamiseen.
... The theoretical foundations of the RAFAELA Nursing Intensity and Staffing system 1 rest on holistic nursing science, which encompasses the importance of meeting patients' physical, psychological, social and spiritual care needs. The complexity of nursing with regard to the science of human resource management emphasizes the importance of a bottom-up management approach and belief in staff competence and the importance of a strategic and engaged leadership (Fagerströ m, 1999;Rauhala, 2008). In Finland, untrained employees do not take part in patient care. ...
... The feasibility, reliability and internal validity of the RAFAELA have been studied thoroughly (Fagerströ m, 1999;Frilund, 2013;Kaustinen, 2011;Pusa, 2007;Rauhala, 2008). However, apart from one observational cohort study showing a linear trend between increasing patientassociated workload and sick leave among nurses the predictive validity of the RAFAELA has not 1 The RAFAELA system is owned by the Association of Finnish Local and Regional Authorities, and its use is managed by the noncommercial Finnish Consulting Group Ltd (FCG). ...
... Optimality of daily nursing workload can be operationalized as a ratio of observed to optimal nursing intensity per nurse (Rauhala, 2008). In the RAFAELA, the optimal level of nursing workload of a unit is determined every second year by a procedure called Professional Assessment of Optimal Nursing Care Intensity Level, PAONCIL (Rauhala and Fagerströ m, 2004). ...
Background:
Patient classification systems have been developed to manage workloads by estimating the need for nursing resources through the identification and quantification of individual patients' care needs. There is in use a diverse variety of patient classification systems. Most of them lack validity and reliability testing and evidence of the relationship to nursing outcomes.
Objective:
Predictive validity of the RAFAELA system was tested by examining whether hospital mortality can be predicted by the optimality of nursing workload.
Methods:
In this cross-sectional retrospective observational study, monthly mortality statistics and reports of daily registrations from the RAFAELA system were gathered from 34 inpatient units of two acute care hospitals in 2012 and 2013 (n=732). The association of hospital mortality with the chosen predictors (hospital, average daily patient to nurse ratio, average daily nursing workload and average daily workload optimality) was examined by negative binomial regression analyses.
Results:
Compared to the incidence rate of death in the months of overstaffing when average daily nursing workload was below the optimal level, the incidence rate was nearly fivefold when average daily nursing workload was at the optimal level (IRR 4.79, 95% CI 1.57-14.67, p=0.006) and 13-fold in the months of understaffing when average daily nursing workload was above the optimal level (IRR 12.97, 95% CI 2.86-58.88, p=0.001).
Conclusions:
Hospital mortality can be predicted by the RAFAELA system. This study rendered additional confirmation for the predictive validity of this patient classification system. In future, larger studies with a wider variety of nurse sensitive outcomes and multiple risk adjustments are needed. Future research should also focus on other important criteria for an adequate nursing workforce management tool such as simplicity, efficiency and acceptability.
... This makes it possible to ensure the quality of nursing, good patient outcomes, good working conditions and the effective use of available resources [21]. The validity and reliability of RAFAELA in hospital settings has been assessed in several dissertations [14] [30] [31] and in primary health care in one dissertation [4]. With RAFAELA it is possible to respond to the constant variation in patients' needs, and it consists of the following components: 1) Daily registration of patients care needs using the OPCq instrument; 2) Daily registration of actual nurse staffing resources; 3. Periodical determination of optimal NI level using the PAONCIL instrument. ...
Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.
... The NI indicates the nursing workload required by a patient's care needs (Lundgrén-Laine & Suominen, 2007), and it measures both direct and indirect patient-related workload (Morris et al., 2007). Patient classifications are used to match patients' care needs with available nursing resources (Fagerström, Rainio, Rauhala, & Nojonen, 2000;Kaustinen, 2011;Rauhala, 2008). ...
... Efforts have been made to monitor patients' care needs and related nursing workload in different types of wards and critical care units (Harrison, 2004), public health nursing (Brady, Byrne, Horan, Macgregor, & Begley, 2008), ambulatory settings (Cusack, Jones-Wells, & Chisholm, 2004;DeLisle, 2009;, and maternity units (Loper & Hom, 2000). However, relatively few of these systems have been scientifically validated or are publicly available (Carr-Hill & Jenkins-Clarke, 1995;Harper & McCully, 2007;Rauhala, 2008). ...
... Many studies concerning validity testing of the RAFAELA™ system and its instruments have been published Fagerström, 2000;Fagerström & Bergbom Engberg, 1998;Fagerström & Rainio, 1999;Fagerström & Vainikainen, 2014;Kaustinen, 1995;Rauhala, 2008). The content validity of the OPCq instrument was evaluated using an expert panel, and the results exhibited relatively high content validity (Fagerström, 2000;Kaustinen, 1995). ...
PurposeTo test the construct validity of an instrument to assess nursing intensity in perioperative settings.MethodsA survey based on 24 core elements of perioperative nursing was used. A total of 652 assessments were performed on 308 patients. Principal component analysis was used.FindingsA model with four principal components was suggested.Conclusions
Patients' care needs appear to vary as they progress along the perioperative continuum. Thus, a given instrument's content differs from the intraoperative to postoperative phases.ImplicationsMore testing is needed to achieve a valid tool for allocating nursing staff in operating departments. Reliable tools are needed to match patients' care needs with available nursing resources.
