The Sheffield Caseload Classification Tool: testing its inter-rater reliability.

Community nursing caseloads are vast, with differing complexities. The Sheffield Caseload Classification Tool (SCCT) was co-produced with community nurses and nurse managers to help assign patients on a community caseload according to nursing need and complexity of care. The tool comprises 12 packages of care and three complexities. The present study aimed to test the inter-rater reliability of the tool. This was a table top validation exercise conducted in one city in South Yorkshire. A purposive sample of six community nurses assessed 69 case studies using the tool and assigned a package of care and complexity of need to each. These were compared with pre-determined answers. Cronbach's alpha for the care package was 0.979, indicating very good reliability, with individual nurse reliability values also being high. Fleiss's kappa coefficient for the care packages was 0.771, indicating substantial agreement among nurses; it was 0.423 for complexity ratings, indicating moderate agreement. The SCCT can reliably assign patients to the appropriate skilled nurse and care package. It helps prioritise and plan a community nursing caseload, ensuring efficient use of staff time to deliver appropriate care to patients with differing needs.

Evidence for a new paradigm of the ministry of parish nursing practice using the nursing intervention classification system.

A national study of parish nurses used the Nursing Intervention Classification (NIC) Use Survey (3rd Ed.) to characterize parish nursing practice. The study categorized NIC interventions based on frequency of use by parish nurses. The majority of nursing interventions focused on the Behavioral Domain, which supports psychosocial functioning and facilitates lifestyle changes and the Coping Assistance Class, which includes spiritual support. Data provides evidence to further understand what parish nurses do in their daily practice, as well as clarifies the complexity and scope of this specialty practice. Findings confirm that parish nursing is a specialty nursing practice as well as a ministry. Objective descriptions of parish nurse practice, including the identification of the most commonly used parish nurse interventions, will assist in providing direction for defining the role of the parish nurse and providing a basis for reviewing the current content of parish nurse curriculum. The database, which uses a standardized nursing language, also provides evidence for a new paradigm of the ministry of parish nursing practice that is intelligible to other nurses, policy makers, and funders.

A study of core interventions in home nursing.

AIM: To gain insight into the core interventions in home nursing. METHODS: In this descriptive, quantitative, cross-sectional study two questionnaires, based on the nursing interventions classification, were used to collect data from 501 nurses working in an organization for home nursing in Belgium. Response rate was 88%. RESULTS: The self-care assistance, (im)mobility and (psycho)social interventions are the most frequently performed interventions in home nursing, but they are performed and can only be interpreted in combination with other, more technical interventions. Therefore, these interventions can be considered the core interventions in home nursing.

Classifying specialist student practice: debates and dilemmas.

At present, the practice elements of the Specialist Community Practitioner Awards within the BSc (Hons) in the Community Health degree course at Manchester Metropolitan University do not directly contribute to degree classification. Student evaluation and external examiner concerns about the heavy assessment load motivated the course team to consider classifying practice at 20 Level III credits which would replace 20 theory credits. The process of developing a credible assessment tool for specialist practice was long and hard but the course team is now in a position to undertake an exploratory study of the assessment and classification of practice. This paper provides an overview of the discussion and debates that took place in the years before the study began. A future paper will provide detail of the study and will include practice educators, students and managers views on the structure, process and outcomes of marking specialist student practice in community settings.

ICD-9-CM coding changes for home care: effective October 1, 2004.

Changes in ICD-9-CM codes for all health providers for 2005 go into effect and are to be implemented on October 1, 2004, with no transition period. This article outlines specific coding changes that may be applicable to home care patients. You'll find the new codes, backgrounds of the disease/condition, and a list of invalid diagnosis codes that can be used as a handy reference for clinicians, managers, and office staff.

Nursing interventions classification. A comparison with the Omaha System and the Home Healthcare Classification.

Standardized languages for nursing practice are required to meet the needs of the profession and the patients we serve. The authors review and compare three classifications of nursing interventions: Nursing Interventions Classification (NIC), the Omaha System, and the Home Healthcare Classification (HHC). The information will help users make the best selection for their agency and client population.

A Dutch patient classification system for community care.

In the Netherlands, a prototype patient classification system for community nursing has been developed to enhance planning, budgeting, and quality of care. This patient classification system encompasses three parameters: type of care needed, expected number of home visits, and the total length of service. The authors describe the classification system and present the results of an evaluation study. Nurses stated that the instrument was useful for determining the demand for care, staffing needs, and work load. Although not all results were positive, the system currently is recommended for use as a long-term planning instrument.

Analysis and management of home health nursing caseloads and workloads.

The Easley-Storfjell Instruments for Caseload/Workload Analysis have been used successfully by home health managers to document the type quantity, and complexity of services provided by clinicians, teams, and the entire nursing staff. By measuring both the time requirements and complexity of interventions, these tools have been useful in assigning cases, managing caseloads and workloads establishing benchmarks, and monitoring productivity. Directions for use of these tools and examples are provided.

Nursing interventions in crisis-oriented and long-term psychiatric home care.

Psychiatric nurses in The Netherlands are moving out of residential mental health institutions and are pioneering home care for the acutely and chronically mentally ill. The purpose of this study was to identify the interventions nurses currently use and to describe the differences between crisis-oriented and long-term psychiatric home care. Data was collected of 159 nursing care plans from four participating crisis-oriented and two long-term psychiatric home care teams. All stated nursing activities were identified and subsequently labelled and classified using the Nursing Intervention Classification (NIC). Results revealed that in both crisis-oriented and long-term psychiatric home care, nurses used a wide range of nursing interventions. Medication Management, Coping Assistance and Activity Therapy were the most frequently undertaken nursing interventions in both types of care. Within crisis-oriented care, Emotional Support and Self-esteem Enhancement dominated, whereas long-term care focused on Socialization Enhancement and Home Maintenance Assistance. The results will be used for further research and for standardization of nursing care plans within these categories of nursing practice.

Nursing interventions classification: a content analysis of nursing activities in public schools.

Nursing Interventions Classification (NIC) is an effort to describe nursing activities by using a standardized nomenclature of nursing treatments (McCloskey & Bulechek, 1992). Limited research focused on community nursing activities has been included in the Iowa Intervention Project to date. The purpose of this study was to investigate how nursing activities performed by RN baccalaureate students in the public school setting conformed to the activities and interventions classifications proposed by the Iowa Intervention Project. Nursing activities were documented by 40 RNs for 1,774 clients in the schools. Those activities conformed to 25 of the 336 NICs. Findings further demonstrated that pain management was the most frequently used NIC, and patterns of clustering of classifications were also common. Although NIC can be used, the fit is not always strong. Specific recommendations are addressed for strengthening NIC use in the public schools.

Describing the work of nursing: the case of postsurgical nursing interventions for men with prostate cancer.

Nursing interventions were provided to older men following prostate surgery during a controlled clinical trial examining nursing care and its effects on quality of life outcomes. The Nursing Intervention Lexicon and Taxonomy (NILT), consisting of 7 categories of nursing interventions, was used to classify intervention statements extracted from 32 home care records. Two major categories of interventions were patient teaching (45%) and psychologically based interventions (20%). In a comparison of the types of interventions provided upon discharge from the hospital with those provided at the end of 1 month of home care, it appeared that patients had not yet shifted from the crisis to the chronic phase of their illness course based on Rolland's framework.

Hitting the target: the equitable distribution of health visitors across caseloads.

BACKGROUND: Health visitors in the United Kingdom work mainly with pre-school children and their mothers. Their distribution across the population is largely historical, highly variable and relates poorly to indicators of population need. METHODS: A range of largely routine data sources were used to describe the nature, variation and statistical determinants of the workload of individual health visitors in Sheffield, England, in 1996-1997. Regression models were tested relating measures of need and deprivation to the total number of client contacts. RESULTS: Caseloads were smaller in the most deprived areas, with wide variation. Most (93 per cent) contacts were with mothers and young children. Health visitors visited the clients designated as highest priority on average 4.7 times more often than routine clients. The main reasons for high priority ratings were child protection concerns, maternal mental health problems, child development and health concerns, and first-time mothers in the postnatal period. Half of all client contacts were with low-priority families for routine child health surveillance or were client initiated. Models based on the number of children under five and any one of a range of measures of social deprivation account for 57-59 per cent of variation in workload and could be used to allocate resources more equitably. CONCLUSIONS: Although most health visitors apparently subscribe to the principle of targeting, the extent varies widely. Constraints on targeting are routine child health surveillance reviews, and client demands. More equitable allocation of health visitors and more explicit targeting policies might increase the effectiveness of the health visiting service.

Commissioning community health care: missing the point.

Discusses commissioning community health care and the fact that present mechanisms do not enable commissioning to meet the needs of patients requiring community care relevant to their needs. The focus on efficiency, money and simple activity does not take into account the complex nature of community care and the need to take a variety of factors into account if commissioning is to be effective.

Avaliação da implantação do CIPESC® em Curitiba / Evaluation of the implementation of CIPESC® in Curitiba

Este relato de experiência tem como objetivo apresentar os resultados das oficinas de avaliação da implantação de um sistema operacional da CIPESC®, que simultaneamente descreve, valida, quantifica e qualifica as práticas de enfermagem em saúde coletiva realizadas no âmbito da extrainternação nas Unidades de Saúde da cidade de Curitiba – PR. As oficinas realizadas ofereceram subsídios para identificação das fortalezas e dificuldades na implantação da nomenclatura CIPESC – Curitiba, mas ao mesmo tempo revelaram contradições nas falas dos enfermeiros. Concorda-se que é pela prática consciente que se superam estas contradições e, a começar delas, deve-se construir uma Enfermagem com potencial interventivo nos perfis epidemiológicos da população.

This report of experience has the objective of presenting the results of the evaluation workshops on the implantation of an operating system of CIPESC, which simultaneously describes,validates, quantifies and qualifies the nursing practices in collective health carried out in the scope of extra-internment in the Units of Health of the city of Curitiba, in the State of Paraná. The workshops provided subsidies for identification of the strong points and the difficulties of implementing the CIPESC-Curitiba nomenclature, but at the same time revealed contradictions in the nurses’ speeches. It is agreed upon that it is through conscious practice that these contradictions are overcome, and, starting from them, is built a Nursing with potential of intervention in the population’s epidemiological profiles.

Este relato de experiencia tiene como objetivo presentar los resultados de los talleres de evaluación de la implantación de un sistema operacional de la CIPESC, que simultáneamente describe, valida,cuantifica y califica las práticas de enfermería en salud colectiva realizadas en el ámbito del extrainternamientoen las Unidades de Salud de la ciudad de Curitiba – PR. Los talleres realizados ofrecieron subsidios para la identificación de las fortalezas y dificultades en la implantación de la nomenclatura CIPESC – Curitiba, no obstante, a la vez, revelaron contradicciones en los discursos de los enfermeros. Se concuerda que es por la práctica consciente que se superan estascontra-dicciones y, a partir de ellas, se debe construir una Enfermería con potencial interventivo en los perfiles epidemiológicos de la población.