Marga Hoogendoorn

27 Methods used for classif ication of needed nursing time From the 71 included articles, we identified 27 different scoring systems with a translation of workload into nursing time needed. Table 1 provides an overview of these 27 systems with the name and the abbreviation as used in daily practice and in this article, a description of their main content and the year of development. This table also shows that the way in which the needed nursing capacity is classified varies largely. There are differences in both content (nursing or medical interventions) and way of categorizing the care (points, time or Nurse:Patient-ratio). Twelve systems (44%) were based on a list of nursing interventions or a combination of nursing and medical interventions with either a description of minutes per intervention (n=3), or points per intervention (n=9). Those points were translated into minutes per point (n=4) or translated into (a categorization of) expected nursing time per shift or an expected Nurse:Patient-ratio (n=5). Nine systems (33%) were based on the level of dependency of the patient or a category of nursing care (i.e. preventive or minimal care to compensatory or intensive care), with a description of time in minutes or hours per category (n=2), or points per category (n=7). The points were translated either into minutes per point (n=1) or translated into (a categorization of) expected nursing time per shift or an expected Nurse:Patient-ratio (n=6). One system (4%) was based on a computerized calculation of activities from a care- plan with points per activity and a translation from points to minutes. In five systems (19%) the classification was based on the expected Nurse:Patient-ratio with a description of the patient category per Nurse:Patient-ratio. Validity and reliability of the scoring systems Content validity Information on the content validity was reported for 20 out of 27 (74%) scoring systems. A summary of the results of the content validity of the scoring systems is presented in Table 2. In 17 of these 20 systems (85%), nurses participated in the selection and weighing of the interventions. For the TISS-76, the interventions were selected by physicians, but the actual weighing of the points was done by a team of physicians and nurses. The interventions included in the PINI were based on nineteen other scoring systems. The interventions included in the SGI-Grading System were based on a retrospective dataset without involvement of nurses. The Content Validity Index was only described for the Acuity-tool with a value of 0.85, which was lower than the considered threshold index of 0.9.