Share This Article:

Testing Reliability and Validity of the Oulu Patient Classification Instrument—The First Step in Evaluating the RAFAELA System in Norway

Full-Text HTML Download Download as PDF (Size:310KB) PP. 303-311
DOI: 10.4236/ojn.2014.44035    3,892 Downloads   4,853 Views   Citations


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.

Cite this paper

Andersen, M. , Lønning, K. and Fagerström, L. (2014) Testing Reliability and Validity of the Oulu Patient Classification Instrument—The First Step in Evaluating the RAFAELA System in Norway. Open Journal of Nursing, 4, 303-311. doi: 10.4236/ojn.2014.44035.


[1] Tervo-Heikkinen, T., Kiviniemi, V., Partanen, P. and Vehviläinen-Julkunen, K. (2009) Nurse Staffing Levels and Nursing Outcomes: A Bayesian Analysis of Finnish-Registered Nurse Survey Data. Journal of Nursing Management, 17, 986-993.
[2] Brown, D.S., Donaldson, N., Burnes Bolton, L. and Aydin, C.E. (2010) Nursing-Sensitive Benchmarks for Hospital to Gauge High-Reliability Performance. Journal of Health Quality, 32, 9-17.
[3] Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., Bruyneel, L., Rafferty, A.M., Griffiths, P., Moreno-Casbas, M.T., Tishelman, C., Scott, A., Brzostek, T., Kinnunen, J., Schwendimann, R., Heinen, M., Zikos, D., Sjetne, I.S., Smith, H.L. and Kutney-Lee, A. (2012) Patient Safety, Satisfaction, and Quality of Hospital Care: Cross Sectional Surveys of Nurses and Patients in 12 Countries in Europe and the United States. British Medical Journal, 344, e1717.
[4] McGillis Hall, L., Wodchis, W.P., Ma, X. and Johnson, S. (2013) Changes in Patient Health Outcomes from Admission to Discharge in Acute Care. Journal of Nursing Care Quality, 28, 8-16.
[5] Rechel, B., Wright, S., Edwards, N., Dowdeswell, B. and McKee, M. (2009) Investing in Hospitals of the Future. European Observatory on Health Systems and Policies.
[6] Schultz, N.A., Larsen, P.N., Klarskov, B., Plum, L.M., Frederiksen, H.J., Christensen, B.M., Kehlet, H. and Hillingsø, J.G. (2013) Evaluation of a Fast-Track Programme for Patients Undergoing Liver Resection. British Journal of Surgery, 100, 138-143.
[7] Report nr. 47 (2008-2009) to the Norwegian Parliament. The Coordination Reform. Proper Treatment—At the Right Place and Right Time.
[8] Kane, R.L., Shamliyan, T.A., Mueller, C., Duval, S. and Wilt, T.J. (2007) The Association of Registered Nurse Staffing Levels and Patient Outcomes. Systematic Review and Meta-Analysis. Medical Care, 45, 1195-1204.
[9] Pering, S.-J. and Yu, M.-L. (2013) Psychometric Testing of an Instrument Measuring Nurse Aides’ Patient Safety Attitudes. Journal of Nursing Management, 21, 1001-1007.
[10] Fagerström, L., Rainio, A.-K., Rauhala, A. and Nojonen, K. (2000) Professional Assessment of Optimal Nursing Care Intensity Level. A New Method for Resource Allocation as an Alternative to Classical Time Studies. Scandinavian Journal of Caring Sciences, 14, 97-104.
[11] Weston, M.J. (2009) Validity of Instruments for Measuring Autonomy and Control over Nursing Practice. Journal of Nursing Scholarship, 41, 87-94.
[12] Rauhala, A. and Fagerström, L. (2004) Determing Optimal Nursing Intensity: The RAFAELA Method. Journal of Advanced in Nursing, 45, 351-359.
[13] Fagerström, L., Rainio, A.-K., Rauhala, A. and Nojonen, K. (2000) Validation of a New Method for Patient Classification, the Oulu Patient Classification. Journal of Advanced Nursing, 31, 481-490.
[14] Frilund, M. and Fagerström, L. (2009) Validity and Reliability Testing of the Oulu Patient Classification Instrument within Primary Health Care for the Older People. International Journal of Older People Nursing, 4, 280-287.
[15] Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A. and Erikson, P. (2005) Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health, 8, 94-104.
[16] Fagerström, L. and Rauhala, A. (2007) Benchmarking in Nursing Care by the RAFAELA Patient Classification System. Journal of Nursing Management, 15, 683-692.
[17] Tavakol, M. and Dennick, R. (2011) Making Sense of Chronbach’s Alpha. International Journal of Medical Education, 2, 53-55.
[18] Landis, J.R. and Koch, G.G. (1977) The Measurement of Observer Agreement for Categorical Data. Biometrics, 33, 159-174.
[19] Altman, D.G. (1997) Practical Statistics for Medical Research. Chapman and Hall, London.
[20] Fagerström, L. (1999) The Patients’ Caring Needs. To Understand and Measure the Unmeasurable. Dissertation, Åbo University, Finland.
[21] Luiking, M.-L., van Linge, R., Bras, L., Grypdonck, M. and Aarts, L. (2012) Psychometric Properties of the Dutch Version of the American Activity Scale in an Intensive Care Unit. Journal of Advanced Nursing, 68, 2750-2755.
[22] Kottner, J., Halfens, R. and Dassen, T. (2008) An Interrater Reliability Study of the Braden Scale in Two Nursing Homes. International Journal of Nursing Studies, 45, 1501-1511.
[23] Gould, D., Goldstone, L., Kelly, D. and Gammon, J. (2004) Examining the Validity of Pressure Ulcer Risk Assessment Scales: A Replication Study. International journal of Nursing Studies, 41, 331-339.

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.