Implementation Strategies of Measurement Instruments and Their Validity as Adopted in Italian Hospital Nursing Practice: An Italian Cross-Sectional Study

PURPOSE.  The purpose of this study was to describe the implementation strategies of measurement instruments and their validity as adopted in Italian hospital nursing practice.

METHOD.  A descriptive, regionally based study was adopted in 2008. Eight public hospitals were included. After collecting the available instruments used by nurses and/or patients in the measurement of patients' problems or perceptions of those problems (actual and/or potential), the researchers conducted two structured interviews per ward: the first with the chief nurse, the second with a clinical nurse. The interviews focused on each measurement instrument collected, on the implementation strategies adopted for the instruments, and on the perceived usefulness and appropriateness of each instrument.

FINDINGS.  Overall, 70 wards were included; 18 (25.7%) of the wards did not use any instrument. In the remaining 52 wards, 156 instruments were collected (from 1 to 10 per ward) evaluating 55 different actual or potential patient problems. Of the instruments adopted, 70.9% were not formally validated. Hospital administration primarily determined which instruments were to be used (67, 42.9%), and introduction to staff was mainly supported by continuing education courses (92, 59%). The level of appropriateness and usefulness of the instruments, as perceived by the clinical nurses and chief nurses, was high (>8 on a scale of 0–10, where 0 = not at all appropriate/useful and 10 = very appropriate/useful).

CONCLUSION.  Despite the increasing demands for reliable nursing data as a basis for measuring nursing effects on nursing outcomes and safety, a number of wards used no measurement instruments at all; within wards that used measurement tools, many instruments had not been validated.

IMPLICATIONS.  The introduction of nonvalidated instruments in Italian hospitals needs to be restricted because of the short- and long-term negative effects these nonvalidated instruments may have. A national consensus on approved and validated instruments for nursing assessment should be made available in the wards as a priority.