Development and Psychometric Testing of a Tool to Measure Nursing Care Intensity for Stroke Patients

BACKGROUND: Nurses play a crucial role in the care of stroke patients improving health outcomes. However, stroke nursing care is complex, and an instrument available to monitor the patient dependence over time and an efficient management of care would be beneficial for the stroke care units. The purpose of this study is to develop and psychometrically test an instrument to measure nursing care intensity for patients admitted to stroke units. METHODS: A 3-step process was implemented. First, item generation was performed based on an established theory. Second, content validity was assessed on the generated pool of items, and finally, the instrument was tested on a sample of 1200 stroke patients at admission and discharge time points, to test its psychometric properties. RESULTS : Item generation was driven by the theory of Roper-Logan-Tierney, and a total of 13 items were derived. Content validity led to the elimination of 5 items. The final instrument, the Chart of Nursing Assessment in Stroke (STROKE-CNA), was made of 8 items. Confirmatory factor analysis had a supportive fit (root mean square error of approximation = 0.077, comparative fit index = 0.99), indicating structural validity. Scores of the instrument at admission were significantly lower than at discharge ( P < .001, Cohen d = 1.42), indicating longitudinal validity. The changes in STROKE-CNA scores between admission and discharge were positively correlated with the corresponding changes in scores on the Scandinavia Stroke Scale ( r = 0.57, P < .001), confirming adequate responsiveness. The STROKE-CNA scores were negatively correlated with age (admission: r = -0.22, P < .001; discharge: r = -0.28, P < .001), indicating convergent validity. Internal consistency was adequate at 0.93, and interrater reliability was optimal, with Cohen kappa ranging between 0.61 and 0.99. CONCLUSIONS : The STROKE-CNA has promising validity and reliability when used for assessing nursing care complexity of patients admitted to stroke units.