Abstract
M.Cur.
The nursing service manager is accountable for the managerial outputs of the nursing
service, being quality nursing care, cost effectiveness and quality nursing staff
management. These managerial responsibilities will influence the overall management
efficiency of the health delivery system. There is a need for a more scientific basis of
staffing in South African critical care units. Various methods are used to determine
staffing needs, but the most accurate and acceptable method being used is the patient
classification system. The success of a critical care patient classification system is
based upon the accurate determination of the ideal nurse-patient ratio. Ideal nursepatient
ratio depends on matching the competency of the critical care nurse to the
severity of the critical care patient's illness. Internationally and nationally very few
guidelines describe the competency requirements that the critical care nurse should
have to function effectively in the critical care unit. To maintain a high standard of
quality nursing care, the critical care nurse should be assigned to a critical care patient
according to her competency level. The aim of this study was to describe a scientific
patient classification system for critical care patients according to which workload and
nursing requirements can be ascertained. Secondly, to describe guidelines for the
competency requirements of a registered critical care nurse assigned to nurse the
different categories of critical care patients categorised by the patient classification
system as prescribed. The aim of the study is justified by means of an exploratory,
descriptive, contextual research design.
A critical care patient classification system has been developed and validated by a
group of critical care nursing experts using a structured two phase research method.
The statistical validity of each item of the critical care patient classification system was
determined by means of a content validity index. All the items of the critical care
patient classification system were rated as valid and therefore the critical care patient
classification system as a whole has been accepted as valid.
The reliability of the critical care patient classification system was tested by means of
a pilot study in two selected research units. It was determined that the inter-rater
reliability was within the 95 per cent confidence interval, that the system could
discriminate between different critical care patients and nurse-patient ratios were
effectively determined by the system.
Critical care nurse competency requirements were identified by critical care nursing
experts by means of a focus group interview. The results obtained from the focus
group interview were verified by a literature control and peer group review. Guidelines
for the competency requirements of the critical care nurse were compiled.
The critical care patient classification system developed will equip the critical care
manager with a scientific instrument to assign personnel to critical care units. The
critical care patient classification system will furthermore assist the critical care unit
manager in the daily utilisation of valuable human resources, in that critical care nurses
with the appropriate level of expertise can be assigned to each patient, thus facilitating
quality critical care nursing.