The Nursing Observed Illness Intensity Scale (NOIIS)

Inpatient progress is monitored mostly via the observation conducted by nursing staff. These tend to be unstructured, vary in reliability between different staff members, and be dependent on what has been written in nursing notes. The Nursing Observed Illness Intensity Scale (NOIIS) was devised to provide a more objective measure of behavioural improvement and symptom reduction. The scale is completed by qualified nurses at the end of every shift, based on everyday nursing observation and interaction with patients, and scores are entered on a NOIIS 'temperature' chart. In this study, more than 6000 ratings were captured on 106 admissions to a psychiatric intensive care unit. Inter-rater reliability of the scale was found to be satisfactory, and validity against the Brief Psychiatric Rating Scale good. Scores were shown to relate to the social organization and treatment methods of the unit. Recovery curves differed significantly by diagnosis, with patients having schizophrenia showing the slowest improvement. From a clinical point of view, the NOIIS can be used to track progress, response to changes in treatment and readiness of the patient for discharge; aids staff deployment; and can be used for clinical audit. For research, the scale can be used in clinical trials of treatment outcomes.