Instrument for classifying dependency in neonatal intensive care: analysis of agreement and reliability

Area of Science:

• Neonatal Nursing
• Healthcare Quality Measurement
• Instrument Reliability

Background:

• Classifying newborn dependence on nursing care is crucial in Neonatal Intensive Care Units (NICUs).
• Standardized instruments are needed to ensure consistent and objective patient assessment.
• Existing tools may require validation for specific clinical settings.

Purpose of the Study:

• To evaluate the reliability and agreement of an instrument designed to classify newborns based on their dependency on nursing care.
• To identify specific care areas within the instrument that demonstrate high or low reliability.
• To determine the overall suitability of the instrument for categorizing care intensity in a NICU.

Main Methods:

• A methodological study was conducted in a NICU setting.
• Six care nurses and one research nurse assessed 35 newborns using a 15-item care instrument.
• Weighted Kappa and Intraclass Correlation Coefficients were employed to analyze inter-rater agreement and reliability.

Main Results:

• High agreement (almost perfect) was observed for weight, oxygenation, and catheter control areas.
• Low agreement (poor) was noted for the reaction to stimuli area.
• The overall Intraclass Correlation Coefficient was 0.94, indicating strong reliability, though some areas showed low reliability due to response variability.

Conclusions:

• The instrument demonstrates overall reliability for categorizing newborn care needs (minimal, intermediate, intensive).
• Refinements in item descriptions are suggested for areas with subjective scoring to improve consistency.
• The validated instrument can be a valuable tool for assessing and improving the quality and safety of newborn care in NICUs.