Translation and Clinimetric Evaluation of SIPI, a Brief Instrument for Measuring the Complexity in Nursing Care

Measuring patient-level complexity of nursing care in acute medical wards is essential for staffing and care planning, yet validated brief instruments in Spanish settings are scarce. The Sistema Informativo della Performance Infermieristica (SIPI) is a brief, intervention-based index designed to quantify nursing-care complexity on general wards.

To translate SIPI into Spanish and evaluate its clinimetric properties in acute medical hospital wards.

A cross-sectional clinimetric instrument validation study. SIPI was translated into Spanish by two bilingual nurses, and a third bilingual nurse performed a back-translation, which was reviewed by one of the original SIPI authors to ensure semantic equivalence. Construct validity was assessed in 212 hospitalised patients in four internal medicine wards. Convergent validity was examined using nurses' perception of the complexity of care. Known-groups validity was assessed by examining whether SIPI behaved as expected in relation to patient age and admission type. The optimal cut-off was determined using a receiver operating characteristic analysis to evaluate discriminant validity.

The Spanish version was semantically equivalent to the original, with only minor wording adjustments. Convergent validity was supported: SIPI scores increased significantly across the four nurse-rated complexity levels and were significantly higher in patients rated as high versus low complexity. In the ROC analysis, SIPI discriminated high- from low-complexity patients with excellent accuracy (AUC = 0.94; 95% CI 0.91-0.97); the optimal cut-off of 53.50 yielded 88.4% sensitivity, 86.0% specificity, 87.6% positive predictive value and 86.9% negative predictive value. Known-groups validity was supported, as patients classified as high complexity by SIPI were significantly older than those classified as low complexity, and SIPI scores were significantly higher in urgent versus scheduled admissions.

The Spanish version of SIPI offers nurse managers a brief, patient-level measure of nursing-care complexity that could complement existing staffing and workload systems to support early identification of high-complexity patients and more equitable, transparent resource allocation, pending confirmation in multicentre, outcome-based studies.

The Spanish version of SIPI showed adequate clinimetric properties, similar to the original Italian version, supporting its use as a brief instrument for measuring the patient-level complexity of nursing care in acute medical hospital wards.