The Evolution of an Ambulatory Nursing Intensity System

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Abstract
To establish a methodology for developing a user-friendly, environmentally specific nursing intensity measurement tool. Nursing intensity measurement systems assess the demand for nursing care in a given setting and must adapt to changes in technology, patient populations, and treatment profiles. Nowhere is this more evident than in a clinical research setting where demands for nursing care are driven by changing patient populations and new biomedical research protocols. This article traces the extension of an adult oncology ambulatory nursing intensity system at the Clinical Center, National Institutes of Health, into 3 day hospitals: medical surgical, pediatrics, and hematology/oncology. A team of stakeholders including nurse managers, clinical nurse specialists, and senior clinical research nurses was assembled. Descriptions of clinical research care for each day hospital were developed and organized into 6 levels with their associated time frames. Descriptions were reviewed by 2 content specialists, and a content validity index quantified the extent of their agreement. A weighted kappa statistic was used to measure interrater reliability. A content validity index of .87 indicated a high level of agreement between specialists. The weighted kappa statistic was .80, demonstrating substantial agreement between 2 raters. This ambulatory nursing intensity tool proved to be adaptable to heterogeneous patient populations.

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