Implementation strategies of measurement instruments and their validity as adopted in Italian hospital nursing practice: an Italian cross-sectional study.

Purpose: The purpose of this study was to describe the implementation strategies of measurement instruments and their validity as adopted in Italian hospital nursing practice.

Method: A descriptive, regionally based study was adopted in 2008. Eight public hospitals were included. After collecting the available instruments used by nurses and/or patients in the measurement of patients' problems or perceptions of those problems (actual and/or potential), the researchers conducted two structured interviews per ward: the first with the chief nurse, the second with a clinical nurse. The interviews focused on each measurement instrument collected, on the implementation strategies adopted for the instruments, and on the perceived usefulness and appropriateness of each instrument.

Findings: Overall, 70 wards were included; 18 (25.7%) of the wards did not use any instrument. In the remaining 52 wards, 156 instruments were collected (from 1 to 10 per ward) evaluating 55 different actual or potential patient problems. Of the instruments adopted, 70.9% were not formally validated. Hospital administration primarily determined which instruments were to be used (67, 42.9%), and introduction to staff was mainly supported by continuing education courses (92, 59%). The level of appropriateness and usefulness of the instruments, as perceived by the clinical nurses and chief nurses, was high (>8 on a scale of 0-10, where 0= not at all appropriate/useful and 10= very appropriate/useful).

Conclusion: Despite the increasing demands for reliable nursing data as a basis for measuring nursing effects on nursing outcomes and safety, a number of wards used no measurement instruments at all; within wards that used measurement tools, many instruments had not been validated.

Implications: The introduction of nonvalidated instruments in Italian hospitals needs to be restricted because of the short- and long-term negative effects these nonvalidated instruments may have. A national consensus on approved and validated instruments for nursing assessment should be made available in the wards as a priority.