Workload measurement and psychiatric mental health nursing: mathematical and philosophical difficulties.

There are difficulties with implementing workload measurements instruments and patient classification systems in psychiatric settings. These instruments are designed at a ratio level of measurement. This would be valid only if nursing practice existed at a similar level. The nurse-client relationship is considered to be the essence of psychiatric nursing and this phenomena is described as ordinal level phenomena. In psychiatric nursing, it is essential to consider the nurse as well as the client, and to assess the current phase of the relationship. There is a need to balance the economic pressure for justification by numbers with the realization that many aspects of nursing practice are not measurable as reducible phenomena nor exist at a ratio level.