Turner-Stokes L, Tonge P, Nyein K, Hunter M, Nielson S, Robinson I
The Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK.
Clin Rehabil. 1998 Aug;12(4):304-18. doi: 10.1191/026921598669173600.
Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3-5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning.
To develop and evaluate the NPDS for use in a rehabilitation setting.
(1) DEVELOPMENT: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) EVALUATION: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement +1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses.
On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73-0.92, p <0.01) and agreement +1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On re-evaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01).
The NPDS is simple and practical to use in a busy setting. It is shown to be reliable and valid in its assessment of nursing dependency on the ward. Its translation into a directly costable measure of continuing care needs in the community now requires evaluation.
残疾评分，如功能独立性测量（FIM）和巴氏指数，已被证明与护理需求相关，但不能直接用于评估护理需求，因为它们既未表明完成一项任务所需的协助人员数量，也未表明所需时间。诺斯威克公园依赖评分（NPDS）是一种序数量表，可用于评估对护理时间的影响。完成该评分需要3 - 5分钟。连同一小套附加问题，它可直接用于评估社区中的护理需求并促进出院计划制定。
开发并评估用于康复环境的NPDS。
（1）开发：在对现有工具进行调查之后，根据任务对护理时间的影响选择任务，并将其分为基本护理需求（BCN）和特殊护理需求（SNN）。设定了分界点以反映所需的协助人员数量和时间。在对NPDS第5版进行评估之后，进行了微小修改以生成第6版，并在较小规模上重新进行评估。（2）评估：使用5名高级护士对23名住院患者进行组内和组间信度测试。分析包括关联性程度、显著差异、绝对一致性以及一致性 +1水平的评估。尽管没有金标准，但BCN部分应与独立评估的巴氏评分呈负相关。使用相同的分析方法，在21名患者中由3名高级护士对第6版进行重新评估。
在初始评估中，组间信度测试显示每对护士之间的总综合评分具有极好的关联性（rho = 0.73 - 0.92，p <0.01），各个项目的一致性 +1水平范围为73%至100%。有显著分歧的是6个项目。在进行微小修改后的重新评估中，BCN、SNN和综合评分在评估者之间和评估者内部仍显示出高度关联性，各个项目的一致性水平非常令人满意。NPDS的BCN部分与巴氏评分显示出良好的负相关性（rho = 0.91，p <0.01）。
NPDS在繁忙环境中使用简单且实用。它在评估病房护理依赖方面显示出可靠且有效。现在需要对其转化为社区持续护理需求的直接可成本化测量方法进行评估。
