title: Nurses' assessments and patients' perceptions: development of the Night Nursing Care Instrument (NNCI), measuring nursing care at night.
abstract: BACKGROUND
  Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night.
  
  
  OBJECTIVE
  The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night.
  
  
  METHODS
  The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'.
  
  
  METHODS
  Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha.
  
  
  RESULTS
  The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items.
  
  
  CONCLUSIONS
  These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.
authors.affiliation: School of Social and Health Sciences, Halmstad University, Sweden. peter.x.johansson@lthalland.se
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
authors.forename: Magnus
authors.initials: M
authors.lastname: Oléni
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009551:Night Care / Q000523:psychology / Q000592:standards*; D009730:Nursing Assessment / Q000592:standards; D015403:Nursing Evaluation Research / Q000379:methods* / Q000592:standards; D009741:Nursing Staff, Hospital / Q000523:psychology; D011594:Psychometrics; D011787:Quality of Health Care / Q000592:standards; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D013548:Sweden