title: Assessing time use in long-term institutional care: development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC).
abstract: BACKGROUND
  Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language.
  
  
  METHODS
  The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero.
  
  
  RESULTS
  The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found.
  
  
  CONCLUSIONS
  The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.
authors.affiliation: School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Tuinman
authors.affiliation: Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Mathieu
authors.initials: M
authors.lastname: de Greef
authors.affiliation: School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
authors.forename: Roos
authors.initials: R
authors.lastname: Nieweg
authors.affiliation: School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
authors.forename: Wolter
authors.initials: W
authors.lastname: Paans
authors.affiliation: Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; School of Nursing & Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Petrie
authors.initials: P
authors.lastname: Roodbol
keywords: Classification; Content validity; Instrument development; Inter-rater reliability; Long-term care; Nursing home; Nursing intervention; Nursing staff; Observation