Patient Acuity Scales

Literature Review

According to DiClemente (2018), nurses have a moral as well as professional obligation to ensure that patient have access to the best possible level of care. This could be achieved via the deployment of a wide range of ideals, systems and tools. Patient acuity could be conceptualized as one of the most instrumental patient classification systems (Garcia, 2017). In the words of the author, acuity comes in handy in efforts to project how many nursing care hours are needed to optimize patients ability to improve (Garcia, 2017, p. 477). Studies conducted in the past have clearly demonstrated that patient acuity scales have a positive impact on not only patient outcomes, but also patient satisfaction. Further, the said scales help increase staff satisfaction and decrease staff burnout.

Patient acuity does not have an assigned definition. What this means is that in the past, various definitions have been offered by multiple authors in an attempt to define this particular concept. Connor, LaGrasta, Gauvreau, Porter, OBrein, and Hickey (2019) observe that the lack of a clear and straightforward definition of patient acuity, and thus identification its key attributes, has largely stifled the effective application of acuity measurements and tools in clinical settings. Brenan and Daly (as cited in Goh, Ang, Chan, He, and Vehvilainen-Julkunen, 2018), in their attempt to offer a concise definition to the concept, indicate that patient acuity could be conceptualized as the physical and psychological status of the patient and is described as the measurement of the patients illness severity and the intensity of nursing care required (694). This is the definition of patient acuity that will be embraced in this context.

There are quite a number of factors that could affect nurse satisfaction. Some of the factors that have been highlighted in the past include, but they are not limited to, resource adequacy, the organizational policies in place, interactions between co-workers, autonomy, etc. According to Carlisle, Perera, Stutzman, Brown-Cleere, Parwaiz and Olson (2020), past studies that have reviewed data related to nurse satisfaction indicate that adequate staffing and proper assignment of tasks also has a positive impact on the ability of nurses to enjoy their roles. For this reason, there exists a valid reason to embrace systems and standards that ensure that nurses are not overwhelmed by tasks and that patient assignments are equitable. This could be achieved by scoring patient needs using data sourced from the relevant workload indicators and patient characteristics (from a clinical perspective). A patient acuity tool could come in handy in these efforts. Further, it should also be noted that in as far as staff satisfaction is concerned, Firestone-Howard, Gonzalez, Dudjak and Rader (2017) make a finding to the effect that nurse-to-nurse communication as well as perceived professional autonomy are greatly enhanced by patient acuity tool. More specifically, in the words of the authors, their findings indicate that the utilization of the PAT has the potential to result in an improvement of nurse satisfaction and perceptions that patient assignments are all equitable (Firestone-Howard, Gonzalez, Dudjak and Rader, 2017, p. E13). This is more so the case given that according to Minnick et al. (as cited in Firestone-Howard, Gonzalez, Dudjak and Rader, 2017), the perceptions that nurses have of an increase in workload are affected by the nature as well as design of the work environment. In this context, the nature and design of the work environment could be in relation to not only events deemed non-routine, but also case difficulty. It would be prudent to note that patient acuity scales have been associated with greater ability to quantify (as well as promote equitability in) RN assignments.

When it comes to patient satisfaction and outcomes, it would be prudent to note that the same is affected by a wide range of factors. The said factors are inclusive of, but they are not limited to, diagnosis quality, decisions made with regard to treatment, as well as strategies put in place to monitor care. One often overlooked factor in as far as patient outcomes is concerned is nurse stuffing levels. According to Garcia (2017), available evidence indicates that patient outcomes could also be impacted by appropriate staffing. Inappropriate staffing could result in greater workload. Firestone-Howard, Gonzalez, Dudjak and Rader (2017) make an observation to the effect that workload greatly impacts patient outcomes. According to the authors, developing greater understanding of the relevance of workload in as far as patient outcomes are concerned would be instrumental in efforts to chart how workload is influenced by patient acuity tools. For instance in a study conducted by Cimiotti et al. (as cited in Firestone-Howard, Gonzalez, Dudjak and Rader, 2017), it was found...…patent acuity assessment as well as ideal nurse-patient assignment. Nguyen (as cited in DiClemente, 2018) also observes that after the deliberate consideration of acuity, nurse managers can accurately establish the needed care level following the assessment of the various needs of patients at the individual level. There are a wide range of factors that could impact the needed level of care for each patient. Some of these factors, according to DiClemente (2018) are the psychological needs of patients, the patients family dynamics, the instruction level required for the patient, the complexity of patient care procedures, etc. According to the authors, these factors play a huge role in the determination of each individual patents amount of nursing care. As a consequence, the relevance of assessing patient acuity cannot be overstated in efforts to make nursing assignments reasonable and more effective. Carlisle, Perera, Stutzman, Brown-Cleere, Parwaiz and Olson (2020) are also of the opinion that there is need to individualize staffing needs to patient needs. In the words of the DiClamente (2017), acuity tools help nurses succeed in promoting the best patient outcomes a standardized tool allows nurses not only to communicate patient needs, but also communicate their own needs (387). Goh, Ang, Chan, He, and Vehvilainen-Julkunen (2018) also observe that patient acuity tools come in handy in nursing wrkload management. In essence, effective management of nursing workload results in increased staff satisfaction as well as better patient outcomes.

One acuity tool that has been deployed in the past is the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool. This particular tool, as Connor, LaGrasta, Gauvreau, Porter, OBrein, and Hickey (2019) point out was formulated in efforts to see to it that patient acuity was quantified in respect of the complexity of nursing cognitive workload. In a study seeking to use this particular tool to scale pediatric acuity measurement, Connor, LaGrasta, Gauvreau, Porter, OBrein, and Hickey (2019) made a finding to the effect that the CAMEO acuity tool was largely feasible and provided an opportunity to further inform decision making in projection of staffing models (151). In essence, this particular study vouches for the relevance of deploying patient acuity scales and tools in clinical settings. In the final analysis, however, it should be noted that there is a need for continued exploration and testing of effective, user friendly,…