The RAFAELA PCS was developed in Finland in the late
1990s and is used to assess the need for nursing resources.
RAFAELA was tested in 14 Finnish hospitals during 2000–
2002 [17]. According to Carr-Hill and Jenkins-Clarke [18],
approaches to measuring NWL can be classified into four
groups: dependency-driven, task-oriented, care plan-driven,
and unit-based. RAFAELA is a dependency-driven method
with a bottom-up management approach (cf. [5]).The main
goal of RAFAELA is to balance patients’ care needs and
nursing resources [19, 20]. Almost every Finnish hospital has
nowimplemented this system and implementation is ongoing
in Norway, Iceland, Sweden, and Holland. RAFAELA is
composed of two instruments. The first is the Oulu patient
classification (OPCq) instrument, whereby each patient’s NI
is measured daily. The second is the professional assessment
of optimal nursing care intensity level (PAONCIL) instrument,
which linksNI to the use of resources and also provides
information on some central nonpatient factors (12 in total)
that may influence nurses’ experiences of NWL.
In order to improve RAFAELA, and given the continuously
changing health care environment, an assessment of
the PAONCIL instrument in regard to its list of nonpatient
The RAFAELA PCS was developed in Finland in the late1990s and is used to assess the need for nursing resources.RAFAELA was tested in 14 Finnish hospitals during 2000–2002 [17]. According to Carr-Hill and Jenkins-Clarke [18],approaches to measuring NWL can be classified into fourgroups: dependency-driven, task-oriented, care plan-driven,and unit-based. RAFAELA is a dependency-driven methodwith a bottom-up management approach (cf. [5]).The maingoal of RAFAELA is to balance patients’ care needs andnursing resources [19, 20]. Almost every Finnish hospital hasnowimplemented this system and implementation is ongoingin Norway, Iceland, Sweden, and Holland. RAFAELA iscomposed of two instruments. The first is the Oulu patientclassification (OPCq) instrument, whereby each patient’s NIis measured daily. The second is the professional assessmentof optimal nursing care intensity level (PAONCIL) instrument,which linksNI to the use of resources and also providesinformation on some central nonpatient factors (12 in total)that may influence nurses’ experiences of NWL.In order to improve RAFAELA, and given the continuouslychanging health care environment, an assessment ofthe PAONCIL instrument in regard to its list of nonpatient
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