Validation of the Gaslini Pediatric Nursing Score© to Assess Pediatric Patients’ Nursing Complexity

Abstract

Highlights What are the main findings? Statistical validation of the Gaslini Pediatric Nursing Score© (GPNS©), used to assess pediatric patients’ nursing complexity in low- and medium-intensity care units of a tertiary pediatric teaching hospital, demonstrated substantial inter-rater reliability, short completion time, and very high perceived ease of use. Exploratory Factor Analysis (EFA) provided evidence consistent with a unidimensional factor structure, supporting the tool’s construct validity. The fair agreement with clinical judgment does not allow considering concurrent validity as established, and the paucity of patients classified within the high-complexity level was not sufficient to consider validation for this subgroup as established. What are the implications of the main findings? The GPNS© constitutes a reliable, non-time-consuming, and easy-to-use tool for assessing nursing complexity among hospitalized pediatric patients in low- and medium-intensity care units within its development setting. Further studies comparing the GPNS© with an externally validated criterion remain necessary. In addition, further research is also needed to assess a larger, representative sample of patients classified at the high-complexity level. Abstract Background/Objectives: Aligning care delivery with patient needs is essential for the quality of care. As nursing needs vary in complexity, Nursing Patient Classification Systems (NPCSs) are critical to guide patient allocation to appropriate care settings. The “Gaslini Pediatric Nursing Score©” (GPNS©) was developed to assess nursing complexity in pediatric inpatients. Following face and content validity testing, this study aimed to validate the GPNS© by assessing its inter-rater reliability, concurrent validity using clinical judgment as the reference standard, construct validity, completion time, and perceived ease of use. Methods: A prospective observational validation study was conducted at a tertiary pediatric teaching hospital. All pediatric patients (from birth to <18 years) admitted to the 17 low- and medium-intensity care units during the study period were included. Data were collected via digital forms by shift nurse pairs. Results: Overall, 389 nurses participated; 192 patients were assessed in pairs, yielding 814 valid forms. Inter-rater reliability was substantial (Cohen’s kappa = 0.785), whereas concurrent validity showed fair agreement (Cohen’s kappa = 0.300), with disagreements occurring predominantly between adjacent complexity levels (weighted Cohen’s kappa = 0.523). Exploratory Factor Analysis (EFA) isolated a single latent variable, conceptualized as “nursing complexity”. The mean completion time was 1.8 min, with a 96.7% positive rating for perceived ease of use. Conclusions: Within its development setting, the GPNS© demonstrated substantial inter-rater reliability, short completion time, and very high ease of use, with EFA providing evidence consistent with construct validity. However, both the fair concurrent validity and the paucity of patients classified within the high-complexity level were not sufficient to consider validation of the GPNS© as fully established. Further studies against an external criterion and on larger samples of high-complexity patients remain necessary.