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levenstam a.-k. & bergbom i. (2002) Journal of Nursing Management10, –Changes in patients' need of nursing care reflected in the Zebra systemDuring 1995–97, many head nurses stated that they had perceived an increase in patients' need of nursing care. A questionnaire was designed to determine the reasons for this. The purpose of the investigation was to answer two questions, ‘What were the reasons for head nurses perception of an increase in patients need of nursing care from 1995 to May 1997?’ and, ‘Does patient classification in the Zebra system reflect the underlying changes in patients’ need of nursing care? The results show that there are several reasons behind changes in the patients need of nursing care. The main reasons are a decreased general level of health among patients and that treatments are more time-consuming. After comparing statistics concerning patient classification with the answers received from the questionnaire, a good level of agreement could be seen in these.