Essential elements in determining patient's complexity of nursing care.

Abstract

BACKGROUND Nurses dedicate majority of working time to satisfy patients' needs, which are oftentimes complex. Although the concept of patient's complexity of care (PCC) has been extensively studied, it remains undefined in its essential characteristics. Various tools for assessing PCC have been developed, yet, there is no gold standard of reference. AIM This study intends to explore the elements that determine PCC focusing on the patient's needs. METHODS The bed management team of a University Hospital developed in 2010 a PCC measurement instrument, similar to a triage system, to classify rapidly patients into macro-levels of care complexity (low, medium, high, intensive). Descriptive analysis of prospectively collected data registered in nursing records during 2016-2017 are presented in this study. The incidence of individual metrics on the value assigned to the overall PCC level was calculated. RESULTS 26593 patients' records were analyzed. The final level of PCC was equal to patient's level of autonomy in 92,2% of cases, to clinical stability in 74,4% and to cognitive status in 58,4%. CONCLUSIONS Our finding indicate that essential elements to determine PCC are patient's autonomy and clinical stability. Therefore, nurses can use these metrics to classify quickly PCC in their work settings. NURSING IMPLICATIONS Identifying and measuring PCC is very important for nurses. It can facilitate and support nurse decision-making in design, implementation and evaluation of activities aimed at improving patient care. Moreover, it can help in the distribution of care loads in the shift, and from an organizational point of view, it can allow defining staffing assets.