Evaluation of the complexity of nursing care in Internal Medicine using two different methods

Introduction

Italy is abandoning the hospital organization model based on clinical specialty divisions in favour of the model based on the intensity of care, in which patients are admitted to the hospital sector most appropriate to their health-care needs, which are related not only to the type of hospitalization, but also to the clinical condition and the degree of dependence. This model includes nursing care, which is organized into health-care sectors based on the complexity of the care required.

Materials and methods

We evaluated the complexity of nursing care in the Operative Unit of the Internal Medicine ward in Legnano hospital using two different methods: the Informative Nursing Performance System (INPS) and the Professionalizing Care Method (PCM). The former was used in a 30-day survey conducted in 2010. Data were collected by trained members of the Unit's nursing staff using an electronic data collection form created with Microsoft Excel^®. The second method was used during a multicenter study conducted in 2009 to validate the PCM: data were collected for 150 consecutive days by trained members of the Unit's nursing staff using an electronic data form managed centrally by the organizer of the study.

Results

The INPS-based survey found that 53.3% of the patients require highly complex nursing care. In the PCM survey, 61% of the patients required nursing care whose complexity was classified as medium-to-high or high. The data collection form used in the INPS survey was simpler and easier to use, with more intuitive questions that could be answered more rapidly (on the average, a total of 2 minutes). The PCM form was more detailed and more difficult to complete (average: 10minutes after the first month of the survey). However, the PCM form was more complete: it considered a number of variables including the evaluation report and the context, and it can be used in place of the initial nursing assessment for elaborating a care plan.

Discussion

The two methods cannot be compared because of differences related to the duration of the surveys, the number of patients evaluated, the number of complexity classes used, and the manner in which the data were elaborated. The results of the two surveys were similar, however, and this finding has served as a starting point for reflection on the reorganization of the Internal Medicine areas of the new Legnano hospital in accordance with the intensity of care model.