Validation of the instrument "Complexity of Nursing Care"-A mixed-methods study.
Evelyn Huber, Michael Kleinknecht-Dolf, Christiane Kugler and 2 others
PMID 31871705WHAT IT FOUND
Nurses can rate daily bedside assessments into a complexity score from low to high.
Two raters generally agreed, but adapting care and predicting intervention effects were hardest to rate.
Key findings
01The seven-item instrument produces a complexity score from low to high.
02Two raters generally agreed on all items, but agreement was lower for adapting nursing care and predicting intervention effects.
03Only a lower ratio of situations required constant attention, marking high nursing-care complexity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No independent standard was available to show that the complexity score measures what it should, because criterion validity could not be investigated. The study did not examine how complexity changes over a hospital stay or produce a summary of complexity across the stay. The qualitative part covered only 12 cases, so it gives limited insight into how nurses experience the instrument in practice. Items about adapting nursing care and predicting intervention effects were harder to rate and had lower agreement, suggesting wording or understanding problems. The instrument requires familiarity and reflection, which nurses may lack in day-to-day practice.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not treat a high complexity score as proof that a patient needs more staff or will have worse outcomes. The study tested whether nurses could rate complexity consistently, not whether the score predicts staffing need or patient results.