Busnel Catherine, Vallet Fanny, Ashikali Eleni-Marina, Ludwig Catherine
Geneva Institution for Home Care and Assistance (imad), Avenue, Cardinal-Mermillod 36, CP 1731, 1227, Carouge, Switzerland.
Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
BMC Nurs. 2022 Jun 24;21(1):166. doi: 10.1186/s12912-022-00942-x.
Person-centered care allows for the inclusion of the totality of a person's needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings.
The COMID-P and the COMID were completed during the fraXity study at the patients' homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC).
A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]).
The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients' needs.
The fraXity study was registered in ClinicalTrials.gov, NCT03883425 , on March 20, 2019.
以患者为中心的护理考虑的是一个人需求和偏好的整体，而不仅仅是临床或医疗方面。这种方法需要开发工具，以便让患者融入其医疗保健过程。基于为护士开发的用于评估家庭护理情况复杂性的30项工具（COMID），本研究提出了一个患者版（即COMID-P）。护士和患者分别独立使用这两种工具对个体情况的复杂性进行评分，以便比较评分结果。
在fraXity研究期间，患者（65岁及以上）和护士在患者家中独立完成COMID-P和COMID。使用卡方检验、麦克尼马尔检验和组内相关系数（ICC）进行项目层面和量表层面的分析。
共保留159对COMID和COMID-P评分用于分析。结果显示，30项中有12项患者/护士达成高度一致，10项达成中度一致，7项达成低度一致。COMID-P和COMID之间的组内相关系数较高（ICC = 0.826，95%CI [0.761 - 0.873]）。
结果表明，患者和护士可以使用具有可比结构特性的工具来评估复杂性。结果还揭示了在复杂性评分方面的一致性和差异，突出了在制定护理计划时达成共识的必要性。需要进一步开展工作，以证明联合评估在制定真正满足患者需求的护理计划中的益处。
fraXity研究于2019年3月20日在ClinicalTrials.gov注册，注册号为NCT03883425。
