Cesare Manuele, D' Agostino Fabio, Damiani Gianfranco, Nurchis Mario Cesare, Ricciardi Walter, Cocchieri Antonello
Center of Excellence for Nursing Scholarship (CECRI), Board of Nursing (OPI) of Rome, Rome, Italy.
Saint Camillus International University of Health Sciences, Rome, Italy.
J Clin Nurs. 2024 Oct 9. doi: 10.1111/jocn.17460.
To explore the impact of medical complexity, defined by the number of chronic conditions, on the complexity of care, as described by the frequency of nursing diagnoses (NDs) and nursing actions (NAs), in paediatric patients.
Retrospective observational study.
This study was conducted in an Italian university hospital and involved the analysis of electronic health records for neonatal and paediatric patients who were consecutively admitted from January to December 2022. The sample was classified into three categories-non-chronic, single chronic and multimorbid patients-according to their clinical profiles. NDs recorded within the first 24 h from patient hospital admission and NAs performed throughout the hospital stay were counted for each group.
Distinct variations in the prevalence and patterns of NDs and NAs were observed across different levels of medical complexity. A significant moderate positive correlation between the number of NDs and NAs was found. However, the frequency of NDs did not directly correlate with the number of chronic conditions. Conversely, a weak but significant negative correlation was identified between the quantity of NAs and the number of chronic conditions. While the frequency of NDs showed a stable but decreasing trend as the number of chronic conditions increased, a higher number of chronic conditions were associated with a lower quantity of NAs.
We discovered a notable variation in the complexity of care across varying levels of medical complexity in paediatric patients. Our findings suggest that the complexity of care does not necessarily correspond to the degree of medical complexity. The observed negative relationship between the number of chronic conditions and the quantity of NAs underscores the need for further research to explore this unexpected finding and its implications for clinical practice.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Without the adoption of standardised nursing terminologies, such as nursing diagnoses (NDs) and nursing actions (NAs), assessing the complexity of care in paediatric settings can be challenging. Integrating clinical nursing information systems that incorporate standardised NDs and NAs into electronic health records is crucial for accurately documenting and analysing the complexity of care and its relationship with medical complexity.
In paediatric patients, the frequency of nursing diagnoses (NDs) at hospital admission is significantly associated with the quantity of nursing actions (NAs) delivered during hospitalisation. However, there is no correlation between the frequency of NDs and medical complexity, as defined by the number of chronic disorders. Specifically, the frequency of NDs decreases with increasing medical complexity, while the quantity of NAs is negatively associated with the number of chronic disorders. This indicates that the complexity of care cannot be inferred solely from medical complexity, and additional factors need to be explored. These findings enhance understanding of how complexity of care relates to medical complexity in paediatric patients. Insights into the prevalence and patterns of NDs and NAs can benefit nurses, managers, researchers and policymakers by informing clinical and organisational decision-making to ensure high-quality care.
The study adhered to the RECORD Statement.
Patients, service users, caregivers or public members were not directly involved in the design, conduct, analysis and interpretation of data or in writing this paper. Patients contributed only to data collection.
探讨由慢性病数量定义的医疗复杂性对儿科患者护理复杂性的影响，护理复杂性通过护理诊断（NDs）和护理措施（NAs）的频率来描述。
回顾性观察研究。
本研究在一家意大利大学医院进行，涉及对2022年1月至12月连续入院的新生儿和儿科患者的电子健康记录进行分析。根据临床特征将样本分为三类：非慢性病患者、单一慢性病患者和多病共存患者。统计每组患者入院后24小时内记录的NDs以及住院期间执行的NAs。
在不同医疗复杂性水平上，观察到NDs和NAs的患病率及模式存在明显差异。发现NDs数量与NAs数量之间存在显著的中度正相关。然而，NDs的频率与慢性病数量没有直接关联。相反，NAs的数量与慢性病数量之间存在微弱但显著的负相关。随着慢性病数量增加，NDs的频率呈现稳定但下降的趋势，而慢性病数量越多，NAs的数量越少。
我们发现儿科患者在不同医疗复杂性水平下护理复杂性存在显著差异。我们的研究结果表明，护理复杂性不一定与医疗复杂性程度相对应。慢性病数量与NAs数量之间观察到的负相关关系凸显了进一步研究以探索这一意外发现及其对临床实践影响的必要性。
对专业和/或患者护理的影响：如果不采用标准化的护理术语，如护理诊断（NDs）和护理措施（NAs），评估儿科环境中的护理复杂性可能具有挑战性。将纳入标准化NDs和NAs的临床护理信息系统集成到电子健康记录中，对于准确记录和分析护理复杂性及其与医疗复杂性的关系至关重要。
在儿科患者中，入院时护理诊断（NDs）的频率与住院期间提供的护理措施（NAs）数量显著相关。然而，NDs的频率与由慢性病数量定义的医疗复杂性之间没有相关性。具体而言，随着医疗复杂性增加，NDs的频率降低，而NAs的数量与慢性病数量呈负相关。这表明护理复杂性不能仅从医疗复杂性推断，还需要探索其他因素。这些发现增进了对儿科患者护理复杂性与医疗复杂性之间关系的理解。对NDs和NAs的患病率及模式的洞察可为护士、管理人员、研究人员和政策制定者提供信息，以进行临床和组织决策，确保高质量护理。
本研究遵循RECORD声明。
患者、服务使用者、护理人员或公众成员未直接参与数据的设计、实施、分析和解释或本文的撰写。患者仅参与了数据收集。
