title: Complexity of nursing care in acute care hospital patients: results of a pilot study with a newly developed questionnaire.
abstract: OBJECTIVE
  The aim of this pilot study was to develop an instrument for measuring complexity of nursing care in hospitalised acute care patients as well as to examine its comprehensibility, its feasibility, the effort required for data collection, and its inter-rater reliability as well as its face validity.
  
  
  METHODS
  This pilot study was designed as a descriptive, explorative cross-sectional survey with multiple measurements of the patient-related complexity of nursing care and a supplemental qualitative questionnaire conducted on six units of a Swiss university hospital. The instrument to assess complexity of nursing care was developed on the framework of Perrow and encompasses on three subscales a total of 15 items with a 5-point Likert scale.
  
  
  METHODS
  The study was reviewed and approved by the Cantonal Ethics Committee.
  
  
  RESULTS
  In total, 866 assessments of complexity of nursing care were carried out on 234 patients. The variability of the results of the six units, from three different specialties, suggests that the sampling was suitable for capturing a wide spectrum of complexity. The results of the three subscales are consistent and the discussion of them with the participating units shows that they are also plausible. The verification of the inter-rater reliability has satisfactory to high intersubjective correlation of the values. There were also a few suggestions for improving comprehensibility as well as on how to support user application. The time expenditure for the assessment between 2 to 5 minutes per patient was accurately.
  
  
  CONCLUSIONS
  With the newly developed questionnaire to measure the complexity of nursing care in acute care hospitals it seems to be possible to assess and to quantify the complexity of nursing care in various acute care hospital settings. Based on the findings and the feedback of the participating users, the questionnaire needs to be improved for large-scale application.
authors.affiliation: Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kleinknecht-Dolf
authors.affiliation: Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, University Hospital, Berne, Switzerland.
authors.forename: Francis
authors.initials: F
authors.lastname: Grand
authors.affiliation: Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, University Hospital, Berne, Switzerland.|Institute of Nursing Science, University of Basle, Basle, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Spichiger
authors.affiliation: Institute for Data Analysis and Process Design, School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Nursing and Allied Health Care Professions, University Hospital Basle, Basle, Switzerland.
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Martin
authors.affiliation: Institute of Nursing Science, University of Basle, Basle, Switzerland.|Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Spirig
mesh_terms: D000208:Acute Disease; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005246:Feedback; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D009729:Nursing / Q000379:methods*; D010865:Pilot Projects; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013557:Switzerland
keywords: acute care hospital; complexity of nursing care; instrument development; pilot study