title: The Concept of Care Complexity: A Qualitative Study.
abstract: BACKGROUND
  Hospital organisations based on the level of care intensity have clearly revealed a concept, that of care complexity, which has been widely used for decades in the healthcare field. Despite its wide use, this concept is still poorly defined and it is often confused with and replaced by similar concepts such as care intensity or workload. This study aims to describe the meaning of care complexity as perceived by nurses in their day-to-day experience of hospital clinical care, rehabilitation, home care, and organisation.
  
  
  METHODS
  Fifteen interviews were conducted with nurses belonging to clinical-care areas and to heterogeneous organisational areas. The interview was of an unstructured type. The participants were selected using a propositional methodology. Colaizzi's descriptive phenomenological method was chosen for the analysis of the interviews.
  
  
  RESULTS
  The nurses who were interviewed predominantly perceive the definition of care complexity as coinciding with that of workload. Nevertheless, the managerial perspective does not appear to be exclusive, as from the in-depth interviews three fundamental themes emerge that are associated with the concept of care complexity: the patient, the nurse and the organisation.
  
  
  CONCLUSIONS
  The study highlights that care complexity consists of both quantitative and qualitative aspects that do not refer only to the organisational dimension. The use of the terminology employed today should be reconsidered: it appears to be inappropriate to talk of measurement of care complexity, as this concept also consists of qualitative - thus not entirely quantifiable - aspects referring to the person being cared for. In this sense, reference should instead be made to the evaluation of care complexity, which would also constitute a better and more complete basis for defining the nursing skills required in professional nursing practice. Significance for public healthIn recent years, reference to the concept of complexity has become increasingly frequent in the management of healthcare systems. This interpretation of reality and of knowledge reflects the increasing use of a multi-disciplinary approach, in both clinical and research fields, that re-evaluates the importance of the environment and the preferences of the individual. The influence of the epistemological theory of complexity in healthcare can also be identified in discussions on the role and methods of epidemiology and public health; in breaking the walls between the exact sciences and the humanities; in the appreciation of qualitative methods of research and the Bayesian approach to biostatistics.
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia.
authors.forename: Milena
authors.initials: M
authors.lastname: Guarinoni
authors.affiliation: Department of Health, Life and Environmental Sciences, University of L'Aquila , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Petrucci
authors.affiliation: Department of Health, Life and Environmental Sciences, University of L'Aquila , Italy.
authors.forename: Loreto
authors.initials: L
authors.lastname: Lancia
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia.
authors.forename: Paolo Carlo
authors.initials: PC
authors.lastname: Motta
keywords: Complexity of care; hospital organization; intensity; nursing