title: Mixed-methods study to develop a patient complexity assessment instrument for district nurses.
abstract: BACKGROUND
  There is increasing reference to complex patient needs in health care. However, little is known about how to measure patient complexity or the relationship between it and district nursing activity.
  
  
  OBJECTIVE
  To illustrate the use of group concept mapping (GCM) to conceptualise and develop items for a patient complexity assessment instrument to be used by district nurses.
  
  
  CONCLUSIONS
  The first phase of this research used GCM conceptualisation and consensus methodology to identify items for a community-based patient complexity instrument. GCM helped to provide a conceptual understanding of community-based patient complexity through focused exploration of the term.
  
  
  RESULTS
  indicated that a number of environmental, sociological, psychological, behavioural, physical and organisational factors needed to be included. This, in turn, showed that an existing taxonomy did not contain the relevant items. Consequently, amendments were made and a new instrument developed.
  
  
  CONCLUSIONS
  GCM is a suitable consensus method for use in nursing theory and developing instruments. It proved successful in achieving consensus with no loss of participants' views.
  
  
  CONCLUSIONS
  GCM is a suitable method for nurses to use in research or practice development activities as it is based on a facilitative and engagement-led approach.
authors.affiliation: University of South Wales, Pontypridd, UK.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Thomas
authors.affiliation: University of South Wales, Pontypridd, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wallace
authors.affiliation: University of South Wales, Pontypridd, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Jarvis
authors.affiliation: University of South Wales, Pontypridd, UK.
authors.forename: Ruth Elizabeth
authors.initials: RE
authors.lastname: Davis
mesh_terms: D009730:Nursing Assessment; D015399:Nursing Research / Q000379:methods*; D009740:Nursing Staff; D014852:Wales
keywords: community nurse; concept mapping; conceptualisation; consensus; district nurse; group concept mapping; instrument development; mixed methods; patient complexity