Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI‐HC

Abstract

Aim Home care nurses often use the Resident Assessment Instrument‐Home Care (interRAI‐HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI‐HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). Design Data were collected at the baseline assessment of the fraXity study ( N = 231, aged ≥ 65), which relied on an observational longitudinal design. Methods Measures were the interRAI‐HC, from which the CI binary variables were computed and the COMID, used as a reference. Results Twenty‐six CI variables were computed from the interRAI‐HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 ( p < .001). Conclusions The study demonstrates that complexity can be assessed directly from the interRAI‐HC by deriving a CI.

Exploring home-based care nurses’ mindset for nursing practices: a phenomenological study

“…As underlined by the findings and in other studies, practising nursing in a home care setting is complex. It includes not only various types of care and patients, but also multiple formal or informal stakeholders that are present and interacting with each other and with the healthcare system, and the complexity involved in situations that are not consistent or alike [ 44 ]. Existing guidelines for long-term care patients, such as the Chronic Care Model [ 45 ] or COMID [ 60 ] may not consider the full complexity of practising nursing in home care settings.…”

“…The ability to manage emergent organisations, like home care, can also shed light on another main concept in this study, namely nurses as all-rounders. Home nursing is a complex service [ 1 , 44 , 60 , 69 ] that includes both emergencies and chronically ill patients with complex diseases and care needs. Further, this can be linked to the system of ‘everyone works on any worklist’.…”

“…Nursing is an adaptive complex system [71], particularly in the home care setting [44]. Theories about nursing may lack focus on integrated care, and development about mindlines in the home care context is poorly developed both in nursing theories and frameworks for practising nursing [72].…”

“…A complex relationship can exist between theory and practice, especially in the caring professions, where one needs the ability to combine knowledge from different fields, communicate effectively and exercise discretion regarding legislation, ethics, and health policies [ 42 , 43 ]. Existing studies indicate particular challenges when nursing is offered in a home care setting [ 44 ]. The developed models for complexity in nursing, such as the Chronic Care Model [ 45 ], are mostly designed for hospital care rather than home care [ 46 ]; there are also complexities involved in knowledge transfer to partners outside the profession [ 47 , 48 ].…”

“…In-home care, nurses are required to utilise a multidimensional, interdisciplinary, and holistic approach. They must address factors related to patients, other health professionals, and the healthcare system such as the quality of care delivery, organisational factors, and so on [ 44 ]. The health and social care sector includes human service organisations that must deal with problems that are unexpected, unpredictable, and complex to solve, referred to as ‘wicked problems’ [ 29 , 49 ].…”