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Originalarbeit

„Man muss stets aufmerksam sein“

Kategorisierung patientenbezogener Komplexität der Pflege im Akutspital

Published Online:May 01, 2020https://doi.org/10.1024/1012-5302/a000738

Abstract

Zusammenfassung.Hintergrund: Die Zunahme von chronischen Krankheiten und Multimorbidität sowie anspruchsvollere Behandlungsmethoden führten in Akutspitälern zu erhöhter Akuität und Komplexität von Pflegesituationen. Ziel: Diese Untersuchung verfolgte das Ziel, Kategorien unterschiedlich ausgeprägter, patientenbezogener Komplexität der Pflege zu explorieren und zu beschreiben. Damit soll das Verständnis der Anforderungen an die Pflege aufgrund von Patientensituationen erweitert werden. Methode: Mit einem kollektiven Case Study Design ließen wir diplomierte Pflegefachpersonen und Pflegeexpertinnen die Komplexität von zwölf Pflegesituationen mit einem Fragebogen einschätzen und interviewten sie zu ihren Überlegungen dazu. In dieser Substudie führten wir eine qualitative Sekundäranalyse dieser Daten durch und suchten nach Kategorien vergleichbarer Komplexitätsausprägung. Ergebnisse: Wir fanden fünf Komplexitätskategorien zwischen „wenig komplex“ und „höchst komplex“. Wenig komplexe Situationen benötigten die Aufmerksamkeit der Pflegefachperson auf Routineinterventionen, während höchst komplexe Situationen ihre dauernde Aufmerksamkeit auf schlecht einschätzbare und kontrollierbare Zustände mit offenem Ausgang erforderten. Schlussfolgerungen: Die fünf Komplexitätskategorien können Hinweise auf unterschiedlich ausgeprägte Komplexität von Pflegesituationen geben. Sie können Führungspersonen bei der bedarfsgerechten Zuteilung von Pflegefachpersonen zu Patientinnen und Patienten unterstützen und einen Rahmen für Reflexionen bei komplexen Pflegesituationen in der Aus- und Weiterbildung bilden.


“One always has to be watchful”: Categorisation of patient-related complexity of nursing care in acute care hospitals

Abstract.Background: The increase of chronic illnesses and multimorbidity as well as more challenging treatment methods have caused higher acuity and complexity of nursing care situations. Aim: The aim of this study was to explore and establish categories which describe different levels of patient-related complexity of nursing care in order to broaden the understanding of demands on nursing care due to patient situations. Methods: Using a collective case study design, we asked registered nurses and clinical nurse specialists to assess the complexity of twelve nursing care situations through a questionnaire before interviewing them about their deliberations on how they rated the situation. In this sub-study, we performed a qualitative secondary analysis of these data and looked for categories of comparable degrees of complexity. Results: We found five categories of complexity, ranging from “slightly complex” to “highly complex”. “Slightly complex” situations demanded a nurse’s attention on routine interventions, while “highly complex” situations demanded their constant attention on poorly assessable and poorly controllable conditions with uncertain outcomes. Conclusions: The five categories of complexity describe characteristics of the different levels of complexity in nursing care situations. They can support nursing managers with allocating nursing staff to patients according to their needs and provide a framework for discussing complex nursing care situations in basic and continuing education.

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