Validazione di un punteggio di gravosità assistenziale infermieristica per i pazienti delle cure domiciliari

Abstract

Identifying a measure of community nurses' workload is complicated due to the difficulty of capturing and standardizing the nature of community nursing across health care settings. Aim of this paper is to validate a workload/caseload nursing score for home care patients. Patients of health care districts of Veneto region with at least two home care visits per month and a multi-dimensional and professional assessment were assesses with instruments used in routine care, adapted to the scope (a multidimensional assessment scale for frail elderly, that includes assessment of cognitive function, social support, mobility, functional status, health care needs); a list of patients needs. Time required for home care visits (excluded travelling time) was voluntarily registered in 5/8 districts. Uni and multivariate analyses were performed and a robust logistic regression accounting for skewed values. A tree regression analysis with CART Package model to identify conceptual nodes of the proposed classification was used. A group of 1298 of home care patients of 9 Districts were assessed and in 639 patients the time needed for home care visits was registered. The predictive value of the model on home care visits over 3 months was 44% while 59% for the time needed for nursing home care visits (number and length of nurses visits). A caseload score allows allocating nursing resources. The role of the family and of the overall environment should be accounted for. Patients need to be regularly re-assessed to capture any changes in their overall situation and needs.