Complexity, instability, and clinical judgment: The role of the COMID tool in home care nursing practice

Introduction: Clinical analysis and nursing judgment are essential in the face of the complexity of home care situations. The COMID (COmplexité Multidimensionnelle pour la pratique Infirmière à Domicile), composed of 30 items and 3 additional questions on clinical judgment, is used in Geneva home care. The objective is to test the empirical links between COMID and nursing judgment.

Method: Analysis of 2,824 COMIDs: 1) ROC analyses between COMID score and judgment and determination of thresholds, 2) correlations between COMID items and judgment, and 3) crossover between judgments of complexity and instability. Results: The COMID score makes it possible to differentiate between situations judged to be complex vs. simple. The correlations between the items and this clinical judgment measure are all significant. Judgments of instability and complexity, while related, correlate differently with total score and dimensions. Discussion, conclusion: COMID is a tool to support nursing judgment of the complexity of situations. It would be interesting to identify its integration for the establishment of care plans.