[The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital]. / Anwendung der DOS und Delirprävalenz.

The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital Abstract: Background: With a prevalence of 12-64%, delirium is a common complication in acute care, associated with negative outcomes such as increased mortality and prolonged length of stay. Many hospitals have guidelines to improve the delirium management. The Delirium Observation Screening Scale (DOS) Score is collected in the study hospital from all patients ≥ 70 years at each shift for at least 3 days. Delirium is diagnosed by a physician and coded according to ICD-10. Purpose: Evaluation of the delirium screening with the DOS according to internal guideline in terms of number of DOS assessments performed, prevalence of delirium (DOS score ≥ 3 points, CD-10 code delirium). Method: This retrospective quantitative single-centre longitudinal study used 2017 and 2018 data of 10046 cases. Statistical analysis methods were used to analyse prevalence of delirium and subgroup comparisons. Results: At least one DOS score was documented in 92% of cases aged ≥ 70-years (n = 5038). DOS implementation varied between 60% in the early, 49% in the late and 38% in the night shift. The prevalence of delirium was 12% according to DOS score ≥ 3 and 4% according to physician diagnosis of a delirium. Cases with a DOS score ≥ 3 were significantly older, more often female, had more comorbidities and were depressed. Conclusions: DOS is performed in most patients when indicated. The DOS implementation frequency varied depending on the shift.

Patients' sexual harassment of nurses and nursing students: A cross-sectional study.

Background: Workplace sexual harassment towards nurses is a global phenomenon: approximately one quarter of all nurses are affected by sexual harassment. The extent and type of sexual harassment vary greatly depending on the country, culture, level of education, and care setting. Notably, patients are amongst the main perpetrators. Importantly, sexual harassment has serious consequences on nurses' health and work performance. Objective: This study examined the prevalence of patients' workplace sexual harassment towards nurses and nursing students at a University of Applied Sciences in Switzerland. Design: A quantitative cross-sectional descriptive correlational design was used. Setting: The survey was conducted at the university's Institute of Nursing under the Department of Health. Participants: Nurses and nursing students who were studying or attending a continuing education programme and had worked as a nurse with direct contact with patients in the last 12 months could qualify as participants. A final sample of 251 participants was used for the analysis. Methods: Data were collected using the 'Sexually Harassing Behaviour Questionnaire from an extraorganizational perspective'. Preliminary analysis involved computing the percentage and absolute frequencies, mean scores, standard deviations, and ranges. The hypotheses were tested using non-parametric tests, such as the Wilcoxon test for two independent samples, Spearman correlation test, and Kruskal-Wallis H test. Results were considered statistically significant at alpha < 0.05. Results: Most participating nurses were women (88.5%) and worked in adult acute care (54.2%). The mean age was 25.5 (SD = 7.5) years. On average, they had worked in the nursing profession for 7 years. 17.1% of the participants had received training on sexual harassment. Overall, 95.6% of the participants reported experiencing sexual harassment of any type at least once in the last 12 months. The most common type of harassment was verbal sexual harassment. Notably, sexual harassment was statistically significantly more frequent the younger the nurses were [rs = -0.13, p = 0.046]. Furthermore, it was statistically significantly more prevalent in adult acute care than in paediatrics [H (10) = 18.4; p = 0.048; Cohen's d = 0.4]. Conclusions: Patients' sexual harassment of participant nurses and nursing students is highly common. The high prevalence of sexual harassment and low number of nurses who have received training on sexual harassment demonstrate the need for initiatives to address this phenomenon in the basic education of nurses. Furthermore, evidence-based interventions against sexual harassment in the nursing profession are needed.

Use of digital technologies to combat loneliness and social isolation: a cross-sectional study in Swiss outpatient care during COVID-19 pandemic.

BACKGROUND: There is limited data on the use of digital technologies in outpatient care in Switzerland. Our objectives were therefore to determine which digital technologies are used and whether they had an impact on loneliness and social isolation in the wake of the COVID-19 pandemic. METHODS: A cross-sectional survey design was used with a convenience sample of 1272 outpatient care providers in Switzerland. The questionnaire used is based on an unsystematic literature review and a previous qualitative study with six outpatient caregivers and two caring relatives, based on which the 30 items for this questionnaire were developed. Data were analyzed descriptively, and group comparisons were made using the Kruskal Wallis test. Changes over time were measured using Friedman test with Bonferroni post hoc tests and Wilcoxon test for paired samples. RESULTS: The impact of the COVID-19 pandemic was evident both on the part of the health care system, e.g., inadequate protective equipment; on the part of health care providers, e.g., increasing fatigue in keeping abreast of the virus as the pandemic progressed; and on the part of clients, who reduced services of care, e.g., out of fear of infection. According to the assessment of the outpatient caregivers, loneliness and social isolation of the clients was high in spring 2020 and increased strongly in the following winter. Alternative solutions, such as digital technologies, were hardly used or not used at all by the clients. CONCLUSIONS: The results suggest that the pandemic is dramatically impacting clients. This highlights the urgent need to invest in the development of appropriate digital technologies reducing the impact of social isolation and loneliness and the associated long-term costs to the healthcare system.

The influence of nurse characteristics on practice skills and attitudes towards working with families in critical care: A regression analysis.

OBJECTIVES: The study aimed to identify nurse characteristics that influence their self-perceived practice skills in working with families and their attitudes towards engaging families in adult and neonatal intensive care units. RESEARCH METHODOLOGY/DESIGN: Secondary data analysis using a descriptive, cross-sectional design. SETTING: An online survey was completed by 256 nurses from six adult intensive (73% response rate) and two neonatal intensive and one intermediate care unit (27% response rate) in a Swiss, university affiliated hospital. MAIN OUTCOME MEASURES: Nurses' self-perceived practice skills in working with families were assessed with the "Family Nursing Practice Scale". Attitudes towards families were measured with the "Families' Importance in Nursing Care - Nurses' Attitudes Scale". Data were analysed with multiple linear regression models. RESULTS: Prior education in family nursing significantly influenced nurses' self-perceived practice skills in working with families. Nurses' clinical speciality had a significant influence on their attitudes towards overall, and on the subscale "family as a burden". Neonatal intensive care nurses showed more open attitudes towards families overall, but perceived family more often as a burden than nurses in adult intensive care. Nurses' perceived skills and attitudes in family engagement significantly influenced each other. CONCLUSION: The results suggest that nurses' prior education in family nursing and clinical speciality determine their ability to work with and engage families in critical care. Our study suggests that integration of family nursing engagement practices in critical care requires educational implementation strategies combined with culture change efforts.

Evaluation of knowledge about gestational diabetes mellitus among postpartum women and its connection with women's sociodemographic and clinical characteristics: a quantitative cross-sectional study.

OBJECTIVE: to define the knowledge level among postpartum women affected by gestational diabetes and identify its association with women's sociodemographic and clinical characteristics. DESIGN AND SETTING: a cross-sectional comparative study was conducted. Data collection took place in a single university hospital in the German speaking part of Switzerland. PARTICIPANTS: a total of 107 postpartum women diagnosed with gestational diabetes in the current pregnancy completed a gestational diabetes mellitus specific knowledge questionnaire (GDMKQ) in German or English in their postpartum period. Further, sociodemographic and clinical characteristics were collected. RESULTS: Women were between 24 and 45 years old, 56.1% had an academic degree, 60.7% were migrant women coming mainly from other European countries, 17.8% had a previous history of gestational diabetes, and 31.8% had a family history of diabetes. As measured with the GDMKQ, women with a higher educational level obtained higher scores and therefore showed a better knowledge level about gestational diabetes compared to women with primary and secondary educational levels (M 13.3 vs M 11.1 and 12.5; χ2 (2) = 13.003, p = .002). In addition, women with a previous history of gestational diabetes also reached higher scores compared to women with no history of gestational diabetes (M 13.6 vs M 12.5, Z = - 2.278, p = .023). CONCLUSION AND IMPLICATION FOR PRACTICE: Even if the knowledge status among women attending this single Swiss hospital is presently very good, a lower educational level was associated with a lower knowledge level and identified as the main factor to hinder women's comprehension of gestational diabetes. More individually tailored consultations by health care professionals may serve to meet women's needs more adequately and support them better in the understanding of their condition.

[Differences in epaAC© in heart failure patients with or without readmission: a retrospective case-control study]. / Unterschiede im epaAC© bei Patient_innen mit Herzinsuffizienz mit oder ohne Rehospitalisation.

Differences in epaAC© in heart failure patients with or without readmission: A retrospective case-control study Abstract. Background: Heart failure is one of the most frequent reasons for hospitalization in elderly people. In heart failure, approximately 22.8 % of hospitalised patients are rehospitalised within 30 days. The nursing assessment tool epaAC could provide information on risk factors for readmission. Aim: The aim of this study was to identify possible group differences in the items and scores of the epaAC discharge assessment with regard to the endpoint of unplanned readmissions within 30 days after discharge from index-hospitalisation. Methods: Using a retrospective case-control design, differences in the epaAC variables were investigated by descriptive and comparative statistics. Chi-square test, Wilcoxon test and t-test were performed with two-sided alpha level α < 0.05. Alpha error accumulation was accounted for by Benjamini & Hochberg correction. Results: No significant group differences were found in all items and scores of the discharge epaAC. There is only weak evidence that the presence of acute respiratory impairment at time of discharge is higher in the patient with rehospitalisation than in those without rehospitalisation. Conclusions: The items and scores of the nursing assessment instrument epaAC did not significantly differ between patients with or without 30-days readmission. Further exploration to assess the epaAC's potential to predict rehospitalisation in heart failure is needed.

[Delirium at the Hospital - Nursing effort and risk of falling: A Routine data analysis]. / Delir im Akutspital ­ Pflegeaufwand und Sturzrisiko.

Delirium at the Hospital - Nursing effort and risk of falling: A Routine data analysis Abstract. Background: In order to reduce the risks and symptoms of delirium, a total hospital guideline for delirium prevention and management was established. To date, there have been few findings on the implementation of the guideline. Question / Aim: The aim of this study was to analyse data collected by application of the Delirium Observation Screening Scale and on the use of care measures for the prevention and treatment of delirium. As part of this analyses, also associations between the screening outcomes (symptoms of confusion) and the implementation of care measures and the rate of fall events, respectively, were examined in patients aged 70 and older. Method: In a non-experimental correlative cross-sectional study, routine data from the patient administration program PatWeb and the patient documentation system WiCare-Doc were analyzed over a period of four months. Results: Patients with symptoms of confusion received twice the duration of delirium-specific care compared to patients without symptoms of confusion. Their risk of falling was 4.4 times higher and after a fall event they received a significantly longer period of delirium specific care. Conclusions: The results show that the care of patients with delirium is intensive. Time is the prerequisite for care adapted to this patient group. The transfer of knowledge into practice must be strengthened to further enable nurses in implementing the prevention and management of delirium. The development of an "Advanced Practice Nurse Delirium" is also recommended for practice development and as support for every day nursing care.

The home care work environment's relationships with work engagement and burnout: A cross-sectional multi-centre study in Switzerland.

This study aimed to investigate the levels of burnout and work engagement among home care workers in Switzerland and to test their association with job demands and job resources. We conducted a multi-centre, cross-sectional survey in the German-speaking part of Switzerland with a convenience sample of seven home care agencies. Data were collected between September 2017 and January 2018. We assessed burnout with the Maslach Burnout Inventory (MBI) and work engagement with the Utrecht Work Engagement Scale (UWES) as well as job demands (overtime, work-family conflicts, experienced aggression and work stressors) and job resources (predictability, staffing, teamwork, leadership, collaboration, social support, sense of community, feedback). To investigate the levels of burnout and work engagement, we applied descriptive statistics. Based on Bakker and colleagues' Job Demands-Resources model, we used a path analysis to test the associations of job demands and job resources with burnout and work engagement. We analysed data from 448 home care workers (response rate 61.8%, mean age 44 years (SD 13.2), 96% female). The frequency of burnout in our sample was low, while that of work engagement was high. Job demands correlated positively with emotional exhaustion (ß = .54, p < .001) and negatively with work engagement (ß = -.25, p < .001). Job resources correlated negatively with emotional exhaustion (ß = -.28, p < .001) and positively with work engagement (ß = .41, p < .001). Work-family conflicts and work stressors correlated strongest with emotional exhaustion, whereas social support and feedback were found to correlate strongest with work engagement. Improvements to the home care work environment might enhance work engagement and reduce burnout. Corrective interventions could focus on reducing specific aspects of job demands, such as work-family conflicts and work stressors, as well as on increasing aspects of job resources, especially social support and feedback.

Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention.

BACKGROUND: It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home. METHODS: A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents. DISCUSSION: The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of "total pain" for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself. TRIAL REGISTRATION: Registration trial number: DRKS00009726 on DRKS, registered 10 January 2017, retrorespectively registered. Clearance certificate is available of the ethics committees of the canton of Thurgau, Switzerland, number: TG K201-02, and Zurich, Switzerland, number: ZH 01-2016.

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis.

AIMS AND OBJECTIVES: To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes. BACKGROUND: Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood. DESIGN: A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families. METHODS: A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used. RESULTS: Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group. CONCLUSIONS: A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family. IMPLICATIONS FOR PRACTICE: Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship.

[Support of the nursing process through electronic nursing documentation systems (UEPD) ­ Initial validation of an instrument]. / Unterstützung des Pflegeprozesses durch die elektronische Pflegeprozessdokumentation (UEPD). Erste Validierung eines Messinstruments.

BACKGROUND: Electronic nursing documentation systems, with standardized nursing terminology, are IT-based systems for recording the nursing processes. These systems have the potential to improve the documentation of the nursing process and to support nurses in care delivery. AIM: This article describes the development and initial validation of an instrument (known by its German acronym UEPD) to measure the subjectively-perceived benefits of an electronic nursing documentation system in care delivery. METHOD: The validity of the UEPD was examined by means of an evaluation study carried out in an acute care hospital (n = 94 nurses) in German-speaking Switzerland. Construct validity was analyzed by principal components analysis. RESULTS: Initial references of validity of the UEPD could be verified. The analysis showed a stable four factor model (FS = 0.89) scoring in 25 items. All factors loaded ≥ 0.50 and the scales demonstrated high internal consistency (Cronbach's α = 0.73 ­ 0.90). Principal component analysis revealed four dimensions of support: establishing nursing diagnosis and goals; recording a case history/an assessment and documenting the nursing process; implementation and evaluation as well as information exchange. CONCLUSIONS: Further testing with larger control samples and with different electronic documentation systems are needed. Another potential direction would be to employ the UEPD in a comparison of various electronic documentation systems.

Early education and counselling of patients with acute coronary syndrome. A pilot study for a randomized controlled trial.

BACKGROUND: At time of discharge, patients with acute coronary syndrome often have a knowledge deficit regarding their disease, further treatment and necessary behavioural changes. It is well known that self-efficacy as a prerequisite for behavioural changes can be influenced by patient education. This study investigated whether an individualized education programme starting early in the cardiac care unit enhanced self-efficacy and rehabilitation programme attendance, and was feasible and satisfying for patients. METHODS AND DESIGN: In a pilot randomized controlled trial, 40 patients with acute coronary syndrome were enrolled. The intervention group received in addition to standard care an early individual needs-oriented educational session in the cardiac care unit and subsequently one on the ward addressing risk factors, medication and self-management as well as referral to a rehabilitation programme by a nurse. Self-efficacy was assessed twice, at attendance in a rehabilitation programme six weeks after discharge. The participants' satisfaction with the intervention was assessed qualitatively. RESULTS: When controlling for anxiety and depression, the intervention group showed significant better self-efficacy scores on the ability to control the symptoms (p=0.034). When controlling additionally for age, no significant differences could be detected. The attendance of a rehabilitation programme was higher in the intervention group. The participants in the intervention group reported high satisfaction with the early education. CONCLUSION: Early education seems to benefit patients with acute coronary syndrome. In light of increased confidence to control one's symptoms and the higher attendance in rehabilitation programmes, as well as a high satisfaction with the intervention, a full powered study will be pursued.

[Development of a nurse-led family counseling program for families of the elderly: the first cycle of a Community-Based Action Research Project (CBPR)]. / Entwicklung einer pflegegeleiteten Familienberatung für Familien älterer Menschen: Der erste Zyklus eines gemeindebasierten Aktionsforschungsprojektes (CBPR).

BACKGROUND: With the support of family members many elderly people can live an independent life at home. Accepting support respectively providing support might be a challenge for both elder and family member. Families often have little professional support to manage those challenges. AIM: Therefore, a nurse-led counseling program for families of the elders has been established. METHOD: The counseling program was developed with community-based participatory research (CBPR) methodology using individual and focus group interviews, as well as a written survey and tested in a pilot study. RESULTS: Managing disease in everyday life, helpful means of support at home, changes in family relations, information about services as well as information how to navigate the healthcare system have been themes to discuss in the counseling sessions. Participants in the pilot study showed a statistically not significant increase in well-being, and preparedness for care and were highly satisfied with the counseling program. CONCLUSIONS: Families of the elderly could actively participate in developing and researching a nurse-led family counseling program. Several family members still engage as co-researcher in the program and participate to improve the new service.

Effects on the quality of the nursing care process through an educational program and the use of electronic nursing documentation.

PURPOSE: To evaluate the effect of the educational program "Guided Clinical Reasoning" (GCR) and the introduction of an intelligent electronic nursing documentation system (e-doc) on the quality of the nursing process. METHODS: Evaluation was conducted at three measurement points and rated with the instrument "Quality of Nursing Diagnoses, Interventions and Outcomes" (Q-DIO). FINDINGS: GCR showed the best Q-DIO-scores. No long-term effect was found after GCR cessation. The e-doc delivered the lowest scores, while showing adequate support in using nursing diagnoses. CONCLUSIONS: E-docs can support conducting the nursing process, but for meaningful e-doc use, clinical reasoning is essential. IMPLICATIONS: High-quality nursing documentation requires recognition of factors obstructing or supporting nurses in the use of e-docs while conducting the nursing process.

Quality of life in adult patients with epilepsy and their family members.

PURPOSE: Epilepsy is not only a neurological disorder but may also have negative psychosocial consequences on people with epilepsy (PWE) and their relatives. Epilepsy has a major impact on quality of life (QoL) in PWE and family members. However, less is known about the impact of family support and family functioning on quality of life for PWE and family members and their interaction. Therefore, the study aimed to investigate factors that influence QoL in hospitalized adult patients with epilepsy and their relatives. METHOD: An explorative cross-sectional study has been conducted in a tertiary clinic in Switzerland. Hospitalized adult patients with epilepsy and their relatives were enrolled in the study. Subjective QoL as well as family support and family functioning were measured with patients and family members. Patients and their relatives assessed the patients' support need and their satisfaction with the care provided. In addition, patients were administered a disease-related HRQoL measure (QoLIED-36, Version 2). Backward stepwise multivariate linear regression analysis was used to explain variances in patients and relatives' subjective QoL. RESULTS: One hundred and four dyads of patient and family member participated. Subjective QoL in patients and family members differed significantly, as did satisfaction with care delivery. In both groups family support contributed significantly to QoL. In the models 40% of the variance in QoL in patients and relatives could be explained. While the quality of life of the family members was affected by the patients' knowledge about the disease and the reason for their current hospitalization, patient QoL scores had no influence on the QoL of family members. The patients' QoL, however, depended significantly on the QoL of the family members. CONCLUSION: Interventions should address both PWE and family members and focus on the self-care improvement of PWE and the well-being and coping of family members. A patient-centred approach needs to include both the PWE and the relatives and address family support in order to alleviate stress in the patients and relatives alike.