[Factors in the implementation of expert standards in nursing: A qualitative study]. / Einflussfaktoren bei der Implementierung von Expertenstandards in der Pflege.

Factors in the implementation of expert standards in nursing: A qualitative study Abstract: Background: Many German health and long-term care facilities face the challenge of implementing expert standards in practice. Implementation models, such as the Consolidated Framework for Implementation Research (CFIR), support the implementation process by identifying the relevant influencing factors that can determine the success of an implementation. Aim: The aim was to identify the factors influencing the implementation of expert standards in nursing care and their interactions. Method: The data were collected by means of guided interviews with ten facilitators of the model implementation units for the implementation of the expert standard on promotion of oral health in nursing and from the project progress records. The data were evaluated by content analysis. Results: In addition to the influencing factors according to the CFIR, two other factors were identified that can determine the success of the implementation of expert standards - local presence and knowledge of implementation theories and models. The various and complex interrelationships between the factors in the implementation of expert standards became particularly clear. Conclusion: Knowledge of the fundamentals of implementation science is helpful for the successful and sustainable implementation of expert standards and for general knowledge transfer in nursing.

[Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]. / Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung.

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.

The health-related quality of life of older people through preventive home visits: A quantitative longitudinal study.

AIMS AND OBJECTIVES: Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study. METHODOLOGICAL DESIGN AND JUSTIFICATION: A quantitative longitudinal study in order to investigate the effects of preventive home visits. ETHICAL ISSUES AND APPROVAL: There were no ethical concerns. Accordingly, ethical approval was granted. RESEARCH METHODS, RESULTS AND CONCLUSIONS: The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form-Health-Survey-12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.

Acceptance of preventive home visits by nurses - The user perspective.

OBJECTIVE: The aim of this study was to investigate acceptance of preventive home visits (PHVs) for older adults in rural Germany. DESIGN: Qualitative descriptive approach. SAMPLE: We investigated the personal, individual perspective of adults aged 65 to 85, who were not yet eligible for benefits from the long-term care insurance, were able to understand and speak German, and who lived in the municipality under study. MEASUREMENTS: Fifteen semi-structured interviews were conducted between 02/2019 and 08/2020. They were transcribed, coded using MAXQDA, and content analyzed. Ethical approval was obtained. RESULTS: The acceptance of PHVs was extremely high and characterized by five main effects: very close relationship with the nurse, well-being, empowerment, satisfaction, ambivalence. Participants wish to receive PHVs in the future and would recommend it to others. Even those with a healthy or health-promoting lifestyle are thankful to be able to refer to the counselling sessions if life circumstances should deteriorate. Those who became care-dependent wish to continue and perceive it as a valuable addition to their care. CONCLUSION: From the participants' point of view, this low-threshold counselling-and-support approach should be maintained in the future. PHVs can support health and independence in older adults and therefore prevent them from becoming care-dependent.

[Homecare arrangements: examining the use of support services in relation to socioeconomic status]. / Häusliche Pflegearrangements: Untersuchung der Inanspruchnahme von Unterstützungsleistungen im Zusammenhang mit dem sozioökonomischen Status.

BACKGROUND: National and international findings indicate that homecare arrangements are influenced by socioeconomic factors. Demographic and social developments justify the assumption of an increasing number of people in need of care from resource-pour groups and therefore a continuously increasing importance of home-based long-term care. OBJECTIVE: It is examined whether income and education of people in need of care and their caregivers are related to the use of support services in homecare arrangements. MATERIAL AND METHODS: Quantitative secondary data analysis of a survey among members of the social association VdK (Sozialverband VdK). The statistical evaluation includes descriptive analyses as well as the investigation of correlations between socioeconomic characteristics and characteristics of the care arrangement. RESULTS: A correlation between income and the use of support services exists regarding so-called 24-hour care, which is more common with high incomes. Other income effects can be seen in the extent to which care services and home help services are used and in measures to adapt the home environment. A higher level of education is related to an increased use of counselling services. The assessment of the care situation is more negative the lower the income. CONCLUSIONS: The results point out that phenomena of social inequality in care exist and that the options for shaping homecare are influenced by socioeconomic factors. The study also shows challenges in dealing with social inequality and provides orientation for further research, which is becoming increasingly important in view of current trends.

Pain Interventions for people with dementia: a quasi-experimental study.

BACKGROUND: Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. METHODS: Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. RESULTS: We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. CONCLUSION: This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. TRIAL REGISTRATION: The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).

[Educational Programmes in Health Services Research in Germany: Current State and Future Perspectives]. / Studiengänge zur Versorgungsforschung in Deutschland: aktueller Stand und zukünftige Perspektiven.

OBJECTIVE: The aim of this study was to analyse accredited study programmes of health services research in Germany at Master's degree level regarding their structural data and content. METHODS: Using a descriptive qualitative design, all included plans of study courses, module handbooks and descriptions of the Master's degree programmes were analysed. RESULTS: The Master's degree programmes were similar in their structural elements as well as in their content of education. They aim at enhancing competences related to the areas of health services research to identify health care needs and to develop, initiate, evaluate and critically assess innovative care strategies across disciplines. DISCUSSION: Although the content is similar, the study programmes focus on specific aspects that allow students to choose a certain programme depending on their preferences. A next step can be the development of a core curriculum that takes into consideration further findings and the discourse of different stakeholders.

[Promotion of oral health in nursing-An interprofessional expert standard]. / Förderung der Mundgesundheit in der Pflege ­ ein interprofessioneller Expertenstandard.

BACKGROUND: People in need of care or with severe disability have a worse oral health status compared to people without these needs. The increasing number of older people who are able to keep their own teeth requires specific steps to support oral health. Whereas in 1997 1 in 4 people between 65 and 74 years of age was toothless, in 2016 this figure had risen to 1 in 8. Special challenges in oral care arise for older people and people with dementia. The management requires an interprofessional approach. OBJECTIVE: Interprofessional development of an expert standard for the promotion of oral health by nurses and a focus on older people. METHODS: The expert standard is based on a systematic literature analysis. Based on this, members of an interprofessional expert working group consisting of nurses, dentists and a representative of those affected formulated recommendations to promote oral health of people in need of care. RESULTS: The interprofessional approach defines the selection of the guiding questions for the literature search, the evaluation of the literature and the formulation of the recommendations. Interventions to maintain and promote oral health were identified for the guiding questions of the expert standard, for example, in cases of oral fungal diseases, mucositis, gingivitis or accompanying symptoms, such as dry mouth and pain. DISCUSSION: Interventions to promote oral health of people in need of care or with severe disability could be focused more deeply within the nursing profession and formulated by an interprofessional group to guide their actions.

[Staffing situation in home-care services: A qualitative study on current and future challenges]. / Die Personalsituation in der ambulanten Pflege.

Staffing situation in home-care services: A qualitative study on current and future challenges Abstract. Background: There are increasing signs of staff shortages in home-care nursing in Germany. Home care providers have an increasing number of vacancies and the provision of care for people in need of care is a challenge. There are only a few approaches to planning personnel requirements in home care and the existing ones are rather complex. Aim and research question: The objective of this study was to gain insights into how staff deployment and staff planning currently take place in German home care services and to evaluate options for the development of staffing measures in home care. Methods: Qualitative, guideline-based expert interviews (N = 33) were conducted and analyzed. Experts were representatives of home care service providers, advisors of home care service providers and experts in the field of human resources management. Data analysis was performed by using content analysis. Results: From the experts' point of view home care services cannot ensure sufficient provision of home care services as needed by care-recipients due to staff shortages. Staff planning as well as recruitment and retention of staff pose an increasing challenge. Staff planning is mainly determined by contractual requirements and the reimbursement system. It is less determined by individual care-recipients' needs. The company size of home care providers depends on staff recruitment and turnover. Conclusions: The staffing situation will be a remaining challenge in the foreseeable future. It will go along with the task to ensure an adequate home care supply. Approaches that go beyond reimbursement driven personnel planning can contribute valuable hints for the future.

[Occupational safety and health promotion in the context of nurse staffing: A scoping review]. / Arbeitsschutz und Gesundheitsförderung im Kontext von Personalbemessung in der Pflege.

Occupational safety and health promotion in the context of nurse staffing: A scoping review Abstract. Background: Increasing workload has led to a rise in mental and physical burden among nurses. In order to prevent this, it should be investigated, whether and to what extent aspects of occupational safety and health promotion can be integrated into nurse-staffing ratios. Aims: The objective of this scoping review was to identify ways and approaches of including occupational safety and health promotion into existing nurse-staffing ratios. Methods: A scoping review was conducted. The literature search took place in relevant professional databases. Articles in English and German language published between January 2015 and April 2020 with a focus on (care) organisations, staffing, occupational safety and/or health promotion, and person-related services were included. Results: Fifteen articles met the inclusion criteria. Three main topics were identified: staffing methods, leadership and control, and work organisation and design. No evidence was found regarding the inclusion of occupational health and safety and health promotion in staffing procedures. However, there is a demand for consideration of aspects "beyond numbers". Conclusions: In the further development of staffing-ratios, factors should be included that go beyond quantifiable measures and, by doing so, also address occupational safety and health promotion.

Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators.

The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term "quality indicator" regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence-based and internationally comparable indicators to help improve patient care and safety worldwide.

Patient safety: understanding human error in intensive nursing care.

OBJECTIVE: To analyze the active failures and the latent conditions related to errors in intensive nursing care and to discuss the reactive and proactive measures mentioned by the nursing team. METHOD: Qualitative, descriptive, exploratory study conducted at the Intensive Care Unit of a general hospital. Data were collected through interviews, participant observation and submitted to lexical analysis in the ALCESTE® software and to ethnographic analysis. RESULTS: 36 professionals of the nursing team participated in the study. The analysis originated three lexical classes: Error in intensive care nursing; Active failures and latent conditions related to errors in the intensive care nursing team; Reactive and proactive measures adopted by the nursing team regarding errors in intensive care. CONCLUSION: Reactive and proactive measures influenced the safety culture, in particular, the recognition of errors by professionals, contributing to their prevention, safety and quality care.

Gender disparities in German home-care arrangements.

An ageing population correlates with rising needs for long-term care (LTC). Support programmes should consider the specific needs of the various subgroups of care dependents and family caregivers. The objective of this study was to analyse the gender-specific disparities in home-care arrangements in Germany, and for this purpose, survey and insurance claims data were used. A survey of 2545 insured care recipients with high-level care needs was conducted in 2012 with the Barmer GEK, a major German statutory healthcare insurance. Insurance claims data were provided for a follow-up, focussing on the group aged 60 years and older. For statistical comparison, chi-squared test and t-tests were used, and a p-value < 0.05 was considered statistically significant. Most care recipients are female, and they are on average 2 years older than males. Men receive family care mostly from their wives, whereas widows frequently live alone and receive care from daughters, sons, other relatives, neighbours and friends, as well as from professional nursing services. Furthermore, women more often anticipate the need for (further) professional assistance and move in with a relative or to an assisted living facility or a nursing home in good time. The desired rate for relocation to a nursing home was higher than the anticipated, and during the 6-month follow-up, the actual rate of relocations was in between both. In summary, the caring situation of men and women is different. Care-receiving men are most often cared for by their wives. Widowed women need a social network and their children in order to remain in their own home. To provide better home-care arrangements for women in this situation, the family and social networks need a stronger focus in politics and research. To stabilise the home-care situation of men with high-level care needs, their wives need more support.

Which need characteristics influence healthcare service utilization in home care arrangements in Germany?

BACKGROUND: We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. METHODS: 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. RESULTS: Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. CONCLUSION: The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.

ATME-Needs, requirements and cross-sectoral patient journeys of patients with out-of-hospital mechanical ventilation and intensive care in outpatient settings: study protocol for an observational study.

INTRODUCTION: An increasing number of tracheotomised and/or ventilated patients with high-cost out-of-hospital intensive care needs and, at the same time, a decreasing number of healthcare professionals inevitably lead to challenges in the care of this patient population. In addition, little is known about this population, their health restrictions, needs, patient journeys, care structures and processes. The project 'Needs, requirements and cross-sectoral care pathways of out-of-hospital ventilated intensive care patients' (ATME) aims to analyse these aspects and explore current care structures to inform further development of care in line with patients' needs and requirements. METHODS AND ANALYSIS: Qualitative and quantitative methods will be used. In preparation of a semistandardised survey, exploratory interviews will be conducted with tracheotomised and/or ventilated patients with out-of-hospital intensive care needs (TVPOI) (n=15), nursing care providers (n=30), outpatient medical centres, as well as outpatient medical, medical technology and therapeutic care providers (n=35). Three semistandardised survey questionnaires for TVPOI (n=2,000) will be developed and conducted with nursing care facilities (n=250) and outpatient medical centres for mechanical ventilation (n=25). Content analyses will be conducted for qualitative data; survey data will be analysed descriptively. In addition, healthcare claims data will be analysed descriptively to provide information on patient journeys. Three result workshops and one consensus conference will be carried out with representatives of the relevant target groups to analyse the suitability of care structures and to develop recommendations for action to improve TVPOI. ETHICS AND DISSEMINATION: The ATME study received a positive vote from the Ethics Committee of the Osnabrück University of Applied Sciences and is registered in 'Deutsches Register Klinischer Studien (DRKS)' (registration number: DRKS00030891). The study results will be presented at national conferences and in relevant peer-reviewed journals. Additionally, study results will be published by the funding institution (the Innovation Committee of the Federal Joint Committee) on their website.

Adoption and Determinants of Assistive Technologies in the Real World: Results from the VdK Study.

INTRODUCTION: While there is growing evidence of the benefits of assistive technologies little is known about their adoption under real circumstances and prevalence for everyday use. OBJECTIVE: The aim of this analysis therefore was (i) to investigate the adoption rates in the real world and (ii) to identify potential determinants of their adoption by care-dependant persons and family caregivers. METHODS: The present study is a secondary analysis based on the data set of the VdK study on home care arrangements (n=53,678). The analysis of the adoption rates included 22,666 care-dependant persons and caregivers, the identification of potential determinants via binary logistic regressions included 5,275 persons. RESULTS: Emergency call systems and technical (smart) aids reached an adoption rate of 40.4 % (care-dependant persons) and 55.3 % (family caregivers). Fall detectors, orientations aids, nursing apps and monitoring systems were used in less than 5 % of the cases. Care degree and the use of an ambulatory nursing service increased the likelihood of using technical aids. CONCLUSION: It can be concluded that innovative and sophisticated types of assistive technologies are still rather scarcely used for home care arrangements in the real world despite large research efforts in the last twenty years.

[Social inequality in home care: A scoping review on the impact of socio-economic resources on home care arrangements]. / Soziale Ungleichheit in der häuslichen Pflege: ein Scoping-Review zum Einfluss sozioökonomischer Ressourcen auf die Gestaltung häuslicher Pflegearrangements.

INTRODUCTION: Inequalities in long-term home care are still rarely considered in the discourse on health inequalities, although there is reason to assume that opportunities for a successful home care arrangement are not equally distributed among those in need of it. This paper pursues the question how socio-economic resources of people in need of care and their family caregivers are influencing the utilization of care services in Germany. METHODS: A scoping review has been conducted to analyse the current state of research. To identify relevant papers the online databases CINAHL including MEDLINE, PubMed, LIVIVO and Web of Science were searched and supplemented by internet research. According to Bourdieu, the research studies included were arranged in economic, educational and social resources. RESULTS: 29 qualitative and quantitative research papers were included in the analysis. 14 papers represent quantitative research results, nine papers are based on qualitative research. Six further papers are analyses based on an international data record. The utilization of care services increases with the level of income and wealth as well as education. On closer examination of individual care services, however, the evidence is inconsistent and only the so-called 24-hour care service is distinguishable as a care arrangement for high-status groups. A compensation of the lower utilization of professional care by informal support cannot be described in quantitative terms. Caregivers with low income and education levels seem to be more likely to not only provide care but also to provide higher-intensity care. DISCUSSION: Despite increasing research reflected in the literature, the evidence remains incomplete and shows inconsistencies so that a valid statement on the degree of inequalities in care provision is not possible. A conceptual basis for the definition of social inequality in the context of long-term home care is lacking as well as a common understanding of equity in care provision. The perspective of people in need of care and their caregivers has hardly been addressed. CONCLUSION: Home care is not only determined by individual need but seems to be decisively influenced by socio-economic restrictions. For a more targeted approach, further research on the use of care services depending on socio-economic resources is needed, explicitly taking into account the user perspective.

From Surviving to Living (on): A Grounded Theory Study on Coping in People with Pancreatic Cancer.

Little research has been conducted on the experience of pancreatic cancer from a patient's perspective. Several factors suggest that trajectory models of chronic illness or other cancers cannot be applied to pancreatic cancer. Within this grounded theory study, 26 problem-centred interviews were conducted with people with pancreatic cancer from Germany. A cancer-specific trajectory model was developed, depicting both curative and palliative courses. Two successive phases form the core: Immediately after diagnosis, there is an acute phase in which patients focus on mere survival, attempt to overcome the short-term consequences of pancreatic cancer and search for information. This initial phase is followed by a circular phase of living on with pancreatic cancer, characterized by adaptation to the long-term consequences of the disease and a repeated experience of fear of recurrence or progression and threat in the context of follow-up examinations. Understanding disease trajectories from a patient's perspective enables health professionals better to understand patients' needs, concerns, and fears and better support them in coping. Trial registration: German Clinical Trials Register, DRKS00020251, 13.01.2020.

What Went Wrong in eMedCare? Formative Evaluation of an IT Project in Primary Care in Two Rural Districts.

INTRODUCTION: The interaction between nurses and physicians in the primary care setting is challenging with regard to structural, process and technical barriers. In order to overcome these barriers, the eMedCare project was launched and a commercial system was implemented. OBJECTIVE: This study aimed at a formative evaluation of the project. The findings should be used retrospectively to understand the failure of the project. METHODS: To this end, two rounds of qualitative interviews with 10 respectively 8 healthcare providers were performed. RESULTS: The interviews revealed a mixed benefit. Difficulties arose because the initial aim to monitor patients shifted towards improving the communication between the providers, partly due to the poor usability of the monitoring system. Additional workload was imposed because the system was not interoperable with the institutional IT systems. CONCLUSION: Projects with an unclear or shifting vision and focus seem to be susceptible to failure. The secure communication applications could have been realised on the intended scale if the national Telematikinfrastruktur had been in place.

Nursing care as a systemic and entrepreneurial phenomenon.

The objective is to produce a critical-reflexivity analysis of nursing care, from the perspective of complexity thinking and social entrepreneurship. Theoretical-reflective study, supported by the framework of complexity thinking and social entrepreneurship. The main characteristics that lead and support nursing care are analyzed from a systemic-entrepreneurial perspective. A parallel is conceived between vertical care, design from a hierarchical structure and nursing care in the systemic-entrepreneurial perspective, which leads to singularity, originality, circularity, complementarity and interactivity. The centrality of nursing care is reaffirmed as a tangible social good or not. Theoretical reflection on nursing care as a systemic and entrepreneurial phenomenon raises a unique and multidimensional perception of the human being/user, health, the nursing work process, in order to achieve an increasingly agile, dynamic, circular, complementary and interdependent care.