[The effects of DRG introduction on nursing]. / Die Auswirkungen der DRG-einführung aus Sicht der Pflege.

UNLABELLED: Nursing personnel associate Diagnosis Related Groups (DRG), implemented in German hospitals in 2004, mostly with a higher workload and with work that is set apart from their patients. Between 2003 and 2005 the Institut für Pflegewissenschaft, Universität Witten/Herdecke, conducted a longitudinal study to measure changes of working structures before, throughout and after the introduction of the case-based lump sum. At three given dates a structured questionnaire was applied to nursing staff and, partially, to doctors in three hospitals in order to assess their subjective view on the effects of DRG introduction. RESULTS were compared to the actual output by multi-moment-recording. RESULTS: The amount of paperwork decreased against expectations. Nevertheless, extra requirements became more comprehensive, while the extent of genuine nursing tasks decreased. In 2005 these tasks were given a lower amount of time than paperwork and extra requirements. Because of methodical restrictions causal relations cannot be established, but this trend has to be monitored closely. Further studies have to be carried out to examine structural changes of nursing tasks and quality of care.

[The amount of nursing care for patients with myocardial infarction--a descriptive study]. / Die Erfassung des Pflegeaufwands bei Patienten mit der medizinischen Diagnose Myokardinfarkt. Eine deskriptive Studie.

In Germany nurses have no evidence-based data about the amount of nursing care for patients with specific medical diagnosis. These data are necessary for the demanded appropriate consideration of criteria of nursing care in a German-DRG. The pilot study "The amount of nursing care for patients with myocardial infarction", which was part of a students research project at the University of Witten/Herdecke, can provide a basis for this consideration. The amount of nursing care for a convenience sample of 26 patients during their stay at a university hospital in Munich is the focus of a cross-sectional descriptive study. A standardized instrument measuring the amount of care was developed by the project group. The nursing intervention system LEP was used to determine the nursing care hours. The patients' average length of stay is 9.5 days. 73 percent spent 2.4 days in the intensive care unit. The average amount of nursing care is 32.2 hours per patient or 3.4 hours per patient and day, respectively. Typical nursing activities as well as an amount of nursing care pattern in the course of the stay can be seen. Variations of nursing care and length of stay show the inhomogeneity of the investigated group. Older patients and patients with associated diagnoses show an increase of the amount of nursing care and length of stay. The amount of nursing care of old patients in the category "motion and transfer" increases drastically compared to younger ones. The results of this pilot study confirm the assumption that just the diagnosis myocardial infarction is not sufficient to predict and describe the amount of nursing care. Based on this study, further research with larger samples and a longer investigation time is necessary.