[Influencing factors for nursing home admission in case of pre-existing need of care - a systematic review]. / Einflussfaktoren für einen Heimeintritt bei bestehender Pflegebedürftigkeit ­ eine systematische Übersichtsarbeit.

INTRODUCTION: Knowledge about predictors of nursing home placement is highly relevant. If they are known, targeted interventions such as counselling can help prevent or delay relocation to a nursing home. Above all, preventive and structural measures can target influenceable predictors. The aim of the review was to map predictors of nursing home admission and thus the permanent stay in inpatient long-term care for the target group of people with a pre-existing need for care. METHODS: A systematic literature search in the databases The Cochrane Library, PubMed, CINAHL, GeroLit and CareLit® was conducted in September 2017. Longitudinal studies with quantitative analyses were included. The methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: 45 cohort studies were included. 21 studies examined study populations with need for care, in 24 studies the care status was unclear. A variety of predictors of nursing home admission with at least one-and-a-half times higher risk for both study populations could be identified, including higher age, dementia, underweight, higher age of caregiver, psychiatric symptoms, smoking status, ethnicity, challenging behaviour in people with dementia, higher number of hospitalizations and lower level of life satisfaction. DISCUSSION: All the predictors identified are relevant to people in need of care. No predictors for the study population with need of care could be identified that are particularly important in contrast to persons with an unclear care status. However, the quality of studies among people with care and support needs is limited compared to studies targeting people with unclear care status. CONCLUSIONS: Many factors seem to predict the admission to a nursing facility. For the first time, these factors are listed in this systematic review for the target group of people in need of care. Interventions or preventive measures based on known influenceable predictors can help prevent or delay nursing home admission.

Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial.

BACKGROUND: Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF. METHODS: Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months. DISCUSSION: Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented. TRIAL REGISTRATION: ClinicalTrials NCT00552552.

[Healthcare of the elderly: results of health services research and implications for nursing practice]. / Pflege alterer Menschen: Ergebnisse der Versorgungsforschung und ihre pflege-praktische Relevanz.

The objects of health services research are, among others, analyses of the demand for healthcare services and institutions and for nursing of ill and disabled elderly people, as well as analyses of the outcome of service performance in view of quality of life, effectiveness, and resource management. In order to adequately describe and support the health state of elderly in current and future life situations, it is important to gather an exact knowledge about epidemiological developments and demands for specific services in the provision of healthcare and nursing care. In case of a disease, the accessibility, quantity and quality of medical, nursing and psychosocial care determine considerably the organisation of life and the way of dealing with the disease. Thus, considerations on prevention, rehabilitation and health promotion for elderly (healthy ageing) gain an increasing relevance, particularly for nursing practice. This article focuses on central aspects of health services research with respect to results of gerontology research and nursing science. Possible demands and perspectives are derived in view of future developments. The issues of quality assurance and quality improvement are of central importance.

[Innovative potentials and new areas of responsibility for nursing in the service sector of the future--results of a Delphi-study in Germany]. / Innovative Potenziale und neue Handlungsfelder für zukünftige Dienstleistungen in der Pflege. Ergebnisse einer Delphi-Studie.

Present reforms and dynamics of development within the health care system have led to different health care needs and new demands on nursing. It has been assumed that in the future a number of innovative potentials and new areas of responsibility will develop. Consequently, new nursing services will also come into being which are to be located at the interface of Nursing and Public Health. Adopting the Delphi technique the Institute for Applied Nursing Research at the University of Bremen carried out nation-wide study which was aimed at experts (n = 41) representing research and development, as well as political interests regarding health and nursing-related institutions of the German health care system. Four areas of responsibility were considered most relevant for the development of new nursing services: consultancy/information work, health promotion/prevention/rehabilitation, management and co-ordination/integration/co-operation. The biggest market is expected within the area of consultancy work. The development of those four areas is closely connected with the grade of professionalisation. Additionally, linking Public Health and Nursing will include a change in the way nursing sees itself. Furthermore, nursing objectives and interventions will be altered, too.

["Nursing care visit: possibilities and limits". An empirical study in Bremen, Hamburg, Mecklenburg-Vorpommern, Lower Saxony and Schleswig-Holstein]. / "Pflegevisite: Möglichkeiten und Grenzen". Eine empirische Untersuchung in den Bundesländern Bremen, Hamburg, Mecklenburg-Vorpommern, Niedersachsen und Schleswig-Holstein.

This study examines the distribution, understanding and objectives of nursing visits as well as the implementation and the experience with nursing visits in 87 hospitals in North Germany (Bremen, Lower Saxony, Hamburg, Schleswig-Holstein and Mecklenburg-Western Pomerania). The survey was conducted using a questionnaire. It was found that nursing visits are implemented in 31% of the departments. By means of the nursing visit the patients are involved in the nursing process. The objectives of nursing visits are patient orientation. and the improvement of the nursing quality. The nursing visit is criticised because of both the level of organisation and the time spent on nursing visits as well as the lack of training, maintaining confidentiality and questions of data protection. The study contributes to a better understanding of nursing visits and a clearer definition of the term. It is the first empirical study of this type that has been conducted in Germany.

A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial.

OBJECTIVE: To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors. METHODS: In ten German centres, 261 patients with cancer-related fatigue were randomly assigned to a patient education program consisting of 6 sessions à 90 min or standard care. The primary outcome measure was cancer-related fatigue. Data were analysed using analysis of variance (ANOVA) with repeated measures. RESULTS: Patients in the intervention group showed statistically significant reduction in cancer-related fatigue (F = 76.510, p < 0.001, η(2) = 0.248). Secondary outcomes also showed significant improvements in all measures, including quality of life (F = 29.607, p < 0.001, η(2) = 0.113), general self-efficacy (F = 27.680, p < 0.001, η(2) = 0.107), exercise self-efficacy (F = 49.230, p < 0.001, η(2) = 0.175), physical activity (F = 8.036, p < 0.001, η(2) = 0.033), anxiety (F = 33.194, p < 0.001, η(2) = 0.125), depression (F = 24.604, p < 0.001, η(2) = 0.096), and fatigue knowledge (F = 55.157, p < 0.001, η(2) = 0.192). CONCLUSION: The program was effective in reducing perceived fatigue as well as further outcomes. PRACTICE IMPLICATIONS: This newly developed education program has the potential to fill a gap in the care of cancer survivors. The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group.

[Chronic fatigue in cancer patients]. / Chronische Fatigue bei Krebspatienten.

BACKGROUND: Due to improvements in long-term survival in cancer patients, emphasis is increasingly placed on chronic symptoms such as cancer-related fatigue in patients after completion of cancer treatment. Fatigue prevalence in these patients ranges from 17% to 56%. However, there is a lack of complex treatments that take the multifactorial character of fatigue causation into account. PATIENTS AND METHODS: Based on a needs analysis, a patient education program was developed and evaluated. The study aimed at cancer patients after completion of the cancer treatment who suffer from chronic fatigue. The self-management program FIBS consists of six modules. Information about fatigue and behavioural therapy orientated strategies and exercises are included. Patients who attended the program were highly satisfied. They were satisfied with the selected topics at an average of 84.0%, and with the conditions at 84.25%. 95.8% of the patients achieved a subjectively perceived personal benefit, on average 8.14 of 12 possible points. The overall patient education satisfaction scored 78.72%. CONCLUSION: The newly developed self-management program closes a gap in health care of cancer patients with chronic fatigue for whom there are hardly any intervention options to date. The program is characterised by target group-specific contents and methods and a high satisfaction of the patients.

A possible way out of poor healthcare resulting from demographic problems: need-orientated home-based-nursing-care and nursing-home-care.

AIM: The aim of is this paper is to present a study in which a system to classify different levels of home-based-nursing and nursing-home care for groups with differing care need is developed. BACKGROUND: Changes in demography, social conditions and medical development are leading to the fact that in the future more people will need specialized nursing care which today's services of home-based-care and nursing-homes cannot provide. METHOD: On the basis of a literature research, the service-structure and the care need of defined groups of patients were analysed and categorized. The resulting grid was used in an Internet-based standardized survey among 144 experts. RESULTS: The results of this study encompass the experts' views and the prognoses on developments in the design of care and service structures for each of the defined groups of patients in North-Rhine-Westphalia, Germany. CONCLUSION: The study reveals the areas and the patient groups with the most significant future needs. Thus, demands and recommendations concerning the prospective design and structure of care and nursing services for home-based nursing and care in nursing-homes can be formulated.