From existential uncertainty to a new mindset promoting recovery: Exploring the development of uncertainty experience in women with vulvar neoplasia - A qualitative longitudinal study.

BACKGROUND: Women with vulvar neoplasia continue to experience uncertainty up to six months post-surgery. Uncertainty in illness is considered a significant psychosocial stressor, that negatively influences symptom distress, self-management strategies and quality of life. According to the Reconceptualized Uncertainty in Illness Theory, the appraisal of uncertainty changes positively over time in chronic illness. We aimed at exploring whether and how the experience of uncertainty develops in women with vulvar neoplasia. METHODS: We selected a purposive sample of seven women diagnosed with vulvar neoplasia in four Swiss and one Austrian women's clinic. By means of a qualitative longitudinal study, we conducted 30 individual interviews at five points of time during one year after diagnosis. We applied Saldaña's analytical questions for longitudinal qualitative research. RESULTS: First, participants experienced uncertainty as an existential threat, then an inherent part of their illness, and finally a certainty. Women initially associated the existential threat with a high risk for suffering from severe health deteriorations. Participants that could reduce their individually assessed risk by adopting health promoting behaviors, accepted the remaining uncertainty. From now on they reframed uncertainty into a certainty. This new mindset was based on a belief of promoting recovery and reducing the risk of recurrence. CONCLUSIONS: The long-lasting and oscillating nature of uncertainty should receive attention in supportive oncology care. Uncertainty concerning existential issues is of special importance since it can inhibit a positive development of uncertainty experience.

Building a programme theory of a specialist paediatric palliative and hospice care programme: development process and methodological reflection.

BACKGROUND: Paediatric palliative and hospice care aims to improve the quality of life of children with life-limiting and life-threatening conditions and their families. The number of these patients has risen significantly in recent years, resulting in an increased need for palliative care for this population. Although the need for paediatric palliative and hospice care is growing, meaningful outcome evaluation to demonstrate its effectiveness as a complex healthcare intervention is in its early stages. For complex interventions (programmes), theory-based evaluations have grown in prominence in recent years. They seek to understand how and why an intervention works by uncovering its underlying mechanisms by means of programme theory. To support both outcome evaluation in paediatric palliative care and a reflective practice of programme theorizing, we aimed to describe the construction of a programme theory for a specialist paediatric palliative and hospice care programme in Austria and to offer a reflective account of its development process. METHODS: We drew on a combination of theory-based evaluation frameworks to construct a programme theory consisting of an action and a change component. Through multiple iterations, incorporating different stakeholders' perspectives and drawing on different sources of knowledge and theory, we theorized how and why the programme likely achieves its intended outcomes. RESULTS: The programme theory outlines the proposed chains of events, causal mechanisms and outcomes of a specialist paediatric palliative and hospice care programme for children and families in several areas corresponding to its main conceptual tenets. Through a range of activities and interventions, the programme triggers coping and adaptation mechanisms that ultimately contribute to family and child wellbeing in physical, psychological, social, and spiritual dimensions. Established trust and partnership between children/families and healthcare professionals as well as a person-centered and family-centered approach were identified as enabling factors. CONCLUSIONS: Our findings provide insights into how a specialized paediatric palliative and hospice care programme works to achieve its intended outcomes for children and families. This helps demonstrate its impact, contributing to meaningful outcome evaluation and service improvement.

Missing nurses cause missed care: is that it? Non-trivial configurations of reasons associated with missed care in Austrian hospitals - a qualitative comparative analysis.

BACKGROUND: Errors of omissions affect the quality of nursing care in hospitals. The Missed Nursing Care Model explains that the reasons for missed care are linked with 1) demand for patient care, 2) labor resource allocation, 3) material resource allocation, and 4) relationship and communication factors. Scientific evidence points to a lack of adequate nursing staffing as the most important factor triggering missed care. However, it remains unclear how the different theoretical reasons for missed care are interlinked with reports on missed care from the perspective of nurses in acute care settings. The aim of this study was to explore non-trivial configurations of reasons for missed care that are associated with missed care interventions from the perspective of nurses working in general units in Austrian hospitals. METHODS: A cross-sectional study was conducted. Data collection was performed using the revised MISSCARE-Austria questionnaire. Our sample consisted of 401 nurses who provided complete data. Data were analyzed using qualitative comparative analysis. Configurational models of contextual factors, reasons for missed care, and missed nursing interventions were analyzed. RESULTS: In our study contextual factors were not consistent precursors of the reasons for missed care. Missed care was consistently present when the demand for patient care was high. A lack of labor resources, in combination with the other known reasons for missed care, was consistently observed when missed care occurred. Different configurations of reasons were found to be non-trivially associated with different types and frequencies of missed care. CONCLUSIONS: To understand the complexity of the causal mechanisms of missed care, complexity theory may be necessary. Accordingly, a theoretical framework that acknowledges that complex systems, such as missed care, are composed of multiple interacting causal components must be further developed to guide new methodical approaches to enlighten its causal mechanisms.

[Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study]. / Pflegerische Qualifikationsniveaus und Umsetzung von Aufgaben für eine Advanced Nursing Practice in Österreich.

Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study Abstract: Background: New fields of practice are emerging under the concept of "Advanced Nursing Practice" (ANP) that offer specialised care provided by nurses who hold master's degrees. In Austria, nurses are currently being trained as Advanced Practice Nurses (APN). Aim: The project aimed to investigate which advanced nursing practice tasks according to the Hamric model are undertaken by nurses at different levels of qualification in Austria. Methods: Certified nurses did participate in a cross-sectional survey through an online questionnaire based on the Role Delineation Model and tailored to the Austrian context. The tasks were assigned based on the Hamric model and were tested and evaluated descriptively according to the qualification level through factor analysis. Results: Completed data was available from 105 participants, among them 80% with undergraduate education, 20% with a master's degree. A tendency in the results showed that the level of qualification was related to the activities carried out. The higher the academic degree, the more activities were performed in the field of leadership. The central ANP-competencies, research and education, are rather weak among all respondents. Conclusion: The results show that activities corresponding to the competencies of an ANP are performed by a heterogeneous group of nurses. Conditions and a standardized understanding of ANP need to be established in order to offer a professional practice that matches the competency profile.

External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling.

PROBLEM: Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. AIMS: This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. DESIGN: A quantitative cross-sectional study. METHODS: The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. RESULTS: The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. CONCLUSION: In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Aggressive behaviour of persons with dementia towards professional caregivers in the home care setting-A scoping review.

AIMS AND OBJECTIVES: To outline and to examine the current research and grey literature on aggressive incidents of persons with dementia towards professional caregivers in the home care setting. We intended to identify evidence and research gaps in this field. BACKGROUND: Worldwide, around fifty million people are living with dementia. Current research indicates that aggressive behaviour of persons with dementia towards professional caregivers occurs frequently in inpatient settings. However, there has been little research on this phenomenon in the home care setting. DESIGN: The design entails a scoping review using the methodological framework of Arksey and O'Malley and PRISMA-ScR. METHODS: A systematic literature search in five databases and a web search in Google Scholar was conducted. Title and abstract screening and a full-text screening were conducted by two independent authors. A free web search for grey literature was conducted in Google. RESULTS: The search yielded 1,376 hits. A total of seven journal articles met the inclusion criteria. In the free web search, six references were identified for inclusion, resulting in a total of 13 references. We identified the following four themes: (1) aggressive behaviour in the context of dementia, (2) triggering factors of aggressive behaviour in persons with dementia, (3) skills and educational needs and (4) hindrances to solving the problem of aggressive behaviour. CONCLUSIONS: There is a lack of literature on aggressive behaviour of persons with dementia in the home care setting, and various hindrances to solving this problematic behaviour have been identified. RELEVANCE TO CLINICAL PRACTICE: For home caregivers, specific education concerning communication skills and responding to aggressive behaviour may help to deal with the situation. A further approach may involve specific training aimed to improve caregivers' confidence.

[Using the TRAPD method to translate the revised MISSCARE Survey from English into German: Revised MISSCARE-Austria]. / Übersetzung des revised MISSCARE Survey zum deutschsprachigen revised MISSCARE-Austria.

Using the TRAPD method to translate the revised MISSCARE Survey from English into German: Revised MISSCARE-Austria Abstract. Background: Questionnaire translations in German-speaking nursing science rely on methods using first- and back-translation techniques despite increasing criticism. In contrast, the TRAPD method is recognized as best practice in intercultural social research. However, experience with the application of this method in German-speaking nursing science is lacking. Aim: To describe the utilization of the TRAPD method using the example of the translation of the revised MISSCARE Survey from English into German and to discuss necessary adaptations, advantages, and limitations of this approach. Methods: An adapted version of the team-based translation method TRAPD was implemented through the steps: preparation, translation, review, adjudication, pretest, and documentation, based on the GESIS guidelines for intercultural questionnaire translation. Results: The new revised MISSCARE Austria instrument consists of 85 items. For the majority of the items, equivalent terms or phrases were found that allowed for a straightforward translation. For some items an adaptation was necessary due to cultural, measurement- and construct-related aspects. Translation equivalence regarding challenging items was examined with the first author and promoted by multiple cognitive pretesting with nurses. Conclusions: Our study strengthens the argument that the TRAPD method is appropriate for translating measurement instruments in German-speaking nursing science. However, this example shows that further experience with this method is necessary for its further development for our discipline.

'After mealtime is before mealtime' - an ethnographic exploration of nursing home residents' practices of dealing with meal requirements.

BACKGROUND: In nursing homes, food is part of the care provided to residents, causing it to be strictly organised within the institutional framework. Moreover, once food has been integrated into the institutional logic, structural and economic aspects regarding organisation of food and eating may dictate individual and social needs, as a theoretical perspective informed by Goffman's notion of the 'total social institution' suggests. This paper describes nursing home residents' practices of dealing with meal requirements in two Austrian nursing homes, to understand how food integrates into the daily routine and how the institutional setting influences the social and material arrangement of food. METHODS: An ethnographic design was chosen to gain an in-depth understanding. Two urban nursing homes were studied over 21 months (approx. 800 h of participant observation and ethnographic interviews collected). Data analysis took place iteratively, following Grounded Theory strategies. RESULTS: As the thick descriptions resulting from this procedure show, observing everyday practices of eating in nursing homes reveals complex dimensions of residents being subject to institutional logics, and also demonstrates that residents develop elaborate strategies to deal with the institutional circumstances. CONCLUSION: A better understanding of the resulting tensions between the restrictions of living in a formal organisation and the agencies of residents described, may contribute to better understanding the effects of structural constraints and to designing more flexible processes.

Detection of delirium by family members in the intensive care unit: Translation, Cross-Cultural adaptation and validation of the Family Confusion Assessment Method for the German-Speaking area.

AIM: The aim of this study was the translation, cross-cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. BACKGROUND: Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German-speaking area yet. DESIGN: A prospective validation study was conducted between January 2020 and October 2020. METHODS: The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany. RESULTS: We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively. CONCLUSIONS: These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training. IMPACT: Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium.

Engagement in purposeful activities and social interactions amongst persons with dementia in special care units compared to traditional nursing homes: An observational study.

BACKGROUND: Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household-like design and individualised stimuli is studied. AIM: To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions. METHODS: We conducted an observational study as part of a theory-driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty-three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments. RESULTS: Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening. CONCLUSION: The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.

Interventions to optimise nutrition in older people in hospitals and long-term care: Umbrella review.

BACKGROUND: Inpatients have a high need for protein-energy intake because of increased physical stress metabolism due to illnesses. Protein-energy undernutrition in older patients increases the risk of complications such as falls, pressure ulcers and even death. An overview of effective interventions addressing this complex issue of malnutrition in older people is missing. AIMS: To give an overview of effective interventions to optimise nutrition in older people in hospitals and long-term care. DESIGN: An umbrella review, according to the Joanna Briggs Institute and PRISMA statement, was conducted in April 2020. METHODS: A systematic search of publications from 2010 until 2020 was conducted in CINAHL, PubMed and Cochrane Database. Included were studies reporting nutrition interventions that involved nurses or the interprofessional team in optimising older hospitalised people's nutrition. Excluded were studies investigating the effects of parenteral nutrition, certain food supplements or tube feeding and research from intensive, community or palliative care. Components of interventions were classified according to the intervention Nutrition management: Patients' assistance, patients' instruction, foodservice, environment for meals and nutrient-dense snacks. FINDINGS: Included were 13 reviews from 19 countries of the continents Asia, Australia, Europe and North America from hospitals and long-term care settings. An interprofessional food promoting culture, including staff training as part of a multi-component measure, has shown to be a successful element in implementing activities of Nutrition Management. CONCLUSION: Several studies synthesised that optimising nutrition in older people in hospitals and long-term care is achievable. Interventions were effective if-on a meta-level-staff training was addressed as part of a multi-component measure to reach an interprofessional food promoting culture. IMPLICATIONS FOR PRACTICE: Interventions to optimise older people's nutrition have to consider an interprofessional food promoting culture, including staff training about the importance of nutrition, patients' assistance and an appropriate environment for meals.

Aggressive incidents in home care services and organizational support: A cross-sectional survey in Switzerland.

AIMS: To explore the available organizational structures addressing aggressive incidents towards home care services staff. BACKGROUND: Organizational structures how professional caregivers deal with care recipients' aggressive incidents. METHODS: An explorative cross-sectional survey using the Violence Experienced by Staff (German version revised) and the Impact of Patient Aggression on Carers Scale was conducted. Data from 852 health care professionals in the German-speaking part of Switzerland were collected between July and October 2019. Multiple logistic regression models were used to investigate associations. The STROBE-Checklist was used as the reporting guideline. RESULTS: Organizational support and management support in home care services were generally rated high and found to cause a significant decrease in negative feelings. Some self-rated skills regarding aggression management were linked to a decrease in perceived burden after aggressive incidents, whereas others increased the perceived burden. CONCLUSION: Organizational structures including official procedures for affected professional caregivers should be established in home care services. This should contain efficient reporting systems and aggression management training for the specific setting. IMPLICATIONS FOR NURSING MANAGEMENT: The study highlights the importance of organizational support regarding aggressive incidents in the home care setting as well as of aggression management training.

[Risk of malnutrition in elderly patients in acute hospitals - implications for nursing practice]. / Gefahr einer Mangelernährung älterer Patient_innen im Akutspital.

Risk of malnutrition in elderly patients in acute hospitals - implications for nursing practice Abstract. Background: The risk of malnutrition is increased in advanced age and acute illness, and its assessment and needs-based support are part of the responsibility of nursing. Research question / objective: The following research question aims to analyse the nutritional status and possible correlations with nursing diagnoses and other patient characteristics from persons who are 80 years old and older: Which patterns in the sense of clusters can be identified concerning calorie and protein requirements and other patient characteristics? METHODS: Explorative cross-sectional study with cluster analysis based on food intake protocols and nursing documentation. Patients from surgery, internal medicine and university acute geriatric care wards were included in this non-probability sample. RESULTS: Four groups were formed out of the data from 135 patients (protein requirement coverage): Well-nourished (116 %), sufficiently-nourished (77 %), insufficiently-nourished (59 %) and poorly-nourished (40 %). A significant correlation between calorie and protein requirement coverage and treatment area has been shown. CONCLUSIONS: The degree of coverage of protein- and energy requirement is related to the treatment area and consequently to its team culture and treatment concept. Based on the characteristics of the well-nourished, a positive effect of interprofessional cooperation and systematic recording of the risk of malnutrition, as implemented in the treatment area of acute geriatric care, might be concluded.

Benefit of a nurse-led telephone-based intervention prior to the first urogynecology outpatient visit: a randomized-controlled trial.

INTRODUCTION AND HYPOTHESIS: Triage has become a valid tool to reduce workload during the first consultation in a specialized clinic. A nurse-led telephone intervention prior to the first urogynecologic visit reduces visit duration and increases patients' and physicians' satisfaction. METHODS: All patients scheduled for their very first visit were recruited. They were randomized into an intervention group (prior contact by a specialized urogynecology nurse) and a control group (no contact). The intervention included a questionnaire about history and symptoms. Patients were prompted to complete a bladder diary. Primary outcome was duration of the consultation; secondary outcomes were patients' and physicians' satisfaction with the intervention. RESULTS: Fifty-five patients were allocated to the intervention group and 53 to the control group with no difference regarding age, BMI, parity, menopausal status and primary diagnosis. Mean duration of the telephone call was 10.8 min (SD 4.4). The consultation was significantly shorter in the intervention group than in the control group (mean difference: 4 min and 8 s, p = 0.017). In the intervention group, 79% of the patients found the consultation quality "excellent," 86% would return, and 77% would recommend our clinic to a relative or friend compared with 68%, 67% and 66%, respectively, in the control group. Physicians were "very satisfied" or "satisfied" with the patient preparation. CONCLUSIONS: A nurse-led intervention reduces the duration of the first uroynecologic consultation and is associated with high patient and physician satisfaction. Further research should evaluate whether it also decreases the number of follow-up visits and further referrals.

Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation.

BACKGROUND: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. METHODS: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. RESULTS: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. CONCLUSIONS: The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept. TRIAL REGISTRATION: DRKS00011513 .

A systematic review of interventions to improve acute hospital care for people with dementia.

The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes. The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.

Effekte von Guided Clinical Reasoning auf die Qualität des Advanced Nursing Process.

Effects of Guided Clinical Reasoning on the Advanced Nursing Process quality - An experimental intervention study Abstract. Background: The correctly applied Advanced Nursing Process leads demonstrably to more accurate nursing diagnoses and better nursing outcomes. It requires nurses' knowledge, clinical decision-making competency, and a positive attitude. Former Guided Clinical Reasoning (GCR) trainings significantly enhanced the Advanced Nursing Process quality. However, the congruence between nursing records, care situations, and patient interviews was not yet investigated. Research question: Which effects has GCR on nurses' knowledge, attitude, clinical performance, and on the quality of the Advanced Nursing Process? Methods: An experimental intervention study was carried out from 2016 until 2018 in a Swiss hospital. The 5-month intervention contained four seminar days and GCR-case meetings and was investigated by an evaluation model (n = 95 nurses, n = 24 patients, n = 225 nursing records). Results: After GCR training, nurses showed greater knowledge (p < 0,0001) and a more positive attitude (p = 0,004) on the Advanced Nursing Process than the control group. The congruence of nursing diagnoses, interventions, and outcomes between observations, interviews, and nursing records was higher in the intervention group. At the last measurement point, nursing diagnoses were stated significantly more accurate, interventions were more effective, and better patient outcomes were achieved (all p < 0,0005). Conclusions: GCR trainings should be used to enhance the Advanced Nursing Process quality, so that based on more accurate nursing diagnoses better patient outcomes are achieved.

Eine Frage des Vertrauens - Grounded Theory-Studie zum Alltagserleben HIV-positiver und an AIDS erkrankter Menschen.

A matter of trust - A grounded theory study on the everyday experience of people living with HIV / AIDS Abstract. Background: Provided that the antiretroviral therapy is taken correctly, HIV / AIDS has become a chronic disease allowing for a nearly normal daily life, which is still, however, characterized by specific challenges. Aim: The aim of this study was to explore how HIV / AIDS patients experience and manage their everyday life, against the backdrop of chronification. Method: A qualitative grounded theory approach according to Corbin and Strauss; problem-centered interviews with 18 participants suffering from HIV / AIDS; analysis of data was performed by applying coding strategies and supported by MAXQDA. Results: The present study shows that "trust" is of crucial significance to HIV / AIDS patients in their private, occupational and healthcare environments, where discrimination, stigma and exclusion still occur. The revelation of the infection status represents a particular challenge. We identified three key patterns of trust: evolved trust, controlled trust and distrust / loss of trust. Depending on these patterns, patients approach their condition in strikingly different ways, with apparent consequences on their quality of life. Conclusion: The here established trust patterns provide a theoretical foundation that may serve as a hub for improving support and care of people suffering from HIV / AIDS. Moreover, reducing the social stigma and discrimination faced by these individuals, primarily in the healthcare system, is paramount for the future handling of the disease.

Die Problematik der Implementierung von Kinästhetik in Einrichtungen der stationären Langzeitpflege - Eine Multiple Case-Study.

Difficulty of implementing kinaesthetics in long-term care institutions - A multiple case-study Abstract. Background: Resources have been invested from long-term care institutions for the development of nursing staffs' kinaesthetics competence for years. Recent studies have shown that implementing or sustainably promoting the kinaesthetics competence is problematic, but in-depth knowledge of the causes thereof is lacking. Aim: Which barriers impede a sustainable implementation of kinaesthetics in long-term care institutions? Method: A "multiple case-study" was carried out in three institutions located in the German-speaking part of Switzerland. The data from guide-based interviews and (case-related) literature on the external context was inductively condensed in the within-case analysis. The results were then compared in the cross-case synthesis and summarized in an abstract way. Results: The synthesis showed that the implementation of kinaesthetics can be influenced negatively at three different institutional levels - management, nursing team and individual nursing staff - as well as by external factors. Conclusions: In nursing practice and nursing science, as well as in the health care sector, a basic understanding of kinaesthetics in the context of professional nursing care is required. Especially those responsible for management and implementation must be aware of possible barriers in order to develop appropriate strategies.

Implementation of a nurse-led self-management support intervention for patients with cancer-related pain: a cluster randomized phase-IV study with a stepped wedge design (EvANtiPain).

BACKGROUND: Pain self-management support interventions were effective in controlled clinical trials and meta analyses. However, implementation of these complex interventions may not translate into identical effects. This paper evaluates the implementation of ANtiPain, a cancer pain self-management support intervention in routine clinical practice according to the Reach Efficacy-Adoption Implementation Maintenance framework. METHODS: In this cluster randomized study with a stepped wedge design, N = 153 adult patients with cancer-related pain were recruited from 01/17 to 05/18 on 17 wards of 3 hospitals in Vienna, Austria. ANtiPain entailed a face-to-face in-hospital session by a trained nurse to prepare discharge according to key strategies, information on pain self-management, and skills building. After discharge, cancer-pain self-management was coached via phone calls. Patient-level data were collected at recruitment, and 2, 4 and 8 weeks after discharge via postal or online questionnaire. Primary outcome was pain interference with daily activities. Secondary outcomes included pain intensity, self-efficacy, and patient satisfaction. Organizational-level data (e.g., on implementation procedures) were collected by study or intervention nurses. The mixed model to analyze patient-level data included a random intercept and a random slope for individual and a random intercept for ward. RESULTS: Recruitment was slower than expected and unevenly distributed over wards and hospitals. The face-to-face session was clinically feasible (mean duration = 33 min) as well as the mean amount (n = 2) and duration of phone calls (mean = 17 min). Only 16 (46%) of 35 trained nurses performed the intervention on nine wards. To deal with the loss of power, analyses were adapted. Overall effects on pain interference were not significant. However, effects were significant in sub analyses of the nine wards that recruited patients in the intervention period (p = .009). Regarding secondary outcomes, the group-by-time effect was significant for self-efficacy (p = .033), and patient satisfaction with information on pain-self-management (p = .002) and in-hospital pain management (p = .018). CONCLUSIONS: The implementation of ANtiPain improved meaningful patient outcomes on wards that applied the intervention routinely. Our analyses showed that the implementation benefited from being embedded in larger scale projects to improve cancer pain management and that the selection of wards with a high percentage of oncology patients may be crucial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02891785 Date of registration: September 8, 2016.