[Intervention-related demands: Criteria for an operating room-specific patient classification. A qualitative focus group study]. / Eingriffsbezogene Anforderungen: Kriterien einer OP-spezifischen Patientenklassifikation.

Intervention-related demands: Criteria for an operating room-specific patient classification. A qualitative focus group study Abstract: Background: Optimal workforce deployment in the operating room-setting has gained high priority in the context of an economized health care system and the development of skill-grade mix. Therefore, mapping intervention-related demands on perioperative nurses as precisely as possible is a frequently discussed need. A surgery-specific patient classification might be helpful. Aim: This paper aims to present core elements of perioperative nursing care in the Swiss-German context and to establish a link to the Perioperative Nursing Data Set (PNDS). Methods: Three focus group interviews with perioperative nurses took place at a university hospital in the German-speaking part of Switzerland. Data analysis was performed in analogy to qualitative content analysis according to Mayring. The content structuring of the categories was based on the relevant PNDS taxonomies. Results: Intervention-related requirements can be divided into three areas: "patient safety", "nursing and caring", and "environmental factors". The conjunction with the PNDS taxonomy serves as a theoretical foundation. Conclusions: Elements of the PNDS taxonomies can describe the demands on perioperative nurses in the Swiss-German context. The identified definition of intervention-related demands can contribute to the visibility of perioperative nursing and promote professionalization as well as practice development in the operating room-setting.

Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients.

Objective: Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants' experiences with pain management and study participation. Methods: A multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part. Results: Twenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P â€‹= â€‹0.04), but no significant group x time effect for worst pain (P â€‹= â€‹0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P â€‹< â€‹0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome. Conclusions: This study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management. Registration number: This study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&draw=2&rank=1.

Exploring learning processes associated with a cancer pain self-management intervention in patients and family caregivers: A mixed methods study.

AIM: Explore learning processes associated with a psychoeducational pain selfmanagement intervention. BACKGROUND: Self-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilitated. METHODS: A convergent parallel mixed methods design with qualitative data collection embedded in a randomized controlled trial (RCT) was used. Outpatients with cancer and FCs were recruited from three Swiss university hospitals. The six-week intervention consisted of education, skills building, and nurse coaching. Quantitative data on pain management knowledge and self-efficacy were analyzed using multilevel models. Patients and FCs were interviewed post-RCT regarding their learning experiences. Qualitative data analysis was guided by interpretive description. Finally, quantitative and qualitative data were integrated using case level comparisons and a meta-matrix. RESULTS: Twenty-one patients and seven FCs completed this study. The group-by-time effect showed increases in knowledge (p = 0.035) and self-efficacy (p = 0.007). Patients' and FCs' learning through experience was supported by an intervention nurse, who was perceived as competent and trustworthy. After the study, most intervention group participants felt more confident to implement pain self-management. Finally, data integration showed that declining health hampered some patients' pain self-management. CONCLUSIONS: Competent and trustworthy nurses can support patients' and FCs' pain self-management by providing individualized interventions. Using a diary, jointly reflecting on the documented experiences, and addressing knowledge deficits and misconceptions through the use of academic detailing can facilitate patients' and FCs' learning of critical skills.

Inter- und intraprofessionelle Zusammenarbeit in Krisensituationen auf der Intensivstation am Beispiel von COVID-19.

Interprofessional and intraprofessional collaboration in crises situations in the intensive care unit regarding COVID-19 - a qualitative, retrospective analysis Abstract. Background: Interprofessional collaboration is elementary in the intensive care unit, a success factor in difficult patient situations and complex therapies. The COVID-19-pandemic challenged newly composed treatment teams, however, experience does not exist. Aim: We analyzed personal experiences and views on inter- and intraprofessional collaboration in intensive care units during the COVID-19-pandemic and identified influencing factors. Methods: We used a qualitative, retrospective study design, collected data from physicians, nurses in intensive care, anesthesia and surgery and physiotherapists during group discussions using the story / dialogue method. We analyzed the data according to Mayring's Qualitative content analysis. Results: We identified two main categories, each with three sub-categories: 1. Mastering a exceptional situation actively (Recognizing a common goal; Acting in solidarity; Getting to know each other in inter- / intraprofessional collaboration), 2. Having overcome the exceptional situation in retrospect (Maintaining personal contacts; Gaining new knowledge and perspectives; Taking what has been learned into the future). The participants rated the interprofessional and intraprofessional collaboration as good to very good. Conclusions: Factors promoting collaboration and positive experiences are to be incorporated into everyday work. The intraprofessional management team thereby defines common goals and values for the best possible patient care.

Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy / Erfolgskritische Faktoren bei der Optimierung des Skill-Grade-Mix auf der Basis von Lean Management-Prinzipien - eine qualitative Teilstudie

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project's success. Conclusions: Project managers should ensure transparency of the project's progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

[Nursing care in the run-up to Swiss DRG ­ Nurses' experiences with interprofessional collaboration, leadership, work load and job satisfaction]. / Pflege im Vorfeld von SwissDRG - Erfahrungen von Pflegenden mit interprofessioneller Zusammenarbeit, Führungsverhalten, Arbeitslast und Arbeitszufriedenheit.

BACKGROUND: The literature reports critically on the consequences of the introduction of case-based hospital reimbursement systems, which hamper the delivery of professional nursing care. For this reason, we examined the characteristics of nursing service context factors (work environment factors) in acute care hospitals with regards to the introduction of the new reimbursement system in Switzerland. AIM: This qualitative study describes practice experiences of nurses in the context of the characteristics of the nursing service context factors interprofessional collaboration, leadership, workload and job satisfaction. METHODS: Twenty focus group interviews were conducted with a total of 146 nurses in five acute care hospitals. RESULTS: The results indicated that for quite some time the participants had observed an increase in complexity of nursing care and a growing invasiveness of clinical diagnostics and treatment. At the same time they noticed a decrease in patient length of stay. They strived to offer high quality nursing care even in situations where demands outweighed resources. Good interprofessional collaboration and supportive leadership contributed substantially to nurses' ability to overcome daily challenges. Job satisfaction was bolstered by interactions with patients. Also, the role played by the nursing team itself is not to be underestimated. CONCLUSIONS: From the participants' point of view, context factors harbor great potential for attaining positive patient outcomes and higher job satisfaction and have to be monitored repeatedly.

[Inflammatory bowel diseases: experiencing illness, therapy and care]. / Chronisch entzündliche Darmerkrankungen: Erleben von Krankheit, Therapie und Betreuung.

People affected by Crohn's disease or ulcerative colitis experience a high level of suffering. A new generation of anti-tumour necrosis factor-α agents can alleviate the burden of symptoms considerably. In order to develop a need-centred care programme for this patient group, we conducted problem-centred interviews with nine patients about their experience of the disease, the therapy and the quality of nursing care. The evaluation was based on qualitative content analysis. Patients' statements revealed three general categories: (1) "the never ending story" of a life with IBD, (2) "the sudden change" due to successful therapy and (3) "the narrow path" of a new stage of life: the disease no longer dominated daily life. The results emphasise the necessity of specific care for this patient group in order to perceptibly enhance their self-management and quality of life. The study illuminates a developing field of ambulant nursing care, based on the knowledge of patients' needs in the context of a chronic disease characterised by an unpredictable and irregular course.