[Interface Communication and Information Transfer in Medical Care for People with Intellectual Disabilities: Qualitative Expert Interviews]. / Schnittstellenkommunikation und Informationstransfer in der medizinischen Versorgung von Menschen mit intellektueller Entwicklungsstörung: Qualitative Expert*innen-Interviews.

BACKGROUND: The aim of this study was to investigate the experiences, barriers, and solutions in communication during the provision of care for people with intellectual developmental disabilities in Germany. As there are approximately 350,000 people living with intellectual or developmental disabilities in Germany, who rely on assistance when communicating with healthcare providers, this study was conducted to examine the communication challenges and potential solutions in this population. The analysis especially focused on the potentials of digital applications facilitating information transfer. METHODS: Thirteen expert interviews were conducted using a structured interview guide with caregivers and medical providers to people with intellectual developmental disabilities. The interviews were analyzed using an inductive and deductive content analysis approach, according to Meuser and Nagel. RESULTS: The results revealed that the provision of care for people with intellectual developmental disabilities was characterized by time constraints and uncertainty when caregivers lack experience in caring for this population. Additionally, information transfer increased in complexity due to an overload of individual information provided by caregivers verbally or paper-based as well due to the passive role of patients who were usually not actively involved in the communication process. With regard to the potential for integrating digital applications for information transfer, a controversy between opportunity and risk emerged. CONCLUSION: The findings demonstrate that there is a need to implement training programs for professionals to enable them to offer improved health care for people with intellectual developmental disabilities. It is essential that caregivers are given sufficient time to communicate with patients, and that digital applications are utilized to support information transfer. Moreover, other research shows that digital applications offer new possibilities to communicate with people with intellectual developmental disabilities, such as the use of simplified or pictorial language. By addressing these communication challenges, healthcare professionals may be able to provide more effective and efficient care to this population. However, this requires further research, which addresses the controversial results regarding digital applications outlined in this paper.

[Digital care beds in long-term care-Support, relief for caregivers or just illusion? An ethnographic explorative study]. / Digitale Pflegebetten in der Langzeitpflege ­ Unterstützung, Entlastung für Pflegende oder nur Illusion? Eine ethnografisch-explorative Studie.

BACKGROUND: The digitalization of care items, in this case the care bed, is a logical consequence of the general shortage of personnel and resources in professional care and an increase in the number of very old people in need of long-term care. Sensors integrated into the nursing bed, interfaces for data transmission and connection to a monitoring system are generated for moments of support and relief for professional nurses and to increase the nursing outcome. Accompanying nursing research examines the implementation of 97 digital care beds in a long-term care facility for old people. METHOD: Mixed methods research approach over 24 months RESULTS: The lack or implementation of a consistent care process, unfavorable accompanying circumstances, interdependent contextual factors and an insufficient implementation management have a negative impact on the implementation and integration of the digital care beds into the care routines. CONCLUSION: For a successful implementation of digital assistance systems (dAS), they have to be considered in the care process besides a reliable technical connection. Furthermore, an implementation management as well as the review and adaptation of all relevant context factors are required.

A typology of nurses' interaction with relatives in emergency situations.

BACKGROUND: In nursing homes, residents' relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. RESEARCH OBJECTIVES: The present analysis aimed at elaborating a typology of nurses' experience of ethical support and challenges in their interaction with relatives in emergency situations. RESEARCH DESIGN: Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring's method of qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Participants were licensed nurses working in nursing homes. ETHICAL CONSIDERATIONS: Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. FINDINGS/RESULTS: In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives' demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives' demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. CONCLUSIONS: Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.

[Quality measurement in long-term care facilities-the need for a systemic understanding]. / Qualitätsmessung in Einrichtungen der Langzeitpflege ­ Notwendigkeit eines systemischen Verständnisses.

In 2019, a new assessment tool for evaluating quality in long-term care facilities was introduced in Germany. The quality indicators are based on a linear understanding of quality, which appears obsolete in view of the many interacting influencing factors (actors, contextual factors). In the international literature, quality assurance in long-term care facilities is rather based on a systemic understanding of quality.This contribution to the discussion is to be classified against the background of the existing debate on quality assessment. Empirical results from two research projects supported by the Innovation Fund, Quality Measurement in Long-Term Care with Routine Data (QMPR) and Cross-Sector & Integrated Emergency and Care Management for the Last Phase of Life in Inpatient Long-Term Care (NOVELLE), are presented to highlight the complexity of quality in long-term care and to also point out the need to develop a systemic understanding of quality in long-term care in Germany. It is necessary to identify the diverse influencing factors in order to develop meaningful and robust quality indicators for long-term care.

[Support of treatment safety by nursing personnel when dealing with emergency situations in long-term care facilities : Results of a qualitative empirical study]. / Unterstützung der Handlungssicherheit von Pflegefachpersonen im Umgang mit Notfallsituationen in Pflegeheimen : Ergebnisse einer qualitativ-empirischen Studie.

A significant number of emergency responses and hospitalizations of nursing home residents are considered avoidable and result in an unnecessary burden or health risk for residents. One cause of these unnecessary emergency responses lies in the lack of confidence of nursing personnel in their own actions and decisions. The goal of the NOVELLE project is to develop recommendations for action for certain emergency situations that enable nursing personnel to make operationalized decisions and empower them to take confident action. The challenges for nursing professionals to act with confidence in emergency situations were collated and assessed through a qualitative interview study. The results of this study are presented.

" darum rufe ich jetzt den Rettungsdienst!"

"… that's why I call the ambulance!" - A qualitative study of emergency scenarios in nursing homes Abstract. Background: In nursing homes, emergencies lead to frequent utilisation of emergency medical services (EMS) and emergency department visits. A broad interprofessional perspective of involved practitioners on emergencies in nursing homes has been little studied so far. Aim: Characterization, identification and prioritization of emergency scenarios by relevance and frequency in nursing homes. Methods: We conducted two multi-method, interprofessional group discussions with a total of 18 participants from nursing, medicine and science in January and February 2020. Group discussions were recorded, transcribed and analyzed using qualitative content analysis according to Mayring. Results: Emergency scenarios in nursing homes arise from interactions between person-related aspects and contextual conditions. The following person-related aspects were named as relevant: Falls, unstable vital signs, abnormal behavior, neurological symptoms and lifelessness. Contextual conditions are classified into organizational-structural, political-legal and ethical aspects. The following were considered to be most relevant: lack of communication between the actors, uncertainties among staff, absent living wills and increasing workload in nursing. Conclusions: Emergencies in nursing homes turn out to be complex emergency scenarios. Contextual conditions are important for dealing with emergency scenarios in nursing homes. Recommended actions should be based on the perspective of involved practitioners on emergencies and take greater account of the contextual conditions.

[Temporary Employees in Nursing Care - Rising Costs, Lack of Social and Professional Acceptance, Missing Introductory and Training Programs]. / Der Einsatz von Leih- und Zeitarbeit in der Pflege ­ steigende Kosten, fehlende soziale und fachliche Akzeptanz, ausbleibende Einarbeitung und Kurzeinweisung.

AIM OF THE STUDY: There is greater deployment of external staff in the German health care system. In political debates as well as in demands of employers' organizations, economic aspects are raised. But the point of view of those affected should not be neglected. This paper aims to describe different perspectives of professional groups. METHODOLOGY: The empirical results are based on eleven partly structured interviews. These were subjected to Mayring's qualitative content analysis. The group of interviewees consists of representatives of the care sector, workforce representatives and personnel management. RESULTS: While employing temporary personnel in ward care of patients, economic, social and professional aspects should be taken into account by all professions involved in the German health care system. CONCLUSIONS: In discussions on this subject, besides rising costs, professional and social acceptance as well as training programs and special introductions are very important.

[Critical discussion on the current quality debate on long-term care-a plea for a systemic and empirical insight into the development and measurement of quality in long-term care]. / Kritische Diskussion zur bisherigen Qualitätsdebatte in der Langzeitpflege ­ ein Plädoyer für eine systemische und auf empirischen Erkenntnissen beruhende Betrachtung der Entwicklung und Messung von Qualität in der Langzeitpflege.

Against the background of the quality debates on long-term care and recurrent reform measures in politics on this topic, a critical discussion on the current state of quality development, testing and reporting in Germany is presented. In Germany, the linear model of Donabedian's structural, process and outcome quality is still used as a basis for quality issues in nursing care; however, international research suggests that multiple and mutually interacting factors influence nursing quality and that a more systematic and systemic perspective for the further development of nursing quality (especially of features, criteria and indicators of nursing quality) appears more appropriate. This article intends to open the perspective of the development, measurement and reporting of quality in nursing and to make a critical contribution for a systemic theory development as a relevant basis for future developments of quality evaluation programs and quality reporting systems in long-term care.

[Compatibility of occupation with nursing relatives in small and medium-sized businesses : Results of an explorative study in a "rural urban" center in eastern Lower Saxony]. / Vereinbarkeit von Berufstätigkeit und Angehörigenpflege in kleinen und mittleren Unternehmen : Ergebnisse einer explorativen Studie in einem "rural-urbanen" Zentrum im Osten Niedersachsens.

In view of the increasing duties of employees as caregivers for relatives, questions arise concerning the compatibility of work and caregiving in the context of small and medium-sized enterprises. The aim of this exploratory study was to give first insights into this issue whereby the related perceptions and needs of this group were investigated. The research included semi-structured interviews with company executives and two workshops with employees according to the photovoice method. The results showed that the enterprises preferred informal in contrast to formal arrangements. Also, they did not have any knowledge concerning the care-related needs of their employees. The chief executive officers showed a highly superficial awareness of this problem. On the employees side the organizational efforts to maintain the care arrangement at home were articulated as a main issue, which could be supported by flexible working time regulations; however, in the current practice this was granted by the employers at the expense of their employees.

Developing digital competencies of nursing professionals in continuing education and training - a scoping review.

Introduction: The German health and care system is transforming due to advancing digitalization. New technological applications in nursing, such as social and assistance robotics, artificial intelligence and legal framework conditions are increasingly focused in numerous research projects. However, the approaches to digitalization in nursing are very different. When integrating technologies such as robotics and artificial intelligence into nursing, it is particularly important to ensure that ethical and human aspects are taken into account. A structured classification of the development of digitalization in nursing care is currently hardly possible. In order to be able to adequately deal with this digital transformation, the acquisition of digital competences in nursing education programs is pivotal. These include the confident, critical and creative use of information and communication technologies in a private and professional context. This paper focuses on the question which specific training offers already exist at national and international level for nursing professions to acquire digital competences. Methods: A scoping review according to the PRISMA scheme was conducted in the PubMed and CINAHL databases. The search period for the scoping review extended from 2017 to 2024. Results: The selection of the studies took place by inclusion and exclusion criteria and the content-related orientation of the publications. After reviewing the titles and abstracts, eight studies were included. Of these, four were published in German-speaking countries and another four in international English-language journals. Discussion: The topic of digitization of the nursing professions and the question of how nurses can acquire digital competences is gaining international attention. Nevertheless, the research on explicit continuing education programs for nursing professions is still undifferentiated. No specific continuing education offer for the development of digital competences of nursing professionals was identified. Many authors remained at the meta-level when developing methodological concepts for the acquisition of digital competences. The systematic integration of digitalization into higher education and continuing vocational training is mentioned in the publications. The development of theory- and research-based educational frameworks, which can be used as a basis for curricula in nursing studies and continuing education, is highly recommendable.

Sustainable integration of digitalisation in nursing education-an international scoping review.

Introduction: Trainees and teachers at nursing schools as well as nursing professionals are increasingly facing new challenges as a result of the digital transformation. Opportunities for the entire care system exist in the improvement of care quality and communication between those involved. However, this change also harbours risks, such as the use of immature digital applications in the care sector, data theft and industrial espionage. In order to be able to exploit the potential of digitalisation despite these risks, it is necessary to integrate relevant aspects such as digital skills into nursing training. The aim of this study is to investigate the extent to which the sustainable integration of digitalisation in nursing education is discussed. Methods: The methods of the systematic literature and database search were carried out in the form of a scoping review according to the PRISMA scheme. The PubMed and CINAHL databases were used for this purpose. The search period covered the years 2017-2023. Findings: After screening the titles and abstracts using inclusion and exclusion criteria, 13 studies were included in the synthesis of findings. The international literature focuses on content areas that highlight trends in digitalisation-related training in nursing. These focal points include concept development, considering the heterogeneity of demand constellations, as well as the reflexive reorientation of existing competences, whereby the technological competence of teachers is not disregarded. Other focal points relate to the initiation of digital skills in training and maintaining the employability of older nursing staff through professional development. Discussion: The literature research shows that there is a rudimentary discussion about digitalisation and curricular developments in nursing training in an international context, while the discourse in the German-language literature is less advanced. Among the sustainability desiderata derived from the literature is the involvement of nursing professionals in the development, testing and implementation of digital technologies. Only through active cooperation between nursing professionals and nursing sciences can the topic of digitalisation be integrated into the education and training of professional nursing in a targeted and future-oriented manner, whereby the focus should always be on the ability to deal with digital technologies and the associated change.

[Trends in place of death for nursing home residents in an urban district during the COVID-19 pandemic: An analysis of death registry data]. / Entwicklung der Sterbeorte von Pflegeheimbewohnern in einem städtischen Versorgungsbereich während der COVID-19-Pandemie ­ eine Auswertung von Daten des Sterberegisters.

BACKGROUND: The nursing home is a common place of death; however, little is known about the place of death with respect to the people living there. Was there a difference in the frequencies of the places of death of nursing home residents in an urban district and in the individual facilities before and during the COVID-19 pandemic? METHODS: Full survey of deaths by retrospective analysis of death registry data from the years 2018 to 2021. RESULTS: Over the four-year period 14,598 people died, with 3,288 (22.5%) being residents of 31 different nursing homes. Over the reference period before the pandemic (March 1, 2018 to December 31, 2019) 1,485 nursing home residents died: 620 (41.8%) in hospital, 863 (58.1%) in a nursing home. During the pandemic period (March 1, 2020 to December 31, 2021) 1,475 death were registered: 574 (38.9%) in hospital and 891 (60.4%) in a nursing home. The mean age over the reference period was 86.5 years (±8,6; median 88.4; 47.9 to 106.2), in the pandemic period it was 86.7 years (±8,5; median 87.9; 43.7 to 111.7). Before the pandemic 1,006 deaths (67.7%) occurred in females, during the pandemic it was 969 (65.7%). The relative risk (RR) as a measure for the increase in the probabilty for an "in-hospital" death during the pandemic period was 0.94. In different facilities, the number of deaths per bed during the reference and the pandemic period varied between 0.26 and 0.98, and the RR from 0.48 to 1.61. DISCUSSION: For all nursing home residents, the frequency of deaths was not increasing and no shift towards an "in-hospital" death was observed. Several nursing homes revealed substantial differences and opposing trends. The strength and the type of effects of facility-related circumstances remain unclear.

Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018-2021.

Aim: The realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital. Methods: A full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021. Results: Over the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min-max: 36-292); number of beds: 102 (±39; 34-210); deaths per bed per year 0.27 (±0.07; 0.15-0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0-21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0-12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably. Conclusion: Resuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.

[Emergency care in nursing homes in the City of Braunschweig: A cross-sectoral view with indicators from deaths, resuscitation, emergency department visits and EMS deployment]. / Notfallversorgung in Pflegeeinrichtungen in der Stadt Braunschweig: Ein sektorenübergreifender Blick anhand von Kennzahlen aus Sterbefällen, Reanimationen, Krankenhauszuweisungen und Rettungsdiensteinsätzen.

INTRODUCTION: General survey of emergency care in nursing homes in the City of Braunschweig. METHODS: Retrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). RESULTS: 30 nursing homes with 3,100 beds (mean: 103; range: 35-250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4-1.6); emergency department visits per bed 1.4 (0.7-3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41-96 %); deaths per bed 0,29 (0.12-0.48); rate of deaths in hospital 46 % (0-62 %); CPRs per 1,000 beds 6.1 (0-28); CPR failure rate 22 (0-83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0-1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. CONCLUSION: Compared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.