[Nursing interventions by school nurses in Germany: A cross-sectional study]. / Interventionen der Schulgesundheitspflege in Deutschland.

Nursing interventions by school nurses in Germany: A cross-sectional study Abstract. Background: The internationally established professional profile of school nursing has not yet been implemented across the board in Germany. In model projects and some international schools the feasibility of the concept and the daily work of school nurses in Germany can already be observed. Urgent and currently often unsolved issues in the school setting are the inclusion of chronically ill students and health promotion in the living environment. Aim: The aim of this paper is to describe the interventions of school nurses in everyday school life. Method: Using a standardized online questionnaire, school nurses in Germany were surveyed regarding the activities they performed and their frequency. The data on the activities were collected based on the Nursing Intervention Classification (NIC). Data were analyzed using descriptive statistics. Results: Respondents (n = 25) focused on acute care and health education/promotion. Nursing interventions that have a family or population-based approach are performed only "every 2-3 months" or less by the average respondent. Conclusions: The daily intensive implementation of diverse nursing interventions indicates an urgent need for nursing expertise in schools.

Parental health literacy and health knowledge, behaviours and outcomes in children: a cross-sectional survey.

BACKGROUND: Health literacy (HL) is closely associated with leading health indicators such as engaging in healthy behaviours and experiencing a healthy social environment. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but there are gaps in the available information and there is not any data available yet for the German context. METHODS: In preparation of an implementation study, a cross-sectional survey was conducted in 28 elementary and secondary schools in Germany. The parent questionnaire was completed by 4217 parents and included the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The child questionnaire examined children's health knowledge, behaviours and outcomes. For children between 6 and 10 years, a parent reported on behalf of their children (N = 1518). Students 11 years and older completed a self-administered questionnaire (N = 2776). Bivariate and multivariate analyses were carried out. Spearman's Rho correlations assess the relationships between household characteristics, parental HL and the health behaviour and outcomes in children. RESULTS: Among the participating parents, 45.8% showed problematic or inadequate HL. The major determinants of high parental HL were high socio-economic status (SES) (r = .088***, 95% CI [.052, .124]), living in West Germany (r = .064***, 95% CI [.032, .096]) and older parental age (r = .057**, 95% CI [.024, .090]). In the multivariate model, only SES remained significant. High parental HL was associated with positive health behaviours in children including healthier nutrition, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol, sexual activity among children and children's weight were not significant. CONCLUSIONS: The results confirm a relationship between low parental HL, SES and some child health behaviours likely to negatively impact their health and wellbeing including less healthy nutrition and less exercise. Strengthening the health knowledge and competencies of parents may contribute to improved child outcomes particularly in the areas of nutrition, exercise and dental health.

[Individual teacher's health literacy and their safety in dealing with chronically ill pupils and emergencies]. / Individuelle Gesundheitskompetenz von Lehrkräften und deren (Un)Sicherheit im Umgang mit chronisch erkrankten Schulkindern und Notfallsituationen.

BACKGROUND: Health literacy (HL) is regarded as a key determinant in health promotion. The support of HL should begin as early as possible to prevent later health problems. In the school setting, teachers play an important role. Due to all-day school and inclusion efforts, teachers are increasingly faced with the health problems of pupils. At the same time, many teachers show their own significant health problems, often due to an enormous workload. OBJECTIVES: This study assesses the level of the individual teacher's HL and examines possible relationships between the individual HL of teachers and their level of uncertainty in dealing with chronically ill pupils. METHODS: A secondary data analysis of a quantitative survey of n = 420 teachers was conducted. A self-assessment of the teacher's HL level was done using HLS-EU-Q16. Furthermore, correlation analyses between the HL and the level of insecurity of teachers in dealing with selected health problems were made. RESULTS: More than half of the teachers showed a limited level of HL and an association between low level of HL and uncertainty in dealing with chronically ill pupils were found. In particular, mental health issues caused difficulties among the teachers. DISCUSSION: There is a large gap between complex health-related demands on the teachers and their required health literacy as well as sovereignty in dealing with chronic and mental impairments in the school setting. These deficits will influence the children's HL and the health development of adolescents.

Malnutrition in Austrian hospital patients. Prevalence, risk factors, nursing interventions, and quality indicators: a descriptive multicentre study.

AIMS: This study reports the prevalence of malnutrition (according to body mass index and malnutrition universal screening tool) and the prevalence of health problems that may influence the development of malnutrition in Austrian hospitals. Screening routines and nutrition-related interventions on patient level and quality indicators on ward and facility levels were also investigated. BACKGROUND: Malnutrition is an undesirable condition of care-dependent patients and can increase morbidity and mortality of those affected; it is therefore required to screen every patient to detect people at risk and treat them early. Only little data are available on the prevalence of the underlying causes and on the extent of nutrition-related interventions. DESIGN: A cross-sectional multicentre study in 11 Austrian hospitals (n = 2,283) in 2009. METHODS: Every patient was assessed by two trained nurses. Data were collected using a standardized validated questionnaire. RESULTS/FINDINGS: The prevalence of malnutrition according to the malnutrition universal screening tool was 15·7% (high risk) and 8·3% (middle risk). A body mass index <20·0 kg/m² was found in 12·0% (6% <18·5 kg/m²). Main problems were loss of appetite (56·6%), acute disease (38·6%), and nausea (22·3%). About 70% of the patients were screened on admission. Patients at risk were referred to a nutritional expert (7-28·7%), received protein-energy-enriched diets (2·5-15·1%) or snacks (5·1-17·4%). A dietician was available in all hospitals; 8/11 hospitals had fixed criteria for assessing malnutrition; guideline policy varied among the facilities. CONCLUSION: The majority of wards acted in compliance with clinical guidelines; nevertheless, there are still some facilities that do not screen and weigh their patients in a standardized manner and do not treat high-risk patients adequately.

Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol.

INTRODUCTION: Delirium is one of the most common forms of acute cerebral dysfunction in critically ill children leading to increased morbidity and mortality. Prevention, identification and management of delirium is an important part of paediatric and neonatological intensive care. This scoping review aims to identify and map evidence on non-pharmacological interventions for paediatric delirium prevention and management in paediatric and neonatal intensive care settings. METHODS AND ANALYSIS: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches will be performed in the databases Medline (via PubMed), CINAHL, Cochrane Library, Ovid (Journals), EMBASE and Web of Science (01/2000-current). Two reviewers will independently review retrieved studies, and relevant information will be extracted using data extraction forms. The results will be presented in tabular format and accompanied by a narrative summary. INCLUSION CRITERIA: The review will include references that describe or evaluate non-pharmacological interventions to prevent or manage paediatric delirium. Conference abstracts, editorials, opinion papers and grey literature will be excluded. ETHICS AND DISSEMINATION: Due to the nature of research involving humans or unpublished secondary data, approval of an ethics committee are not required. The dissemination of findings is planned via professional networks and publication in an open-access scientific journal.

Higher pressure ulcer risk on intensive care? - comparison between general wards and intensive care units.

OBJECTIVE: The objective of the study was to evaluate the effect of being treated in intensive care units in comparison with general hospital wards regarding pressure ulcer occurrence when controlled for various risk factors. BACKGROUND: Pressure ulcer occurrence is commonly used as an indicator for the quality of care. Large-scale incidence studies are costly and difficult to perform. DESIGN: Secondary analysis of patient data (n = 32,400) collected during 2002-2009 as part of eight multicentre pressure ulcer surveys in 256 German hospitals. METHODS: Ward-acquired pressure ulcer rate was used for the calculation of effect sizes as a surrogate parameter for pressure ulcer incidence. The SRISAG (surface, repositioning, immobility, shear forces, age, gender) logistic regression model was used to control for differences in case mix. RESULTS: Pressure ulcer prevention and intrinsic and extrinsic risk factors differ for patients from hospital wards compared with those from intensive care wards. The ward-acquired pressure ulcer rate in general hospital wards was 3·9% (1·5% excluding grade 1). In intensive care, the rate was 14·9% (8·5% excluding grade 1), which corresponds with an unadjusted odds ratio of 4·3 (95%CI 3·8-4·9). After the SRISAG model was applied, the odds ratio was reduced to 1·5 (CI 1·2-1·7). CONCLUSION: When surface, repositioning, immobility, shear forces, age and gender are controlled for the institutional factor intensive care unit vs. general hospital wards is no longer a high-risk factor for the development of pressure ulcer. The SRISAG model is simple and can be used to compare the occurrence of pressure ulcer between different medical specialties. RELEVANCE TO CLINICAL PRACTICE: Application of this model allows more valuable comparison of the occurrence of pressure ulcer in different specialities and enables clinical practitioners and health care planners to use this outcome as an indicator for the quality of care to avoid confounding.

[Integrating academic nurses in German university hospitals: a follow-up survey]. / Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: ein Follow-up-Survey.

INTRODUCTION: The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. METHOD: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. RESULTS: In total, n=29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n=786 between 2015 (n=593) and 2018 (n=1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD=1.66; min - max=1.09 - 6.69; Q1 - Q3=1.49 - 4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD=1.40; min - max=0.47 - 5.42; Q1 - Q3=0.87 - 3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). DISCUSSION: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool. A psychometric comparison.

AIM: Comparison of the diagnostic accuracy of two pressure ulcer risk assessment scales and one generic nursing assessment tool. BACKGROUND: Guidelines for pressure ulcer prevention recommend an initial risk screening of all patients, followed by appropriate nursing interventions. Additionally, personal and financial resources have to be allocated carefully to avoid excessive or too little treatment. Risk assessments should be accurate and applicable, and some studies showed that generic nursing tools also provide specific information for nursing diagnoses, like risk for pressure ulcer. DESIGN: Cross sectional observational study. METHODS: A total of 1053 adult patients of a university hospital in Germany were investigated. For each patient, the Braden Scale, the Waterlow Scale and the Care Dependency Scale were completed. A skin inspection was conducted by trained nurses. Correlations between the three scales and the mean values of each pressure ulcer risk assessment scales for each Care Dependency Scale value were calculated. To determine the association between susceptibility to pressure ulcer and observed pressure ulcer, the area under the curve was calculated. RESULTS: There was a higher correlation between the Braden Scale and the Care Dependency Scale (r = 0.82) than between the two pressure ulcer risk assessment scales (-0.65). The highest area under the curve was reached by the Braden Scale (0.86), followed by the Care Dependency Scale (0.83) and the Waterlow Scale (0.81). Only the Braden Scale (cut-off 18) and the Care Dependency Scale (cut-off 65) reached the psychometric requirements of at least 70% sensitivity and 70% specificity. CONCLUSIONS: The Care Dependency Scale could be used for both a general nursing assessment and as a screening tool for risk for pressure ulcers. The Braden Scale showed the highest association with the occurrence of pressure ulcer. RELEVANCE TO CLINICAL PRACTICE: The Care Dependency Scale is a useful screening tool to identify patients at risk for pressure ulcers. Nursing assessment activities might be reduced by using a generic nursing assessment tool also for specific risk screening.

Potentials of School Nursing for Strengthening the Health Literacy of Children, Parents and Teachers.

Health literacy (HL) plays a key role in explaining health disparities. School nurses (SN) provide health related expertise within the school setting. A positive effect on the HL of children but also their teachers and parents has been suggested by some research, but gaps persist in the available information. As a pilot project, SN, which are not common in German schools, were placed in 28 public elementary and secondary schools in two German states. Children (11+ years, n = 2773), parents (n = 3978) and teachers (n = 420) participated in a 2017 baseline (T0) survey. Data collection was repeated in 2018 (T1). HL was measured using the Health Literacy for School-Aged Children scale (HLSAC) (children) and the European Health Literacy Short Scale (HLS-EU-Q16) (adults). Descriptive and multivariate data analyses were carried out. The HL of all groups increased between T0 and T1. Low child HL decreased from 17.9% to 14.9%. Problematic and inadequate HL dropped from 43.8% to 38.8% among parents and from 49.9% to 45.8% among teachers. Improvements were significant for children and parents but not for the teachers. Despite the relatively short intervention period and a relatively non-specific spectrum of interventions, there is some evidence that SN may contribute to strengthening HL within the school setting. The longer-term effects of SN on health literacy and child health should be further examined. For this, a clearer conceptualization of the scope of work of the SN in Germany including their educational interventions is imperative.

Hospital pressure ulcer prevalence rates and number of raters.

AIM: The purpose of this study was to evaluate the influence of different numbers of nurse raters conducting skin inspection (one or two) on observed pressure ulcer prevalence rates. BACKGROUND: Pressure ulcer prevalence and incidence rates are important outcome measures for the quality of care. To ensure reliability and comparability of such rates standardisation of study methods is recommended. It is assumed that data accuracy can be improved if skin inspection is conducted by a team of two raters. DESIGN: A secondary data analysis of pressure ulcer prevalence data was conducted. METHOD: Groups of hospital patients which were examined by one (n = 2420) or two raters (n = 15,009) were compared regarding demographic characteristics, pressure ulcer risk and pressure ulcer prevalence. Logistic regressions were conducted to examine the association between the number of raters (one or two) and the outcome pressure ulcer (yes/no). RESULTS: Groups of one and two raters were comparable regarding demographic characteristics. There was no statistically significant difference regarding pressure ulcer prevalence between both groups (p = 0.222). There was no relation between the number of raters and the probability of identifying a pressure ulcer patient (p = 0.060). CONCLUSIONS: Pressure ulcer prevalence rates in the analysed studies were not affected by the number of raters. There seems to be no relation between the numbers of nurses conducting skin inspection and observed prevalence rates. RELEVANCE TO CLINICAL PRACTICE: Conducting pressure ulcer prevalence studies require a lot of effort and personal costs. Provided that one nurse alone or a team of two nurses rate the existence of pressure ulcers equally it is no longer obligatory to have two raters. This would save resources. However, when patients are restricted in their mobility two nurses are recommended to provide assistance in patient turning.

Does the number of raters influence the pressure ulcer prevalence rate?

We analyzed data from pressure ulcer prevalence studies conducted in nursing homes between 2004 and 2006 concerning differences in the observed pressure ulcer prevalence rates while looking into the number of nurses conducting skin inspections (one or two). Results of the analysis revealed that the number of raters did not influence the observed pressure ulcer prevalence rate. Adequate preparation and training of ward nurses for data collection seem to be sufficient to achieve reliable data.