Demand for community-based Case Management in Austria - a qualitative analysis.

BACKGROUND: The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses'task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. METHODS: A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. RESULTS: The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. CONCLUSIONS: Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

[Preventive home visits : Cross-sectional study to support an independent lifestyle for elderly people]. / Präventive Hausbesuche : Querschnittstudie zur Unterstützung der selbstständigen Lebensführung älterer Menschen.

BACKGROUND: In the interest of preventing or postponing dependency on care and assistance for as long as possible, preventive home visits to people aged over 70 years living at home were conducted by registered nurses. AIM: Assessment of the functional health of people over 70 years of age and counseling or information carried out based on the identified problem areas and resources. MATERIAL AND METHODS: A multidimensional nursing assessment through self-evaluation was applied for 345 people aged over 70 years. RESULTS: The sample of people investigated showed a high level of competence in self-care; however, a large number of functional health impairments could be identified that are reflected in the high requirement for counseling and information. DISCUSSION: It became evident that recruiting of study participants was difficult and that care by family members was an important resource for people aged over 70 years. From this it was recommended that in the future sustainable advertising efforts should be conducted and special attention needs to be given to counseling and information for family members in preventive home visits.

The diagnostic efficiency of the extended German Brøset Violence Checklist to assess the risk of violence.

BACKGROUND AND PURPOSE: The prevention of aggression and violence of patients is part of the challenge for the psychiatric inpatient care. Resources needed are a systematic risk assessment and taking preventive measures according to the risk. The extended Brøset Violence Checklist (BVC-CH) is an assessment instrument for the short-term assessment of the risk of violence for physical attacks toward medical staff and other patients. Until now, the instrument was only validated in the context of the development phase of the instrument. The aim of this study was to investigate how valid the BVC-CH scale is for adult psychiatry in acute inpatient care facilities. METHODS: In a prospective cohort study, 232 consecutively admitted patients were assessed using the BVC-CH. The calculation of the predictive values was based on a contingency table. The discriminatory power of the instrument and the determination of the cutoff point were done using the receiver operating characteristic (ROC) curve analysis. Physical attacks were registered with the Staff Observation of Aggression Scale-Revised (SOAS-R). RESULTS: The sensitivity was 58.8% and the specificity was 96.8% by a cutoff point of > or = 7. By choosing a cutoff point of > or = 6, the sensitivity was 64.7% and the specificity was 95.1%. A value of .93 was determined for the area under the curve receiver operating characteristic (AUC(ROC)). CONCLUSIONS: Overall, the BVC-CH is a valid instrument for the short-term prediction of physical attacks. Further research of the BVC-CH is recommended but in particular for the cutoff point.

CareNet Tyrol - Information System Success Assessment for Case & Care Management Service.

BACKGROUND: CareNet is the IT-based tool for Case and Care Management (CCM) in Tyrol, which facilitates standardised documentation of CCM activities. OBJECTIVES: Analysing the pilot usage of CareNet Tyrol. METHODS: Evaluation of the success and user experience of CareNet, expert interviews and a questionnaire-based assessment. RESULTS: Feedback from users in both phases indicated that the CareNet platform provides general benefits, but falls short of fully supporting the daily work of CCM experts and avoiding the need for parallel use of different documentation tools. CONCLUSION: This paper provides an insight into the ongoing transition to digital documentation for CCM at LIV Tyrol. While user feedback highlights areas for improvement, digital documentation is proved to be beneficial for the CCM team.

Health literacy and clinical outcomes in patients with total knee arthroplasty in different rehabilitation settings: An exploratory prospective observational study.

BACKGROUND: Limited health literacy is associated with negative clinical outcomes. Although research on health literacy has increased in recent years, there is still a lack of evidence for orthopaedic patients undergoing joint replacement and in the rehabilitation sector. OBJECTIVES: The aims of this study were to assess health literacy of patients undergoing total knee arthroplasty (TKA) and to observe its course during rehabilitation. Furthermore, we aimed to investigate associations between health literacy and clinical outcomes as well as differences regarding rehabilitation settings. METHODS: In this prospective observational study, data about (n = 92) patients' health literacy and clinical outcomes were collected. Baseline assessments were conducted preoperatively (T0) and followed-up after three (T1) and six (T2) months. Health literacy was assessed with the European Health Literacy Questionnaire, pain scores, functional restrictions and activity levels with standardised patient-reported outcome measures (PROMs). Subgroup analyses were conducted regarding inpatient and outpatient rehabilitation. RESULTS: Out of 92 patients, 77 completed postoperative rehabilitation between T0 and T1. Health literacy improved from T0 to T1 (p < 0.001) and subsequently remained constant until T2. Although the study showed an average improvement in health literacy scores in post-discharge rehabilitation, subgroup analyses indicated that patients did not achieve higher levels of health literacy. Pain scores were higher in patients undergoing outpatient rehabilitation (p = 0.022). No differences were found in other outcomes regarding rehabilitation settings and health literacy. CONCLUSIONS: Based on our results, there seems to be no association between health literacy and clinical outcomes. Furthermore, the results regarding health literacy over the rehabilitation period indicated a need for enhancement of educational strategies to strengthen health literacy in the context of inpatient and outpatient orthopaedic rehabilitation.

The role of health literacy in orthopaedic rehabilitation after total knee and hip arthroplasty: A scoping review.

BACKGROUND: Health literacy (HL) is a key aspect in empowering patient education as part of orthopaedic rehabilitation after total knee or hip arthroplasty (TKA/THA). OBJECTIVES: This scoping review aims to demonstrate the prevalence of patient-related outcome measures in studies on the effectiveness of orthopaedic rehabilitation of older people after TKA/THA. The review also focuses on the identification of outcome measures that assess patients' HL or HL-related aspects. METHODS: A scoping literature search was conducted using the JBI methodology for scoping reviews. The databases MEDLINE (PubMed), CINAHL Complete, The Cochrane Library, Academic Search Elite, and ERIC were searched with keywords and phrases to find relevant literature. Identified outcome measures were conceptually analysed in a peer reviewed procedure. Those with suspected HL-related content were analysed at item level. Text analyses were performed using MAXQDA. RESULTS: 117 papers were included in this review. 45 patient-related outcome measures could be found, 2 of which assess HL-related aspects. No paper could be found that assessed patients' HL in orthopaedic rehabilitation after TKA/THA. CONCLUSIONS: HL has hitherto been of limited importance in orthopaedic rehabilitation. Health professionals are responsible for assessing patients' health literacy and developing appropriate strategies for patient education in the context of orthopaedic rehabilitation.

[Interventions and their effects on informal caregivers of people with dementia: a systematic literature review]. / Interventionen und deren Effekte auf pflegende Angehörige von Menschen mit Demenz--Eine systematische Literaturübersicht.

In home-care situations, the caring family members of people suffering from dementia are exposed to a great number of physical, mental and social burdens, and restrictions, putting themselves at risk of falling ill. Caring family members need adequate forms of relief in order to be able to care for the family member at home for as long as possible, and with the best possible physical and psychological status. In the present paper, interventions of relief and promotion and their effects on family members caring for dementia patients have been investigated and described on the basis of a systematic literature review. The presentation of the results shows that psycho-educational, relieving, supportive, psychotherapeutic and multimodal offers as well as counselling and case/care management among caring family members have significant effects on parameters such as burdens, level of depression, subjective well-being, skills/knowledge as well as symptoms and institutionalisation of the person in need of care. None of the interventions investigated, however, covers the entire range of parameters. In order to be able to ensure the individual support of caring family members, a superordinate organisational concept (case/care management, family health nursing) which meets the needs of the caring family members, combines and interlinks tailor-made offers for caring family members is required. Registered nurses could play a central role as care managers or family health nurses in ensuring home-based care for people with dementia. Further investigations on multimodal offers and case/care management are needed. In this context, it is essential to take well-considered decisions on study design, sample size, and result parameters (assessment instruments) in order to gain significant results and homogeneous data.

[Stay in, dropout of and re-entry into the nursing profession of nurses under the aspect of specific types of nursing professionals in Austria]. / Berufsverbleib, -wiedereinstieg und -ausstieg diplomierter Pflegender in Osterreich unter Berücksichtigung spezifischer Berufsgruppen.

BACKGROUND: In Austria, a short to very short employment period of registered nurses has been recognised. On closer inspection, however, one can see that there is hardly any scientific data available on this topic. AIM: The aim of the study was to gather data on the duration of the employment period andto investigate the reasons for the stay in, dropout of, and re-entry into the profession by registered nurses in Austria. Another objective was to find out whether there are correlations between specific individual types of registered nurses and their professional careers. METHOD: Registered nurses, who obtained their nursing degree in Austria between 1965 and 2003, were surveyed through a questionnaire that had been elaborated within the framework of a focus group. RESULTS: The analysis revealed a considerably longer stay than reported in German-speaking literature. Furthermore, we were able to identify five different types of individuals with regard to the stay in, dropout of and re-entry into the nursing profession.

[Influence of patient education on pain experience in patients with malignant tumours]. / Der Einfluss von Patientenedukation auf das Schmerzempfinden bei Patienten mit einer malignen Tumorerkrankung.

According to the current laws in Austria and Germany, pain educational measures can be implemented by nurses. The aim of this study was to clarify the impact of patient education by nurses on pain experience among cancer patients. We used the method of systematic review of the relevant literature. Three of four randomized controlled studies revealed a positive influence of patient education on pain experienced by cancer patients. These results were substantiated by a meta-analysis as well as by a systematic review. We came to the conclusion that patient education makes an important contribution to pain relief among cancer patients. Moreover, it promotes patient compliance as well as communication between healthcare professionals and patients.

Self-Reported Questionnaire of Functional Health of Home-Dwelling Elderly People Living in Austria: Based on the Patient Questionnaire of the Standardized Assessment of Elderly People in Primary Care.

AIM: The aim was to review the construct validity and reliability of a functional health assessment questionnaire (Questionnaire on Functional Health 2 [Q-FH2]). METHODS: The Q-FH2 was used to assess 344 elderly people in a home setting. A polychoric correlation matrix was applied to conduct a principal axis factor analysis with oblique rotation. The number of factors was determined using various procedures and calculated using theta coefficients to estimate ordinal reliability. RESULTS: The exploratory factor analysis supported a 4-factor solution with an explained total variance of 82%. The internal consistency showed  coefficients ranging from 0.758 to 0.854. CONCLUSION: The Q-FH2 appears to be a useful instrument to assess the multidimensionality of functional health as defined by the International Classification of Functioning, Disability and Health to determine the resources and deficits regarding the independent living of older adults and to derive appropriate consulting measures.

The Inter-Rater Reliability of the Observation Instrument for Assessing Pain in Elderly With Dementia: An Investigation in the Long-Term Care Setting.

BACKGROUND AND PURPOSE: The Observation Instrument for Assessing Pain in Elderly With Dementia (BISAD) was developed in Germany. The instrument demonstrated high inter-rater reliability values for the original French version. So far, there are no results to that effect in the Austrian long-term care setting available. The objective of this study was to investigate agreement and inter-rater reliability of BISAD in residents with dementia. METHODS: A quantitative multicenter-descriptive cross-sectional design with a convenience sample of 71 residents. RESULTS: Analysis of all eight items demonstrated fair to moderate concordance. Absolute agreement of the total value was 25.32%. Subtotals of the observation before mobilization was 52.11%, and during mobilization 32.39%. CONCLUSION: The reliability analysis shows that the items are less reliable. Currently, BISAD does not make a reliable contribution to clinical decision making in the tested setting.

Inter-Rater Reliability and User-Friendliness of the Delirium Observation Screening Scale.

BACKGROUND AND PURPOSE: Delirium is a common and often unrecognized complication of hospitalized elderly patients. Currently, there is no evidence for inter-rater reliability studies between registered nurses in the literature. Furthermore, the user-friendliness of the Delirium Observation Screening Scale (DOSS) has not been tested in Austria. METHODS: A quantitative cross-sectional design with a convenience sample of 141 patients and 36 nurses in an Austrian hospital. RESULTS: Analysis of rater-agreement and inter-rater reliability on item level, total score as well as category of delirium risk demonstrated very high agreement. In contrast, no or only fair kappa coefficient were determined. The user-friendliness of the scale was partially satisfactory. CONCLUSIONS: The very high absolute agreement speaks for the reliability of DOSS although the kappa paradox became obvious. The results of the presented study relate only to the tested setting.

Structural Analysis of Treatment Cycles Representing Transitions between Nursing Organizational Units Inferred from Diabetes.

In this paper, we investigate treatment cycles inferred from diabetes data by means of graph theory. We define the term treatment cycles graph-theoretically and perform a descriptive as well as quantitative analysis thereof. Also, we interpret our findings in terms of nursing and clinical management.

Comparison of frontal teaching versus problem-oriented learning at the school of healthcare and nursing: nursing neurological patients.

In view of conflicting opinions about the advantages and disadvantages of frontal teaching (FT) and problem-oriented learning (POL), we carried out a pilot project in which both of these methods were used for teaching one specific course namely, 'Nursing Neurological Patients'. The aim was to determine whether there are short- or long-term differences in student performance at examinations. The results showed that over a short term (4 weeks after completion of the course), students remembered very well what they had learnt in their frontal teaching course, but lost some of this knowledge in the long term (7 months after completion of the course). In contrast, in the long term, students retained better what they had learnt under the method of POL.

Network nursing: connections between nursing and complex network science.

PURPOSE: Nursing processes are complex and include quite a few nonlinear interrelationships that are difficult to discover. Moreover, the formal description, visualization, and analysis of these processes are nontrivial challenges. The purpose of this paper is to establish the term network nursing as synonym for using quantitative graph theory in nursing science and to discuss how network nursing can be used for tackling such complex challenges in nursing science. METHODS: In particular, methods from quantitative graph theory, divided into two major classes, comparative network analysis and network characterization, are employed to solve challenging problems in nursing. FINDINGS: We demonstrate by way of example that this mathematical apparatus is feasible to tackle research questions when modeling and analyzing nursing processes. Here we use a "NANDA-I" showcase to illustrate how nursing networks can be derived from nursing data and how these networks can be used to compare different patients regarding their nursing diagnoses. CONCLUSIONS: Nursing networks can be used to characterize patients from a nursing perspective. Especially, they allow a process-based view and are able to map relationships or dependencies. One major advantage of a networking approach is that it can be applied independently from the underlying nursing classifications or terminologies. IMPLICATIONS FOR NURSING PRACTICE: Network nursing makes it possible to formally investigate the nursing process and thus opens up a so far little-known cosmos of possibilities and methods to expand nursing knowledge.

Measurement and quantification of generalized tonic-clonic seizures in epilepsy patients by means of accelerometry--an explorative study.

Epilepsy is one of the most common neurological diseases, which has a cumulative lifetime incidence of 3%. Two to threefold increased morbidity and mortality rates are reported, especially if generalized tonic-clonic seizures (GTCS) occur. A wireless small and user-friendly detection system would be helpful in early identification of seizures. This could minimize the risk of seizure-related injuries and further allow complete seizure frequency documentation, especially in a non-clinical private setting. The aim of our study was to develop a design and to conduct an exploratory validation of an accelerometry (ACM)-based detection system for GTCS detection in real-time. Patients were recruited via the Epilepsy Monitoring Unit at the Department of Neurology, Medical University Innsbruck. In three out of 20 patients, four GTCS could be recorded. The ACM sensors recorded increased activities at the stated seizure time, which clearly differed from everyday movements. The temporary sensitivity (100%), specificity (≥88%) and the positive predictive value (≥75%) of the detection suggests a promising alarm/false alarm ratio. The validity of the detection device has to be evaluated with more data in order to be able to significantly confirm the positive results and to further develop a cut-off algorithm for automatic seizure detection.

Development and alarm threshold evaluation of a side rail integrated sensor technology for the prevention of falls.

OBJECTIVE: Patient falls constitute a serious problem both for the persons fallen and for the institutions involved. Bed-exit alarm systems are used to reduce patient falls. Existing bed-exit alarm systems have several disadvantages depending on the technology used. As in "Evaluation of Bed-Exit Alarms" stated, restless, light weighted, uncooperative, incontinent and confused patients require different systems. The aim of this work is to present the research and development process of the integrated, universally applicable BUCINATOR bed-exit-alarm system. METHODS: The use-case technique was applied to capture the functional requirements for the development of the new integrated bed-exit alarm system. An experimental study was carried out to collect data regarding preliminary sensitivity and specificity for alarm set-off. RESULTS: Major identified requirements for an optimized bed-exit alarm system were usability, wide range usage, low costs, hygiene factors, integration into nursing beds and nurse call systems and an adequate alarm/false alarm ratio with early alarm trigger functionality. On the basis of the criteria mentioned above, a sensor system was developed, comprising tubes with an air-filled passageway attached on the top of side rails. These tubes are coupled via lines to transducers which trigger an alarm when a predetermined level of pressure is reached. Both the preliminary sensitivity (96.0%) and the specificity (>or=95.5%) of the trigger level indicate a satisfactory alarm/false alarm ratio which is now to be evaluated in a clinical trial. CONCLUSIONS: After experimental testing, BUCINATOR shows great potential to be a reliable bed-exit alarm system. In general, bed-exit alarm systems with extended features could play a major role in ambient assisted living technologies. LIMITATIONS: Besides the theoretical evaluation, it will be imperative to perform more tests and to gather more data about the effect on fall rates and resulting injuries.