[Development and content validity of a questionnaire to assess knowledge about delirium]. / Weiterentwicklung und Inhaltsvalidierung eines Fragebogens zur Erfassung des Wissens über das Delir.

BACKGROUND: Delirium is a neuropsychiatric syndrome that can have serious consequences and is often overlooked by healthcare professionals. The level of knowledge about delirium is often insufficient among nursing and medical staff. At the current time there is no suitable questionnaire to record the level of knowledge in German-speaking countries. AIM: Development of a questionnaire and evaluation of content validity. METHODS: Following a literature search to identify current best practice, several questionnaires were identified. An already published questionnaire with the dimensions of basic knowledge of delirium and risk factors has been translated, adapted and extended by the dimension of nonpharmacological delirium prevention. Delirium experts assessed the relevance of the questionnaire items in two rounds of reviews. Content validity was calculated using the Content Validity Index (CVI) at item (I-CVI) and scale (S-CVI) level. Additionally, the modified Kappa (k*) was calculated using a lower 95% confidence interval (CI). RESULTS: The original 30-item questionnaire was expanded to include 18 delirium prevention items. After the first round of scoring 30 out of 48 items showed good to excellent I­CVI scores. Considering the comments, 6 items were discarded and 12 were adapted in terms of language and content. In the final version of the questionnaire 41 items with excellent scores remained. The total scale score increased from 0.88 in the first version to 1.0 in the final version. Nurses were identified as the target group, potentially also therapists and medical personnel. CONCLUSION: The delirium knowledge questionnaire is content-valid.

[Teaching digital competences in nursing education-a comparative analysis of the federal and state framework curricula]. / Vermittlung digitaler Kompetenzen in der Pflegeausbildung ­ eine Vergleichsanalyse der Rahmenpläne von Bund und Ländern.

BACKGROUND AND OBJECTIVE: The digital transformation of healthcare requires changed competences in the nursing professions. The reform of nursing education opens up the opportunity to anchor the requisite content in vocational education. The framework curricula of the expert commission ("Rahmenpläne der Fachkommission nach § 53 Pflegeberufegesetz") form the basis for the federal states to create their own framework curricula. This paper examines to what extent and in what form the framework curricula take up digitalisation. MATERIAL AND METHODS: The framework curricula were investigated in an explicative-qualitative content analysis between August and October 2021. First, the frequency of previously defined keywords was determined. This was followed by a systematic context analysis. RESULTS: Merely six federal states had created their own framework curriculum; the others used the federal framework curriculum, which only addresses the acquisition of competences in the field of digitalisation to a small extent. Digitalisation was addressed to varying degrees in the federal state's own framework plans but only selectively overall. Recommendations for practical exercise formats were hardly given. DISCUSSION: The acquisition of competences in the area of digitalisation forms the foundation for later professional life and is an important component of the digital transformation. In the context of the possibility of modifying nursing education until 2024, the topic should be taken into focus more strongly. Improvements can also be made directly at technical and vocational schools as well as universities since the framework curricula are sometimes only of a recommendatory nature.

[GRAN-ONCO: "German Research Agenda for Nursing Oncology" - Development of a nursing research agenda of oncology nursing in Germany]. / GRAN-ONCO: "German Research Agenda for Nursing Oncology".

GRAN-ONCO: "German Research Agenda for Nursing Oncology" - Development of a nursing research agenda of oncology nursing in Germany Abstract. Background: The establishment of research priorities and bundling in an agenda is an instrument to systematize the multitude of nursing research topics. In contrast to other countries, there is currently no oncological nursing research agenda in Germany. Aim: Development of a research agenda for oncological nursing as part of a discursive process, taking into account different perspectives of the groups of people involved in oncological nursing. Method: Within the framework of a mixed methods design, oncological research topics were identified on the basis of a systematic literature review and prioritized and completed by nurses in oncological nursing practice and research through a survey using a standardized online questionnaire as well as qualitative expert groups. Results: The synthesis of the literature included 29 publications from which 55 topics were extracted. Based on the results of the survey, 23 topics were identified as priorities. According to the result of the survey and the feedback of the experts (n = 15), special attention should be paid to the following topics in the future: disease and therapy-related effects and the associated needs and changes. At the same time, communication, information, counseling, and education as well as the question of quality of life and care at the end of life due to the disease should be prioritized for nursing research. Conclusion: For the first time, a research agenda for oncological nursing is available for Germany. It is an important step in professionalization and thus offers orientation for the scientific further development of oncological nursing.

Validation of two nurse-based screening tools for delirium in elderly patients in general medical wards.

BACKGROUND: Delirium is an acute disturbance characterized by fluctuating symptoms related to attention, awareness and recognition. Especially for elderly patients, delirium is frequently associated with high hospital costs and resource consumption, worse functional deterioration and increased mortality rates. Early recognition of risk factors and delirium symptoms enables medical staff to prevent or treat negative effects. Most studies examining screening instruments for delirium were conducted in intensive care units and surgical wards, and rarely in general medical wards. The aim of the study is to validate the Nursing Delirium Screening Scale (Nu-DESC) and the Delirium Observation Screening Scale (DOS) in general medical wards in a German tertiary care hospital, considering predisposing delirium risk factors in patients aged 65 and older. METHODS: The prospective observational study including 698 patients was conducted between May and August 2018 in two neurological and one cardiology ward. During their shifts, trained nurses assessed all patients aged 65 or older for delirium symptoms using the Nu-DESC and the DOS. Delirium was diagnosed according to the DSM-5 criteria by neurologists. Patient characteristics and predisposing risk factors were obtained from the digital patient management system. Descriptive and bivariate statistics were computed. RESULTS: The study determined an overall delirium occurrence rate of 9.0%. Regarding the DOS, sensitivity was 0.94, specificity 0.86, PPV 0.40 NPV 0.99 and regarding the Nu-DESC, sensitivity was 0.98, specificity 0.87, PPV 0.43, NPV 1.00. Several predisposing risk factors increased the probability of delirium: pressure ulcer risk OR: 17.3; falls risk OR: 14.0; immobility OR: 12.7; dementia OR: 5.38. CONCLUSIONS: Both screening instruments provided high accuracy for delirium detection in general medical wards. The Nu-DESC proved to be an efficient delirium screening tool that can be integrated into routine patient care. According to the study results, pressure ulcer risk, falls risk, and immobility were risk factors triggering delirium in most cases. Impaired mobility, as common risk factor of the before mentioned risks, is well known to be preventable through physical activity programmes.

[Working conditions and health status of young physicians and nurses in German hospitals]. / Arbeitsbedingungen und Gesundheitszustand junger Ärzte und professionell Pflegender in deutschen Krankenhäusern.

BACKGROUND: Profound transformations in the German healthcare system lead to intense working conditions for young employees in inpatient care. Published data suggest associated health risks. OBJECTIVES: This investigation aims to assess current stress factors, their consequences, and subjective measures for improvement. METHODS: During September 2017, a cross-sectional survey was conducted among physicians and nurses ≤35 years of age and with work experience in inpatient care not exceeding six years. Field access was gained via seven scientific and professional societies. The electronic questionnaire consisted of mainly validated instruments. Regression models included confounders into the final data analysis. RESULTS: Included in the final data analysis were 1060 complete cases. The overall response rate was 13%. Different stress factors (e.g. time-related or psychosocial) were found at high levels. These stress factors were connected to reduced health and higher risk of burnout. Furthermore, they were associated with inferior perceived quality of care. Young physicians claimed less documentation requirements and less intense working conditions. Young nurses demanded fair salary and an appropriate nurse-patient allocation. CONCLUSION: Today's working conditions in inpatient care are a threat to the health status of young employees. General conditions, which ensure a sustainable healthy and effective working environment, need to be ensured.

Virtual Reality Applications for the Implementation of Domestic Respiratory Rehabilitation Programs for Patients With Long COVID and Post-COVID Condition: Scoping Review.

BACKGROUND: Due to a high number of patients affected by long COVID or post-COVID condition, an essential step to address the long-term effects of COVID-19 lies in the development and implementation of flexible and accessible rehabilitation programs. Virtual reality (VR) technologies offer the potential to support traditional therapies with individualized at-home programs. OBJECTIVE: This study aims to provide an overview of existing scientific evidence on the development and implementation of VR-assisted respiratory rehabilitation programs for patients with long COVID and post-COVID condition and to synthesize the results. METHODS: We conducted a scoping review of studies from 6 databases. PubMed, CINAHL, Cochrane, ScienceDirect, Web of Science Social Sciences Citation Index, and PEDro were searched using an exploratory search strategy. The search, which was last updated in February 2024, included peer-reviewed studies on immersive VR applications providing respiratory rehabilitation programs for patients with chronic obstructive pulmonary disease and long COVID or post-COVID condition. Exclusion criteria were studies in clinical or inpatient settings, telemedicine, nonimmersive VR applications, and gray literature. Nine publications were included in this review. Findings were extracted and summarized from the studies according to the JBI (Joanna Briggs Institute) method and thematically categorized. Topics covered were study characteristics, physiotherapeutic concept, clinical parameters, as well as usability and acceptability. RESULTS: The 9 publications included in the qualitative analysis were published in 2019-2023. Eight empirical studies were included: 4 followed a mixed methods design, 3 were qualitative studies, and 1 followed a quantitative method. One scoping review was included in the data analyses. Four of the included studies were on patients with chronic obstructive pulmonary disease. The 9 studies demonstrated that VR-supported respiratory rehabilitation programs result in positive initial outcomes in terms of physical as well as psychological parameters. Particularly noteworthy was the increased motivation and compliance of patients. However, adverse effects and lack of usability are the barriers to the implementation of this innovative approach. CONCLUSIONS: Overall, VR is a promising technology for the implementation of individualized and flexible respiratory rehabilitation programs for patients with long COVID and post-COVID condition. Nevertheless, corresponding approaches are still under development and need to be more closely adapted to the needs of users. Further, the evidence was limited to pilot studies or a small number of patients, and no randomized controlled trials or long-term studies were part of the study selection. The included studies were performed by 4 groups of researchers: 3 from Europe and 1 from the United States.

Pressure Injury Prevention in Patients in Prone Position With Acute Respiratory Distress Syndrome and COVID-19.

INTRODUCTION: In patients with acute respiratory distress syndrome, prone positioning improves oxygenation and reduces mortality. Pressure injuries occur frequently because of prolonged prone positioning in high-risk patients, and preventive measures are limited. This article describes 2 patients who developed minimal pressure injuries despite several prone positionings. Prevention strategies are also described. CLINICAL FINDINGS: A 64-year-old man and a 76-year-old woman were admitted to the hospital with respiratory insufficiency. Due to acute respiratory distress syndrome, both patients were intubated and received mechanical ventilation and prone positioning. DIAGNOSIS: Both patients had positive test results for SARS-CoV-2 and a diagnosis of acute respiratory distress syndrome. INTERVENTIONS: Patient 1 was in prone position for 137 hours during 9 rounds of prone positioning; patient 2, for 99 hours during 6 rounds of prone positioning. The standardized pressure injury prevention bundle for prone positioning consisted of skin care, nipple protection with a multilayer foam dressing, a 2-part prone positioning set, and micropositioning maneuvers. For both patients, 2-cm-thick mixed-porosity polyurethane foam was added between skin and positioning set in the thoracic and pelvic areas and a polyurethane foam cushion was added under the head. OUTCOMES: Patient 1 developed no pressure injuries. Patient 2 developed category 2 pressure injuries on the chin and above the right eye during deviations from the protocol. CONCLUSION: For both patients, the additional application of polyurethane foam was effective for preventing pressure injuries. These case reports support the addition of polyurethane foam to prevent pressure injuries in patients placed in the prone position.

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.

[Identification of measures conducive to learning for the introduction of digital and assistive technologies (DAT) in processes of nursing care: a qualitative study]. / Identifikation von lernfördernden Maßnahmen zur Einführung von digitalen und assistiven Technologien (DAT) in Prozesse der pflegerischen Versorgung: eine qualitative Studie.

Background: Digital, assistive technologies (DAT) are finding their way into care processes. There are no concepts for introducing nursing professionals DAT in a structured manner. A structured concept makes sense for a sustainable implementation of DAT. This paper suggests a guideline to train nurses in dealing with DAT. Aim: The work addresses the question of how nursing professionals experience and evaluate a structured approach of sensitization, qualification and testing with respect to DAT. This is also intended to assess the extent to which a transformative learning approach changes the willingness of nurses to use DAT. Method: In a long-term inpatient facility, nurses have been made aware of DAT and instructed in its use. The nurses were trained in using two robotic systems and a passive exoskeleton. The experience and perception of the structural design of the educational approach were surveyed through interviews. Evaluation took place by qualitative content analysis according to Kuckartz. Results: All 5 nurses surveyed had completed 3 years of training in nursing care. 2 of the interviewees perform tasks in the management of the care unit. All interviewee rated the structured approach positively. The approach increases the interest to think about an integration of DAT. It turns out that the accuracy of fit of DAT to care-related problems as well as the necessity to make DAT available by employers are crucial prerequisites for DAT integration into practice. Conclusion: A structured concept can sustainably increase the willingness of nurses to use DAT. Poor implementation of DAT is based on a lack of knowledge and concepts for education and training. The reflection that has been initiated enables DAT to be checked for specific care problems.

COVID-19: Development and implementation of a video-conference-based educational concept to improve the hygiene skills of health and nursing professionals in the Republic of Kosovo.

Introduction: The COVID-19 pandemic caught the health care systems of all countries unprepared. For the further education of healthcare personnel in the Republic of Kosovo, it became necessary to implement a concept for practical training in hygienic working. A video-conference-based educational concept to bridge the physical distance between Germany and Kosovo enabled the rapid, theoretical and practical transfer of knowledge. Methods: Current evidence on COVID-19 and Standard Operation Procedures (SOP) were researched. Healthcare staff in Pristina were advised and trained in ten online sessions on hygienic working under pandemic conditions via the "Logitech Rally for DFNconf" video conferencing system. The seminars were interpreted consecutively (Albanian). The Situational Judgement Test (HygiKo-SJT) should describe changes in participants' hygiene knowledge. Results: A total of 25 people were trained in hygiene-related knowledge in terms of basic and specific hygiene for COVID-19. The weekly training sessions made it possible to address questions and subsequently provide practical knowledge. The HygiKo-SJT did not show a generalizable, measurable improvement in hygiene competence. Conclusion: Participants benefited from the concept and rapid implementation of a live video-conference-based seminar on "Hygiene under Pandemic Conditions". The positive experience in terms of guidance, advice and training provides the basis for implementing a dedicated "Hygiene" module in Kosovo.

Delirium on stroke units: a prospective, multicentric quality-improvement project.

BACKGROUND: Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management. METHODS: Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others. RESULTS: Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6-4.7) vs. post 3.0 (2.2-4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved. CONCLUSIONS: Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke. REGISTRY: DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436 .

[Evidence-based non-pharmacological delirium prevention on general wards - A systematic literature review]. / Evidenzbasierte nicht-pharmakologische Delirprävention im allgemeinstationären Bereich ­ Eine systematische Übersichtsarbeit.

BACKGROUND: Delirium is a disturbance of attention and consciousness and a serious complication, especially in older hospitalized patients. For non-pharmacological delirium prevention, mainly so-called multicomponent programmes are described, which have to be adapted to the individual risk profile. The aim of this systematic review was to summarize the current status of the available evidence on non-pharmacological delirium prevention in general wards. METHOD: The databases MEDLINE via Pubmed, CINAHL, EMBASE, PsycINFO and Cochrane Library were searched for the period from 1990 to November 2018; the methodological quality of the systematic reviews and meta-analyses was evaluated with AMSTAR 2. In order to reflect the broad spectrum of delirium prevention, international guidelines were included in the systematic review. RESULTS: A total of 77 titles were read in full text, nine reviews and six guidelines were included in the analysis. Eight meta-analyses demonstrated that non-pharmacological multicomponent programmes for delirium prevention reduce the incidence of delirium compared to standard care (RR 0.65 to 0.73; OR 0.47 to 0.64, with varying methodological quality). The effect size was similar in the surgical (RR 0.63 to 0.71; OR 0.64) and non-surgical (RR 0.65 to 0.73; OR 0.47) general ward setting. The multicomponent programmes for delirium prevention each consisted of a different number of interventions. In addition to twelve person-related interventions, e. g. promotion of orientation, mobility, day-night rhythm, environmental adjustments and staff training programmes, were considered. CONCLUSION: Non-pharmacological multicomponent programmes for the prevention of delirium in general wards effectively reduce the incidence of delirium and must be adapted to the individual risk factors of each patient.

Prevalence of Second Victims, Risk Factors, and Support Strategies among German Nurses (SeViD-II Survey).

BACKGROUND: Second victim phenomena (SVP) are critical to workplace and patient safety, and epidemiological data are limited to investigate the causes and impact on German health care. We investigated SVP in German nurses regarding prevalence, causes, and predisposition compared to a preceding study on German physicians (Second Victims in Deutschland/SeViD-I). METHODS: We conducted a nationwide anonymous cross-sectional online study in 2020 using a modified SeViD questionnaire including the BFI-10 (personality traits). Statistical analysis was conducted using chi² tests and binary logistic regression models. RESULTS: Of 332 nurses, 60% reported to experience SVP at least once a working lifetime, with a 12-month prevalence among SVP of 49%. Of the nurses, 24% reported recovery times of more than 1 year. In contrast to physicians from SeViD-I, a main cause for becoming a second victim was aggressive behavior by patients. High neuroticism values, higher age, and medium work life experience, but neither gender nor workplace position, were predisposing for SVP. Like SeViD-I, nurses reported demand for an institutional response in cases of SVP. CONCLUSIONS: SVP is common among German nurses and comprises other causes and a different course than in physicians. Further research should concentrate on specific prevention strategies, e.g., profession- and workplace-based educational programs.

How Perceived Quality of Care and Job Satisfaction Are Associated with Intention to Leave the Profession in Young Nurses and Physicians.

German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was to improve our understanding of the factors that trigger intentions to leave the profession. For this purpose, data from 1060 young physicians and nurses in hospital care were analysed. Intentions to leave the profession was assessed with the Copenhagen Psychosocial Questionnaire (COPSOQ). In the first step, the association was determined between intention to leave the profession and the factors of perceived quality of care and job satisfaction. In a second step, a mediation analysis was performed to determine the effect of perceived quality of care after correction for the possible mediator of job satisfaction. There were statistically significant negative associations between perceived quality of care and intention to leave the profession (beta: -2.9, 95% CI: -4.48--1.39) and job satisfaction and intention to leave the profession (beta: -0.5, 95% CI: -0.64--0.44). The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions.