Prevalence of delirium in gastroenterology/hepatology units: A cross-sectional study.

Prevalence rates of delirium amount to 22.0% within acute-care settings. In contrast, 30-40% of patients with liver cirrhosis may develop hepatic encephalopathy, a condition that has been classified as a syndrome of delirium, based on recent pathophysiology findings. However, the prevalence of delirium in gastroenterology and hepatology units is unknown.The aims of the study were (i) to identify delirium prevalence rates in inpatients of gastroenterology/hepatology wards, (ii) to analyze the delirium motor subtype, and (iii) to assess associations between delirium and patient characteristics.In this monocentric, cross-sectional, epidemiological study, point prevalence was assessed at six time points in three gastroenterology/hepatology units within a German university hospital. Delirium was assessed using the 4 'As' Test (4AT) and delirium subtype by the delirium motor subtype scale. Patient characteristics were collected from patient charts.The sample consisted of 188 patients, aged 18 to 98 years (mean age 64, n=110 male). Of them, 18.1% of patients showed delirium symptoms (61.8% hypoactive, 29.4% mixed, and 8.8% hyperactive). For the participants aged ≥65 years (n=96), prevalence of delirium amounted to 26.0%. Significant associations were observed between delirium and the following characteristics: age (p=0.001), length of hospital stay until assessment (p=0.043), cerebrovascular disease (p=0.002), dementia (p=0.010), diabetes mellitus with chronic complications (p=0.012), and gender (nonsignificant trend, p=0.050), while no association was detected between moderate or severe liver disease and delirium (p=0.414).In conclusion, overall prevalence rates of delirium were rather low and did not increase in patients with liver disease.

Health-Related Quality of Life in Patients With Ventricular Assist Device: Psychometric Evaluation of the German Version of the Quality of Life With a Ventricular Assist Device Questionnaire.

BACKGROUND: Ventricular assist device (VAD) implantation has become an alternative treatment for patients with end-stage heart failure. In Germany, valid and reliable instruments to assess health-related quality of life in patients with VAD are lacking. OBJECTIVE: The aim of this study was to present the psychometric validation of the German version of the Quality of Life with a Ventricular Assist Device questionnaire. METHODS: In a multicenter, cross-sectional study, 393 participants (mean age, 58.3 years; 85.8% male, 60.3% bridge to transplant, and 72.8% living with VAD for ≤2 years) completed the German Quality of Life with a Ventricular Assist Device questionnaire of physical, emotional, social, cognitive, and meaning/spiritual domains. Item and confirmatory factor analyses were conducted to test item difficulty and discrimination and the underlying structure, respectively. To examine internal consistency, Cronbach α was assessed. Convergent construct validity was tested using the Kansas City Cardiomyopathy Questionnaire and the Patient Health Questionnaire-9. Readability was examined using Flesch Reading Ease index and Vienna Factual Text Formula. RESULTS: The Quality of Life with a Ventricular Assist Device showed reasonable item difficulty (Ptotal = .67) and mostly moderate to high discriminatory power (rit > 0.30). In confirmatory factor analysis, root-mean-square error of approximation (0.07) was acceptable for model fit, but no other indices. Acceptable internal consistency was found (α ≥ 0.79), with the exception of the cognitive domain (α = 0.58). The overall questionnaire and single domains demonstrated convergent validity (r ≥ 0.45, P < .001). The questionnaire showed adequate readability (Flesch Reading Ease, 64.11; Vienna Factual Text Formula, 6.91). CONCLUSION: Findings indicate a promising standardized clinical instrument to assess health-related quality of life in patients with VAD.

My hands are running away - learning a complex nursing skill via virtual reality simulation: a randomised mixed methods study.

BACKGROUND: Clinical skills training is an essential component of nursing education. However, sometimes education does not sufficiently prepare nurses for the real world. Virtual reality (VR) is an innovative method to complement existing learning strategies, yet few studies investigate its effectiveness. This study compared educational outcomes achieved by three groups learning with either of two different VR simulation variants, with varying technological features, or a video training on the endotracheal suctioning skill. METHODS: The investigated outcomes were knowledge and skill acquisition, learner satisfaction, and technology acceptance. 131 undergraduate nursing students were randomised into three groups, based on the interventions they received. Knowledge was assessed through a pre-post-test design, skill through a post-intervention objective structured clinical examination on a manikin, learning satisfaction and technology acceptance through standardised questionnaires, and qualitative feedback through focus groups. RESULTS: All interventions led to a significant knowledge acquisition, with no significant difference between the groups. The video intervention group performed significantly better than the VR groups in skill demonstration. One of the two VR intervention groups had a significantly higher learner satisfaction than the video group. Technology acceptance was high for both VR groups, with the simpler VR simulation resulting in higher technology acceptance than the one with more experimental features. Students described the VR experience as realistic, interactive, and immersive, and saw the opportunity to practise skills in a safe environment, learn from mistakes, and increase knowledge and confidence. CONCLUSIONS: For the development of VR trainings, we recommend keeping them simple and targeting a specific educational outcome since trying to optimise for multiple outcomes is resource intensive and hard to achieve. Psychomotor skills were easier for participants to learn by watching a video on the procedure rather than practically learning it with the VR hardware, which is a more abstract representation of reality. We therefore recommend using VR as a complementing resource to skills labs, rather than replacing existing learning strategies. Perhaps VR is not ideal for practising practical psychomotor skills at the moment, but it can increase knowledge, satisfaction, motivation, confidence and prepare for further practical training. TRIAL REGISTRATION: Not applicable.

Translation and Psychometric Evaluation of the German Version of the Thirst Distress Scale for Patients With Heart Failure.

BACKGROUND: In patients with chronic heart failure, thirst can be perceived as an intensive and burdensome symptom, which may have a negative impact on patients' quality of life. To initiate thirst-relieving interventions, assessment of thirst and its related distress is essential. At the time of this study, no instrument was available to evaluate thirst distress in patients with heart failure in Germany. OBJECTIVE: The aims of this study were to translate the "Thirst Distress Scale for patients with Heart Failure" (TDS-HF) from English into German and to test validity and reliability of the scale. METHODS: The English version of the TDS-HF was translated into German. A linguistically and culturally sensitive forward-and-backward translation was performed. Psychometric evaluation included confirmatory factor analysis, reliability in terms of internal consistency, and concurrent validity. RESULTS: Eighty-four hospitalized patients (mean age, 72 ± 10 years; 29% female; mean left ventricular ejection fraction, 36% ± 12%; 62% New York Heart Association functional classes III-IV, 45% on fluid restriction) from an acute care hospital were involved in the study. The item-total correlation ranged from 0.58 to 0.78. Interitem correlations varied between 0.37 and 0.79. Internal consistency was high, with a Cronbach α of 0.89. There was a high correlation between the total score of the TDS-HF and the visual analog scale to assess thirst intensity ( r = 0.72, P ≤ .001), and a low correlation with fluid restriction ( r = 0.35, P = .002). CONCLUSIONS: The evaluation of the German TDS-HF showed satisfactory psychometric properties in this sample. The instrument is usable for further research and additional psychometric testing.

Competencies and needs of nurse educators and clinical mentors for teaching in the digital age - a multi-institutional, cross-sectional study.

BACKGROUND: The impact of technology and digitalization on health care systems will transform the nursing profession worldwide. Nurses need digital competencies to integrate new technology in their professional activities. Nurse educators play a crucial role in promoting the acquisition of digital competences and therefore need to be digitally competent themselves. Research on digital competencies of nursing educators is scarce but suggests lack of digital knowledge and skills and support needs. Although digitalization is to be seen as a global process, regional contexts need to be taken into account, such as pre-existing competencies, local conditions, and individual needs. Thus, it remains unclear which competencies nurse educators possess and which support needs they have. Aim of this study was to assess nurse educators' and clinical mentors' digital competencies and explore their needs and requirements concerning the digital aspects of their pedagogy and teaching activities in Germany. METHODS: A descriptive exploratory study with a cross-sectional design was conducted. Participants were identified using a convenience sampling approach. Data were collected during July and September 2020 using a standardized self-reported questionnaire that was developed specifically for this study. The questionnaire was provided in a paper and online format and participants could decide which format to use. It contained open- and closed-ended questions. Data were analyzed using descriptive and content analysis. Additionally, explorative subgroup analyses based on job designation, age, and gender were performed. Reporting of this study adhered to the STROBE checklist. RESULTS: A total of 169 educating nurses participated in the survey. The respondents considered themselves as digitally competent and showed a positive attitude towards the integration of digital technology in their teaching activities. Their perceived preparedness to integrate digital technology into teaching and training varied. Almost all respondents (98%) declared a need for further training and seemed motivated to participate in corresponding educational events. There were some indications for differences in competencies or needs between subgroups. CONCLUSIONS: Educating nurses appear to possess basic digital competencies but there is a need to support their professional development in terms of new technologies. Findings can be used as a basis for developing supportive interventions. Further qualitative investigations could inform the design and content of such interventions.

Hand hygiene monitoring technology: A descriptive study of ethics and acceptance in nursing.

BACKGROUND: Nosocomial infections represent a serious challenge for healthcare systems worldwide. Adherence to hand hygiene plays a major role in infection prevention and control. These adherence rates can be improved through behaviour tracking innovations. This requires the systems to be widely implemented and accepted. Therefore, both a systematic analysis of the normative issues related and the evaluation of technology acceptance are equally important. OBJECTIVES: To explore and describe relevant aspects regarding the acceptance of technology and ethical implications using a tracking device to measure and improve adherence to hand hygiene. RESEARCH DESIGN: A quantitative study with a descriptive design was performed. PARTICIPANTS AND RESEARCH CONTEXT: A total of 75 questionnaires were collected in three hospitals in Germany. Acceptance of technology was measured with n = 60 participants (n = 50 nurses; n = 9 physicians; n = 1 not disclosed) and ethical assessment with n = 15 participants (nurses only). ETHICAL CONSIDERATIONS: Ethical approval for this study was obtained from the institutional review board. FINDINGS: The acceptance of technologies improving hygiene in general was good (median = 80.5, interquartile range = 28, range: 0-100). The experience with technologies in general (median = 48.5, interquartile range = 57, range: 0-100) and the acceptance of the specific technology (mean = 82.23, standard deviation = 15.16 (range: 23-138)) was moderate. There was a significant positive correlation between the acceptance and experience of technology in general (r = 0.217, p = .025). Ethical concerns played a minor role. The need for practical support was a key topic. DISCUSSION: Study participants accepted technologies improving hygiene; however, the specific device implemented was only moderately accepted. This creates specific opportunities in the implementation process for higher later acceptance. More practical support and an increase in experience may create opportunities for device implementation with high acceptance and low ethical concerns. CONCLUSION: Study results indicate a vast potential for improving the implementation process of hand hygiene technologies. Ethical concerns in this study did not seem to be a relevant barrier for successful implementation of hand hygiene technologies.

[Interprofessional knowledge and skills training of the insertion technique for the PEG placement on simulators - development and testing of a national curriculum for physicians and nurses]. / Interprofessionelles Wissens- und Skillstraining der PEG-Anlage an Simulatoren ­ Entwicklung und Testung eines nationalen Curriculums für Ärzte und spezialisierte Pflegende.

INTRODUCTION: Expert opinion within the field of gastroenterology mandates a national training curriculum to be completed prior to performing a percutaneous endoscopic gastrostomy (PEG).The goal of the present study is both the development and evaluation of such a curriculum, thus aiming to provide physicians and nurses with the necessary knowledge and skills to safely perform the PEG procedure. METHODS: Testing was performed using a non-randomized, interventional pilot study on simulators. This included a: (1) preparatory, (2) theoretical, and (3) practical phase. Following the theoretical phase, cognitive skills were assessed with a knowledge test. During the practical phase, each participant's puncture procedure was recorded with a multi-channel video, and sensorimotor skills were evaluated with an assessment instrument (AS-PEG). Finally, participant satisfaction was evaluated using a questionnaire. RESULTS: Seven physicians and 17 nurses completed all phases and final examinations, as defined in the curriculum. An average of 70.3 ±â€Š3.7 (61-75) of 76 points and 37.1 ±â€Š2.1 (32-40) of 42 points were achieved in the knowledge and acquired sensorimotor skills tests, respectively. Overall, the evaluation revealed a high level of satisfaction among the participants with respect to content, achievement of learning objectives, and acquired practical skills. CONCLUSION: Dissemination of the curriculum is deemed useful and necessary to provide the theoretical and practical knowledge for physicians and nurses through a structured inter-professional knowledge and skills-training format and to offer nurses a legally secure framework.

Patient-related complexity of nursing care in acute care hospitals - an updated concept.

RATIONAL: The interest in complexity of nursing care has grown in science and practice in recent years because of changed patient profiles and higher average levels of patient acuity in acute care hospitals. AIM: The aim of this study was to redefine the concept of patient-related 'complexity of nursing care' in acute care hospitals. DESIGN: The hybrid model for concept development was chosen. METHODS: In a first theoretical phase, we performed a narrative literature review regarding defining elements of patient-related 'complexity of nursing care' and developed a working definition. In the fieldwork phase, we investigated collective case studies representing 12 nursing care situations. The theoretical phase was updated before all findings were synthesised, and in the final analytical phase, the preliminary working definition was refined. ETHICS: An ethical committee judged the study as unproblematic (waiver no. 82/14 from 5 December 2014). RESULTS: The concept was redefined confirming previous understandings of patient-related 'complexity of nursing care' as a dynamic, relational concept characterised by the instability, variability and uncertainty that exist. The extent of complexity was determined by multifaceted patient problems and resources as well as extensive knowledge, experience, attention and caring skills of registered nurses interacting with each other. LIMITATIONS: The study did not include organisation-related complexity of nursing care. CONCLUSIONS: The redefinition of the concept may support a common understanding of patient-related demands on nursing care among practitioners, managers and politicians which is important regarding patient safety and health nursing staff.

Supporting migrants and refugees with posttraumatic stress disorder: development, pilot implementation, and pilot evaluation of a continuing interprofessional education for healthcare providers.

BACKGROUND: Refugees and migrants face an increased risk of developing posttraumatic stress disorder (PTSD). Adequate care can be insufficient due to language barriers, cultural differences, and knowledge deficits of health service providers. Therefore, professional associations requested that healthcare providers to be educated to provide culturally sensitive care. An evidence-based educational intervention in the form of a continuing interprofessional education (CIPE) for healthcare providers on the topic of PTSD in migrants and refugees was developed, pilot-implemented, and evaluated according to the first two levels of the Kirkpatrick evaluation model (reaction and learning). METHODS: The development of a curriculum for the CIPE intervention was based on a narrative literature review. Its content was validated by experts (N = 17) in an online survey and analyzed using both the Content Validity Index and a thematic analysis. The evaluation of the CIPE intervention was performed by conducting a pilot study with a quasi-experimental single group, using a pre-posttest design. In total, there were 39 participants distributed among three pilot courses. We collected and analyzed data on satisfaction, knowledge, and feasibility. RESULTS: The curriculum for a half-day course, consisting of 8 modules, showed almost excellent content validity (S-CVI = 0.92). In the pilot-implementation phase, participants were "very satisfied" with the pilot courses and a positive effect on their knowledge was detected. No correlation between satisfaction and knowledge gain was found. CONCLUSIONS: The CIPE intervention can be considered feasible and seems promising in its effects on satisfaction and knowledge. The insights gained in this study can be used to adapt and optimize the educational intervention, whereby the feedback from course attendees is particularly useful. Future studies need to further examine the effects in larger samples and more robust study designs.

[Animal-assisted interventions in acute inpatient geriatrics]. / Tiergestützte Interventionen in der stationären Akutgeriatrie.

BACKGROUND: In the future an increasing number of patients in acute inpatient geriatric settings can be expected and their care needs new concepts. Animal-assisted interventions with dogs may represent a potential strategy to consider since animals can have a positive effect on patients' physical, psychological and social capabilities. OBJECTIVE: Identification of clinical and patient-specific outcome parameters by animal-assisted interventions for residents in long-term settings and discussion of the transferability of identified evidence to acute geriatric inpatient settings. METHODS: A literature review of animal-assisted interventions with dogs for long-term residents was conducted using the electronic databases Livivo, PubMed, CINAHL® and Cochrane as well as manual searching of references. Qualitative and quantitative studies from the last 16 years were included. RESULTS: A total of 12 studies were included. Of these studies 10 presented significant results and reported positive effects of animal-assisted interventions for geriatric patients based on clinical, behavioral, cognition, emotional and socializing factors, quality of life and motor skills. CONCLUSION: Animal-assisted interventions may represent a promising intervention for patients in acute geriatric settings. In the future, research on the use of animal-assisted interventions in acute geriatric settings is needed.

Implementierung eines neonatalen Schmerzassessmentinstruments auf einer neonatologischen Intensivstation - Ein Qualitätsentwicklungsprojekt.

Implementation of a Neonatal Pain Assessment Instrument at a Neonatal Intensive Care Unit - A Quality Improvement Project Abstract. Background: Optimal pain management is necessary in order to not jeopardize the development of preterm neonates. Aim: Implementation and evaluation of systematic and best possible pain assessment with the Bernese Pain Scale for Neonates for all preterm and sick neonates of a neonatal intensive care unit by nursing staff. Methods: The educational concept is based on three key strategies: knowledge translation (group- and one-on-one training), reflection (case conferences) and clinical training. The frequency of the use of the Pain Score was recorded before (T0) and after implementation (T1) and six months after completion of the project (T2). Results: Before the implementation (T0) the use of the Bernese Pain Scale was regulated by an internal guideline but its application could not be verified during the baseline period (fulfillment rate of 0 %). After implementation (T1) at least one assessment per shift per neonate could be achieved in 99.1 % of the cases. Nurses conducted 210 assessments on 38 neonates in T1. In follow-up (T2) six months after implementation fulfillment rate of 100 % in 34 neonates was achieved with 188 pain assessments. Conclusions: This implementation strategy was successful in establishing the assessment instrument in clinical practice.

["One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals]. / "Man muss stets aufmerksam sein".

"One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals Abstract. Background: The increase of chronic illnesses and multimorbidity as well as more challenging treatment methods have caused higher acuity and complexity of nursing care situations. Aim: The aim of this study was to explore and establish categories which describe different levels of patient-related complexity of nursing care in order to broaden the understanding of demands on nursing care due to patient situations. Methods: Using a collective case study design, we asked registered nurses and clinical nurse specialists to assess the complexity of twelve nursing care situations through a questionnaire before interviewing them about their deliberations on how they rated the situation. In this sub-study, we performed a qualitative secondary analysis of these data and looked for categories of comparable degrees of complexity. Results: We found five categories of complexity, ranging from "slightly complex" to "highly complex". "Slightly complex" situations demanded a nurse's attention on routine interventions, while "highly complex" situations demanded their constant attention on poorly assessable and poorly controllable conditions with uncertain outcomes. Conclusions: The five categories of complexity describe characteristics of the different levels of complexity in nursing care situations. They can support nursing managers with allocating nursing staff to patients according to their needs and provide a framework for discussing complex nursing care situations in basic and continuing education.

Care of (potentially) brain-dead patients: A qualitative study protocol.

AIM: Aim of this study was to describe the experiences of intensive care unit (ICU) nurses, physicians and relatives of (potentially) brain dead patients; and to develop recommendations to optimize the workflows on ICUs. BACKGROUND: Limited published information on caring for brain dead patients suggest it to be a burden for the nursing staff. It also remains unclear how physicians and relatives of (potentially) brain dead patients perceive these experiences. DESIGN: Interpretive phenomenology according to Benner. METHODS: Medical caregivers (nurses' und physicians) from multiple wards in a German University Medical Center and relatives of (potentially) brain dead patients will be interviewed. Data collection will include episodic interviews with participants' experiences in care of (potentially) brain dead patients. The study is funded by the Ministry of Science, Research and the Arts, Baden-Württemberg (1 February 2016). DISCUSSION: Gaining insights into caring for (potentially) brain dead patients and its associated burden will lead to the development of better recommendations to assist all people involved. IMPACT: Expand the understanding of the experience of healthcare professionals in the care for (potentially) brain dead patients. Understand the experience of relatives of (potentially) brain dead patients. Findings from this study will support the development of recommendations for action by a multi-professional expert group consisting of nurses, physicians, healthcare managers and patient advocates. TRIAL REGISTRATION: Protocol version. German Register for Clinical Studies (Registration No. DRKS00010420) Database of Health Services Research Germany (Project Nr. VfD_16_003710).

[Career prospects of graduate Bachelor nursing degree programs - Results of a nationwide study in Germany]. / Berufsperspektiven von Absolventinnen und Absolventen grundständig qualifizierender Pflegestudiengänge − Ergebnisse einer bundesweiten Verbleibstudie.

Career prospects of graduate Bachelor nursing degree programs - Results of a nationwide study in Germany Abstract. BACKGROUND: Graduates of Bachelor nursing degree programs are available on the labour market for a few years. Currently, there is no empirical evidence or reports on different fields of these academically prepared nurses in Germany. AIM: Aim of this study was to assess the whereabouts of academically prepared nurses in the German labour market, their satisfaction with their current working conditions, and future prospects of the graduates. METHODS: A cross-sectional design was conducted using an online survey to assess whereabouts of academically prepared nurses (n = 273) after graduation from all German Bachelor nursing degree programs. RESULTS: The majority of 77.6 % of participating nurses worked in direct acute settings or in elderly care. Those, working in direct patient care appeared to be significantly more dissatisfied with their working conditions in comparison to those in extended nursing practice (p = 0.000). High satisfaction scores were reported for qualification-adjusted activities, and working conditions in general. Positive perspectives for personal growth and development see 81.3 %. However, 31.1 % of this sample were enrolled in Master programs or plan to enrol in a further education study program into the next future. CONCLUSIONS: In order to become implicit, the process of academic nursing education needs to continue in all practice settings. However, innovative human resources development strategies are needed to use the benefit and full scope of practice in academically prepared nurses in Germany.

The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support.

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.

[Comparison of safety insertion techniques of percutaneous endoscopic gastrostomy in nurses and physicians - a non-randomized interventional pilot study on a simulation model]. / Vergleich der Sicherheit der perkutan gastralen Punktion im Rahmen der PEG-Anlage zwischen Ärzten und spezialisierten Pflegenden ­ eine nicht randomisierte, interventionelle Pilotstudie an Simulatoren.

Percutaneous endoscopic gastrostomy (PEG) insertion represents a standardized procedure for enteral nutrition in patients with long-term eating difficulties for various reasons. In a clinical setting, delegation of stomach puncture and placement of a PEG tube, within the context of percutaneous endoscopic gastrostomy amongst nurses, occurs. In Germany, there are no studies yet showing the differences between physicians and nurses regarding the safety of percutaneous stomach puncture.In a non-randomized quasi-experimental interventional study on a simulation model, the safety of stomach puncture within the context of percutaneous endoscopic gastrostomy between physicians and nurses with special training was compared. Technical skills were recorded with video cameras and provided the basis for the following analysis. The study contained: (1) a theoretical preparation phase, (2) training on simulation model and a repeated practice of the skills, and (3) stomach puncture on the simulation model. The actions were recorded with a multichannel video technique. As part of the concept, nurses and physicians were trained together in theory and practice. The analysis was conducted with the newly designed Assessment Instrument Percutaneous Endoscopic Gastrostomy (AS-PEG). Seven physicians and 17 nurses took part in the pilot study. On average, the physicians reached a score of 36.4 ±â€Š2.2 (33 - 39) and nurses 37.4 ±â€Š2 (32 - 40), while the maximum score was 42. The evaluation of technical skills on the recorded videos by means of Assessment Instrument Percutaneous Endoscopic Gastrostomy (AS-PEG) showed no tendency to significant differences between physicians and nurses after theoretical and practical training. The study contributes a first objective evaluation of technical skills on stomach puncture within the context of percutaneous endoscopic gastrostomy with the newly designed AS-PEG.

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

AIM: To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. BACKGROUND: The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. DESIGN: Hybrid model of concept development and embedded mixed-methods design. METHODS: The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. DISCUSSION: Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept.

Development of a curriculum for infection control nurses for the qualification of infection control link nurses ­ results of focus group interviews with ward managers and infection control nurses in acute care hospitals in Germany / Entwicklung eines Curriculums für Hygienefachkräfte zur Qualifikation von hygienebeauftragten Pflegenden. Ergebnisse von Fokusgruppeninterviews mit Stationsleitungen und Hygienefachkräften in deutschen Akutkrankenhäusern

Background: In the guidelines issued by the Robert Koch Institute, the training and establishing of infection control link nurses (HYG-PFLEGs) as multipliers is stipulated in order to propagate the acceptance and implementation of recommended hygiene measures. To date, there is no standardized format for the further education of these nurses in Germany. Aim: To develop a modular curriculum for HYG-PFLEGs to be trained by infection control nurses. Method: Ward managers (n = 15) and infection control nurses (n = 14) from different hospitals in North Rhine-Westphalia were interviewed about the specific requirements for curricula for infection control link nurses. Four focus group interviews were carried out between October 2012 and January 2013. The tape recordings were transcribed and analysed according to Mayring's content analysis. Results: HYG-PFLEGs were regarded as an indispensable entity for controlling the flow of information between the wards and hygiene teams in hospitals. A core curriculum adjustable for differing institutions should contain a high share of hygiene-related contents, pedagogical-didactical, and psychological competencies as well as practical forms of education. Conclusions: Within the context of the implementation of complex interventions these results provide a basis for the development and implementation of a modular curriculum for infection control link nurses.

Sexual Counseling in Patients With Heart Failure: A Silent Phenomenon: Results From a Convergent Parallel Mixed Method Study.

BACKGROUND: Patients with heart failure (HF) often worry about resuming sexual activity and may need information. Nurses have a role in helping patients to live with the consequences of HF and can be expected to discuss patients' sexual concerns. OBJECTIVE: The aims of this study were to identify whether nurses discuss consequences of HF on sexuality with patients and to explore their perceived role and barriers regarding this topic. METHODS: A cross-sectional research design with a convergent parallel mixed method approach was used combining qualitative and quantitative data collected with a self-reported questionnaire. RESULTS: Nurses in this study rarely addressed sexual issues with their patients. The nurses did not feel that discussing sexual concerns with their patients was their responsibility, and only 8% of the nurses expressed confidence to do so. The main phenomenon in discussing sexual concerns seems to be "one of silence": Neither patients nor nurses talk about sexual concerns. Factors influencing this include structural barriers, lack of knowledge and communication skills, as well as relevance of the topic and relationship to patients. CONCLUSION: Cardiac nurses in Germany rarely practice sexual counseling. It is a phenomenon that is silent. Education and skill-based training might hold potential to "break the silence."

Postoperative weight gain during the first year after kidney, liver, heart, and lung transplant: a prospective study.

CONTEXT: Studies of all types of organ transplant recipients have suggested that weight gain, expressed as an increase in body mass index (BMI), after transplant is common. OBJECTIVES: To describe weight gain during the first year after transplant and to determine risk factors associated with weight gain with particular attention to type of transplant. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 502 consecutive organ transplant recipients (261 kidney, 73 liver, 29 heart, 139 lung) to identify patterns of BMI change. Measurements were made during regular outpatient clinical visits at 2, 6, and 12 months after transplant. Data were retrieved from patients' charts and correlated with maintenance corticosteroid doses. RESULTS: Overall, mean BMI (SD; range) was 23.9 (4.5; 13.6-44.1) at 2 months and increased to 25.4 (4.0; 13.0-42.2) by the end of the first postoperative year. BMI levels organized by World Health Organization categories showed a trend toward overweight/obesity in kidney (53.4%), liver (51.5%), heart (51.7%), and lung (33.1%) patients by 12 months after transplant. BMI changed significantly (P= .05) for all organ types and between all assessment points, except in kidney recipients. Maintenance corticosteroid doses were not a predictor of BMI at 12 months after transplant for most patients. CONCLUSIONS: Weight gain was common among patients undergoing kidney, liver, heart, and lung transplant; however, many showed BMI values close to normality at the end of the first year after transplant. In most cases, increased BMI levels were related to obesity before transplant and not to maintenance corticosteroid therapy.