Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.

BACKGROUND AND AIM: Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS: A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS: Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION: These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.

Effectiveness of nurse-delivered patient education interventions on quality of life in elders in the hospital: A systematic review.

BACKGROUND: Nurse-delivered education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. To our knowledge, no systematic review has addressed the effects of nurse-delivered education interventions on the quality of life in a general elderly inpatient population. OBJECTIVES: To evaluate the effectiveness of nurse-delivered education interventions compared to usual care with regard to the quality of life in elders in the hospital. METHODS: A systematic review was performed to identify randomized controlled trials examining the effects of nurse-delivered educational interventions on the quality of life in elders in the hospital. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p-values were extracted to determine the effectiveness of the interventions. RESULTS: Four studies were included in the review. One study testing multicomponent interventions showed positive effects on quality of life. Two studies showed no effect, and one study showed a negative effect of the intervention on quality of life. Methodological appraisal revealed single biases in most of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Because of the scarcity of positive findings, methodological issues, and heterogeneity between studies, this review could not provide evidence of the effectiveness of nurse-delivered education interventions in elders in the hospital for improving quality of life. Nurse-delivered education may be more effective as a part of multifactorial interventions. Further studies should examine interventions that focus on quality of life using validated measures.

Effects of a hospital-based education programme on self-care behaviour, care dependency and quality of life in patients with heart failure--a randomised controlled trial.

AIMS AND OBJECTIVES: To evaluate the effects of a nurse-led, hospital-based heart failure specific education session with a three-month telephone follow-up on self-care behaviour, care dependency and quality of life for patients with chronic heart failure. BACKGROUND: Patient education in patients with heart failure is able to promote heart failure-specific self-care, to reduce mortality, morbidity and rehospitalisation rates and to enhance quality of life, especially if heart failure education is embedded in a multidisciplinary approach. Evidence of the effect of a nurse-led self-care education, quality of life and care dependency in addition to standard medical treatment in Germany is lacking. DESIGN: Nonblinded, prospective, single-centre, randomised controlled trial. METHOD: Sixty-four patients were allocated either to the intervention group or to the control group. Patients in the intervention group received education about heart failure self-care with a consecutive telephone follow-up over three months in addition to standard medical treatment. Patients in the control group received standard medical treatment only. RESULTS: Data of 110 patients (58 in the intervention group and 52 in the control group) with a mean age of 62 years and mean left ventricular ejection fraction of 28·2% could be analysed. Self-care education had a significant influence on overall heart failure self-care but not on quality of life and care dependency. CONCLUSION: A single education session with a consecutive telephone follow-up is able to improve overall self-care behaviours but not quality of life. Care dependency was not influenced by the education session. RELEVANCE TO CLINICAL PRACTICE: The easy to implement and short educational intervention has a positive effect on self-care behaviour for patients with heart failure. However, there was no effect on quality of life and care dependency. To improve quality of life and to influence care dependency, different measures have to be applied.

Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals.

AIMS AND OBJECTIVES: The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. BACKGROUND: Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. DESIGN: A nonparticipant observational descriptive design was used. METHODS: A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. RESULTS: A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. CONCLUSION: This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. RELEVANCE TO CLINICAL PRACTICE: This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.

Dealing with aggressive behaviour in nursing homes: caregivers' use of recommended measures.

AIMS AND OBJECTIVES: To identify groups of caregivers in terms of their use of measures for dealing with resident aggression and the differences between these groups related to their characteristics. BACKGROUND: Caregivers in nursing home are confronted with a major challenge when faced with the aggressive behaviour of residents. Therefore, the application of recommended measures is important in supporting caregivers and promoting safety for residents. DESIGN: Cross-sectional survey. METHODS: A total of 804 caregivers working in 21 Swiss nursing homes provided data. The questionnaire used was based on published recommendations regarding management of aggressive behaviour and amendments by experts. RESULTS: The most widely used measure aimed to calm down the resident and to understand the meaning of aggressive behaviour. Physical activities were applied by around 50% of the respondents, and interdisciplinary case reviews as well as standardised instruments for assessment and documentation were used by <50%. Caregiver characteristics such as employment level, support from superiors, institutionalised support for affected caregivers and training in aggression management are associated with their use of recommended measures. Furthermore, caregivers' competence in empathising with the residents' perspective in connection with their professional experience has a positive influence on applying recommended measures. CONCLUSION: Caregivers use multifaceted measures in understanding the meaning of underlying aggression, but there is a certain failure to use standardised instruments. Caregivers differ significantly in the frequency of their application of recommended measures. Support from superiors and assistance for affected caregivers positively influence their use of measures, whereas training in aggression management leads to less use. RELEVANCE TO CLINICAL PRACTICE: Findings show the importance of support from superiors and institutionalised assistance for affected caregivers. Caregiver competence in empathising with the residents' perspective is important in using person-centred approaches in the care of residents with aggressive behaviour.

Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies.

AIM: The aim of this study was to compare the degree of care dependency between hospitalised patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD). METHODS: Secondary data analysis of five German prevalence studies from 2007 to 2011. Care dependency was measured using the Care Dependency Scale. RESULTS: Hospitalised patients with CHF or COPD are to a limited extent care dependent, and their overall care dependency does not differ (p = 0.56). Care dependency items with the lowest mean were mobility, hygiene, getting (un)dressed, continence, avoidance of danger and daily activities. Patients with CHF or COPD did not differ statistically significantly in those items. Only the items 'eating and drinking' almost achieved statistical significance (p = 0.06). CONCLUSION: Patients with CHF or COPD did not differ in levels of care dependency. Both patient populations are restricted in engaging in activities potentially associated with physical condition and possibly influenced by perceived dyspnoea. Furthermore, comorbidities like incontinence and cognitive impairment seem to play an important role regarding the degree of care dependency.

Mobility and quality of life after discharge from a clinical geriatric setting focused on gender and age.

PURPOSE: The purpose of this study was to assess the long-term functional status and quality of life of older individuals with functional mobility impairment. DESIGN: A prospective longitudinal study was conducted. METHODS: The study sample consisted of elderly patients who had been admitted to a rehabilitation facility in Hamburg, Germany. Data were collected from February 2008 to August 2009 in the rehabilitation center and the living environment of the participants after discharge. Quality of life was assessed using the WHO Quality of Life-BREF; activities of daily living were measured using the Barthel-Index (BI). FINDINGS: Functional status and overall quality of life increased from admission (BI = 73.33) to 6 months postadmission (BI = 89.29) but decreased at 12 months postadmission (BI = 85.71). Quality of life significantly increased in the psychological domain from admission (57.85) to 6 months follow-up (67.85) (p = .010). Men showed a better functional status over time (p = .010) than women. Higher quality of life scores were associated with higher MMSE (p = .031) and self-efficacy scores (p = .019) at admission. CONCLUSION: The findings of this study suggest a need for interventions to improve functional status and quality of life in this population, especially following 6 months after discharge. CLINICAL RELEVANCE: Special interventions should address physical quality of life and physical functioning. Gender differences should be considered in planning and implementing programs.

Does the care dependency of nursing home residents influence their health-related quality of life?-A cross-sectional study.

BACKGROUND: Studies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission. METHOD: Eleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains "Physical Mobility", "Energy", "Pain", "Social Isolation", "Emotional Reaction" and "Sleep". Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL. RESULTS: 120 residents were included in total. HRQOL was mostly reduced in the domains "Physical Mobility" and "Energy" (mean scores >43.0), while impairment differences in the domains "Pain", "Social Isolation", "Emotional Reaction" and "Sleep" were only moderate (≤25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain "Pain" than men (mean score women: 29.5 ± 31.5; males: 14.9 ± 17.2; p = 0.011). Care dependency had an influence on the domain "Sleep" (ß = -0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain "Sleep" than residents with a high care dependency (mean score 15.3; SD ± 19.0 versus mean score 32.8 SD ± 33.2; p < 0.02). CONCLUSION: The level of care dependency has no influence on the HRQOL from the nursing home residents' perspective apart from the domain "Sleep". High care dependency residents have a lower HRQOL in the domain "Sleep" compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain "Pain".

Effectiveness of nurse-delivered patient education interventions on quality of life in outpatients: a systematic review.

BACKGROUND: Nursing education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. No review has addressed the effects of overall nursing education interventions on the quality of life in a general outpatient population. OBJECTIVES: The objective of this study is to evaluate the effectiveness of nurse-delivered education interventions compared with usual care with regard to the quality of life of outpatients. METHODS: A systematic search was performed to identify randomized controlled trials that examined the effects of nurse-delivered educational interventions on the quality of life of outpatients. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p values were extracted to determine the effectiveness of the interventions. RESULTS: Twenty-nine studies were included in the review. Approximately 70% of the studies included showed no effects on quality of life. The studies that showed positive effects each used different types of interventions. A methodological appraisal revealed biases in most of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Because of an overall lack of effectiveness and heterogeneity between studies, no evidence for the effectiveness of nursing education interventions in outpatients was observed. Further studies should examine interventions that focus on quality of life using validated measures.

[Nurses' experiences with aggressive behaviour of nursing home residents: a cross sectional study in Swiss nursing homes]. / Erfahrungen und Umgang der Pflegenden mit aggressivem Verhalten von Bewohner(inne)n: eine deskriptive Querschnittstudie in Schweizer Pflegeheimen.

The present exploratory descriptive cross-sectional study with the participation of 814 (51.8%) caregivers in 21 Swiss nursing homes provides insight into caregivers' experiences and handling of residents' aggressive behaviour. Moreover, caregiver burden with regard to resident aggression and the consequences on the caregiver-resident-relationship were investigated. The survey was carried out by means of validated questionnaire. Approximately 38% of participants experienced aggressive incidents during the last seven days prior to data collection. In most cases aggressive behaviour was caused by residents suffering from dementia and/or depression and occurred during nursing interventions involving physical contact. As a trigger for aggressive behaviour participants predominately assumed "non-understanding and excessive demand" of residents. Reassuring conversation and keeping oneself at a distance were most often used to calm the situation. Approximately 40% of participants experienced physical attacks as especially distressing and circa 23% were frightened, particularly when aggressive behaviour occurred without warning. Approximately 4% of caregivers avoided contact with residents after an aggressive incident and 12.3% perceived a disturbed relationship. It can be assumed that caregivers do not adequately perceive emotions possibly underlying aggressive behaviour in the escalation phase and therefore may not identify early signs of beginning aggression.

The Nottingham Health Profile: a feasible questionnaire for nursing home residents?

BACKGROUND: The Nottingham Health Profile (NHP) assesses perceived emotional, social, and physical health problems and the extent to which such problems affect daily activities. The objective of our study was to determine the feasibility of the NHP for nursing home residents. METHODS: A prospective multicenter observational study was conducted in 11 nursing homes from April 2008 to December 2009 in which 286 newly admitted residents were included. Cognitive status was evaluated using the Mini-Mental State Examination (MMSE). The feasibility of the NHP was determined by administration rate, time and type of administration, and missing items. A cut-off point stating the MMSE score up to which the NHP can be applied was determined with receiver operating characteristics curves (ROC). Internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation; ICC) were evaluated. RESULTS: Administration rate was 44.4% (n = 127) ranging from 76.1% for normal residents to 5.9% for residents with a severe cognitive impairment. An average of 12.6 (SD + 6.0) minutes was required for data collection and 92.1% (n = 117) of the questionnaires were completed during an interview. Frequently missing items were in the domain "Pain" (47.2). MMSE scores were significantly higher in the group with a completed NHP (P < 0.001) and analyses of ROC curves indicated a cut-off point of >16 on the MMSE score. Cronbach's α was >0.7 in four domains and >0.6 in two domains, while the ICC in all domains was >0.7. CONCLUSION: The NHP is a feasible questionnaire for residents with normal cognitive function and moderate cognitive impairment, and can be administered in nursing homes.

Factors associated with resident aggression toward caregivers in nursing homes.

PURPOSE: Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. DESIGN: A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. METHODS: Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. FINDINGS: The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04). CONCLUSIONS: Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. CLINICAL RELEVANCE: The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.

Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey.

UNLABELLED: AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated. BACKGROUND: There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved. DESIGN: A cross-sectional survey. METHOD: The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. FINDINGS: Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. CONCLUSION: To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

Use of physical restraints in nursing homes and hospitals and related factors: a cross-sectional study.

AIMS AND OBJECTIVES: The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. BACKGROUND: Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. DESIGN: A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. RESULTS: The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. CONCLUSIONS: Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. RELEVANCE TO CLINICAL PRACTICE: Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

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.

Responsiveness of the Care Dependency Scale for Rehabilitation (CDS-R).

Around 10% of Western Europe's population suffer from a disability which can entail a decrease of independency and quality of life. However, the lives of these people can be improved by rehabilitative treatment and care. Changing the degree of dependency from dependent to independent is essential in rehabilitation, as is the assessment of these changes. To perform such kind of measurements, assessment instruments have to be responsive. In spite of this concern, responsiveness of assessment instruments is studied to a small extent only. This also applies to the Care Dependency Scale for Rehabilitation (CDS-R), a short assessment instrument measuring the care dependency of patients regarding physical and psychosocial aspects. In this longitudinal-study, the responsiveness of the CDS-R, in general and related to different disease-groups, should be determined. Therefore, a convenience sample of 1564 patients was assessed in an Austrian rehabilitation centre with the scale after admission and before discharge. Responsiveness was determined by descriptive analysis, calculation of effect-sizes and significance tests. Differences between admission and discharge occurred on a statistically significant level for patients who changed. Kazis' effect-sizes can be considered as of small/medium effect for patients who changed (0.24/0.49), and as of large effect according to Liang (0.86/1.46). Eta squared was 0.10/0.19 which can be interpreted as of moderate/large effect for patients who changed. Responsiveness-analyses related to different disease-groups showed constantly large effect-sizes for patients with musculoskeletal-disorders. These results indicate that the CDS-R can detect patient-changes over time and discriminate between patients who change under rehabilitation or not. These aspects argue for the responsiveness of the scale, wherefore the CDS-R seems to be appropriate for the assessment of treatment/health-care effectiveness and the evaluation of individual patient-changes. Nevertheless further research is recommended to confirm the level of responsiveness of the scale in general and for different disease-groups.

Comparison of the responsiveness of the Care Dependency Scale for rehabilitation and the Barthel Index.

OBJECTIVE: The aim of this study is to compare the responsiveness of the Care Dependency Scale for Rehabilitation (CDS-R) and the Barthel Index in rehabilitation. DESIGN: A longitudinal study was performed over six months (2007-8) where patients were assessed using the scales after admission and before discharge. SETTING AND SUBJECTS: A convenience sample of 1,542 patients was recruited in an Austrian rehabilitation centre. MEASURES: The CDS-R and the Barthel Index. DATA ANALYSIS: Responsiveness was determined by descriptive analysis, significance tests and calculation of effect sizes. RESULTS: For the 1,542 patients, the calculation according to Kazis yielded values of 0.10 for both instruments. For the group of patients who showed clinically relevant changes, values of 0.50 were obtained for the CDS-R and 1.06 for the Barthel Index. For the group 1,542 patients, the calculation according to Liang yielded values of 0.42 for the CDS-R and 0.34 for the Barthel Index. For the group of patients who showed clinically relevant changes, values of 1.47 were obtained for the CDS-R and 1.92 for the Barthel Index. CONCLUSION: The Barthel Index seems to be slightly more responsive than the CDS-R, and both instruments seem to be appropriate for the assessment of patients' changes over time. Nevertheless, the exact level of responsiveness could not be clearly identified for both instruments. To confirm the level of responsiveness, further research is recommended.

Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies.

AIMS AND OBJECTIVES: The objective of this study was to compare fall rates in older hospital inpatients with and without cognitive impairment. Relationships between age, gender, mobility, cognitive impairment, care dependency, urinary incontinence and medical disciplines were investigated. BACKGROUND: Falls are common in older people with cognitive impairment, but studies in the hospital setting are rare. DESIGN: A secondary analysis of three nationwide prevalence studies in German hospitals from the years 2005, 2006 and 2007 was conducted. METHOD: Trained staff nurses used a standardised instrument to collect data about accidental falls within the last two weeks in their institutions and about other patient characteristics. Data from 9246 patients aged 65 years or older from 37 hospitals were analysed. RESULTS: The fall rate for cognitively impaired patients was 12·9%, while only 4·2% of older persons without cognitive impairment experienced a fall. Comparison between medical disciplines showed great differences concerning fall risk for confused and non-confused inpatients. In multivariate logistic regression analysis, the odds-ratio association of cognitive impairment and falls was 2·1 (CI 1·7-2·7). Higher age (OR 1·5, CI 1·2-1·9), greater care dependency (OR 1·6, CI 1·1-2·1), reduced mobility (OR 2·6, CI 1·9-3·7) and being a patient on a geriatric ward (OR 1·8, CI 1·1-2·9) were also statistically significant predictors in this model. CONCLUSIONS: Cognitively impaired older people constitute a high-risk group for accidental falls in hospitals. RELEVANCE TO CLINICAL PRACTICE: Fall prevention strategies in the hospital setting should address cognitively impaired inpatients as an important high-risk group.

Nursing home caregivers' explanations for and coping strategies with residents' aggression: a qualitative study.

AIMS AND OBJECTIVES: This study explored caregivers' perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression. BACKGROUND: Working in a nursing home is associated with a high risk to experience aggression from residents or patients. Despite existing recommendations for dealing with aggression there is a lack of information about caregivers' ways of dealing with it in practice. DESIGN: A qualitative study with focus group method was conducted. METHOD: Five focus group interviews, with a total of 30 participants, from nursing homes in Switzerland were undertaken employing a semi-structured interview guideline. For analysing the data, qualitative content analysis was employed. RESULTS: Analysis of the data produced three themes with additional sub-themes. One main theme concerns the explanations of the caregivers in regard to the occurrence of aggressive behaviour. This theme is subdivided into two areas, the contributory resident related factors and the caregiver related factors. The measures for handling aggressive behaviour are illustrated in the second theme 'dealing with residents'. The third theme refers to the strategies of the caregivers when confronted with aggressive behaviour -'self-protection' and 'coping with the situation'. CONCLUSION: Caregivers use a broad spectrum of interventions for reducing aggression, some of which are recommended by guidelines but often ignore the link between aggressive behaviour and physiological issues like pain or elimination. The caregivers only very rarely linked their practical knowledge about aggressive behaviour with theoretical knowledge. RELEVANCE TO CLINICAL PRACTICE: The results give insight into the caregivers' perspectives on factors leading to aggression and their coping strategies. Caregivers are informed about relevant reasons for aggressive behaviour and its management, but do not apply a systematic approach. Furthermore, the anxiety of caregivers involved in aggression incidents is an under examined area.

Measuring patient and visitor violence in general hospitals: feasibility of the SOVES-G-R, internal consistency and construct validity of the POAS-S and the POIS.

AIMS: To investigate the feasibility of a survey measuring patient and visitor violence after translation and modification, namely the Survey of Violence Experienced by Staff (German version revised) and to validate the shortened Perception of Aggression Scale (POAS-S) and the Perception of Importance of Intervention Skills Scale (POIS) after adaptation for use in a general hospital setting. BACKGROUND: The use of different approaches and research instruments for investigating patient and visitor violence negatively influences the comparability of studies. Typically, general hospitals use self-administered surveys. However, support for these instruments' validity is insufficient. METHODS: Between November 2006-January 2007, 291 nurses working in general hospitals in the German-speaking region of Switzerland completed the SOVES-G-R, the POAS-S and the POIS (response rate=71%). Results. The participants' responses demonstrated a need for modifications to enhance the feasibility of the SOVES-G-R in two categories, namely experiences with patient and visitor violence in 'the past 12 months' and in 'the past working week'. The POAS-S revealed the same factor solution as in earlier studies, with two factors explaining 38·0% of variance. In the POIS, two factors were distinguished: (1) structured interventions and evaluation and (2) the importance of preventive measures. CONCLUSIONS: The SOVES-G-R, the POAS-S and the POIS are adequate for investigating factors influencing the occurrence of patient and visitor violence in general hospitals. Given the changes in the SOVES-G-R and the moderate size of our sample, further testing with a larger sample is recommended. RELEVANCE TO CLINICAL PRACTICE: The instruments help determine which clinical settings have a greater risk of patient and visitor violence and the specific factors that influence this risk. This can facilitate the implementation of situation-specific preventive measures against patient and visitor violence in general hospitals.