Development and validation of a questionnaire on problem-based learning to evaluate facilitation by the tutor and the student group.

BACKGROUND: The study objective was to develop and validate a questionnaire to capture facilitation activities in PBL by the tutor and the group with reference to a theoretical model of teaching quality. METHODS: We developed 19 items assigned to six factors to evaluate collaborative learning processes in relation to facilitation by the tutor and the student PBL group. We analysed construct and criterion validity in 419 undergraduate medical students in 152 online PBL groups. RESULTS: Construct validity was confirmed based on factor dimensionality in line with the theoretical assumptions as well as satisfactory internal reliabilities and intraclass correlation coefficients. Criterion validity was supported by the correlation of a) tutor facilitation activities with the success of group self-facilitation and b) facilitation activities with learning gain and satisfaction in the PBL sessions. DISCUSSION: The questionnaire provides a more comprehensive understanding of collaborative learning processes in PBL and the interplay between facilitation activities by the tutor and the group.

[Participatory research in Germany - quo vadis?] / Partizipative Gesundheitsforschung in Deutschland ­ quo vadis?

GOAL: Participatory Health Research (PHR) approaches are becoming more common in Germany. In this paper, appropriate support strategies for the funding and implementation of PHR projects in Germany are described. METHOD: Nine strategies are discussed, based on the research experience of the German Network for Participatory Health Research (PartNet) and other international networks. RESULTS: In order to foster PHR in Germany, 1) funds have to be available for those participating in the research process, and 2) for the participatory processes themselves; 3) the requirement to promote participation should be incorporated routinely in tender notices, as well as 4) in special funding programs as a funding requirement; 5) participation in research projects should be part of a formative evaluation; 6) methodology development in this field needs specific funding; 7) review processes for research bids need to be adapted to take into account the specifics of PHR; 8) coordination needs to be established across participatory research projects; 9) and successful models and examples of participation in research should be disseminated. CONCLUSION: It is necessary to adapt research funding programs in Germany to the specific requirements of PHR so as to promote meaningful participation on the part of non-academic partners and to avoid tokenism.

[What are the reasons for patient dropout in nursing home residents in an intervention study. An analysis of unit nonresponders in 12 German nursing homes]. / Welche Ausfallursachen liegen bei Pflegeheimbewohner(inne)n in einer Interventionsstudie vor? Eine Analyse der Unit-Nonresponder in zwölf deutschen Pflegeheimen.

BACKGROUND: Non-response bias is a major problem for the validity of survey answers. Analyses of reasons for non-response in surveys with nursing home residents (NHR) are scarce. AIM AND METHOD: The aim of this study was to develop reliable and valid categories which represent reasons for non-response in nursing homes using the "Prozessmodell induktiver Kategorienbildung" following Mayring (2010). Furthermore, characteristics of unit non-responder and responder were compared. RESULTS: Forming of categories of reasons for non-response was conducted with 522 NHR, longitudinally. Four major categories were identified (general refusal, health reasons, accessibility, excessive demand) and further 17 subcategories. Unit-non-responder and responder did not differ in age and sex; however follow-up non-responder showed differences in marital status, training qualification, and cognitive status. CONCLUSIONS: The presented scheme of categories can be used to assess reasons for non-response in nursing homes. Standardised assessment of reasons for non-response may contribute to higher response rates in this setting.

Perceived enactment of autonomy of nursing home residents: A German cross-sectional study.

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.

Health outcomes and quality of life of residents of shared-housing arrangements compared to residents of special care units - results of the Berlin DeWeGE-study.

AIMS AND OBJECTIVES: To compare different health outcomes as well as quality of life (QoL) between people with dementia living in shared-housing arrangements (SHA) and special care units (SCU) in nursing homes. BACKGROUND: Often situated in large apartments in mostly urban settings, SHA are a specific German kind of small-scale living facilities for older care-dependent persons, predominantly suffering from dementia. SHA are completely disconnected from traditional nursing homes. DESIGN: In a longitudinal design, all new residents of SHA and SCU suffering with dementia in Berlin were surveyed for one year. They were assessed when they moved into the SHA or SCU and again 6 and 12 months later. METHODS: We surveyed physical and psychological health outcomes including ADL-functioning (Barthel), neuropsychiatric symptoms of dementia (NPI) and challenging behaviour (Cohen-Mansfield agitation inventory) as well as QoL (Qualidem). RESULTS: Fifty-six persons (43 women, 13 men) were recruited into the longitudinal study. The average age was 82·5 years at admission, participants mostly had a moderate level of cognitive impairment (mean Mini Mental State Examination = 13·3), prevalence of neuropsychiatric symptoms was high. During the one-year follow-up, analyses show a significant decrease in cognitive abilities but also of neuropsychiatric symptoms in both groups. In SHA, QoL increases on average during the one-year study period. CONCLUSIONS: Both types of facilities attract slightly different populations according to our data. Comparison of SHA residents to SCU residents documented no significant beneficial effects of settings in terms of health outcomes. RELEVANCE TO CLINICAL PRACTICE: As no clear advantage of either SHA or SCU in nursing homes can be demonstrated for residents with dementia who move in newly, it is impossible to give a clear evidence-based recommendation and the decision for one setting or the other can be made according solely to personal preference of the resident.

Physical activity in nursing homes--barriers and facilitators: a cross-sectional study.

PURPOSE: To explore different institutional barriers to and facilitators of physical activity (PA) in nursing homes. METHODS: Cross-sectional survey of 40 German nursing homes and 217 nursing-home residents (NHRs; M ± SD age 80 ± 10.2 yr, 55% women, MMSE ≥20). Quantitative data were collected on the structural characteristics of nursing homes and the PA services available. RESULTS: Forms of exercise available were not adequately communicated to residents. Overall participation was below 50%. Awareness was significantly higher in residents with informed relatives (p = .003). A broad range of forms of exercise was generally available (M ± SD 5 ± 2.22, range 0-10), but they were rarely tailored to NHRs' needs and their effectiveness remains questionable. CONCLUSION: Multidimensional opportunities to promote PA in NHRs are identified.

[Shared-housing arrangements for care-dependent older persons - characteristics, development and drivers]. / Ambulant betreute Wohngemeinschaften für alte, pflegebedürftige Menschen - Merkmale, Entwicklung und Einflussfaktoren.

Shared-Housing Arrangements (SHA) for care-dependent older persons gain increasing importance as a setting for nursing care in Germany, both in terms of numbers and user preference. This article aims to answer the questions in which phases SHA have developed over time, what the initiator's objectives are, and what factors contributed to SHA proliferation. A systematic review of the literature was conducted that finally included 73 articles. As a result it can be demonstrated that SHA started from "individual user initiatives", became "developing novel services" and finally established themselves as "regular services" in the nursing setting. A typology of different models of SHA can be organised along two dimensions: Firstly the temporal dimension of care organisation and secondly the way care services are purchased. Objectives formulated by the initiators of SHA are: Establishment of a family - like environment, inclusion of relatives, community orientation, security of care provision and maintenance of self-determination. Tailor-made financial and legal regulations supported the spread of SHAs. In reflection of the available literature it becomes evident that no satisfactory consensus on those elements exist that are constitutive for SHAs. Furthermore, there is a dearth of research on whether postulated objectives and other health related goals are actually being met in SHAs. Open questions pertain also the level of self-determination achieved in practice and other outcomes attained.

[Shared-housing arrangements for care dependent older persons. Support from family members and volunteers]. / Ambulant betreute Wohngemeinschaften für altere, pflegebedürftige Menschen. Unterstützung von Angehörigen und Ehrenamtlichen.

Due to growing numbers of older care dependant persons shared-housing arrangements (SHA) were developed as a new approach, especially for those elderly People suffering from dementia. The involvement of family members and volunteers is a core component of the SHA concept. Besides the active involvement in meaningful activities, relatives also often act as legal representatives. Empirical data concerning how frequently family members and volunteers are involved as well as the tasks they pursue is lacking. The aim of the study is to describe and evaluate the involvement of family members and volunteers in SHA. Special Care Units (SCU) are observed in comparison. In january 2009, all identified SHA and SCU in the city of Berlin were included in a cross-sectional survey as part of the DeWeGE-study. The DeWeGE-study was the first one on SHA in the city of Berlin. Data was collected using a written, standardised questionnaire. We collected data related to the frequency and tasks of family members and volunteer involvement as well as to the residents characteristics. 963 residents of 105 SHA and 17 SCU were included. More persons suffer from dementia in SCU than in SHA. SHA offer events to inform relatives and volunteers about their possible involvement less often than SCU. Family members are involved in meaningful activities in around 50 percent of all SHA and SCU. The proportion of family members who are present in the unit at least once per week is significantly higher in SCU than in SHA. No statistically significant difference between SHA and SCU is found regarding the involvement of volunteers. In SHA, legal representatives are more often paid professionals than in SCU. The real involvement of family members and volunteers in SHA does not reflect the conceptual propositions of this care arrangement.

[Autonomy in the nursing home--conceptual considerations regarding self-determination and capacity to act on the basis of a model]. / Autonomie im Pflegeheim--Konzeptionelle Uberlegungen zu Selbstbestimmung und Handlungsfähigkeit anhand eines Modells.

Autonomy is an exceptionally complex philosophical concept which is present in ethical considerations in health care settings. Currently, no consistent definition of autonomy exists. From the perspective of the authors, self-determination and capacity to act independently are essential aspects of autonomy. While there are limited general results regarding autonomy in old age, autonomy of nursing home residents and the corresponding critical influence factors still lack in-depth examination. The aim of this article is to contribute to a more thorough understanding of autonomy of nursing home residents. Due to the high percentage of residents with cognitive impairment, this population plays a crucial role regarding the conceptualisation of autonomy. Various approaches combined with the perspectives developed by the interdisciplinary PAiN-Project team (Pain and Autonomy in the Nursing Home), led to the formulation of a novel conceptualisation of autonomy. Based on theoretical and discursive considerations, the model "Determination Factors of Autonomy" focuses on the residents' self-determination and ability to perform activities of daily living in the nursing home context. According to the author's conceptualisation, autonomy occurs in various ranges in regard to self-awareness as well as the appreciation of autonomy by others.

Falls Self-Efficacy in German Nursing Home Residents: Assessment of Validity and Determination of a Cutoff Point.

Approximately one in every two German nursing home residents falls at least once in a 1-year period and just as many report a fear of falling. It has been hypothesized that falls self-efficacy mediates the relationship between fear of falling and functional ability. The aim of the current study was to develop the German Nursing Home Falls Self-Efficacy Scale, examine its validity, and estimate a cutoff point to differentiate nursing home residents with low or high falls self-efficacy. Nursing home residents were assessed at baseline (n = 178, mean age = 83.7 years) and 6-month follow up (n = 115, mean age = 83.9 years). Factorial and construct validity analyses provided preliminary support for the validity of the scale. A cutoff point of 11.5 was generated by receiver operating characteristic curve analysis. This scale may assist health care professionals in differentiating between nursing home residents with low and high falls self-efficacy and supporting residents in providing appropriate interventions. [Res Gerontol Nurs. 2016; 9(3):134-144.].