RESUMO
Advance care planning in the acute hospital: A qualitative analysis of terms and conditions Abstract: Background: Advance Care Planning (ACP) is an internationally established concept aimed to facilitate anticipatory care planning in the event of future inability to consent. In Germany, ACP is currently not regularly offered to patients in acute care hospitals. Aim: We aimed to identify preconditions for implementation of ACP in acute care hospitals in Germany through review of the international literature and expert interviews. Methods: A systematic literature search was carried out in the databases MEDLINE and CINAHL for internationally used strategies for implementing ACP in acute care hospitals. Consecutively, a guide for interviews with experts to evaluate the strategies was developed. Interviews were analyzed by qualitative content analysis according to Mayring. Results: Out of 13 included publications, 17 preconditions were identified and assigned to 16 categories after evaluation by experts. In international ACP programs, it was described how to proceed and organize the ACP conversation. German experts emphasized that appropriate preconditions, such as sufficient time resources and training, must be granted, whereas the literature search revealed the conversation process and organization as important determinants. Conclusions: The implementation of ACP programs is conceivable, but requires specific conditions as legal regulation and defining and structuring of the processes.
RESUMO
Nursing roles and competencies in emergency care - focusing on geriatric emergency care: A Scoping Review Abstract. Background: Older patients make up an increasing number of emergency admissions in Germany. Their complex needs require advanced nursing competencies. Aim: The aim of this scoping review was to identify extended nursing roles in the emergency care of geriatric patients, to describe the training or educational programs that enable nurses to fill these roles and to compare these to the task catalog of German nurses with standard three-year training. Methods: The literature search was conducted in the databases MEDLINE and CINAHL. In addition, forward and backward citation tracking was performed. To describe the situation in Germany a snowballing literature search was carried out using Google and experts were contacted. A sheet created for this review was used for data extraction. Results: A total of 13 publications were included and seven extended competencies were extracted: Collection of information, initial assessment, coordination, medical / nursing care, treatment planning, follow-up, and education. Training qualifying nurses to take on these competencies were academic and / or specialized training measures, partially with the requirement of subject-specific working experience. In Germany advanced training courses are offered, while academic specializations are the exception. A comparison with the German task catalog was not possible. Conclusions: Internationally there are varying nursing roles, which often require both professional experience and academic training. No specific German nursing role profile could be identified. Specific qualification pathways do not exist.