Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach.

AIM: To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008. BACKGROUND: By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice. SOURCES OF EVIDENCE: After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives). CONCLUSION: Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade. IMPLICATIONS FOR NURSING PRACTICE: The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries. IMPLICATIONS FOR HEALTH POLICY: Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

Family Caregivers Employed by Home Care Agencies: Lessons Learned From Switzerland and the United States.

Background: Increasing demands for home care staff has been triggered in the past decades by shorter hospital length of stay, and a shift of responsibility for complex care regimens to private households. Therefore, an innovative model to employ family caregivers in home care agencies is expanding in Switzerland and the United States. This policy brief aims to identify core characteristics of the model and analyze its potential benefits and challenges. Evidence: The model is expanding based on legal ground but without the requisite scientific evidence. After an initial patient assessment by a registered nurse, and assigned hands-on tasks to family caregivers, the salary is derived from payer reimbursement. Policy Options and Recommendations: Standards need to be in place to determine the family caregivers qualification that are specific to the client situation of all age groups. Supervision of quality of care, labor law, and blurred roles of biographical relationships remains at the responsibility of the home care agency. Conclusion: Further research for the data-driven exploration of the model is needed to inform the many stakeholders involved.

[Civilian Service to Support Informal/Family Caregivers at Home: Acceptance and Need in Switzerland]. / Zivildienstleistende zur Unterstützung pflegender Angehöriger zu Hause ­ Akzeptanz und Bedarf in der Schweiz.

BACKGROUND: There is an unmet and increasing need for informal/family care for older adults, the sick, and those with disabilities living in private households. Alternative civilian services provided by so-called "zivis" could make an important contribution to supporting informal caregivers. However, its acceptance and the actual demand by informal caregivers and care recipients are not well understood. METHOD: A total of 314 informal caregivers and 78 care recipients were surveyed about their potential demand for a zivi and their preferences regarding qualifications of zivis, kind of service expected, working time, service duration, as well as willingness to pay. We used descriptive and inferential statistical methods for the analysis. RESULTS: Informal caregivers (87%) and care recipients (90%) deemed zivis beneficial in private households, and acceptance increased with the general need for care. For most respondents, the qualifications of the zivis were not their first priority, but rather a "pleasant personality". Help with household chores and transportation assistance were a important for the vast majority of respondents, help with personal hygiene for 40% (caregivers) and 35% (care recipients), respectively. CONCLUSION: Zivis could serve as an important pool of carers for persons in private households with impaired ability to carry on with activities of daily life caused by ill health, especially cognitive and physical decline. They can offer help in many areas of living, but continued and reliable assistance is important.

[Alternative civilian service as a "helping hand" in private households - potentials for reconciling work and informal care]. / Zivildienstleistende als "helfende Hände" im Privathaushalt.

Alternative civilian service as a "helping hand" in private households - potentials for reconciling work and informal care Abstract. Background: Informal caregivers (or family caregivers) are considered as the backbone of unpaid care in private households. As they are increasingly often employed, new sources of aid in domestic long-term care settings are needed. The Swiss Federal Council therefore mandated the Swiss Federal Office of Civilian Service to commission a study of how civil servants would be accepted as aids by informal caregivers and which services the latter would use. Aim: The results contribute to the development of alternative civilian services in Switzerland based on empirical evidence from informal caregivers who are employed at the same time. Methods: 158 informal caregivers from three language regions of Switzerland who were employed at the time answered a standardized quantitative survey. Their data was analyzed by descriptive and inferential statistical methods (hypothesis testing, regression). Results: Situations in which the cared-for person had cognitive limitations (29 %) constituted for the majority of the working time of civil servants as desired by informal caregivers (56 %) and were associated with increased willingness to pay. Support with caregiving tasks of personal hygiene and transport services were frequently desired, and the underlying settings required above-average intensity of support. Conclusions: There is a need for aid along the entire span of informal caregivers' working life. Reconcilability of employment and informal long-term care is dependent on a well-functioning, flexible network, which cannot be ensured by the labor market alone.

Implementing Buurtzorg-derived models in the home care setting: a Scoping Review.

Background: Buurtzorg is a pioneering healthcare organization founded in the Netherlands. Buurtzorg has established independent, self-managing teams of nurses and promises high-quality home care at a lower cost through person-centered care, continuity of care, building trusting relationships, and networks in the neighborhood. Traditional home care services are increasingly reorganized according to the Buurtzorg-principles. Objectives: This review aims to describe the experiences gathered during the implementation of the Buurtzorg-derived model outside the Netherlands. It further outlines their potential effects. Design: Scoping Review. Methods: Several electronic databases were searched for relevant articles, supplemented by hand-searching and internet searches for gray literature. Various publication types that described the implementation of the Buurtzorg model or its outcomes in countries other than the Netherlands were included. The data were analyzed using qualitative content analysis. Two authors coded the data in several cycles and created categories and subcategories. Results: The review identified 25 publications reporting the experiences or outcomes of Buurtzorg-derived models outside the Netherlands. Upon implementing elements of Buurtzorg, the home care organizations adopted a person-centered care approach, with improved communication with patients and family caregivers, and could establish new networks with other services. The main challenges were related to the self-managed working culture, the organizational framework, or national healthcare policies, which hindered the implementation process. Conclusions: The implementation of Buurtzorg-derived models is complex, challenging, and requires adaptations on several levels: upskilling of networking and staffing competencies in teams, leadership and IT requirements in the organization, and policy changes in the healthcare system. Individualized approaches and solid conceptual preparation are required for implementation. Tweetable abstract: Experiences with the implementation of Buurtzorg in home care services outside the Netherlands. A scoping review @HegeduesAnna.

Gut leben zuhause mit Multimorbidität.

Living well at home with multimorbidity - A project on the contribution of advanced practice nursing in home health care Abstract. Background: Multimorbidity has increased among the elderly, leading to loss of autonomy, lower quality of life, complex treatment plans and higher rates of complications and hospitalisations. Functional impairment and challenging therapy management make the use of home health nursing services essential. Experience in primary care and in hospitals has shown that Advanced Practice Nurses (APN) lead to a better quality of care for patients with multimorbidity. However, there is no data yet regarding the potential contribution of APNs to the care of these patients in home healthcare settings. Aim: To develop the role of the APN in a home health nursing organisation for patients with multimorbidity, applying internationally established APN core competencies. Methods: Characteristics of referred clients were collected and presented in case studies in an APN practice development project based on the PDCA-cycle. Benefits for clients, family caregivers, the nursing team, and for interprofessional collaboration were elaborated. Results: During the project period, a total of 40 clients were assigned to APN-care. An increase in stability in complex situations and higher confidence of clients and family caregivers in their individual health management were achieved. Discussion: The key factors were the APN's leadership role in best practice development and interprofessional collaboration. The APN played an important role in coordinating the numerous parties involved. Limits and transfer: This role must be further established. Empirical research is required to show the effect on quality of care.

Zwischen Himmel und Hölle: Erfahrungen von Eltern mit einem kritisch kranken Kind mit extrakorporaler Membranoxygenierung (ECMO) - Eine qualitative-explorative Studie mit Paarinterviews.

Between Heaven and Hell: Experiences of parents with a critically ill child with extracorporeal membrane oxygenation (ECMO) - A qualitative-explorative study with couple interviews Abstract. Background: It is a traumatic experience for parents when their child's severe illness necessitates a period of intensive care. This situation becomes even more challenging for parents if a highly technical therapy such as extracorporeal membrane oxygenation (ECMO) in the Pediatric Intensive Care Unit is required. Aim: The study explores the experiences of parents of critically ill children undergoing ECMO therapy with the aim of better understanding their needs and identifying courses of action for healthcare professionals. Method: The qualitative-explorative study was based on interviews with six couples whose critically ill child is or has been receiving ECMO during the last year, which were used to examine their experiences. The analysis of six such interviews was performed using intensive paraphrasing and inductive coding. Results: The parents' situation can be best characterised as ambivalent with simultaneous feelings of hope and fear. They recognize the danger to their child's life, leading to intense feelings of helplessness with strong emotional reactions. It becomes apparent that there is too little fit between the emotional world of the parents and the action patterns of the health care professionals. Conclusions: The health care professionals thinking logic is based on professional criteria, such as the life threat and risks of ECMO, which ignores the emotional needs of the parents. For this reason, it is important to be more sensitive to the parents and to share positive little signs about their child' s state of health and ability to suffer with them.

Experiences of relatives with outpatient palliative care: a cross-sectional study.

AIM: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN: A cross-sectional survey. METHODS: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

Das Potenzial neuer Technologien zur Unterstützung von Pflege über eine räumliche Distanz - Literaturstand und qualitative Befunde.

The potential of technological assistance to support distance caregiving - literature review and empirical results Abstract.Background: Due to demographic change, increasing labour mobility and changing family patterns, social relationships often exist over long distances. Supporting relatives over a distance is therefore a highly topical issue but still little discussed, also in Germany and Switzerland. Aim: The project "DiCa" (2016 - 2019) with an interdisciplinary research team from Germany (EH Ludwigsburg) and Switzerland (Careum School of Health, Zurich) aims to investigate different dimensions of "Distance Caregiving". This paper deals with the possible use of new technologies to support these care arrangements. Methods: Based on a literature review, qualitative interviews were conducted with "Distance Carers" and partner companies in Germany to investigate the use of new technologies in the context of "Distance Caregiving". Results: There are initial approaches concerning technical solutions in home care and in companies. So far communication options via telephone and smartphone and flexible working time and workplace regulations have played an important role. However, the potential of new technologies does not seem to be fully explored. Conclusions: In order to make the most of the various possibilities of innovative technologies in the context of "Distance Caregiving" for those affected but also for companies, well-researched information and independent advice and counseling are required for all parties involved in the care process.

[Distance caregiving-empirical insights from an employer perspective]. / "Distance Caregiving" ­ empirische Einblicke aus betrieblicher Perspektive.

BACKGROUND AND OBJECTIVE: Labor market mobility and demographic change contribute to higher numbers of people providing care for their family members from a distance. Concerning the reconciliation of work and care the geographic distance between family members becomes more and more important. For progressive employers, this raises the question to what extent their portfolio is sufficient to support distance caregivers. METHODS: Using an interview guideline, 4-6 expert interviews were conducted in 5 partner companies (human resources department, management, executive, works council or employee representative, directors in nursing services; N = 24). The interviews were recorded, transcribed applying standardized procedures, and evaluated using content analysis by means of deductive and inductive categorization. RESULTS: The participating companies had already established numerous reconciliation measures but did not yet focus on distance caregiving. As caregiving issues generally touch on taboo subjects, there is an enhanced need for sensitization and information for all parties involved (management, executives, employees). For distance caregivers, a culture of trust, transparent information and good communication are particularly important. CONCLUSION: To achieve good reconciliation of work and care, working caregivers and executives need a corporate culture which is sensitive to care issues and able to address previously tabooed aspects. In addition, company portfolios for distance caregiving are needed to provide data-driven, thoughtful and timely support for employees and managers.

[Current findings on distance caregiving : What do we know and what do we not (yet) know?] / Aktuelle Befunde zu "distance caregiving" : Was wissen wir und was (noch) nicht?

BACKGROUND: Demographic change, increasing work mobility as well as changed family patterns lead to social relationships over long distances; however, support from relatives from a distance is hardly debated in the German-speaking region. The project "DiCa" (2016-2019) studies various dimensions of long-distance caregiving. OBJECTIVE: This article presents the state of the art in research on specific characteristics of care arrangements from a distance. In addition, it presents the underlying challenges, strategies, and supportive as well as hindering conditions. MATERIAL AND METHODS: Systematic literature review. RESULTS: These studies, conducted largely in the Anglo-American region, draw a clear picture of who distance caregivers are (in general well-educated daughters or daughters-in-law) and that they make a substantial contribution to care in terms of organization, coordination, and emotional support in addition to visits. Distance impedes the flow of information about the health condition of the person in need of care and limits the possibilities to react to the needs at short notice or in crisis situations. Distance caregivers are often faced by financial as well as emotional burdens due to the care situation and lack of control even if there are some support strategies and compatibility between care and occupation, e.g. emergency management, local support networks, flexible working arrangements. CONCLUSION: In the German-speaking region, pertinent studies on long-distance caregiving are missing. Internationally, the numbers of cases are not always clear and there is a lack of sound knowledge on the assessment of the care arrangements on the part of the distance caregiver, the actual role of the distance, specific barriers, conflicts, effective strategies and solution options. This applies to people in family homecare as well primary care facilities and employers.

A tool for the consensual analysis of decision-making scenarios.

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4-12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework's five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.

"Watchful? For sure!" ­ Health professionals as family carers and their roles in patient safety / "Wachsam? Aber sicher!" - Gesundheitsfachpersonen als fachkundige Angehörige und ihre Rolle in der Patientensicherheit

Background: Little is known about family caregivers in the context of adverse events that occur during the care of their significant others. Nurses as family caregivers can draw on expert specific knowledge and nursing skills. Aim: To explore how family carers who are also trained nurses experience and deal with adverse events that occur during the care of their significant others. Method: As part of a larger research project using a sequential mixed methods design, 30 semi-structured interviews were conducted with health professionals, who were also family caregivers, of whom 20 were qualified nurses. All interviews were theoretically coded, dimensionalized and contextualized. Based on the nurses' data a model was developed. Results: The model illustrates the dilemma the interviewed nurses experienced when they need to deal with safety-relevant problems. As family caregivers with expert knowledge and skills, they were vigilant in surveilling the care provided. They were quick to identify risks and vulnerable points in the system of care being delivered. However, before taking action, they carefully considered the advantages and disadvantages of intervening, and also whether or not to admit that they were health care professionals. Conclusions: In the case of events relevant to the health and safety of their significant others, family carers who are trained nurses are most likely to use their expert knowledge, in situations with a perceived high risk to health, to minimise the potential harm.