[Focus on semi-residential care - Development of science-based impulses for the design of day care for the elderly]. / Teilstationäre Versorgung im Fokus ­ Entwicklung wissenschaftsgestützter Impulse zur Gestaltung von Tagespflegen für ältere Menschen.

BACKGROUND: Despite its important role in the elderly care system, day care in Germany has so far rather little attention paid to it. Keeping their patients' health and self-reliance and facilitating relief and support for family caregivers are central tasks of day care, regulated by law. Nevertheless, there is not only a lack of findings about the working methods and effects of day care, but also of orientation in terms of how to configure high-quality care on a structural, process-related and conceptual level. The aim of the TpQ project ("Weiterentwicklung und Qualitätsverbesserung von Tagespflege in Nordrhein-Westfalen", "further development of and quality improvement in day care facilities in Northrhine-Westphalia") was to close this gap and to offer the institutions a catalogue of impulses that contains current national and international research findings as well as the perspectives of every stakeholder associated with day care. METHOD: In an explorative sequential mixed-method design, we conducted a search for and a synthesis of the literature in the form of a scoping review, qualitative interviews with guests, relatives, non-users, employees and managers of day care, association representatives, nursing scientists and business consultants, a quantitative paper-based survey among guests, relatives, employees and managers of day care and an expert conference for result validation. The sample received study information either directly by mail or through the staff of the recruited adult day care facilities. The survey-area is the federal state of North Rhine-Westphalia. The analysis of the qualitative data was conducted according to the qualitative content analysis and was used for the development of the quantitative surveys. The quantitative data analysis was descriptive. Based on the comparison with literature analysis and qualitative findings, the impulses for the design of day care were finally formulated and validated during an expert workshop. RESULTS: From the literature (N=49) and the interviews (N=85), different expectations and wishes with regard to day care were generated. These included staff and structural requirements as well as concrete ideas of the conceptual orientation of day care. The quantitative survey (N=392) showed considerable agreement with the content-related and organizational requirements of the qualitative survey and allowed us to identify the relevant quality aspects from the point of view of guests, relatives and staff of day care facilities. In summary, 15 dimensions for the design of day care (conception/basic principles, quality management, nursing care, transport/driving service, opening hours, equipment, networking, staff, introduction of new guests, activity offers, health promotion and prevention, promotion of social participation, support of relatives, public work, counseling) were defined as relevant quality areas and explained with 81 impulses. DISCUSSION AND CONCLUSION: Addressing the perspective of users, family caregivers and other persons involved in adult day care reveals complex requirements and opportunities for the design of adult day care. In contrast to existing quality inspection guidelines, the impulses can be used to independently assess adult day care with the goal of contributing to the further development and sharpening of the profile of adult day care.

Case management and care expertise as a prevention approach for adults with intellectual disabilities (FaPP-MgB): study protocol for a randomized-controlled trial.

BACKGROUND: Adults with intellectual disabilities have a higher prevalence of unhealthy eating habits, stress, low levels of mobility, and comparable drug consumption as the general population. Consequently, they suffer from several chronic diseases earlier and more often, but there are fewer prevention and health promotion services including this population. The goal of this study is to determine if an advanced practice nursing approach in the community with home visits is an effective way to improve the health status of adults with intellectual disabilities. METHODS: We will conduct a randomized-controlled trial with waiting list design in Hamburg, Germany. Inclusion criteria are diagnosis ICD F70-F79 and exclusion criteria are care level > 3 according to the German Social Code XI or being at the end-of-life. Participants will be block randomized. The intervention consists of advanced practice nurses performing case management, social space analysis, prevention planning, and counseling through four outreach home visits on nutrition, mobility, addiction, and stress. Comparison is usual care. The primary outcome is health status (WHODAS) after 12 months. Secondary outcomes are health-related quality of life (EQ-5D) and resilience (RS-11) after 6 and 12 months. The calculated sample size is 256 with an estimated dropout of 30%. Raters and analysts will be blinded. Analysis will be performed using ANCOVAs. DISCUSSION: By providing case management and utilizing their nursing expertise, advanced practice nurses will provide valuable input and guidance on prevention and health promotion for people with intellectual disabilities. They will close the gap between health and social care, which is prominent in Germany, through cooperation between the existing care sectors. The findings will be disseminated in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00028771 , registered 4 July 2022, Universal Trial Number: U1111-1277-0595.

Promoting health literacy in people with intellectual disabilities via explanatory videos: scoping reviews.

People with intellectual disabilities have a significant lower level of health literacy compared to the general population which exacerbates participation of the target group. Therefore, people with ID shall be strengthened with regard to health literacy. Explanatory videos are a promising approach to reach that goal. Yet, explanatory videos are neither frequently used in people with intellectual disabilities nor is known a lot about the efficacy of explanatory videos. Two scoping reviews were conducted. One review is an update of an existing review dealing with Health Literacy in people with intellectual disabilities. The second review focused on explanatory videos and people with intellectual disabilities. CINAHL, PubMed, PubPsych and Web of Science were searched. Health Literacy and intellectual disability: nine publications were identified: five publications focused on several aspects of Health Literacy in the target group. A total of four publications discussed ways to increase Health Literacy in people with intellectual disabilities. One publication described existing barriers in accessing and understanding health-related information for people with intellectual disabilities. Explanatory videos and intellectual disability: No eligible publications could be found. The conceptual discussion on health literacy in people with intellectual disabilities is continuing. Nevertheless, often only small subgroups are addressed. Although ideas for increasing health literacy in people with intellectual disabilities exist, there are only little interventions that were scientifically evaluated. There are publications that deal with explanatory videos in the context of intellectual disability, but they do not focus on the efficacy of these videos or special needs of the target group.

There is an ongoing scientific discussion about health literacy and people with intellectual disabilities which is still located on a conceptual level. Most of the literature that was identified via one of the scoping reviews deals with certain aspects of health literacy. Some studies examined interventions that aim at improving health literacy in people with intellectual disabilities. A fairly disregarded intervention for increasing health literacy can be found in explanatory videos. Yet, there are hardly any studies that evaluate the effectiveness of using explanatory videos for people with intellectual disabilities. Therefore, a project at the University of Applied Sciences Bielefeld develops and evaluates explanatory videos for the target group. Their health literacy shall be strengthened.

Health Literacy of People with Intellectual Disabilities: How Meaningful Is the Social Context for a Target Group-Oriented Model of Health Literacy?

Health literacy is primarily understood as an individual construct. People with intellectual disabilities still seem to be a "hidden" population in health literacy research. A target-orientated health literacy approach for this population is needed for developing precise and effective interventions that consider social context dimensions. Therefore, the following research question was answered: Which dimensions influence the health literacy of people with intellectual disabilities? A secondary data analysis containing 38 guided interviews with people with mild to moderate intellectual disabilities was conducted. The analysis followed the content analysis by Schreier (2012). Six main dimensions were inductively outlined, which are "interpersonal relationship", "organizations and communities", "healthcare system", "education", "digital interaction spaces", "politics", and "cultural contexts". All these dimensions influence people with intellectual disabilities on an individual level regarding their level of health literacy. The importance of these single dimensions becomes clear, although for now, the link between all these dimensions is not yet considered. In future research, the focus should be on how to develop interventions considering social context dimensions. Furthermore, analyzing the connection between those dimensions seems promising.

Promoting physical activity in everyday life of people with intellectual disabilities: An intervention overview.

People with intellectual disabilities show significantly lower levels of physical activity than the general population in respect to all consequences for health. A positive effect of physical activity on health preservation has been proven, but interventions for physical activity in everyday life seem to be rare for people with intellectual disabilities. Based on a previously conducted scoping review the Template for Intervention Description and Replication (TIDieR) checklist was prepared. This article describes and compares physical activity interventions in everyday life for individuals with intellectual disabilities with the aim to of identifying successful strategies and areas for improvement. The 12 included interventions are heterogeneous, but commonalities and similarities can be identified. There are suggestions for successful strategies to implement physical activity interventions. However, much information could not be found. The promotion of healthier lifestyles is important to improve the overall health in this population.

"With Enthusiasm and Energy throughout the Day": Promoting a Physically Active Lifestyle in People with Intellectual Disability by Using a Participatory Approach.

People with intellectual disabilities have a comparatively low level of physical activity and are affected by associated numerous impairments and diseases. However, target group specific interventions and concepts aiming at sustainable physical activity-related behavior change in everyday life are rare and the needs and perspectives of the target group have hardly been considered so far. Therefore, a target-group oriented intervention was developed. The research and developmental process was characterized by a participatory approach, involving people with intellectual disabilities throughout the whole process. For example, the interview guideline, design of the interview situation and ways of communicating were developed in a participatory manner. Twenty-four qualitative interviews with people with intellectual disabilities were conducted to explore individual physical activity-related experiences and strategies. Individual and contextual influences on physical activity were identified. Interview results were used to conceptualize an intervention that aims at promoting physical activity in the everyday life of people with intellectual disabilities by strengthening their self-management strategies. The intervention was tested in practice and modified based on communicative validation methods. Good acceptance in the long term is also expected, as the intervention takes place in people's living environment, is socially embedded and builds upon the needs of the target group.

[Graduates of the Model Study Courses in the Health Professions in North Rhine-Westphalia: Employment Characteristics and Competencies in Professional Practice]. / Verbleib der Absolventinnen und Absolventen der Modellstudiengänge in den Gesundheitsfachberufen in Nordrhein-Westfalen: Ergebnisse zu Beschäftigungsmerkmalen und Kompetenzen in der Berufspraxis.

AIM: The aim of this article was to present key results of the graduates' survey VAMOS. The study examined the professional status of the graduates of 12 model study courses in the health professions in North Rhine-Westphalia. The focus of the article was on the employment characteristics of the current main jobs and the application of the academic competencies in everyday professional life. METHODS: In the early summer of 2018 (April to June), 515 graduates of the model study courses in nursing (N=244), physiotherapy (N=97), speech therapy (N=95), occupational therapy (N=47), and midwifery (N=32) were included in an online cross-sectional survey. Graduating classes between the winter semester 2013/2014 and the summer semester 2017 were included. In addition, employers (N=109) were interviewed who hired graduates from the model study courses. RESULTS: The main jobs of the graduates were mostly located in hospitals and outpatient therapy practices. Eight out of ten graduates (84%) performed tasks in direct contact with patients as the main part of their employment. In 71% of these cases, the regular tasks were combined with extended activities in comparison to colleagues without an academic degree. On average, the graduates felt confident in all competency dimensions examined in this study. In all dimensions, employers perceived a "competence advantage" for graduates compared to colleagues without an academic degree. CONCLUSION: The results of this graduate survey support the current recommendation to have the study programs in the five health care professions governed by professional laws and to enable the programs to be carried out at universities.

[Quality criteria for university-based practical learning in nursing: Results of a Delphi method]. / Qualitätskriterien für hochschulisches Praxislernen in der Pflege - Ergebnisse eines Delphi-Verfahrens.

INTRODUCTION: A Bachelor of Nursing qualification has been facilitated by the new Care Professions Reform Act since January 1, 2020 as a standard in Germany. Due to the Reform Act students must have completed 2,300hours of practical training in a healthcare institution. Recent projects have revealed that the practical part of current study programs is inadequate with regard to content, organization and didactics. Therefore, specific quality criteria need to be developed for institutions providing academic training of nursing professionals that are in line with the requirements of medical teaching hospitals. METHODS: These quality criteria have been developed from March 2019 to February 2020 in a three-phase process using the Delphi technique. Phases I and II were conducted as online surveys among various stakeholders (n = 396; n = 555) to identify quality criteria and to assess both their relevance and feasibility. Phase III consisted of an expert conference to finally select the quality criteria. RESULTS: The result was a set of requirements for practical and academic education with a total of 55 criteria subdivided into five dimensions (organizational, personal, infrastructural, formal and didactic). DISCUSSION: Against the background of the diversity of settings and institutions providing practice learning opportunities for nursing students and their specific frameworks, the practicability of individual criteria needs to be discussed. Also, the level of commitment and the related approval process have to be questioned. CONCLUSION: The criteria developed should be a tool to leverage quality, that is to improve the practical learning part of the nursing study programs. The addressees include representatives of universities and healthcare institutions taking part in the fundamental academic qualification in nursing care. The results provide guidance for the selection and the design of strategic and operational cooperation. Furthermore, the criteria can be used as a basis for the certification of academic teaching institutions.

Inclusion of People with Intellectual Disabilities in Health Literacy: Lessons Learned from Three Participative Projects for Future Initiatives.

Background: People with intellectual disabilities (IDs) constitute a high-risk group in relation to several diseases. Promoting their health literacy (HL) could be highly beneficial in the management of health information and making informed decisions. However, there are varying ranges of cognitive, communication and literacy levels in people with IDs. According to our literature review, a HL concept for this target group has not been adequately conceptualized. Methods: To increase knowledge about the target group, adapted HL results from three innovative (research) projects are presented. Results: The key factors are: a) target group orientation; b) social context and everyday life; c) individual resources, like communication and literacy levels; d) a multi-modal strategy to strengthen HL; and e) the self-determination and participation of people with IDs. Conclusions: The projects illustrate that the HL of people with IDs has been successfully addressed by taking these key factors into account. A target-group-orientated HL concept could affect more than positive health outcomes; it could also empower a high-risk group in relation to health problems. However, to develop successful action concepts and strategies, valid data are crucial. The heterogeneity of people with IDs is one of the biggest challenges in obtaining such data. Future studies will need to face these challenges.

Health Literacy and People with Intellectual Disabilities: What We Know, What We Do Not Know, and What We Need: A Theoretical Discourse.

Although health literacy is widely discussed and many heterogeneous conceptualizations exist, people with intellectual disabilities have remained largely unconsidered. The purpose of this conceptual paper is to analyze the particularities of this target group and discuss and consider implications that arise when conceptualizing the health literacy of people with intellectual disabilities. Therefore, we explore relevant approaches from multiple disciplines and examine their transferability to a conceptual understanding of health literacy for people with intellectual disabilities. For future directions we identified three main dimensions: (1) disentangle health literacy from empowerment; (2) apply a positive, asset-based focus to health literacy; and (3) focus on health literacy as a distributed resource across individuals and their individual life-world.

[Impact of assisted vacations on female caregivers' burden]. / Betreute Urlaube als Entlastungsangebot am Beispiel von pflegenden Frauen ­ eine qualitative Studie.

Impact of assisted vacations on female caregivers' burden Abstract. BACKGROUND: In everyday life, female caregivers experience various burdens due to their responsibilities and challenges. To relief and regenerate from the stressful daily routine, assisted vacations may be a viable option. Previously, there were no empirical findings available that focus on requirements and expectations of female caregivers. Neither do they provide information about the organisation nor do they provide information about the implementation of assisted vacations. AIM: The aim of the study was to collect data concerning the attitudes and expectations of female caregivers about assisted vacations to identify positive effects and elements. METHODS: Ten problem-centered interviews with female caregivers, a group interview with four staff members of a supplier of assisted vacations, and one expert interview with the management of the supplier were operated. To analyse the gathered data the qualitative content analysis by 13-2Gläser & Laudel was conducted (2010). RESULTS: A specific anamnesis beforehand the assisted vacations, a continuous development of trust and relationships as well as a professional proactive support and take-over of nursing activities can help female caregivers to enjoy restful and relieving holidays. Six identified conditions contribute to experience a recreative assisted vacation. CONCLUSIONS: Staff members who accompany assisted vacations get lots of information about family caregivers. This could be used for ongoing support of family caregivers after the assisted vacations to reduce their burden.

[Quality in nursing care--action research in "Hamburger Behindertenhilfe"/Hamburg to disabled care]. / Qualität in der Pflege--Aktionsforschung in der Hamburger Behindertenhilfe.

A two year action research program with the title "Quality in Nursing Care" was carried out by a large institute for disabled care in Hamburg. Presently, the importance of quality in nursing as a profession is seen to be secondary to that of pedagogy in the area of disabled care. A major explanation for this could be the fact that 150 years ago the treatment and care of disabled people lay predominately in the field of theology and only later in that of medicine. In the second half of the 20th century, in the 60ies and 70ies to be precise, starting with an investigative commission "Psychiatryenquete "pedagogical science began to focus on the education of disabled people and their integration within society. At this point in time, seen from the pedagogical point of view, the care of disabled people in theory and practice freed itself from being a medicine concentrated profession and from the dominance of nursing care. However in today's society due to the increasing number of disabled people requiring expert nursing care there is a necessity to examine care related needs of assistance. With the research project "Quality in Nursing Care" an institute for disabled care has looked at different nursing care interventions and methods that our society may require for the changing situation we are presently being confronted with. An analysis of the requirements, the content and evaluation of the three chosen project related interventions, (the individual consulting of inhabitants with regard to the broadening of the competence skills, the development of expert nursing competence through further and continuous education of multipliers, and the development of codes and guidelines for activities) will be introduced. Beginning with the basic and primary principle of the action research, the researchers have developed, with the participating members of the institutions, the specific aims of the work undertaken and the interventions studied and executed. The most important discovery made during the project work undertaken is that the assessment of the extensively nursing linked problems experienced by the inhabitants in disabled care at this point in time is either simply not receiving enough attention or not being taken sufficiently into consideration by the predominately pedagogically trained staff. Taking this into account it is quite clear that professional nursing support in the long term has an important role to play in a successful disabled people orientated care concept.