Stress among nursing staff and interventions in Austrian nursing homes: Results of a survey in the first and the second waves of COVID-19.

Background: Most of the limited number of studies that have been carried out on COVID-19 in nursing homes have not included primarily nursing staff. Nevertheless, knowledge about staff experiences will help to provide recommendations for the future. Aim: The aim of this study was to describe stress experienced and interventions performed by nursing staff and to identify factors that are associated to the perceived stress among Austrian nursing home staff during the first and the second waves of COVID-19. Methods: A secondary data analysis of two cross-sectional surveys performed in 2020 and 2021 among nursing home staff was performed. We did descriptive analysis as well as univariate and multivariate logistic regression analyses. Results: A total of 449 nurses participated in the first survey and 300 in the second survey. 12.7% experienced high stress levels in the first wave, while 26.0% experienced high stress levels in the second wave (p < 0.001). The analysis showed that nursing staff in the second wave had a 2.195-fold higher relative chance of experiencing a high stress level compared to nursing staff in the first wave (p < 0.001). Caring for COVID-19 residents (odds ratio [OR] 1.827; p = 0.007) and being female (OR 1.992; p = 0.018) also significantly increased the relative chance of experiencing a high stress level. Some protective interventions, such as the use of FFP masks, increased between the two waves, while others decreased, such as the practice of airing the residents' rooms. Conclusion: Austrian nursing staff in nursing homes experienced more stress during the second wave, illustrating the heavy burden of the long pandemic on staff. Nursing management should plan appropriate supportive interventions such as psychological help, stress relief measures and financial incentives for nursing staff, especially for the identified high-risk groups. Supplementary Information: The online version of this article (10.1007/s16024-022-00395-x) contains supplementary material, which is available to authorized users.

[Make nursing practice visible through nursing science in times of COVID-19]. / Pflegepraxis durch Pflegewissenschaft in Zeiten von COVID-19 sichtbar machen.

Due to coronavirus disease 2019 (COVID-19) nursing practice is facing enormous challenges. Nevertheless, nursing science was hardly actively represented as a mouthpiece for the practice in the public discussions on the COVID-19 pandemic. Therefore, the question arises which projects with a focus on nursing and COVID-19 have been carried out at Austrian universities. Overall, six projects were identified using the snowball method. Of the studies one showed that an increased wearing time of masks is associated with an increased stress level for nursing personnel. An additional study result showed that almost 50% of lay people used masks incorrectly. Individual experiences, interventions undertaken and solution approaches from the perspective of the nursing staff with respect to ethical challenges in nursing homes were collected in a further project. This and other projects show that nursing science, with its knowledge and as a voice for nursing practice, has taken the initiative and contributes to the COVID-19 discourse. Additionally, the findings of the projects can be used as a basis for making future political decisions.

Association between malnutrition risk and pain in older hospital patients.

OBJECTIVE: To describe the prevalence of malnutrition risk and pain in older hospital patients and characterise the association between these two problems. RESEARCH METHODS AND PROCEDURES: The study includes a secondary data analysis of data collected in two cross-sectional studies. Data collection was performed in 2017 and 2018 using a standardised and tested questionnaire. The study protocol was approved by an ethical committee. RESULTS: Data from 3406 patients were analysed. Among the participants, 24.6% of the patients were at risk of malnutrition, and 59.6% of the patients reported feeling pain. A significantly higher number of patients with pain (26.4%) were at risk of malnutrition than patients without pain (22.1%). The multivariate logistic regression analysis showed that patients with severe/very severe or unbearable pain were 1.439 times more likely to develop a risk of malnutrition than patients without pain. Patients with cancer or diseases of the digestive system were twice as likely to develop malnutrition than those without these diseases. CONCLUSIONS: The results of this study show that older patients with severe pain are at higher risk of developing a risk of malnutrition than those without pain, although the study design (cross-sectional) does not imply causality. Therefore, special efforts should be made to assess pain in these patients to reduce the negative consequences of this pain, such as malnutrition.

[Nursing care during the COVID-19 pandemic - a particular challenge]. / Pflege während der COVID-19 Pandemie: Eine besondere Herausforderung.

BACKGROUND: Nursing quality is one of today's priorities in health care. The COVID-19 pandemic had posed particular challenges for nursing practice. There is currently only limited information available about nursing care in health care institutions during the COVID-19 pandemic. AIM: Therefore the aim of this study was to describe the quality of nursing care during the COVID-19 pandemic with respect to the available structural circumstances (structure), the applied interventions (process) and the perceived stress of nursing staff (outcome). METHOD: A cross-sectional study using an electronic questionnaire was carried out in different health care institutions. The questionnaire includes general questions as well as questions on structure, process and outcome indicators. RESULTS: 2605 nurses participated in this online survey. The study showed that nurses were often provided with guidelines and trainings on protective measures. About two thirds of the nurses reported a sufficient availability of face masks, yet half of the participants wore them longer than eight hours. The study also showed that nurses often applied personal (e.g. use of face masks) and general protective measures (e.g. hand sanitation). Around two thirds of the nurses experienced moderate to high levels of stress. CONCLUSION: Health care institutions need to be equipped with sufficient and adequate protective materials in order to be prepared for a second wave of the COVID-19 pandemic or other pandemics. Nurses who are working in times posing extraordinary challenges and stress need to be provided with psychosocial support programmes. These measures are indespensable for ensuring high quality nursing care even under extraordinary circumstances.

Changes in the availability of clinical practice guidelines for malnutrition: A 6-y multicenter study.

OBJECTIVE: The aim of the study was to examine the availability of clinical practice guidelines for malnutrition in hospitals over a period of 6 y and the subsequent use of nutritional interventions in malnourished patients. METHODS: This study was conducted as a secondary data analysis of data that were collected from 2012 to 2017 in a quantitative, cross-sectional, multicenter study called the National Prevalence Measurement Quality of Care (LPZ). Data from 15 hospitals and 5650 participating patients were analyzed. RESULTS: The availability of clinical practice guidelines for malnutrition at the institutions increased from 6.7% in 2012 to 100% in 2017 (P < 0.001). The control of compliance to the guidelines increased from 28.6% to 85.7% (P < 0.001) and the documentation of malnutrition risk improved from 63.1% to 87.5% (P = 0.008). In 2017, the intervention "referral to dietitian" was used 8.3% more often (P < 0.001). The number of patients who did not receive any intervention decreased from 70% in 2012 to 55.6% in 2017 (P < 0.001). CONCLUSIONS: The availability of guidelines on malnutrition increased in participating hospitals over the 6-y study period. Regular controls of adherence to the guidelines positively correlated with their availability. More interventions to treat malnutrition were carried out in 2017. The use of clinical practice guidelines in this study was associated with more interventions treating malnutrition.

Dysphagia and factors associated with malnutrition risk: A 5-year multicentre study.

AIMS: To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. DESIGN: A secondary analysis of cross-sectional data from the years 2012-2016. METHODS: The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. RESULTS: Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high-risk group for the co-occurrence of dysphagia and risk of malnutrition. CONCLUSIONS: Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. IMPACT: What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care.

Does Conducting a Risk Assessment Facilitate Better Care for Patients at Risk of Pressure Injuries?

OBJECTIVE: To evaluate if the use of a pressure injury (PI) risk assessment is associated with the more frequent use of international evidence-based guideline interventions in patients at risk of PI. METHODS: Data were collected through a multicenter cross-sectional prevalence study conducted on November 14, 2017. Study authors analyzed data from 532 patients 65 years at risk of PI or older in Austrian hospitals. MAIN OUTCOME MEASURES: Repositioning, mobilization, floating heels/heel devices, moisture/barrier cream, patient education, malnutrition screening, referral to a dietitian, and hydration/nutrition management. MAIN RESULTS: The risk assessment was documented on admission for 80% (n = 435) of the at-risk patients. Patients for whom a PI risk assessment was conducted were older and more care dependent, and nearly 20% had a PI compared with patients for whom no risk assessment was conducted upon admission. Conducting a risk assessment led to a statistically significantly higher number of internationally recommended PI preventive interventions being performed for at-risk patients, such as provision of moisture/barrier cream, mobilization specific for PI, malnutrition screening, and floating heels or heel suspension devices. CONCLUSIONS: These results showed that conducting and documenting a risk assessment led to more recommended interventions being performed. Although such interventions are recommended for all patients, these findings are especially relevant for patients at mild or moderate risk of PI who might be otherwise overlooked, which in turn could reduce hospital-acquired PI rates.

[Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients]. / Dekubitusrisikoeinschätzung und präventive Maßnahmen bei Krankenhauspatientinnen und -patienten: Gehen-Sitzen-Liegen.

Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients Abstract. Background: Internationally, it is recommended to use the clinical view with a validated instrument for pressure ulcer risk assessment to determine subsequent measures. We could not identify any study investigating risk assessment and subsequent measures for mobile / chairfast / bedfast patients. Aim of the study: To identify the degree of agreement between the Bradenscale and clinical view regarding pressure ulcer risk in mobile / chairfast / bedfast patients and subsequent preventive measures. Method: Data from 5274 hospital patients from the "Nursing quality measurement 2015", a cross-sectional multicenter study, were collected. Results: Out of all mobile, chairfast or bedfast patients assessed as at risk of pressure ulcer with the Bradenscale, 22.3 % (mobile), 61.7 % (chairfast) and 86.1 % (bedfast) were also assessed as at risk by clinical view. More than 3 / 4 of the chairfast patients that were not at risk according to clinical view received preventive measures. Conclusion: The consequences over time for patients that received no measures due to discrepancies in the risk assessments should be focused. Furthermore the evaluation of measures in patients without a risk of pressure ulcer is of critical importance. The aspect of patient mobility deserves special attention due to the low agreement of the risk assessments in chairfast and mobile patients.

Effectiveness of conservative urinary incontinence management among female nursing home residents-A cluster RCT.

BACKGROUND: Guideline-compliant conservative management of urinary incontinence (UI) is the first step of the initial management for UI and is recommended for long-term care in older persons. Recent studies have focused on the effects of guideline-compliant UI management. However, most of these studies were tested in another setting than nursing homes and were not focused on conservative management. AIMS: To measure the effectiveness of 29 evidence-based nursing recommendations regarding the conservative management of UI in Austrian nursing homes. METHODS: The study is a cluster randomized intervention trial with institution as the unit of randomization. Twelve nursing homes in two Austrian provinces (Styria, Carinthia) were randomly allocated to the intervention group (IG) and control group (CG). Data were collected from participating residents over a three-month period. The intervention consisted of the implementation of recommendations for the conservative management of UI among female nursing home residents. The primary outcome variable was the daily UI experienced by the participating residents. RESULTS: Residents in the (IG n = 216) had a lower risk (OR = 0.14, p = 0.02) of experiencing daily UI and were less likely to receive absorbent products (OR = 0.01, p = 0.01) than residents in the CG (n = 165). Residents in the IG (OR = 5.16, p = 0.00) were five times more likely to receive recommended interventions (e.g., bladder training) than residents in the CG. CONCLUSION: Introducing guideline-compliant management into nursing practice can increase the likelihood of evidence-based interventions for the conservative management of UI. The intervention in this study targeted on nurses/nurse managers and can be recommended for the nursing home setting.

Six Nursing Care Problems in Hospitals: A Cross-Sectional Study of Quality of Care.

BACKGROUND: Investigations on the quality of nursing care relating to various care problems are rare. PURPOSE: This study assessed the (1) fulfillment of structural indicators, (2) application of nursing interventions as process indicators, and (3) prevalence rate as outcome indicators with regard to various care problems. METHODS: A cross-sectional multicenter study was conducted in 30 Austrian hospitals with 2878 patients. RESULTS: The highest number of structural quality indicators was fulfilled for pressure ulcers, falls, restraints, and pain. In malnutrition and urinary incontinence, a lack of structural indicators was observed. Most interventions were offered to patients with pressure ulcers or those who had experienced a fall. The lowest frequency of nursing interventions was seen in malnourished and incontinent persons. CONCLUSION: There is a need for the national adaptation of guidelines for malnutrition and urinary incontinence. This may increase the frequency of evidence-based nursing interventions.

Nutritional management of older hospitalised patients with pressure injuries.

This cross-sectional, multicentre study was conducted in hospitals to investigate nutritional interventions conducted in patients aged 70 years or older with (risk of) pressure injuries. A total of 1412 patients from 33 hospitals with 208 wards participated in the study. A standardised questionnaire was used to collect demographic data and data on care dependency, malnutrition risk, risk for/prevalence of pressure injuries, and nutritional interventions. Data analyses were conducted by using descriptive statistics, chi-square tests, or independent t-tests. According to the Braden Scale, 678 (48.0%) of the patients were at risk of developing pressure injuries, and 71 patients (5.0%) had at least one pressure injury (assessed by skin inspection). The most frequently conducted nutritional interventions in patients with pressure injuries were providing support during mealtimes (50.7%), food specifically desired by the patient (40.8%), and conducting a malnutrition screening (39.4%). One quarter of the patients with pressure injuries were referred to a dietitian. The provision of an energy-enriched/protein-enriched diet (18.3%), energy-enriched/protein-enriched snacks (12.7%), or oral nutritional supplements (8.5%) was rare. Nutritional care in older patients with risk of pressure injuries is suboptimal. Health care professionals need to raise awareness regarding the importance of nutrition in the management of patients with pressure injuries.