Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study.

BACKGROUND: Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. OBJECTIVE: We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. DESIGN AND METHODS: A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. RESULTS: A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. CONCLUSIONS: This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. TWEETABLE ABSTRACT: Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. STUDY REGISTRATION: DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.

Interventions to enhance safety culture for nursing professionals in long-term care: A systematic review.

Background: Recognizing safety risks and promoting safe care is essential for care dependent people and should be an integral part of the overall preventive endeavors while providing care. The term 'safety culture' describes efforts regarding the acknowledgement and reduction of safety risks. Enhanced safety culture in health care organizations can be associated with a lower incidence of missed nursing care and adverse events. Objective: Identify strategies to enhance safety culture in long-term care settings and describe factors facilitating or inhibiting the process from the available evidence. Design: This systematic review is a narrative description of intervention studies. Methods: CINAHL and MEDLINE were searched in May 2020 using terms such as safety culture, safety climate, intervention development. Gray literature was searched between May and September 2020. An additional search in Cochrane Library was conducted in September 2022. Only intervention studies feasible to enhance the safety culture were included. Intervention study criteria were met when an organized, planned action to prevent or change a specific behavior took place and when this action was transparently and systematically evaluated. The screening, data extraction, and rating processes were conducted by two researchers independently. The ROBINS-I tool was utilized to assess the risk of bias of the studies. Results: Seven intervention studies were included, all evaluated with a critical risk of bias. Strategies found to enhance the safety culture in care settings include collegial exchange of experiences and learnings, integration of staff's perceptions, external facilitation, staff training, and a structured, multi-step procedure of the intervention process. Some studies were unable to show statistically significant enhancement in safety culture from the interventions implemented. Factors facilitating the implementation of interventions include good connections and trust between staff and managers, and the manager's active support of the project goals, as well as targeting achievable ideas considering time and resources. Time pressure, heavy workloads and high staff turnover may inhibit the process. Conclusions: All included studies had a high risk of bias, and possible effects must be considered accordingly. Overall, there was considerable heterogeneity in interventions aiming to enhance safety culture. Despite these aspects, promising approaches are training staff's knowledge and competencies regarding open communication and teamwork as part of a multifaceted program. Future research would benefit from participative, carefully developed, comprehensively evaluated interventions for enhancing safety culture, specifically within in-home care settings. Registration: The review was not pre-registered but described on the website of the Center for Quality in Care. Tweetable abstract: Participatory change management & staff training help ensure momentum & trust in endeavours to enhance safety culture in long-term care.

Implementation of Intentional Touch for Geriatric Patients with Chronic Pain: A Qualitative Pilot Study.

BACKGROUND: Intentional Touch (InTouch) refers to a soft physical touch with the aim to ease complaints and enhance well-being. Central questions were perception of InTouch by nurses and patients and possible effects on pain perception. PATIENTS AND METHODS: InTouch was developed by stakeholder involvement. Nurses working in geriatric care received expert training in InTouch. Semi-structured interviews and participant observation (including video recording) were conducted with nurses applying and patients with chronic pain receiving InTouch after the beginning of the intervention and after 4 weeks. Interviews were analyzed based on Qualitative Content Analysis and video recordings based on Qualitative Visual Analysis. RESULTS: Six elderly patients with chronic pain and 6 nurses were included. Nurses and patients equally described relaxation, well-being, and a sensation of warmth during the intervention. Patients reported no pain during the intervention. After the intervention, 3 patients each experienced pain relief or no change. Patients described better drive and positive feelings, and nurses felt empowered in their nursing work. Empathetic attention had special importance for improving the therapeutic relationship. CONCLUSION: The results of this study suggest that InTouch promoted relaxation, well-being, and pain relief for elderly people suffering from chronic pain and may contribute positively to the therapeutic relationship.

[Quality reporting in long-term care facilities-information requirements, search strategies, and information sources for persons in need of care and their family members]. / Qualitätsberichterstattung zur stationären Pflege ­ Informationsbedürfnisse, Suchstrategien und Informationsquellen von Pflegebedürftigen und ihren Angehörigen.

Persons in need of care and their family members should be able to realistically assess and compare the quality of care services. Recent legislation therefore states that the current procedure to assess and present care quality has to be developed further. While quality measurements can be informed by the literature, knowledge on suitable formats for presenting quality information that is suitable for care-receiving persons and their families is highly fragmentary.The "Development of quality reporting in long-term care" project, a cooperation between the Charité, the federal association of the AOK (AOK-Bundesverband), and the Center for Quality in Care (ZQP), provides the current findings on the information requirements of persons in need of care and their family members when choosing a care facility. Aspects related to nursing staff have a particularly high relevance, e. g. respectful behavior of the personnel, well-trained caregivers, sufficient staff density, seldom changes in the personnel of the institution, and thoroughly conducted care that is adjusted to individual needs. These criteria have been given the highest relevance by persons in need of care as well as their family members.The findings hint at the necessity to provide comprehensive and detailed information about the staffing of care facilities in the future: for example, on the staff ratio and qualifications. Apart from that, comprehensive knowledge on formats to present information is urgently needed - taking into account the needs of care-dependent persons and their families and how information can be optimally processed.

[10-year anniversary of the Long-term Care Charter : Time to take stock]. / 10 Jahre Pflege-Charta : Zeit, Bilanz zu ziehen.

Ten years ago, the Charter for People in Need of Long-term Care was published in Germany. The Charter contains a series of basic rights for people in need of long-term care. At the initiative of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), this was developed in a complex consensus process together with the Federal Ministry of Health (BMG) and representatives from all areas of care. Since then, the Charter has gained practical relevance in various areas of care and has entered into legislation. The article looks at the dissemination and impact of the Charter following a review of the social and legal environment. Further implementation requirements and the revision of the charter are discussed.

[Needs-based offers and gender-specific aspects in nursing homes : Results of a representative survey among directors of nursing homes]. / Bedürfnisorientierte Angebote und geschlechtsspezifische Aspekte in Pflegeeinrichtungen : Ergebnisse einer repräsentativen Befragung von Einrichtungsleitungen.

BACKGROUND: Nursing and care that consider individual and biographically shaped impressions requires, among other things sensitivity for the specific needs of persons in need of care. OBJECTIVE: A representative survey was conducted among directors of nursing homes to provide information about the importance of gender-specific aspects in nursing. MATERIAL AND METHODS: In a written survey 516 directors of German resident care facilities were interviewed about their attitudes and perceptions regarding the subject, about information on general and gender-specific offers and about demographic information on the management of nursing homes. RESULTS: Activities specifically considering the needs of men and women (gender-specific 43.1 %) are not widespread in the nursing homes surveyed. Most respondents reasoned that there was no demand for such offers (57.1 %) or that they are dispensable due to the composition of residents (47.6 %). Of the respondents 36.4 % saw specific needs more with women than with men (18.4 %). Nevertheless, the need for male-specific activities is given a relatively high priority. The consideration of gender aspects in the planning of care processes (57.0 %) and the regular reflection of gender issues (20.7 %) are strongly correlated with the existence of gender-specific offers, while structural factors, such as the institution size and the education of nursing home directors are not. CONCLUSION: Currently, gender-specific activity offers in nursing facilities are not widespread. Existing offers are mostly based on traditional gender stereotypes; therefore, it would be desirable if the diversity in the reality of life and the individual needs of women and men would be recognized.