Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes.

BACKGROUND: Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm 1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm 1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development. METHODS: The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm 1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm 1.0 into Algorithm 2.0 will be derived. DISCUSSION: In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).

[Academic nursing education in Germany: Similarities and differences in formal structure]. / Primärqualifizierende Studiengänge in der Pflege: Gemeinsamkeiten und Unterschiede im formalen Aufbau.

BACKGROUND: The German Nursing Professions Act establishes a primary qualifying course of studies at universities, which is completed with a bachelor's degree and a vocational qualification as a nurse. The Nursing Professions Act and the Nursing Training and Examination Ordinance open up some possibilities with regard to the study program concept. The present paper examines the question of how the degree programs are formally structured. METHODOLOGY: A document analysis of the curricula or module manuals of the degree programs existing in December 2022 was conducted, which ultimately included 26 degree programs in the analysis. The module handbooks were analyzed and compared in terms of content using an inductively developed analysis grid. RESULTS: There are considerable differences between the programs in terms of total duration/total workload, length and rhythm of practical study phase, composition of workload of practical study phase, as well as the extent of university study and the ratio of classroom to self-study. DISCUSSION: Due to the high number of validations (20 from 26), the results are meaningful. The findings suggest that it is often less content-related than pragmatic reasons or external constraints that guide the design of the degree programs. From a vocational education and training perspective, too few alternations between practical and academic study phases or very extensive self-study phases could be disadvantageous for the students' acquisition of competencies.

[Competency-based learning objectives of primary qualifying nursing studies and intended task profiles]. / Kompetenzziele von primärqualifizierenden Pflegestudiengängen und intendierte Aufgabenprofile.

INTRODUCTION: Since 2020, it has been possible in Germany to complete a primary qualifying degree in nursing in addition to vocational training in nursing. The study presented here investigates the extent to which the intended competence goals prepare students for the future fields of activity of university-qualified nurses. METHODS: The research question was answered (1) by means of a content analysis of module manuals for primary qualifying courses, specifically the information on the intended learning outcomes in the university part of the course, and (2) by evaluating the results of the analysis in focus groups with those responsible for the course. The areas of competence were used as evaluation criteria for the analysis of the module manuals. The text elements were coded using the analysis software MAXQDA. In the further course of the analysis, the competence areas were combined into three areas with a view to the task profiles (direct care, indirect care and competence area V/research competence) and the percentage weighting of the competence goals was calculated. Using study results from the project "Investigation of the implementation of the study programs within the framework of university nursing training according to the Nursing Professions Act", the hours spent in these areas and the distribution of presence and self-learning time for direct nursing were determined. The results and the reasons for the curriculum design were then discussed in focus groups with those responsible for the degree program. RESULTS: The module manuals reveal clear differences in formal design. The analysis of the learning outcomes specified in the module manuals according to the competence areas also shows considerable differences in the distribution of the percentages for the individual competence areas. In relation to direct care, the percentages range between 55% and 71%, the hours vary between 2,022 and 3,622 hours. With indirect care, the range is 246 to 520 hours. A comparatively high number of hours is planned for competence area V/research competence (869 to 1,426 hours). Also, the analysis leads to the conclusion that within the degree program with the lowest number of hours of face-to-face teaching only 690 hours of face-to-face teaching are spent on direct care, while the degree program with the highest number of hours provides 1,968 hours for face-to-face teaching. In the focus group discussions, the persons responsible for the degree program took a critical view of the hours spent on developing skills in indirect care in the primary qualifying degree programs. Those responsible for the degree programs also regard the very small number of face-to-face hours at some university locations as insufficient to develop direct care skills. DISCUSSION: The results suggest that the primary qualifying courses in some areas and at some study locations do not adequately prepare for the task profiles intended for HQP.

[Task Profiles of Nurses in Germany With a Bachelor's Degree]. / Aufgabenprofile für Pflegefachpersonen mit Bachelorabschluss in Deutschland.

Since more than ten years, German universities have been offering courses that enable students to become qualified professional nurses but without an academic degree or to acquire an academic bachelor's degree in nursing. However, there is still a lack of clarity regarding the task profiles of professionally qualified nursing professionals without an academic degree and of those nursing professionals with a bachelor's or master's degree. In order to identify task profiles for nurses with a bachelor's degree, a multi-stage literature search was first conducted as well as a content-analytical evaluation of the literature found. The results were then analyzed in terms of the level of qualification required for this purpose, and the tasks thus identified for the bachelor's level were reviewed and adjusted using three focus groups. The study concluded that the literature often recommended tasks that were not skill-appropriate. Moreover, there was a tendency to suggest tasks in indirect care. Through the study, five tasks for direct care and five tasks for indirect care were identified. In direct nursing, nursing process control/design in highly complex nursing situations was ranked first on a scientific basis. Based on the difficulties in determining appropriate tasks in direct nursing, it is concluded that the indicators for highly complex nursing situations need further operationalization. In addition, the practical parts of the study degree course must be better prepared than before with regard to the tasks that the graduates need to take on later.

[Development of a qualification mix model (QMM) for inpatient long-term care as a basis for personnel assessment instruments]. / Entwicklung eines Qualifikationsmixmodells (QMM) für die stationäre Langzeitpflege als Grundlage für Personalbemessungsinstrumente.

The current staffing levels for nursing care in long-term care are too low. There are no empirically verified figures with regard to the exact quantitative and qualitative need for additional staff. In order to develop a scientifically based method that is able to determine the number and qualifications of the nursing staff required for nursing care based on a facility-specific resident structure, a qualification mix model (QMM) was needed that indicates the minimum level of qualification available for the professional provision of nursing interventions. Such a model has not yet existed. Due to a lack of normative or empirically based assignment of interventions and qualification levels, a theoretical approach was chosen for the conception of the QMM using existing qualification frameworks, competence models, legal stipulations, the new assessment tool and nursing studies. By differentiating the complexity of work requirements, a total of 10 intervention classes-some with sub-classes-were formed, each of which was linked to one of five qualification levels. The resulting QMM enables qualifications to be assigned to care-relevant interventions as a normative basis of measuring staffing requirements, and also provides orientation for a more competence-oriented distribution of work and responsibility in inpatient long-term care. Since the model is structurally conservative and based on current (i.e. at the time of development) legal stipulations, it is a minimum standard.

[Digitalization and Health Sciences - White Paper Digital Public Health]. / Digitalisierung und Gesundheitswissenschaften ­ White Paper Digital Public Health.

Potential limits and risk of digitalization in public health will be a core topic of the High profile Research Area Health Sciences at the University of Bremen in coming years. A white paper was developed to support positioning in this dynamic research. The paper describes the Health Sciences viewpoint on core evaluation criteria for digital public health, identifies interfaces and approaches for interdisciplinary cooperation and discusses cross-cutting themes as well as demarcations with respect to digitalization in medicine (digital health). An abbreviated version of the white paper is presented for discussion.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65 years - qualitative results regarding acceptance and needs of participants and non-participants.

BACKGROUND: It remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions. METHODS: Two hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements. RESULTS: Based on the participants' and non-participants' statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important. CONCLUSIONS: To motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

Ready to participate? Using qualitative data to typify older adults' reasons for (non-) participation in a physical activity promotion intervention.

BACKGROUND: A sufficient amount of regular moderate physical activity (PA), at least 2.5 h of moderate to vigorous PA per week as recommended by the WHO, is one of the most important lifestyle factors for maintaining good health in old age. However, less than one in four older adults (65 years or older) in Germany meets this recommendation for PA. Although previous research has found several factors related to participation in PA programmes, little is known about how these factors simultaneously affect participation decisions of older adults and how PA programmes can accommodate these dynamics. Taking an everyday life perspective, this study aimed to identify multidimensional types of PA behaviour among older adults. METHODS: In this qualitative study, 25 episodic interviews were conducted with participants and non-participants (ratio 1:3) of a structured PA intervention for older adults (65 years or older). Direct and indirect recruitment methods (e.g. pick up, gatekeeper) were used in different municipalities in Northwest Germany. The interviews were analysed according to the Grounded Theory methodology and a typology of PA participation behaviour was derived from the responses of the interviewees. RESULTS: Four types of PA participation behaviour were identified based on different activity goals and time management preferences: 'Health designer', 'Flexible function-oriented type', 'Comparison and competition type' and 'Fun and wellness-oriented type'. The results indicate that the structured PA intervention was better able to reach the health designer and the competitive type but was less successful in accommodating the function- or wellness-oriented type. CONCLUSIONS: In order to improve older adults' participation in PA, preventive offers should take various activity goals and the desire for flexible time management in everyday life into account. The typology of PA participation behaviour contributes to a better understanding of the target group and can thus help to improve the development, communication and implementation of tailored PA interventions.

[Results of Evaluation of Academic Initial Vocational Training in Therapeutic Professions]. / Ergebnisse der Evaluation der hochschulischen Erstausbildung in den therapeutischen Berufen.

AIM: With focus on 2 points, we summarize the results of the evaluations of up to 13 model degree courses in therapeutic health professions. The aim was to investigate the structural conception of the degree courses and the competencies of the students. METHODS: We use content analysis to find out common structures in officially binding documents, such as accreditation documents, evaluation documents and study plans. To analyse competencies, we use a mixed method design: A validated assessment tool enables students to estimate their own competencies (self-assessment) (N=286) and qualitative interviews which focus on expert-therapists in the practice field (peer-assessment) (N=29). RESULTS: Regarding the structural conception, the degree courses generate solutions that are strongly marked by application of the present vocational law that is in many places not compatible with academic standards. As far as competencies are concerned, academic initial vocational training enables students to work scientifically. With this, the degree courses successfully develop competencies in students that are necessary to meet the current health care requirements. CONCLUSION: The results support the recommendation to reform the vocational law regulations and to implement the model degree courses into regular legal structures.

Ageing, Health and Equity-Broad Perspectives Are Needed to Understand and Tackle Health Challenges of Ageing Societies.

Demographic change and the evolving demands on healthcare systems, especially in the provision of healthcare and long-term care for a growing number of older people, are among the greatest social challenges of the next decades.[...].

[Evaluation of preliminary grades and credits in nurse training programs]. / Evaluation der Anrechnung von Vornoten in der Gesundheits- und (Kinder-) Krankenpflegeausbildung.

In the federal state of Bremen preliminary grades were included to the extent of 25 % in written, oral and practical final grades during the time period 2009-2014. The evaluation focuses on the effects of preliminary grades on the scale of final grades and the performance of learners as well as on the assessment of the appropriateness of final grades. A mixed-methods design was employed that consisted of a quasi-experimental study comprising of surveys of students and teachers of comparative and model courses as well as a qualitative study using group discussions. The results confirm that preliminary grades lead to a minimal improvement of the final grades of some exclusively low-achieving students. The assessment of appropriateness hardly changed. From both learners' and teachers' point of view there is still great dissatisfaction concerning the practical final grades. With regard to learning habits an increased willingness to learn new skills on the one hand and a partly increased performance pressure on the other hand were demonstrated. On the basis of these research results, the authors recommend the regular introduction of preliminary marks into the nursing training.

[Current state of competence assessment in nursing]. / Entwicklungsstand der Kompetenzmessung im Berufsfeld Pflege.

Competency measurement is central to the optimisation of outcome oriented educational processes in nursing, similar to the concept of evidence based practice. The classification of measurement tools provides the basis for describing the current state of research and development in relation to competence measurement in nursing science, and any gaps are identified. The article concludes with questioning the importance of outcome oriented quality orientation in order to achieve an increase in quality during training. Further methodological developments and qualitative studies are needed to examine the context specific processes of interaction and learning, beyond competence diagnostics.

[Competence diagnostic in the field of nursing]. / Kompetenzdiagnostik im Berufsfeld Pflege.

The efficiency and effectiveness of educational programmes in the occupational field of nursing are only assessable through testing and comparing achieved learning results. In search of an appropriate diagnostic instrument, a comprehensive literature research in German-speaking countries concerning the current state of competence diagnostics in the occupational field of nursing had been conducted. Additionally, a similar research of international, professional journals had been done. The investigations lead to the result that a massive gap exists concerning national and international research of systematic, theoretically and empirically well-founded development of instruments measuring nursing competence. Finally, a conclusion for the development of instruments in nursing competence diagnostics is drawn.

[Biography-oriented diagnostics in counselling of patients with chronic illness]. / Biografieorientierte Diagnostik in der Beratung von Patienten mit chronischen Erkrankungen.

The article examines two concepts of counselling of patients by nurses that are popular in the German-speaking area with regard to their underlying scientific standpoint and ideals and their implications on counselling-process and -result. The authors determine that both concepts disregard the biographic construction processes which are so important for coping with and tackling chronic illness. The article concludes with a discussion of prospective use of biographic diagnostics in counselling of patients with chronic illness.

["And it is always recommended"--educational concepts and expertise in nursing practice]. / "Und es wird immer so empfohlen"--Bildungskonzepte und Pflegekompetenz.

This article presents the results of a qualitative empirical study of interaction between teachers and students during lessons in nursing training, focussing in particular on the perspectives of nursing didactics. It examines whether the classes warrant appropriate preparation for beginners with regard to the complex demands of professional practice. The presentation focuses on a widespread educational concept named "rule-orientation". This category summarises those communication patterns of teachers which create rules for operating in typical nursing situations and which are presented as benchmarks for professional practice. Limitations associated with this concept are (1) lacking science-based justification of those operation rules, (2) the communication of standards and recipes instead of clinical judgement, and (3) the partial resolution of intrinsically contradictious demands in nursing practice. Three nursing didactical target dimensions for nursing education are being concretised as a referential framework for class-related decisions that can contribute to better qualify nursing students for professional practice.