[If dependency makes vulnerable: Nursing home residents' claims for dignity-conserving nursing care - A narrative literature review]. / Wenn Abhängigkeit verletzlich macht: Ansprüche von Pflegeheimbewohnenden an eine würdevolle Pflege.

If dependency makes vulnerable: Nursing home residents' claims for dignity-conserving nursing care - A narrative literature review Abstract. Introduction: Due to an increase in the very old population, it is important to know what is needed in order to support older people's needs regarding dignity-conserving nursing care when living in a nursing home. Aim: The aim of this article is to gather information on how nursing home residents feel respected and protected in regards of their dignity. Methods: A narrative literature review was conducted in the databases CINAHL Complete and PubMed. Six qualitative studies met the inclusion criteria and were compared regarding similarities. Results: The protection of dignity is jeopardized not only by the residents' dependency, but also by nurses, social environment, and society. To protect their own dignity, residents wanted to be perceived as individuals and be treated with respect. Additionally, they wanted to be as independent as possible and take part in meaningful activities. Discussion: Facilitation of staff members as well as flat, peripheral leadership structures are important in order to protect the residents' dignity. The residents' needs regarding social and societal participation has been additionally challenged due to the Covid-19 pandemic. At the same time, the pandemic enforced innovations that may help protect nursing home residents' dignity. Conclusions: These findings can help nurses to protect the dignity of nursing home residents in their daily lives and in the implementation of care measures.

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study.

BACKGROUND: Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support. METHODS: Using an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table. RESULTS: Of the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for 'care and assistance at home' and 'meal services'). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care. CONCLUSIONS: Given the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.

A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project.

INTRODUCTION: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. METHODS: We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders' feedback and preliminary implementation strategies. RESULTS: Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. CONCLUSION: Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.

Patient-related complexity of nursing care in acute care hospitals - an updated concept.

RATIONAL: The interest in complexity of nursing care has grown in science and practice in recent years because of changed patient profiles and higher average levels of patient acuity in acute care hospitals. AIM: The aim of this study was to redefine the concept of patient-related 'complexity of nursing care' in acute care hospitals. DESIGN: The hybrid model for concept development was chosen. METHODS: In a first theoretical phase, we performed a narrative literature review regarding defining elements of patient-related 'complexity of nursing care' and developed a working definition. In the fieldwork phase, we investigated collective case studies representing 12 nursing care situations. The theoretical phase was updated before all findings were synthesised, and in the final analytical phase, the preliminary working definition was refined. ETHICS: An ethical committee judged the study as unproblematic (waiver no. 82/14 from 5 December 2014). RESULTS: The concept was redefined confirming previous understandings of patient-related 'complexity of nursing care' as a dynamic, relational concept characterised by the instability, variability and uncertainty that exist. The extent of complexity was determined by multifaceted patient problems and resources as well as extensive knowledge, experience, attention and caring skills of registered nurses interacting with each other. LIMITATIONS: The study did not include organisation-related complexity of nursing care. CONCLUSIONS: The redefinition of the concept may support a common understanding of patient-related demands on nursing care among practitioners, managers and politicians which is important regarding patient safety and health nursing staff.

["One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals]. / "Man muss stets aufmerksam sein".

"One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals Abstract. Background: The increase of chronic illnesses and multimorbidity as well as more challenging treatment methods have caused higher acuity and complexity of nursing care situations. Aim: The aim of this study was to explore and establish categories which describe different levels of patient-related complexity of nursing care in order to broaden the understanding of demands on nursing care due to patient situations. Methods: Using a collective case study design, we asked registered nurses and clinical nurse specialists to assess the complexity of twelve nursing care situations through a questionnaire before interviewing them about their deliberations on how they rated the situation. In this sub-study, we performed a qualitative secondary analysis of these data and looked for categories of comparable degrees of complexity. Results: We found five categories of complexity, ranging from "slightly complex" to "highly complex". "Slightly complex" situations demanded a nurse's attention on routine interventions, while "highly complex" situations demanded their constant attention on poorly assessable and poorly controllable conditions with uncertain outcomes. Conclusions: The five categories of complexity describe characteristics of the different levels of complexity in nursing care situations. They can support nursing managers with allocating nursing staff to patients according to their needs and provide a framework for discussing complex nursing care situations in basic and continuing education.

Validation of the instrument "Complexity of Nursing Care"-A mixed-methods study.

Aims: This study aimed to psychometrically test the instrument "Complexity of Nursing Care" and to broaden the understanding of the instrument's psychometrics and applicability. Design: Embedded mixed-methods design. Methods: We performed a cross-sectional study assessing all stationary patients of five Swiss hospitals daily for up to 5 days with the instrument "Complexity of Nursing Care" over a 1-month period in 2015. The scale's psychometrics were analysed using partial least square structural equation modelling. In the qualitative study section, we completed 12 case studies and analysed them case-wise and across cases. Quantitative and qualitative results were synthesized in tables. Results: Structural equation modelling confirmed a reflective-formative second-order model of the instrument with good psychometric properties leading to a formula for the calculation of a complexity score. Qualitative results evolved descriptions of low and high extent of complexity. Narrative considerations of two raters deepened the understanding of the inter-rater reliability.

[Patient-related complexity in nursing care - Collective case studies in the acute care hospital]. / Patientenbezogene Komplexität in der Pflege ­ Kollektive Case Studies im Akutspital.

Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. BACKGROUND: Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. AIM: We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. METHODS: In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. RESULTS: The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. CONCLUSIONS: Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

Patient-related complexity of care: a challenge or overwhelming burden for nurses - a qualitative study.

BACKGROUND: Patient-related complexity of nursing care in acute care hospitals has increased in recent years, in part due to shorter hospital stays and the increase in multimorbid patients. However, little research has been conducted on how nurses experience complex nursing care situations. AIMS: The aim of this study was to gain a better understanding of how nurses experience complex nursing care situations in Swiss acute care hospitals. METHODS: This qualitative study utilised focus group interviews and thematic analysis. Focus groups facilitate different perspectives of the topic. Thematic analysis is suitable for the analysis of everyday stories. Participants were 24 Registered Nurses with experience in their field, from four Swiss hospitals. The evaluation was performed in six steps according to themes. Participation was voluntary. This study was part of a multicentre research project that had been approved by the responsible ethics committees. RESULTS: Three main themes regarding the experience of complex nursing care situations were found: complexity as a challenge, complexity as an overwhelming burden and mediating factors. Mediating factors included time resources and teamwork and interprofessional collaboration as contextual conditions. Additionally, nurses' individual characteristics such as their professional experience and expertise, as well as their personal and professional values and beliefs were considered as mediating factors. These mediating factors may determine whether complex nursing care situations are experienced as challenging or overwhelming. LIMITATIONS: The findings from this study are limited as only experienced nurses participated in the study. CONCLUSIONS: Nurses are ambivalent with regard to how they experience complex nursing care situations. The contextual conditions and the nurses' personal characteristics play a key role in whether nurses perceive complex nursing care situations as positive challenges or overwhelming burdens. These findings are important for managers, as they can support nurses to master complex nursing care situations.

Descripción de la concordancia clinicopatológica y satisfacción del paciente en la cirugía menor en un centro de atención primaria / Description of clinical pathological concordance and patient satisfaction in minor surgery in a Primary Care centre

OBJETIVO: Describir las características de la cirugía menor (CM) en un centro de atención primaria (AP) evaluando la concordancia anatomopatológica y clínica, así como la satisfacción del paciente. DISEÑO: Estudio descriptivo y retrospectivo. EMPLAZAMIENTO: Atención primaria, Centro de Salud (CS) urbano en Almería. PARTICIPANTES: La población fueron los usuarios pertenecientes al CS urbano derivados por sus médicos de familia o pediatras para realización de CM a la consulta durante el año 2013 que consintieron la intervención. Se obtuvo una muestra de 223 pacientes. MEDICIONES PRINCIPALES. Las variables analizadas fueron: sexo, edad, localización de las lesiones, tipo de intervención realizada, diagnóstico clínico, diagnóstico anatomopatológico, complicaciones y satisfacción del paciente. Los datos fueron extraídos de la historia clínica, de los informes de anatomía patológica y mediante encuesta de satisfacción realizada vía correo y telefónica a los pacientes. RESULTADOS: En nuestra población la mayoría fue del sexo masculino 53,8%, la edad media fue de 51,12 años con desviación típica de 19,02, la localización de las lesiones que más se intervinieron fue en la cabeza (35,4%). El procedimiento más utilizado fue la electrocirugía (62,8%), biopsiándose solo el 16,9% de las lesiones, de las cuales las más frecuentes fueron los fibromas (32,3%), obteniéndose una correlación clinicopatológica >80% con un índice Kappa de 0,783 (p < 0,001). El número de complicaciones fue bajo. La satisfacción del paciente fue alta. CONCLUSIONES: Aunque se han generalizado técnicas sencillas de CM, como la electrocoagulación, en AP la CM sigue siendo segura y satisfactoria para el usuario

AIM: To describe the minor surgery (MS) characteristics in a Primary Care (PC) centre, and to evaluate the clinical pathological concordance and patient satisfaction. DESIGN: Descriptive and retrospective study. SETTING: Primary Care, urban health care centre, Almería, Spain. PARTICIPANTS: The population were the patients belonging to urban Primary Health Care centre, referred by their family physicians or paediatricians for the performing of MS during year 2013, and who consented to the intervention. A sample of 223 patients was obtained. MAIN MEASUREMENTS: Variables analysed were: sex, age, locations of the lesions, type of intervention, clinical diagnosis, histopathology diagnosis, complications, and patient satisfaction. The data were extracted from the medical history, the histopathology reports, and by using a satisfaction questionnaire completed by post or telephone by the patients. RESULTS: The population consisted of 53.8% males, and had a mean age of 51.12 years (SD 19.02). The location of the most intervened lesions was in the head (35.4%). Electro-surgery was the most used procedure (62.8%), with only 16.9% of the lesions being biopsied, of which the most frequent was fibroids (32.3%). The clinical pathological concordance was > 80% and the Kappa index was 0.783 (P <.001). The complications presented were low. The patient's satisfaction was high. CONCLUSIONS: Although a simple MS technique like electro-surgery has become more extensive, MS in PC remains safe and satisfactory for the user

[Description of clinical pathological concordance and patient satisfaction in minor surgery in a Primary Care centre]. / Descripción de la concordancia clinicopatológica y satisfacción del paciente en la cirugía menor en un centro de atención primaria.

AIM: To describe the minor surgery (MS) characteristics in a Primary Care (PC) centre, and to evaluate the clinical pathological concordance and patient satisfaction. DESIGN: Descriptive and retrospective study. SETTING: Primary Care, urban health care centre, Almería, Spain. PARTICIPANTS: The population were the patients belonging to urban Primary Health Care centre, referred by their family physicians or paediatricians for the performing of MS during year 2013, and who consented to the intervention. A sample of 223 patients was obtained. MAIN MEASUREMENTS: Variables analysed were: sex, age, locations of the lesions, type of intervention, clinical diagnosis, histopathology diagnosis, complications, and patient satisfaction. The data were extracted from the medical history, the histopathology reports, and by using a satisfaction questionnaire completed by post or telephone by the patients. RESULTS: The population consisted of 53.8% males, and had a mean age of 51.12 years (SD 19.02). The location of the most intervened lesions was in the head (35.4%). Electro-surgery was the most used procedure (62.8%), with only 16.9% of the lesions being biopsied, of which the most frequent was fibroids (32.3%). The clinical pathological concordance was >80% and the Kappa index was 0.783 (P<.001). The complications presented were low. The patient's satisfaction was high. CONCLUSIONS: Although a simple MS technique like electro-surgery has become more extensive, MS in PC remains safe and satisfactory for the user.

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

AIM: To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. BACKGROUND: The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. DESIGN: Hybrid model of concept development and embedded mixed-methods design. METHODS: The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. DISCUSSION: Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept.

Activation of the MAPK/Akt/Nrf2-Egr1/HO-1-GCLc axis protects MG-63 osteosarcoma cells against 15d-PGJ2-mediated cell death.

Despite considerable efforts to improve treatment modalities for osteosarcoma (OS), patient survival remains poor mainly due to pro-survival pathways in OS cells. Among others, prostaglandins (PGs) are the potent regulators of bone homoeostasis and OS pathophysiology. Therefore, the present study aimed to elucidate the impact of 15-deoxy-Δ(12,14)-PGJ2 (15d-PGJ2, a stable PGD2 degradation product) on cell death/cell survival pathways in p53-deficient MG-63 OS cells. Our findings show that 15d-PGJ2 induces generation of reactive oxygen species that promote p38 MAPK activation and subsequent Akt phosphorylation. This pathway induced nuclear expression of Nrf2 and Egr1, and increased transcription of haem oxygenase-1 (HO-1) and the catalytic subunit of glutamate cysteine ligase (GCLc), catalysing the first step in GSH synthesis. Silencing of Nrf2, Egr1 and HO-1 significantly elevated 15d-PGJ2-mediated reduction of cellular metabolic activity. Activation of cell survival genes including HO-1 and GCLc inhibited 15d-PGJ2-induced cleavage of pro-caspase-3 and PARP. Annexin V/propidium iodide staining showed an increase in early/late apoptotic cells in response to 15d-PGJ2. The observed 15d-PGJ2-mediated signalling events are independent of PGD2 receptors (DP1 and DP2) and PPARγ. In addition, the electrophilic carbon atom C9 is a prerequisite for the observed activity of 15d-PGJ2. The present data show that the intracellular redox imbalance acted as a node and triggered both death and survival pathways in response to 15d-PGJ2. Pharmacological or genetic interference of the pro-survival pathway, the p38 MAPK/Akt/Nrf2-Egr1/HO-1-GCLc axis, sensitizes MG-63 cells towards 15d-PGJ2-mediated apoptosis.

LPA-induced suppression of periostin in human osteosarcoma cells is mediated by the LPA(1)/Egr-1 axis.

Lysophosphatidic acid (LPA), a naturally occurring bioactive phospholipid, mediates a multitude of (patho)physiological events including activation of mitogen-activated protein kinases (MAPKs). As LPA may induce cellular reponses in human osteosarcoma, the present study aimed at investigating expression of various LPA receptors, LPA-mediated activation of MAPK via G-protein coupling, and expression of early response genes in a cellular model for human osteosarcoma. We show that MG-63 cells express three members of the endothelial differentiation gene (Edg) family of G-protein coupled receptor transcripts (LPA(1-3)) but only two (LPA(4/5)) out of three members of the non-Edg family LPA receptor transcripts. Stimulation of MG-63 cells with LPA or synthetic LPA receptor agonists resulted in p42/44 MAPK phosphorylation via LPA(1)-LPA(3) receptors. Using pharmacological inhibitors, we show that LPA-mediated phosphorylation of p42/44 MAPK by LPA receptor engagement is transmitted by G(αi)-dependent pathways through the Src family of tyrosine kinases. As a consequence, a rapid and transient upregulation of the zinc finger transcription factor early growth response-1 (Egr-1) was observed. Egr-1 expression was strictly mediated via G(αi)/Src/p42/44 MAPK pathway; no involvement of the G(αq/11)/PLC/PKC or the PLD/PI3 kinase/Akt pathways was found. LPA-induced expression of functional Egr-1 in MG-63 cells could be confirmed by electrophoretic mobility shift assay. LPA-induced Egr-1 upregulation was accompanied by a time-dependent decrease of periostin (previously called osteoblast-specific factor 2), a cell adhesion protein for pre-osteoblasts. Silencing of LPA(1) and/or Egr-1 in MG-63 cells reversed LPA-mediated suppression of periostin. We here demonstrate a crosslink between Egr-1 and periostin in cancer cells, in particular in human osteosarcoma.

15-Deoxy-Δ12,14-prostaglandin J2 induces Cox-2 expression in human osteosarcoma cells through MAPK and EGFR activation involving reactive oxygen species.

Prostaglandins (PGs), important modulators in bone biology, may also contribute to tumor formation and progression in human osteosarcoma. 15-Deoxy-Δ(12,14)-PGJ(2) (15d-PGJ(2)), a metabolite of PGD(2) and PPARγ-ligand, exerts a panel of biological activities via receptor-dependent and -independent mechanisms. As inducible cyclooxygenase-2 (Cox-2) is a candidate inflammatory marker in human osteosarcoma and a rate-limiting enzyme in PG biosynthesis, this study aimed at investigating intracellular redox status and signaling cascades leading to Cox-2 induction in human MG-63 osteosarcoma cells. 15d-PGJ(2) induced the accumulation of reactive oxygen species (ROS) that in turn may lead to upregulation of Cox-2 via two different routes in a PPARγ-independent manner. First, phosphorylation of p38 MAPK directly enhances Cox-2 expression by promoting mRNA stability. Second, 15d-PGJ(2) induces activation of epidermal growth factor receptors and downstream activation of Cox-2 via phosphorylation of p42/44 MAPK. Glutathione precursor molecules reversed enhanced ROS levels and Cox-2 expression. Functional activity of Cox-2 expression was tested by measurement of PGE(2) and PGF(2α). The synthetic compound 9,10-dihydro-15d-PGJ(2) lacking the α,ß-unsaturated carbonyl group in the cyclopentenone ring did not exhibit the cellular responses observed with 15d-PGJ(2). We conclude that the electrophilic carbon atom of 15d-PGJ(2) is responsible for alterations in intracellular redox status and Cox-2 expression.

[Eating in hospital--a challenge for the interdisciplinary team]. / Essen im Spital - eine interdisziplinäre Herausforderung.

Annually, the hospital Zollikerberg in Switzerland collects data about patient satisfaction. Among others, patients are asked to rate food preparation, variety, presentation, and temperature of the meals as well as the overall quality of the food. The study presented in this article explored what the aspect food quality means to patients. A total of 24 patients participated in 23 narrative interviews which were transcribed and analysed using the method of inductive content analysis. In general, patients were satisfied with the meals in the hospital, i. e., preparation, variety, presentation and temperature as well as the mealtimes. The staff was described as being friendly and helpful. Potential for improvement was identified with regard to information about food variety, and services for people whose appetite was limited. Patients experienced difficulties particularly in the first days of hospitalisation to identify their food options. Patients with a reduced appetite tried to choose meals they found most appealing. Given the widespread problem of malnutrition in hospitals this last point needs attention both from the nursing and the interdisciplinary team.

[OLA - Optimizing quality of life of elderly people. Development of quality measurement tools for nursing homes and assisted living organizations]. / OLA: Optimierung der Lebensqualität im Alter: Entwicklung eines Fragebogens zur Zufriedenheit der Angehörigen von Bewohnerinnen in Altersinstitutionen.

There are no systematically used quality measurement instruments for nursing homes in Switzerland. That is why a private organization developed its own quality measurement tools. This article describes the development of a questionnaire for satisfaction of family members of nursing home residents. The aim was to construct a valid and reliable instrument. Background for the construction of the items were problem-based interviews with relatives, knowledge from literature as well as know-how from management and a master's prepared nurse. Factor analyses of 145 questionnaires showed the following themes: "your relationship to the staff", "relationship of staff members to residents", "everyday life in the institution", "the institution as home for your family member" and "know-how of staff". These themes are consistent with the literature. Cronbach's alpha of these factors was between 0.78 and 0.91. The instrument meets the requirements of both science and practice.