Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol.

INTRODUCTION: Delirium is one of the most common forms of acute cerebral dysfunction in critically ill children leading to increased morbidity and mortality. Prevention, identification and management of delirium is an important part of paediatric and neonatological intensive care. This scoping review aims to identify and map evidence on non-pharmacological interventions for paediatric delirium prevention and management in paediatric and neonatal intensive care settings. METHODS AND ANALYSIS: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches will be performed in the databases Medline (via PubMed), CINAHL, Cochrane Library, Ovid (Journals), EMBASE and Web of Science (01/2000-current). Two reviewers will independently review retrieved studies, and relevant information will be extracted using data extraction forms. The results will be presented in tabular format and accompanied by a narrative summary. INCLUSION CRITERIA: The review will include references that describe or evaluate non-pharmacological interventions to prevent or manage paediatric delirium. Conference abstracts, editorials, opinion papers and grey literature will be excluded. ETHICS AND DISSEMINATION: Due to the nature of research involving humans or unpublished secondary data, approval of an ethics committee are not required. The dissemination of findings is planned via professional networks and publication in an open-access scientific journal.

[Nursing interventions by school nurses in Germany: A cross-sectional study]. / Interventionen der Schulgesundheitspflege in Deutschland.

Nursing interventions by school nurses in Germany: A cross-sectional study Abstract. Background: The internationally established professional profile of school nursing has not yet been implemented across the board in Germany. In model projects and some international schools the feasibility of the concept and the daily work of school nurses in Germany can already be observed. Urgent and currently often unsolved issues in the school setting are the inclusion of chronically ill students and health promotion in the living environment. Aim: The aim of this paper is to describe the interventions of school nurses in everyday school life. Method: Using a standardized online questionnaire, school nurses in Germany were surveyed regarding the activities they performed and their frequency. The data on the activities were collected based on the Nursing Intervention Classification (NIC). Data were analyzed using descriptive statistics. Results: Respondents (n = 25) focused on acute care and health education/promotion. Nursing interventions that have a family or population-based approach are performed only "every 2-3 months" or less by the average respondent. Conclusions: The daily intensive implementation of diverse nursing interventions indicates an urgent need for nursing expertise in schools.

[Integrating academic nurses in German university hospitals: a follow-up survey]. / Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: ein Follow-up-Survey.

INTRODUCTION: The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. METHOD: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. RESULTS: In total, n=29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n=786 between 2015 (n=593) and 2018 (n=1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD=1.66; min - max=1.09 - 6.69; Q1 - Q3=1.49 - 4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD=1.40; min - max=0.47 - 5.42; Q1 - Q3=0.87 - 3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). DISCUSSION: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

[Individual teacher's health literacy and their safety in dealing with chronically ill pupils and emergencies]. / Individuelle Gesundheitskompetenz von Lehrkräften und deren (Un)Sicherheit im Umgang mit chronisch erkrankten Schulkindern und Notfallsituationen.

BACKGROUND: Health literacy (HL) is regarded as a key determinant in health promotion. The support of HL should begin as early as possible to prevent later health problems. In the school setting, teachers play an important role. Due to all-day school and inclusion efforts, teachers are increasingly faced with the health problems of pupils. At the same time, many teachers show their own significant health problems, often due to an enormous workload. OBJECTIVES: This study assesses the level of the individual teacher's HL and examines possible relationships between the individual HL of teachers and their level of uncertainty in dealing with chronically ill pupils. METHODS: A secondary data analysis of a quantitative survey of n = 420 teachers was conducted. A self-assessment of the teacher's HL level was done using HLS-EU-Q16. Furthermore, correlation analyses between the HL and the level of insecurity of teachers in dealing with selected health problems were made. RESULTS: More than half of the teachers showed a limited level of HL and an association between low level of HL and uncertainty in dealing with chronically ill pupils were found. In particular, mental health issues caused difficulties among the teachers. DISCUSSION: There is a large gap between complex health-related demands on the teachers and their required health literacy as well as sovereignty in dealing with chronic and mental impairments in the school setting. These deficits will influence the children's HL and the health development of adolescents.

Parental health literacy and health knowledge, behaviours and outcomes in children: a cross-sectional survey.

BACKGROUND: Health literacy (HL) is closely associated with leading health indicators such as engaging in healthy behaviours and experiencing a healthy social environment. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but there are gaps in the available information and there is not any data available yet for the German context. METHODS: In preparation of an implementation study, a cross-sectional survey was conducted in 28 elementary and secondary schools in Germany. The parent questionnaire was completed by 4217 parents and included the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The child questionnaire examined children's health knowledge, behaviours and outcomes. For children between 6 and 10 years, a parent reported on behalf of their children (N = 1518). Students 11 years and older completed a self-administered questionnaire (N = 2776). Bivariate and multivariate analyses were carried out. Spearman's Rho correlations assess the relationships between household characteristics, parental HL and the health behaviour and outcomes in children. RESULTS: Among the participating parents, 45.8% showed problematic or inadequate HL. The major determinants of high parental HL were high socio-economic status (SES) (r = .088***, 95% CI [.052, .124]), living in West Germany (r = .064***, 95% CI [.032, .096]) and older parental age (r = .057**, 95% CI [.024, .090]). In the multivariate model, only SES remained significant. High parental HL was associated with positive health behaviours in children including healthier nutrition, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol, sexual activity among children and children's weight were not significant. CONCLUSIONS: The results confirm a relationship between low parental HL, SES and some child health behaviours likely to negatively impact their health and wellbeing including less healthy nutrition and less exercise. Strengthening the health knowledge and competencies of parents may contribute to improved child outcomes particularly in the areas of nutrition, exercise and dental health.

Potentials of School Nursing for Strengthening the Health Literacy of Children, Parents and Teachers.

Health literacy (HL) plays a key role in explaining health disparities. School nurses (SN) provide health related expertise within the school setting. A positive effect on the HL of children but also their teachers and parents has been suggested by some research, but gaps persist in the available information. As a pilot project, SN, which are not common in German schools, were placed in 28 public elementary and secondary schools in two German states. Children (11+ years, n = 2773), parents (n = 3978) and teachers (n = 420) participated in a 2017 baseline (T0) survey. Data collection was repeated in 2018 (T1). HL was measured using the Health Literacy for School-Aged Children scale (HLSAC) (children) and the European Health Literacy Short Scale (HLS-EU-Q16) (adults). Descriptive and multivariate data analyses were carried out. The HL of all groups increased between T0 and T1. Low child HL decreased from 17.9% to 14.9%. Problematic and inadequate HL dropped from 43.8% to 38.8% among parents and from 49.9% to 45.8% among teachers. Improvements were significant for children and parents but not for the teachers. Despite the relatively short intervention period and a relatively non-specific spectrum of interventions, there is some evidence that SN may contribute to strengthening HL within the school setting. The longer-term effects of SN on health literacy and child health should be further examined. For this, a clearer conceptualization of the scope of work of the SN in Germany including their educational interventions is imperative.

[State of development of the role of academic nursing staff at German university hospitals in 2015]. / Survey zur Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken - Stand 2015.

INTRODUCTION: In order to meet the requirements of the increasing complexity of patient care it is recommended to promote more differentiated nursing staff structures and to integrate academic nurses, which is international standard and recommended by the German Science Council. The implementation level is unclear. What is the percentage of nurses with an academic degree at German university hospitals, and what are their task profiles? METHOD: Standardised written survey by nursing directors of all 32 German university hospitals and medical universities in 2015. RESULTS: The response rate was 75 %. The ratio of nurses with an academic degree amounted to 1.7 % overall, and to 1.0 % in direct patient care. The activities of nurses with an academic degree correspond to international Advanced Nursing Practice approaches including conceptual development (76 %), support of evidence-based care (72 %), practice projects (64 %) and patient counselling (56 %). There were significant variations among hospitals nationwide concerning pay rates with a current lack of reliable pay structures. DISCUSSION: This is the first national survey to determine the quota of nurses with an academic degree in direct patient care. The ratio of 1 % is well below the 10 to 20 % recommended by the German Science Council - hence the need for immediate action and comprehensive reforms. A follow-up survey is planned for 2017.

Underweight and malnutrition in home care: A multicenter study.

BACKGROUND & OBJECTIVES: This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. METHODS: In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. RESULTS: Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI < 20 kg/m(2)) and 10.2% (clinical judgment). Missing values were high in both malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. CONCLUSION: Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time.

Mobility is the key! Trends and associations of common care problems in German long-term care facilities from 2008 to 2012.

BACKGROUND: Although enormous efforts have been made in auditing the quality of care, there are only few epidemiological studies available about the actual occurrence of immobility, malnutrition, urinary incontinence, cognitive impairment, falls and pressure ulcers in long-term care facilities. OBJECTIVE: The objective of this study was to provide prevalence estimates of common nursing care problems in long-term care facilities and to investigate any associations between them. DESIGN: Secondary data analysis of five consecutive annual cross-sectional multicenter studies from 2008 to 2012. SETTING: 262 different long-term care facilities throughout Germany. PARTICIPANTS: 14,798 residents older than 18 years who gave informed consent. METHODS: Health conditions were rated based on direct resident examinations according to the current international definitions. Demographic characteristics were compared with available national population statistics. Apart from descriptive statistics, Chi(2) tests were carried out for bivariate and log-regression models were performed for multivariate associations. RESULTS: Prevalence rates were stable over the years with the highest prevalence of 73.5% (95% CI 72.8-74.2) being found for urinary incontinence, for cognitive impairment it was 54.1% (95% CI 53.3-54.9) and for immobility it was 36.5% (95% CI 35.7-37.3). The lowest prevalence rates were established for the risk of malnutrition with 13.0 (95% CI 12.4-13.5), for pressure ulcers with 4.8% (95% CI 4.5-5.1) and for falls (4.4% 95% CI 4.1-4.8). In the multivariate model, immobility was most strongly associated with all of the other conditions. No statistically significant associations were found between pressure ulcers and falls, pressure ulcers and urinary incontinence, pressure ulcers and cognitive impairment and between malnutrition and urinary incontinence. CONCLUSION: Decision-makers and clinical practitioners may primarily focus on the maintenance and enhancement of mobility, because this seems to be the key predictor for many other health conditions in the context of care dependency in the nursing home setting.