[The role of nurses in pharmaceutical care in Germany: A qualitative analysis]. / Die Rolle der Pflegenden in der pharmazeutischen Versorgung in Deutschland ­ Eine qualitative Analyse.

BACKGROUND: In 13 European countries, laws have been passed that allow nurses to prescribe medicines, but mostly within a limited framework and with a doctor involved. Germany is not among these countries. Only the prescription of medical aids has already been included into the development of extended nursing competencies. We investigated the views of the health care professions involved (doctors, pharmacists and nurses) regarding the role of nurses in pharmaceutical care. METHOD: We conducted 22 semi-structured interviews with 23 members of the three professional groups involved in the European research project DeMoPhaC. These data collected in Germany were analysed using qualitative content analysis. Five main categories were developed. RESULTS: Pharmaceutical care by nurses can be described within the following main categories: 1. Knowledge and competences, 2. Patient care, 3. Communication, 4. Multi-professional team and 5. System. The communication between the professional groups involved and with patients and caregivers is of particular importance. Interaction in the multi-professional team is just as crucial. Pharmaceutical care takes place within the health system which sets the framework and often boundaries as well. The current and ideally conceived roles of nurses are seen differently in the respondents' respective contexts. Between the professional groups there is both agreement and dissent on the topics addressed. However, the development of nursing roles requires collaborative and transparent processes in teams and organisations. Particularly in the hospital setting, the participants saw a great need for change in order to achieve cooperation at eye level. DISCUSSION: The results show that nurses play their role in the complex field of pharmaceutical care under very heterogeneous circumstances. The empowerment of nurses, which was called for by some participants, cannot be achieved from within the professional group alone. Cooperation from all the players involved is needed. The development of nursing roles in the medication process with simultaneous expansion of qualifications and competences can contribute to making the nursing role more attractive. Clear role models promote the transparency of processes for all involved. If all players know what they can expect of nurses, tasks can be redistributed in the multiprofessional team. CONCLUSION: The above-mentioned diversity of perspectives can be a resource for development and individual solutions. However, it can also be interpreted negatively as a sign of uncertainty and less standardised ways of working. In view of the data evaluated here, the prescription of medicines by non-medical professionals remains a distant goal for developments in the German health care system. First of all, structures and processes are required that permanently guarantee safe pharmaceutical care with equal participation of all relevant stakeholders.

Fear of falling from the perspective of affected persons-A systematic review and qualitative meta-summary using Sandelowski and Barroso's method.

BACKGROUND: Fear of falling (FoF) affects a large number of older people, whether they have a history of falls or not. This has an impact on their lives. FoF is a potentially modifiable factor, which has been identified as one of the most important threats to older people's autonomy. OBJECTIVES: To gain a comprehensive understanding of the phenomenon, we conducted a systematic review and meta-summary. The available evidence from qualitative research exploring how people experience FoF and how FoF affects daily living was aggregated. METHODS: We followed the approach by Sandelowski and Barroso (2007) as a method to aggregate knowledge based on an exhaustive literature search. We searched the databases CINAHL, MEDLINE, PsycINFO and SSCI systematically for relevant articles as well as grey literature until September 2020. Out of the included studies, findings were extracted, edited, grouped and abstracted into meta-findings. Finally, the manifest frequency effect size of each abstracted meta-finding was calculated. RESULTS: Out of 2978 identified studies, 15 met our inclusion criteria, which were published between 1993 and 2017 and included a total of 276 participants. We extracted 578 findings, and the abstraction process resulted in 183 meta-findings. We identified three main topics: 'Triggers and reasons for FoF identified by affected people', 'Consequences attributed to FoF' and 'Strategies to manage FoF in daily life'. CONCLUSION: Our findings demonstrate that FoF has a far-reaching impact on the lives of those affected. With the aggregation of the existing qualitative data with the application of the frequency effect size, we were able to identify three areas of particular importance to those affected: (1) controlling the risk, (2) creating a safe environment and (3) staying independent. Implications for practice these three areas of particular importance to those affected should be taken into account when revisiting or creating new interventions to prevent or reduce FoF.

Patients' experiences of delirium: A systematic review and meta-summary of qualitative research.

AIMS: The purpose of this systematic review and meta-summary was the aggregation of the empirical qualitative literature on patients' experiences of delirium in order to support the development and implementation of patient-oriented delirium management and to guide future research. DESIGN: We conducted a systematic literature review of qualitative research published between January 1980 and June 2019. DATA SOURCES: In June 2019, we searched in Medline, CINAHL, SSCI and PsycInfo to identify relevant reports. In addition, we conducted searches in three dissertation databases (BASE, DART and ProQuest) and Google Scholar. REVIEW METHODS: We used methods developed by Sandelowski and Barroso to construct a meta-summary of the findings by extracting them from the reports, abstracting them into meta- findings and calculating their manifest interstudy frequency effect sizes. RESULTS: Out of the 742 identified records, 24 reports based on delirium experience accounts of 483 patients met our criteria and were included. One thousand ninety-seven findings were extracted from these reports and abstracted into 92 meta-findings. These were grouped to the five emerging themes 'perception', 'emotions', 'interaction with others', 'dealing with delirium' and 'influence on further life'. CONCLUSION: Delirium is commonly perceived as an overall distressing condition, which can accompany and influence patients even after hospital discharge. IMPACT: This systematic review and meta-summary is the most comprehensive aggregation of qualitative research of the patient delirium experience to date. It allows us to better understand, extract meaning from, and weigh the qualitative findings in their context by calculating their manifest frequency effect sizes. This can be used to support the development and implementation of delirium management concepts.

Healthcare provision, functional ability and quality of life after proximal femoral fracture - 'ProFem': Study protocol of a population-based, prospective study based on individually linked survey and statutory health insurance data.

INTRODUCTION: Proximal femoral fractures (PFF) are among the most frequent fractures in older people. However, the situation of people with a PFF after hospital discharge is poorly understood. Our aim is to (1) analyse healthcare provision, (2) examine clinical and patient-reported outcomes (PROs), (3) describe clinical and sociodemographic predictors of these and (4) develop an algorithm to identify subgroups with poor outcomes and a potential need for more intensive healthcare. METHODS AND ANALYSIS: This is a population-based prospective study based on individually linked survey and statutory health insurance (SHI) data. All people aged minimum 60 years who have been continuously insured with the AOK Rheinland/Hamburg and experience a PFF within 1 year will be consecutively included (SHI data analysis). Additionally, 700 people selected randomly from the study population will be consecutively invited to participate in the survey. Questionnaire data will be collected in the participants' private surroundings at 3, 6 and 12 months after hospital discharge. If the insured person considers themselves to be only partially or not at all able to take part in the survey, a proxy person will be interviewed where possible. SHI variables include healthcare provision, healthcare costs and clinical outcomes. Questionnaire variables include information on PROs, lifestyle characteristics and socioeconomic status. We will use multiple regression models to estimate healthcare processes and outcomes including mortality and cost, investigate predictors, perform non-responder analysis and develop an algorithm to identify vulnerable subgroups. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (approval reference 6128R). All participants including proxies providing written and informed consent can withdraw from the study at any time. The study findings will be disseminated through scientific journals and public information. TRIAL REGISTRATION NUMBER: DRKS00012554.