"The supreme discipline of Nursing"-A qualitative content analysis of nurses' opinions on caring for people eighty years of age and older.

Introduction: Nurses often experience stress and feel under time pressure when working with older people, increasing their job dissatisfaction. Especially people 80 years of age and older often require more complex and a greater measure of care, as the risk of care dependency is higher in this age group. This study was conducted to collect nurses' experiences and opinions regarding the care of people 80 years of age and older, as well as to learn more about how nurses perceive this care. Method: We analysed narratives collected in an Austrian nationwide, cross-sectional online study to investigate nurses' attitudes towards people 80 years of age and older and their perceptions regarding their care (N = 1197). Data were collected from May-October 2021 by using a convenience sampling method. In total, 149 participants filled in the free text field; these texts were analysed using a qualitative content analysis method. Results: Three main themes emerged from the analysis of the nurses' narratives: (1) 'opinions on people in need of care', (2) 'reputation of nursing profession', and (3) 'criticism of current nursing practice'. Most narratives were assigned to the subthemes 'positive opinions on nursing', 'ideal image of nursing', and 'shortage of staff'. Conclusion: Nurses considered their work with people aged 80 years and older to be meaningful and important, but they criticised working conditions which need to be improved. This could be achieved by offering further education and increasing nursing staff. Further research is needed to investigate nurses' needs and wishes regarding the care of people aged 80 years and older.

Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study.

AIM: Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration. DESIGN: Qualitative study. METHODS: Semi-structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews. RESULTS: Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working. CONCLUSION: In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals. IMPACT: The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice. REPORTING METHOD: In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021.

Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.

Cultural competence among nursing students and nurses working in acute care settings: a cross-sectional study.

BACKGROUND: The increasing cultural diversity in healthcare in European countries, including Austria, has highlighted the need to enhance nurses' cultural competence. Assessing cultural competence and identifying relevant influencing factors can help to improve culturally competent care. The aim of this study was to assess the cultural competence of nurses and nursing students working in Austrian acute care settings and to identify influencing factors using the Cultural Competence Assessment scale. METHODS: A cross-sectional design was used. Data collection was carried out in March 2021 with nurses and nursing students in the last year of their studies who were working in Austrian acute care settings. Descriptive analysis was applied to display the general characteristics of the study participants and the levels of their overall cultural competence. A multiple linear regression analysis was conducted to analyze the influencing factors of cultural competence. RESULTS: The nurses' cultural competence level was moderate to high (mean = 3.89; SD = .48). Their age, educational level, cultural diversity training and self-perceived cultural competence significantly influenced the level (F (6, 875) = 18.971, p < .0000, adj. R2 = 1.09). CONCLUSIONS: Providing culturally competent healthcare services for culturally diverse patients is essential for all healthcare professionals, and especially for nurses who spend the most time with patients. Effective interventions, such as educational training, need to be implemented in order to deliver culturally competent care and potentially reduce disparities in healthcare and improve patient outcomes.

Obesity and its associated factors in older nursing home residents in three European countries-Secondary data analyses from the "International Prevalence Measurement of Care Quality".

BACKGROUND: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. OBJECTIVE: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0-34.9 kg/m2 ), class II (BMI 35.0-39.9 kg/m2 ), and class III (BMI >40.0 kg/m2 )) amongst older nursing home residents in European countries. METHODS: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD-10, and care dependency. Descriptive and logistic regression analyses were performed. RESULTS: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p = .006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). CONCLUSIONS: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. IMPLICATIONS FOR PRACTICE: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents.

Nurses' perspectives on caring for and attitudes towards adults aged eighty years and older.

BACKGROUND: Adults aged 80 years and older form a vulnerable group regarding perceived ageism, because they are often stereotyped as being frail and dependent. Nurses often display biased behaviour and hold negative attitudes towards this age group, due to the fact that they have frequent contact with patients who need complex care. As this frequent contact can negatively influence the quality of care, we performed this study to assess nurses' attitudes towards adults aged 80 and older and their views regarding their care, as well as to identify factors that influence attitudes. METHODS: A cross-sectional study design was used. A convenience sample of 1179 Austrian nurses was taken, and their attitudes were measured using the Ageing Semantic Differential (ASD) Scale. Their views on caring for older adults were assessed with the Perspectives on Caring for Older People (PCOP) Scale. Multiple linear regression was used to examine factors that influence nurses' attitudes. The Ethics Committee of the Medical University of Graz (EK Number 31-320 ex 18/19) gave their ethical approval for this study. RESULTS: Nurses display neutral to positive attitudes towards adults aged 80+ and view caring for them positively. Positive attitudes were indicated, for example, by the factors of a positive view towards the care of older patients, a higher education and a personal relationship with older adults. Negative attitudes were indicated by the factors of being female and interacting more frequently with older care receivers. CONCLUSIONS: Although the nurses' attitudes were not negative, they should be encouraged to view this patient population more positively. Educational interventions to alter nurses' attitudes and thus to improve the quality of care are recommended. As the ASD measures some aspects of ageism, it is recommended to consider qualitative methods in future studies to obtain a deeper knowledge of ageism in nursing care.

Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals.

Background: Besides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care. Aims: This study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults. Method: A qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant. Results: A total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement. Conclusion: Health professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

Development and psychometric evaluation of an instrument to assess Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) in Indonesian community-dwelling older adults.

BACKGROUND: The prevalence of pressure injuries among community-dwelling older adults in countries worldwide is still a serious problem. In Indonesia, older adults mostly rely on family members for (medical) care. Therefore, involving family members in the prevention and treatment of pressure injuries (PIs) could potentially decrease its prevalence rates. However, family members are usually not trained for such tasks. Hence, it is essential to first get more insight into the current state of affairs on family members' knowledge, attitude and actual practice of preventing PIs. Due to the lack of an existing instrument to measure knowledge, attitude and practice of family caregivers in preventing PIs, this study focuses on the development and evaluation of psychometric properties of such an instrument. METHODS: Three phases of instrument development and evaluation were used, including item generation, instrument construction and psychometric testing of the instrument. A total of 372 family caregivers of community-dwelling older adults who randomly selected participated in this study. Principal factor analysis, confirmatory factor analysis and Cronbach's alpha were performed to evaluate factor structure and internal consistency of the Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) instrument. RESULTS: The final version of the KAP-PI-instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach's Alpha values of 0.83, 0.93 and 0.89, respectively. The instrument appeared to be both reliable and valid. CONCLUSION: The KAP-PI instrument can be used in family nursing or community nursing practice, education, and research to assess knowledge, attitude and practice of pressure injury prevention of family caregivers.

'End of life': a concept analysis.

BACKGROUND: The concept of end of life (EOL), as in the term end-of-life care, is used synonymously in both palliative and terminal care. Practitioners and researchers both require a clearer specification of the end-of-life concept to be able to provide appropriate care in this phase of life and to conduct robust research on a well-described theoretical basis. AIMS: The aim of this study was to critically analyse the end-of-life concept and its associated terminology. METHOD: A concept analysis was performed by applying Rodgers' evolutionary concept analysis method. FINDINGS: Time remaining, clinical status/physical symptoms, psychosocial symptoms and dignity were identified as the main attributes of the concept. Transition into the end-of-life phase and its recognition were identified as antecedents. This study demonstrates that end-of-life care emerged following the application of the 'end-of-life concept' to clinical practice. CONCLUSION: The early recognition of the end-of-life phase seems to be crucial to ensuring an individual has well-managed symptoms and a dignified death.

Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study.

OBJECTIVES: The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK. METHODS: This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK. RESULTS: A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%). CONCLUSION: The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.

Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers' and Nurses' Assessments: A Comparative Study.

Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers' and nurses' assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers' and nurses' assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient's discharge together with family caregivers.

A Consensus Definition of End of Life from an International and Interdisciplinary Perspective: A Delphi Panel Study.

Background: Those working in the field of palliative care have recognized that many terms are being used synonymously and that clear definitions (or any definitions) for many of these terms are lacking. The synonymous use of the terms palliative and end of life (EOL) can especially lead to conflicts in clinical practice, such as a tardy referral to palliative care. Such conflicts may then result in poorer treatment of patients, for instance, pain management. In research, the lack of clear definitions or even of any established definition for central concepts, such as EOL, weakens study validity and research outcomes. Objective: The aim of this study was to establish a concise definition for the EOL phase. Design: A modified Delphi study design was chosen. A structured questionnaire based on a previously conducted concept analysis about the EOL was used. Setting: A panel of international and interdisciplinary experts was established. Between 34 (1st round) and 21 (4th round) individuals participated in the anonymous online expert panel. Results: After four panel rounds, we were able to provide a definition which covers physical and psychosocial aspects that should be considered at the beginning of the EOL phase and possible predictions about the remaining time. The definition also covers aspects of EOL care, such as considerations related to the individual's dignity, spirituality, and maintenance of relationships. Conclusion: EOL is a term which is defined by considering multiple aspects that affect the process of identifying the EOL phase, the EOL phase itself and the resulting care options.

The German version of the Cultural Competence Assessment (CCA-G): cross-cultural adaptation and validation study in Austrian acute care settings.

BACKGROUND: Adapting practices to respond sensitively to increasingly culturally diverse patients can be challenging. Therefore, cultural competence among nurses needs to be assessed to evaluate their current cultural competence and the need for interventions to improve daily nursing practice. Little is known about cultural competence of nurses in German-speaking countries, including Austria, as there is currently no validated tool in German to assess cultural competence in nurses. The aims of this study were to translate and cross-culturally adapt the Cultural Competence Assessment scale in German and to evaluate its psychometric properties. METHODS: This is a methodology study with a cross-sectional design. Conducting a convenience sampling, Austrian nurses working in the direct care of patients in acute care settings were invited to participate in this study. Data collection was conducted in March 2021. The translation and cross-cultural adaptation were conducted by following the guidelines of Sousa et al. (J Eval Clin Pract 17:268-74, 2011) and Beaton et al. (Spine 25:3186-91, 2000). The face and content validity, structural validity, and internal consistency reliability of the Cultural Competence Assessment scale, which consists of 25 items, was evaluated. Data were analysed using content validity index, confirmatory factor analyses as well as McDonald's Omega. Descriptive statistics were computed with the statistical software IBM SPSS Statistics 26, while the confirmatory factor analysis was conducted with the R package Lavaan. RESULTS: Overall, 915 nurses completed the questionnaire. Twenty items had an acceptable item content validity index. Using confirmatory factor analyses, a two-factor model with 14 items yielded a good fit (x2/df = 3.16; CFI = .923; TLI = .908; RMSEA = .055 (.049-.062) and SRMR = .039). Internal consistency reliability was found to be acceptable, as indicated by a Omega of .87. CONCLUSION: The German version of the Cultural Competence Assessment scale (CCA-G) can be recommended for measuring cultural competence behaviour of nurses in acute care settings. The 14-item scale showed strong construct validity and acceptable internal consistency. Further research using repeated measures could determine the cultural sensitivity and indicate if the tool is applicable in other healthcare settings and for other healthcare professionals.

Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations.

Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals' communication style as well as the patients' personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended.

Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study.

OBJECTIVE: This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana. DESIGN: The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire. SETTINGS: Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community. PARTICIPANTS: This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally. RESULTS: Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains. CONCLUSIONS: The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.

Perceived quality of collaboration in dehydration care among Dutch nursing home professionals: A cross-sectional study.

AIM: To explore the perceived quality of collaboration in dehydration care among nursing and medical staff in Dutch nursing homes. DESIGN: A cross-sectional study. METHODS: An online questionnaire was administered to nursing and medical staff in February 2020 to assess the quality of collaboration in dehydration care and its influencing factors. Descriptive statistics, chi-square tests and multinomial logistic regression analysis were used to describe the results and examine differences between groups. RESULTS: In total, 695 questionnaires were completed by multiple levels of (specialized) nursing staff and nursing home physicians. The quality of collaboration was assessed as good (23.2%), sufficient (59.4%) and insufficient (17.4%). Predicting factors related to perceiving the quality of collaboration as good were working experience, dehydration training during education and the presence of a dehydration protocol/guideline in the nursing home. Enabling factors related to collaboration in dehydration care were 'availability of sufficient aids to detect dehydration', 'continuity in the care relationship' and 'sufficient background data of the resident in the care record'. Factors that hinder collaboration were 'insufficient knowledge about dehydration among nursing and medical staff', 'the absence of a team meeting in which the topic dehydration is discussed' and 'insufficient staffing level among nursing and medical staff'. CONCLUSION: Collaboration in dehydration care was generally assessed as sufficient. Participants with >10 years of working experience, who received dehydration training during their education and had a dehydration protocol/guideline available in the nursing home, perceived the quality of collaboration more often as good. Experienced barriers and enablers for collaboration in dehydration care varied between professional groups. Therefore, it is important to gain more insight into (informal) caregivers' perceptions on what is expected from each other about dehydration care. IMPACT: Care professionals experience several limiting factors in collaborating in dehydration care. Addressing these factors could optimize dehydration care in Dutch nursing homes.

Attitudes towards older adults (80 years and older): A measurement with the ageing semantic differential - A cross-sectional study of Austrian students.

INTRODUCTION: The aims of the study were to investigate the four-factor structure of the German version of the Aging Semantic Differential (ASD) and to gain initial insights into the attitudes of nursing, medical and humanities students towards older people in Austria. METHOD: A cross-sectional study design with a convenience sample was chosen. RESULTS: The ASD was completed by 255 Austrian nursing, medicine, and humanities students, who described their attitudes towards persons who are 80 years of age and older. The applicability of the four-factor structure (instrumentality, autonomy, acceptability and integrity) of the German version was confirmed by performing a confirmatory factor analysis. The mean age of students in our sample was 23.6 years; 79% of these were female. The sample displayed negative attitudes regarding the factors of autonomy and instrumentality, but more positive attitudes regarding the factors integrity and acceptability. The attitudes of the students in the three study programmes differed, with the medical students displaying the most negative attitudes. Students who displayed positive attitudes had statistically significantly higher levels of knowledge about ageism and better possibilities to hold personal conversations with older people (80+) in the family or circle of friends. CONCLUSION: We conclude that having more knowledge about ageism and close personal contacts to older persons can support positive attitudes towards older individuals.

Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey.

PURPOSE: Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN: This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS: Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS: IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS: This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.

Humanoid socially assistive robots in dementia care: a qualitative study about expectations of caregivers and dementia trainers.

OBJECTIVE: To examine the expectations of informal caregivers, nurses, and dementia trainers regarding the support of (physical and psychosocial) human needs by humanoid social assistive robots (SARs) in dementia care. METHODS: A qualitative study was conducted with 11 homogeneous focus groups of informal caregivers, nurses and dementia trainers providing dementia care at home, in adult daycare centers, or in nursing homes. A qualitative content analysis was performed using a concept- and data-driven coding frame. RESULTS: Focus group discussions with 52 individuals were held. Participants reported mostly positive expectations and stated that SARs could offer potential support in all components of human needs, especially in avoiding danger (e.g. recognise danger, organise help), communication/contact with others (e.g. enable telephone calls, provide company), daily activities (e.g. remind of appointments, household obligations), recreational activities (e.g. provide music), eating/drinking (e.g. help cook), and mobility/body posture (e.g. give reminders/instructions for physical exercise). Participants also mentioned some negative expectations in all human needs, predominantly in communication/contact with others (e.g. loss of interpersonal interaction) and avoiding danger (e.g. scepticism regarding emergencies). CONCLUSION: Participants stated that SARs had great potential to provide assistance in dementia care, especially by reminding, motivating/encouraging and instructing people with dementia. Informal caregivers and nurses also considered them as useful supportive devices for themselves. However, participants also mentioned negative expectations, especially in communication/contact with others and avoiding danger. These findings demonstrate the support caregivers and dementia trainers expect from humanoid SARs and may contribute to their optimisation for dementia care.

Care dependency of patients and residents at the end of life: A secondary data analysis of data from a cross-sectional study in hospitals and geriatric institutions.

AIMS AND OBJECTIVES: The holistic care dependency concept can be applied to gain comprehensive insights into individuals' care needs in the end-of-life (EoL) phase. This study was carried out to measure and characterise the "care dependency" phenomenon in this phase and to obtain deeper knowledge about this phenomenon. BACKGROUND: The end of a human life is often characterised by a physical decline, often implying that a high amount of care is needed. Non-malignant diseases can develop unpredictably; therefore, it is difficult to detect the onset of the EoL phase. DESIGN: Data were collected in a cross-sectional multicentre study, using the Austrian Nursing Quality Measurement 2.0. METHODS: Descriptive and multivariate statistical methods were used. Care dependency was measured with the Care Dependency Scale (CDS). The study follows the STROBE guideline. RESULTS: Ten per cent (n = 389) of the sample (N = 3589) were allocated to "a pathway for management of patients at the end of life." The patients and residents in the EoL phase are significantly older and more often diagnosed with dementia, and circulatory system and musculoskeletal system diseases. Of these patients, 60% were care dependent completely or to a great extent. Dementia and age represent main influencing factors that affect the degree of care dependency at the end of life. CONCLUSION: Our results show that the "typical" EoL patient or resident is female, old and affected by dementia and/or circulatory system diseases. Dementia and age were identified as main factors that contribute to very high care dependency. RELEVANCE TO CLINICAL PRACTICE: The measurement of care dependency may support the identification of special care needs in the EoL phase. Gaining deeper knowledge about the care dependency phenomenon can also help healthcare staff better understand the needs of patients with non-malignant conditions in their last phase of life.