[International exchange program for anesthesia nursing students : Retrospective analysis of sustainable evaluation criteria]. / Internationales Hospitationsprogramm Lernender in der Anästhesiepflege : Retrospektive Analyse nachhaltiger Evaluationskriterien.

BACKGROUND AND AIM: Anesthesia nursing students have little contact with relevant global contexts of their professional practice and health care as a whole. An international exchange program between a German postgraduate institution and a US university focuses on this global perspective and provides insights into each other's healthcare systems. The article offers insight into a successful international exchange program and analyzes possible evaluation criteria for the program. MATERIALS AND METHODS: A retrospective analysis of program implementation at both institutions, evaluations conducted to date, and exchange experiences that have taken place is conducted. From this, possible quantitative and qualitative evaluation criteria were identified. RESULTS: A total of 13 student exchange trips and 7 reciprocal faculty visits were recorded as part of the program. Over the 6­year period analyzed, a total of 15 clinical institutions were recruited for job shadowing. Additional outcomes included joint scientific projects and publications (contributions to journals and congresses). DISCUSSION AND CONCLUSION: The structured goal setting and operationalization of an international cooperation are helpful for the later analysis of its success. In the example described, anesthesia nursing students, faculty, and the participating institutions benefited from the international exchange program. From this, quantitative and qualitative evaluation criteria could be identified and described for future use for international exchange of anesthesia nursing students.

[Children visiting intensive care units and emergency departments : Kids are welcome!] / Besuche von minderjährigen Angehörigen in der Intensiv- und Notfallmedizin : Kinder als Besucher willkommen!

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.

[Are we missing the first step? : An online expert survey in a mixed methods design on current state analysis of perioperative risk estimation and preoperative preparation of patients over 65 years old in Germany]. / Are we missing the first step? : Eine Online-Experten-Befragung im Mixed-Methods-Design zur Ist-Analyse der perioperativen Risikoeinschätzung und präoperativen Vorbereitung von Patienten ab 65 Jahren in Deutschland.

BACKGROUND: The proportion of patients over 65 years of age in surgical care is increasing in Germany. Frailty represents a relevant problem in the perioperative care of older patients and has a negative impact on the postoperative outcome. The individual degree of frailty can be influenced. Multimodal prehabilitation concepts can contribute to improving the degree of frailty in the perioperative care of affected patients. As a multidimensional syndrome, frailty is related to the aging process, affects multiple organ systems and typically leads to increased vulnerability to internal and external stressors. This is accompanied by a decrease in homeostatic reserves and resilience, which implies an increased risk of several adverse health outcomes, such as loss of physical function and quality of life. Prehabilitation is described as a multimodal concept to prepare patients preoperatively in the best possible way for elective surgical procedures, thereby minimizing postoperative complications and improving the patients' outcome. METHOD: Current state analysis of perioperative care of patients over the age of 65 years in relation to frailty assessment and the use of prehabilitation concepts. Conducting a multicenter online survey of anesthesiology experts (n = 189) in German anesthesiology departments. Survey of the preoperative preparation and assessment routine in patients aged 65 years and over using a mixed methods design questionnaire. OBJECTIVE: The aim of this study was to demonstrate the applied assessments and measures taken for specific perioperative risk assessment and preoperative preparation of patients aged 65 years and over. RESULTS: Specific risk assessments or additional preoperative preparation of patients older than 65 years are currently not carried out routinely. The preoperative risk assessment and preparation usually focus on ascertaining the patient's previous illnesses or diseases. Assessment instruments for assessing frailty and multimodal prehabilitation concepts are not used in clinical practice in a noteworthy quantity. CONCLUSION: In German clinical practice frailty assessment and structured prehabilitation approaches in perioperative care of older patients are not broadly known or established. Multimodal prehabilitation concepts can positively influence the outcome of older patients. To this end, it should be considered good clinical practice to assess and address frailty in older patients and to establish multimodal prehabilitation approaches tailored to this patient group.

[Improving clinical competences and skills-collaborative learning strategies in intensive care medicine]. / Klinische Handlungskompetenzen gemeinsam verbessern ­ interprofessionelles Lernen in der Intensivmedizin.

This article examines the competencies required from intensive care nurses and physicians regarding complex patient care in the intensive care unit. Traditional training methods and structures in critical care are put into context with the contemporary educational requirements. The goals are promotion of the interprofessional cooperation between nurses and physicians as well as a comparison between previous educational methods and their implications on the resulting skills. Clinical competences are defined as the result of basic professional training as well as further education, which can improve the quality of patient care. Options for improving teaching are shown through the presentation of the various learning venues for theory and clinical practice. Contemporary skills labs and simulation trainings are discussed as a useful supplement to traditional approaches such as traditional nursing practice instruction. It will also be discussed how collaborative learning between nurses and physicians at all levels of training can lead to better patient care by increasing the individual and shared competences.

Caloric consumption during early mobilisation of mechanically ventilated patients in Intensive Care Units.

OBJECTIVE: To evaluate a) the magnitude of the increase in caloric consumption due to early mobilisation of patients with mechanical ventilation (MV) in Intensive Care Units (ICU) as part of routine care, b) whether there are differences in caloric consumption due to active or passive mobilisation, and c) whether early mobilisation in routine care would lead to additional nutritional requirements. DESIGN: Prospective, observational, multi-centre study. SETTING: Medical, surgical and neurological ICUs from three centres. PATIENTS: Patients on MV in ICU who were mobilised out of bed as part of routine care. MEASUREMENTS AND MAIN RESULTS: Caloric consumption was assessed in 66 patients by indirect calorimetry at six time points: (1) lying in bed 5-10 min prior to mobilisation, (2) sitting on the edge of the bed, (3) standing beside the bed, (4) sitting in a chair, (5) lying in bed 5-10 min after mobilisation, and (6) 2 h after mobilisation. Differences in caloric consumption in every mobilisation level vs. the baseline of lying in bed were measured for 5 min and found to have increased significantly by: +0.4 (Standard Deviation (SD) 0.59) kcal while sitting on the edge of the bed, +1.5 (SD 1.26) kcal while standing in front of the bed, +0.7 (SD 0.63) kcal while sitting in a chair (all p < 0.001). Active vs. passive transfers showed a higher, but non-significant consumption. A typical sequence of mobilisation including sitting on edge of the bed, standing beside the bed, sitting in a chair (20 min) and transfer back into bed, would require an additional 4.56 kcal compared to caloric consumption without mobilisation. CONCLUSIONS: Based on this data, routine mobilisation of MV patients in ICU increases caloric consumption, especially in active mobilisation. Nevertheless, an additional caloric intake because of routine mobilisation does not seem to be necessary.