Der Prozess des Medikamentenselbstmanagements: Eine Modellrevision auf Basis einer qualitativen Sekundäranalyse.

The process of medication self-management: a model revision based on a qualitative secondary analysis Abstract. Background: For safe and effective use of medication, specific skills are required which are inherent in the concept of medication self-management. In order to provide adequate counseling, it is important for registered nurses, physicians and pharmacists to know how medication self-management works in everyday life for the people affected. This process was presented in 2013 in a first conceptual model by Bailey et al. Aim: The purpose of this study was to enhance the empirical foundation of the existing model and to gain an in-depth theoretical understanding of the process of medication self-management. METHOD: A qualitative secondary analysis was conducted based on data from a semi-standardized survey (n = 395) of people in Austria, who regularly take medicine. The data were analysed according to the structuring content analysis. RESULTS: The extended model shows a new kind of logic. While the steps "fill", "take", "monitor" and "react" are always conducted one after the other, "integrate" and "maintain" form components that are mutually dependent and start after successfully completing the first four steps. "Understand" is a component that influences all steps. The whole process is influenced by personal, socio-economic, disease and medication-related factors, by supportive systems and by the overall health care system. CONCLUSIONS: Based on the present study, the drug self-management process is a complex, multi-layered and iterative one. In the context of counselling, it is important to focus on "understanding" at every step.

[Development and test-theoretical analysis of an instrument for data collection on patients' preferences and experiences concerning participation in nursing care decisions in acute hospitals]. / Entwicklung und testtheoretische Analyse eines Erhebungsinstruments zu Präferenzen und Erleben von Patienten in Bezug auf die Beteiligung an pflegerischen Entscheidungen im Akutspital.

Patient orientation and patient participation are important aspects of modern health care and should be taken into consideration in the context of nursing care decision-making. The concept of evidence-based nursing also includes patient preferences in participation on decision-making, an area, however, which has not been adequately investigated so far. The aim of the present study was the development and testing of an instrument in German language for collecting data on patients' preferences and the experience of patients regarding their participation in nursing care decision-making in acute hospitals. The generation of items was based on available literature and in collaboration with specialists, using the theoretical model of Charles, Gafni and Whelan (1999). For testing the instrument, data was collected on 967 adult patients in surgical and medical wards of five hospitals in Vienna from October 2007 to March 2008. Test theoretical analyses included checking internal consistency, construct validity and criterion validity. The reliability of the scale preference and experience were confirmed by Cronbach's alpha (> or = 0.84) and the results of item analysis. The construct validity was supported by representing the decision model in the data. The criterion validity (concordant and discriminant validity) was tested with the two external criterions of subjective satisfaction with the information provided and decision making, and was supported by the results both at the level of total scores and at the level of item scores. In summary, the developed instrument represents an adequately reliable and valid test-theoretic, and also model-theoretic instrument for research in the field of evidence-based nursing. Therefore it is capable of gathering new knowledge on patients' preferences on participation in nursing care decision making.

[Patients' preferences and experience regarding participation in nursing care decisions in acute hospitals--an analysis of conformity of preferences and experience, and factors influencing different types of decision making]. / Präferenzen und Erleben von Patienten zur Beteiligung an pflegerischen Entscheidungen im Akutspital - Eine Analyse der Ubereinstimmung von Präferenz und Erleben sowie der Einflussfaktoren bezogen auf verschiedene Entscheidungstypen.

Patients' preferences regarding their participation in nursing care decisions represent a key aspect of the concept of evidence-based nursing; nonetheless, very little quantitative research has been carried out in this area. The aim of the present study was to describe the patients' preferences and experience concerning their participation in nursing care decision-making processes in acute hospitals. A total of 967 patients in five hospitals in Vienna participated in this study by completing questionnaires. The results revealed that 38.5 % of patients preferred the paternalistic style of decision-making, 42.1 % wanted to make decisions together with the nursing staff and 5.7 % expressed a wish to make their own decisions. During their hospital stay, however, patients experienced paternalistic decision-making to a higher degree than they wished for. Age, sex, form of treatment and subjectively experienced health condition represented person-related characteristics that influenced preferences regarding the form of decision-making. The results of this study underline the importance of collecting data on patients' preferences in decision-making processes in order to meet the social, legal, and professional demands of patient-oriented nursing care based on the most recent scientific knowledge.