[Advancing standards for the development of evidence-based health information for consumers: Needs and priorities among members of the Network for Evidence-based Medicine]. / Inhaltliche Weiterentwicklung von Standards zur Erstellung evidenzbasierter Gesundheitsinformationen: Eine Bedarfserhebung und Priorisierung im EbM-Netzwerk.

BACKGROUND: The Good Practice Guidelines for health information, Good Health Information Austria and Guideline Evidence-based Health Information are established resources for developing evidence-based health information in the German-speaking regions. The aim of this project was to capture challenges in applying these standards in practice, identify gaps and development needs and gain insights for their further development. METHODS: In December 2020, members of the working group for patient information and involvement of the Network for Evidence-based Medicine were invited to share their experiences and needs in applying German standards for evidence-based health information through an online survey focussing on open questions (part 1: needs assessment). The feedback was analysed using qualitative content analysis and presented in a workshop at the EbM Congress 2021 with the goal of specifying the feedback from the needs assessment and discussing ideas for the further development of the standards (part 2: specification). In the final step, a second survey was conducted in February 2023 to prioritize the identified topics by the working group members (part 3: prioritization). The results were analysed descriptively. RESULTS: Among the 41 participants, only 23% considered the standards to be sufficient, and only 55% found their application in the development of information to be easy or rather easy. The needs assessment and workshop (n=46) helped to identify various areas of action. With regard to the application of the standards, the following challenges were identified: lack of user orientation, content gaps, methods and risk communication. Gaps in the standards were identified regarding formats, content, and the connection to healthcare provision. For the advancement of the standards ideas for additional content, stakeholder involvement, and improvement of the usability of the standards were identified. In the prioritization survey, the topic areas, "presenting benefits and harms" and "content beyond treatments (in particular, diagnostics and prognosis)" were considered to be the most important (n=36). DISCUSSION: Among members of the working group for patient information and involvement of the German Network for Evidence-based Medicine, a high demand has been identified for the further development of standards for creating evidence-based health information. In addition to content development, the integration of existing documents and tools should also be considered, including products issued by other institutions. The success of advancing the standards also depends on improving their applicability - for example through an attractive online platform. The results are limited by the sample which only included members of the EbM Network's patient information and participation working group and a limited response rate. CONCLUSIONS: The needs assessment showed that the currently established standards and recommendations for the development of evidence-based health information in the German-speaking regions represent important cornerstones but need to be expanded to answer more practice-oriented questions. The challenges and proposed solutions stated by the participants can help further develop the standards. The prioritization can be used to set priorities for the development of the standards, guide the order of possible work packages and allocate resources.

[Factors in the implementation of expert standards in nursing: A qualitative study]. / Einflussfaktoren bei der Implementierung von Expertenstandards in der Pflege.

Factors in the implementation of expert standards in nursing: A qualitative study Abstract: Background: Many German health and long-term care facilities face the challenge of implementing expert standards in practice. Implementation models, such as the Consolidated Framework for Implementation Research (CFIR), support the implementation process by identifying the relevant influencing factors that can determine the success of an implementation. Aim: The aim was to identify the factors influencing the implementation of expert standards in nursing care and their interactions. Method: The data were collected by means of guided interviews with ten facilitators of the model implementation units for the implementation of the expert standard on promotion of oral health in nursing and from the project progress records. The data were evaluated by content analysis. Results: In addition to the influencing factors according to the CFIR, two other factors were identified that can determine the success of the implementation of expert standards - local presence and knowledge of implementation theories and models. The various and complex interrelationships between the factors in the implementation of expert standards became particularly clear. Conclusion: Knowledge of the fundamentals of implementation science is helpful for the successful and sustainable implementation of expert standards and for general knowledge transfer in nursing.

[Latent safety threats in a pediatric emergency department: Using in situ simulation to test a new trauma room concept]. / Latente Sicherheitsmängel in einer pädiatrischen Notaufnahme: Testung eines neuen Schockraumkonzepts mithilfe von In-situ-Simulation.

INTRODUCTION: Structured emergency room concepts have been shown to contribute to patient safety. Until now there has been no uniform emergency room concept for critically ill and seriously injured children and adolescents in the emergency room at the Altona Children's Hospital in Hamburg. This concept has been newly developed in interdisciplinary cooperation and includes the use of new clinical premises as well as new responsibilities and team compositions. The introduction of new processes and rooms for handling emergencies is associated with a risk of overlooking latent safety deficiencies or detecting them only after the process has been implemented. This may have a direct impact on patient safety. Before moving to new clinical premises, in situ simulation can be helpful to identify and to resolve latent safety threats in advance. Therefore, this method was chosen to test the newly created emergency room concept in the future emergency room at the Altona Children's Hospital. METHODS: Two in situ simulations were carried out in the future real emergency room. Latent safety threats detected by the observation team and the participants (medical and nursing staff of the Altona Children's Hospital from the departments of pediatric surgery, traumatology, orthopedics, pediatrics, anesthesia, intensive care medicine, radiology, emergency medicine) were collected using free text notes after the simulations and evaluated retrospectively. In order to better deal with these latent safety threats, the observations were classified into different categories: working environment (e.g., lack of equipment, unfavorable positioning of material), process (e.g., lack of defined responsibilities in the team) and other safety threats that did not fall into one of the two categories defined. RESULTS: A total of 51 latent safety threats were identified during the two in situ simulations. Of these, 22 (43.1%) were assigned to the "working environment" category, 20 (39.2%) to the "process" category and 9 (17.7%) to the "other safety threats" category. Of the latent safety threats identified, 46 (90.2 %) could be resolved before the emergency room was put into operation. For the non-recoverable safety threats, safety concepts were developed in order to further minimize the risk of patient hazard. DISCUSSION: With the help of this study, it could be shown that the implementation of in situ simulation before the commissioning of new clinical premises and the introduction of new processes can contribute to the detection of latent safety threats in an interdisciplinary German pediatric emergency department.

[Implementing systematically: To what extent can implementation science make an educational contribution to health care practice?] / Systematisch implementieren. Inwiefern kann die Implementierungswissenschaft einen Bildungsbeitrag für die Akteure im Gesundheitswesen leisten?

BACKGROUND: Implementation science is currently struggling with the challenge to translate its findings into implementation practice in health care. Therefore, it is of interest to explore to what extent advanced trainings are relevant for health care practice to support knowledge circulation, and what needs to be considered in their design. DESIGN OF EDUCATIONAL INITIATIVES AND TRAINING: Internationally, numerous initiatives have emerged in recent years to make implementation science more accessible to health care implementers. They focus, in particular, on the development of curricula for actors in health care practice and the widespread implementation of these qualification programs. In German-speaking countries, the interest in health services research is particularly evident at the level of Master's degree programs to make implementation science accessible to health care. However, these efforts need to be complemented by a participatory, needs-oriented and theory-based approach to advanced training for implementers in health care practice. This will enable the required competencies to be addressed on different levels of training and the further development of training formats. DISCUSSION: Recent literature shows that implementers in German-speaking countries can benefit from a training program tailored to their needs. International experience in the field of advanced training in implementation science for health care practice allows us to derive essential components for the development of advanced training for the German-speaking region.

Advance Care Planning in Australia: Progress in research and implementation.

Advance Care Planning in Australia has its foundations in the Respecting Patient Choices model, which was initially implemented in one state. The Australian population is diverse, ageing and geographically dispersed, with health and aged care services provided by a range of different organisations and regulated at different levels. Key challenges in ACP implementation include discomfort with ACP discussion, inconsistent legislation and ACP documentation across jurisdictions, poor quality control of ACP documents and difficulties accessing ACP documents at the point of care. The COVID-19 pandemic exposed a range of issues but also led to some innovative practices which have continued after the relaxation of public health restrictions. Ongoing implementation work focuses on meeting the needs of diverse communities and sectors in ACP, while seeking an overall coherence in policy and standardisation of practice through high-level best-practice principles, quality standards and policy frameworks.

Advance Care Planning in Hong Kong.

Hong Kong is a well-developed city with outstanding healthcare services, leading to the highest life expectancy in the world. Paradoxically, the quality of end-of-life care in this city lagged behind that of many other high-income regions. Possibly, the advances in medicine contribute to the death denial culture, hindering communication about end-of-life care. This paper discusses challenges arisen due to poor public awareness and professional training and local initiatives to promote advance care planning in the community.

Implementation of Advance Care Planning in Norway.

Advance Care Planning has a relatively short history in the Norwegian health care services. This article gives an overview of advance care planning research and its implementation in the health care services in Norway. Advance care planning has received increased attention from policymakers and the health care services. Research projects have been performed, and several are on-going. Implementation has largely treated advance care planning as a complex intervention, with a whole-system approach that puts emphasis on the conversation and patient activation. Advance directives have a peripheral role in this context.

Making Advance Care Planning a part of cancer patients' end-of-life care in Rwanda.

After the devastating damage inflicted by the 1994 Genocide against the Tutsi, Rwanda made great strides in reconstructing its healthcare system from scratch. Although cancer mortality rates continue to rise, there is still a dearth of qualified healthcare workers for advance care planning (ACP) for terminally ill patients. I will draw on lessons learned through the literature search for the initiation of ACP and reflect on their adaptation to the existing policies, healthcare systems, and workforce in Rwanda. We hope to introduce advance care planning into the clinical package given to patients with cancers in terminal illness and their families in Rwanda. The introduction of ACP by skilled, qualified, and specialized healthcare professionals in Rwanda will help establish a practical ACP strategy at the hospital and in the community to benefit patients and their loved ones for an enhanced quality of life in end-of-life care. There is a need for training, policy-making, and community mobilization for the awareness of ACP.

Advance Care Planning in South Africa.

South Africa (SA), an upper middle-income country, faces significant challenges, including severe inequality, poverty, high unemployment rates, unequal access to basic services, and a long history of human rights violations. It is a diverse nation with eleven official languages. The country also bears a heavy burden of communicable and non-communicable diseases, with many patients seeking healthcare services too late. Despite the pressing need, palliative care is still an emerging field in South Africa, with limited funding allocated for its integration. Advance Care Planning (ACP) is a recommended practice in SA for patients with serious illnesses while they are still in good health and can function independently. Non-Governmental Organizations (NGOs) in SA have played a significant role in integrating ACP planning within their settings through advocacy and training. ACP has been included in both formal academic training and training programs offered by NGOs. Additionally, research has been initiated to evaluate the acceptability and validity of the Serious Illness Conversation Guide within the cultural diversity and complexities of the SA context. Acceptance of ACP amongst SA healthcare workers and the public faces many challenges. Many South Africans still have a low level of trust and acceptance towards the public healthcare system. In many South African cultures discussing death and dying is considered culturally taboo. Traditional cultures interpret and apply the concept of individual autonomy differently. The philosophy of "Ubuntu", which translates to "I am because we are", is widely endorsed in the country, prioritising community needs over individual needs. It is, therefore, essential for healthcare professionals engaging in ACP conversations not to make assumptions about a person's preferences for communication, decision-making and care, based on external attributes. Instead, they should respectfully explore these preferences and be adaptable in their approach to ACP. The implementation of ACP in SA is still in its early stages, requiring further research to inform culturally sensitive approaches to advance care planning.

Advance Care Planning in Singapore: The genesis and evolution of a national programme.

Singapore is a developed country that is aging rapidly. In 2011, a national programme in Advance Care Planning (ACP) known as Living Matters was launched. Over the years, the programme has grown and evolved. While ACP has become routine in some hospital units, challenges remain in implementing ACP as a standard of care across all levels of the healthcare system. Opportunities abound in improving the quality of the ACP process and in bringing ACP upstream into outpatient clinics, primary care and into the community.

Parental substance use and home visiting programs: Implementation considerations for relationship-based treatment.

Home visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child-focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship-based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship-based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs.

Los programas de visita a casa pueden ofrecer un apoyo clave a madres en recuperación de trastornos por abusos de sustancias (SUD) y los niños pequeños expuestos a sustancia prenatalmente. Sin embargo, las familias que recibieron el impacto de SUD materno pudieran no beneficiarse de los servicios tradicionales de visita a casa en cuanto al desarrollo enfocados en el niño tanto como las familias que no sufren el impacto de SDU, lo cual sugiere la necesidad de ajustar el ofrecimiento de servicios para este grupo de población. Dada la necesidad de implementar servicios amoldados dentro de los programas de visita a casa para familias que sufren el impacto de SUD, nos propusimos investigar las barreras y los aspectos que facilitan la implementación a manera de informar la futura integración de una intervención de crianza con base en la relación, específicamente desarrollada para progenitores con SUD (Cuidados Maternales Desde Dentro) en los programas de visita a casa. Llevamos a cabo nueve entrevistas y cinco grupos de enfoque con un grupo muestra racialmente diverso (N = 38) de progenitores y proveedores que ofrecen los servicios a familias que sufren el impacto de SUD en los Estados Unidos. Los análisis de contenido cualitativo arrojaron tres temas más prominentes relacionados con dominios de implementación separados y las asociadas barreras y aspectos que la facilitan: (1) involucramiento, (2) entrenamiento, y (3) sostenibilidad. Concluimos que el escenario de visita a casa pudiera mitigar las barreras logísticas de acceso para familias afectadas por SUD, mientras que los servicios con base en la relación pudieran mitigar las barreras emocionales que los progenitores con SUD experimentan cuando se les refiere a programas de visita a casa.

Les programmes de visite à domicile peuvent offrir un soutien critique aux mères qui se rétablissent d'un trouble lié à l'usage d'une substance (TUS) et aux jeunes enfants exposés à des substances avant leur naissance. Cependant les familles impactées par des TUS maternels ne bénéficient pas de services de visite à domicile traditionnels autant que des familles non impactées par un TUS, suggérant le besoin d'ajuster des prestations de service pour cette population. Vu le besoin de mettre en place des services adaptés au sein des programmes de visite à domicile pour les familles impactées par des TUS, nous avons décidé d'étudier les barrières et les facteurs de facilitation de mise en place afin d'éclairer l'intégration future d'une intervention de parentage basée sur une relation développée spécifiquement pour des parents avec des TUS (le maternage de l'intérieur suivant l'anglais Mothering from the Inside Out) dans des programmes de visite à domicile. Nous avons procédé à neuf entretiens et cinq groupes d'étude avec un échantille variés du point de vue racial (N = 38) de parents et de prestataires offrant des services pour des familles affectées par des TUS aux Etats-Unis d'Amérique. Une analyse qualitative de contenu a donné trois groupes importants lié à des domaines de mise en place séparés et les barrières et facteurs de facilitation y étant liés: (1) l'engagement, (2) la formation, et (3) la durabilité. Nous concluons que le contexte de visite à domicile peut mitiger les barrières logistiques à l'accès pour les familles affectées par des TUS, alors que les services relationnels peuvent mitiger les barrières émotionnelles dont les parents avec des TUS font l'expérience lorsqu'on leur recommande des programmes de visite à domicile.

Perspectives of physicians and medical assistants on the implementation of NAAT-based point-of-care testing for SARS-CoV-2 in primary care in Germany.

INTRODUCTION: Given their high diagnostic accuracy and fast turnaround time, rapid SARS-CoV-2 tests based on nucleic acid amplification technologies (NAAT) have great potential to expand access to testing and decrease delays in diagnosis of COVID-19. OBJECTIVES: The aim of this study was to investigate feasibility, acceptance, organizational consequences and other implementation aspects of the use of a NAAT-based SARS-CoV-2 rapid test (ID NOW™ COVID-19, Abbott Diagnostics) for symptomatic primary care patients with a suspected SARS-CoV-2 infection. METHODS: Cross-sectional survey among primary care physicians and medical assistants from Thuringia (Germany) during the third wave of the COVID-19 pandemic in March and April 2021. The health care providers surveyed had previously used the NAAT-based SARS-CoV-2 rapid test as part of a pilot study. RESULTS: Eleven physicians (ten general practitioners and one paediatrician) and 22 medical assistants from Thuringia (Germany) participated in the written survey. Four physicians were additionally interviewed. The majority of the surveyed health care providers rated user-friendliness, integration into practice routine, impact on communication with patients and technical reliability of the NAAT-based SARS-CoV-2 rapid test as (very) positive. Greater workload and the costs for measuring devices were identified as disadvantages compared to PCR laboratory tests. Four out of ten physicians rated the lower sample turnover as unfavourable. CONCLUSION: Our survey shows that NAAT-based point-of-care SARS-CoV-2 testing gained widespread acceptance among physicians and medical assistants, positively influences workflows, can improve patient communication and could therefore be successfully implemented into routine primary care.

Moving towards patient-centered care and shared decision-making in Germany.

The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.

New status report from Norway: Implementation of patient involvement in Norwegian health care.

In Norway, shared decision-making (SDM) is on the top of the priorities announced by the health authorities. Accountability for implementing this priority has been delegated to the four health regions, and from there into particular departments, hospital trusts, working groups or SDM coordinators. Using abundant public funding, different approaches to producing and implementing patient decision aids have been developed. However, none of these is implemented by any Norwegian services on a regular basis, while the accessible decision aids on the national health platform are not quality approved and in very little use. An ongoing new project is aimed to resolve this dilemma. Health professional training has been developed as a meta-curriculum with multiple modules, adaptive to setting and user group, and designed as an open-source learning platform, based upon the experience of "SDM Ambassadors" delivering the training. Most of the modules are already implemented on a regular basis in the South-Eastern Health Region, and 5000 health care professionals have already graduated from the training modules. However, in the standard patient pathways, and in most of the national medical guidelines, the patient is still considered to be a passive receiver of directives or recommendations, rather than an active participant in their own health decisions. Considerable structural implementation has been done in the education guidelines of all health professions on all levels to embed SDM principles. Teaching in SDM skills, quality of information and evidence-based nursing has become standard in most of the programs at Norwegian universities. Nevertheless, we currently still have no reliable estimate on the degree to which patients are actually involved in their own health decision-making. Further efforts in the process of implementing the patient's choice in the health system should involve the municipal services, follow a research-based strategy, include monitoring and consider the quality level of the informational environment of health-related decisions.

Shared decision-making in the Netherlands: Progress is made, but not for all. Time to become inclusive to patients.

Dutch initiatives targeting shared decision-making (SDM) are still growing, supported by the government, the Federation of Patients' Organisations, professional bodies and healthcare insurers. The large majority of patients prefers the SDM model. The Dutch are working hard to realise improvement in the application of SDM in daily clinical practice, resulting in glimpses of success with objectified improvement on observed behavior. Nevertheless, the culture shift is still ongoing. Large-scale uptake of SDM behavior is still a challenge. We haven't yet fully reached the patients' needs, given disappointing research data on patients' experiences and professional behavior. In all Dutch implementation projects, early adopters, believers or higher-educated persons have been overrepresented, while patients with limited health literacy have been underrepresented. This is a huge problem as 25% of the Dutch adult population have limited health literacy. To further enhance SDM there are issues to be addressed: We need to make physicians conscious about their limited application of SDM in daily practice, especially regarding preference and decision talk. We need to reward clinicians for the extra work that comes with SDM. We need to be inclusive to patients with limited health literacy, who are less often actually involved in decision-making and at the same time more likely to regret their chosen treatment compared to patients with higher health literacy.

Implementation of patient-centred care in Denmark: The way forward with shared decision-making.

LEGAL AND POLITICAL LANDSCAPE IN SHARED DECISION MAKING: Current Danish legislation empowers patients in securing their rights, but there are no present legislative developments in Denmark to support patient involvement. Policy initiatives within health care, however, show positive trends by, for example, including recommendations for shared decision making (SDM) in national clinical guidelines and the allocation of resources to fund projects in SDM. Within the last five years, three out of five regions have launched centers in patient involvement and SDM to focus on training, implementation of patient decision aids (PtDAs) and to foster the cultural change in SDM. A national dissemination of a template for easy building of PtDAs accessible via an online platform is one of the latest initiatives. THE WAY FORWARD: Although the political discourse on SDM is gathering speed, an unclear definition and purpose of SDM is a barrier to real-life implementation. Politicians, leaders and clinicians seem to be moving at different paces and in different directions and are lacking consensus on SDM as a paradigm requiring training, leadership and a patient-centered mindset. CONCLUSION: Many relevant initiatives are underway. However, SDM is also challenged by the lack of legislation and a central push for real SDM implementation in Denmark.

Shared decision-making in Malaysia: Legislation, patient involvement, implementation and the impact of COVID-19.

Shared decision making (SDM) activities in Malaysia began around 2010. The rise in the numbers of patients with chronic disease in Malaysia underscores a growing need for doctors to practice patient-centred care and SDM as more Malaysians come into regular contact with health decision-making scenarios. Recent guidelines for medical professionalism have emphasized that options and risks be discussed in consultations, especially for procedures with risk of adverse outcomes. Although SDM is not legally required, principles of SDM are applied in legal judgements on informed consent. Research on SDM has grown to include the adoption of patient and public involvement in research, an increased emphasis on incorporating local cultural values in SDM, and implementation of SDM in Malaysia's health system and organizational culture. While COVID-19 hindered the progress of SDM research, one positive development was that vaccination choices heightened public consciousness about personal decisional autonomy and the need to discuss pros and cons with doctors before making a medical decision.

Implementing shared decision-making in UK: Progress 2017-2022.

Shared decision making has been on the policy agenda in the UK for at least twelve years, but it lacked a comprehensive approach to delivery. That has changed over the past five years, and we can now see significant progress across all aspects of a comprehensive approach, including leadership at policy, professional and patient levels; infrastructure developments, including the provision of training, tools and campaigns; and practice improvements, such as demonstrations, measurement and coordination. All these initiatives were necessary, but the last, central coordination, would appear to be key to success.

Die Problematik der Implementierung von Kinästhetik in Einrichtungen der stationären Langzeitpflege - Eine Multiple Case-Study.

Difficulty of implementing kinaesthetics in long-term care institutions - A multiple case-study Abstract. Background: Resources have been invested from long-term care institutions for the development of nursing staffs' kinaesthetics competence for years. Recent studies have shown that implementing or sustainably promoting the kinaesthetics competence is problematic, but in-depth knowledge of the causes thereof is lacking. Aim: Which barriers impede a sustainable implementation of kinaesthetics in long-term care institutions? Method: A "multiple case-study" was carried out in three institutions located in the German-speaking part of Switzerland. The data from guide-based interviews and (case-related) literature on the external context was inductively condensed in the within-case analysis. The results were then compared in the cross-case synthesis and summarized in an abstract way. Results: The synthesis showed that the implementation of kinaesthetics can be influenced negatively at three different institutional levels - management, nursing team and individual nursing staff - as well as by external factors. Conclusions: In nursing practice and nursing science, as well as in the health care sector, a basic understanding of kinaesthetics in the context of professional nursing care is required. Especially those responsible for management and implementation must be aware of possible barriers in order to develop appropriate strategies.

Evaluation of attitudes towards telemedicine as a basis for successful implementation: A cross-sectional survey among postgraduate trainees in family medicine in Germany.

BACKGROUND: By comparison with other countries of the European Union Germany is only middle-ranking in terms of telemedicine usage. There is a relevant gap between the legal framework and the actual state of implementation. Healthcare providers play an important role in this implementation process as they are increasingly confronted with the application of telemedical scenarios. Therefore, the aim of this survey was to determine attitudes towards telemedicine of postgraduate trainees in Family Medicine (FM) in Germany. METHODS: A cross-sectional survey was conducted between July and October 2016 among postgraduate trainees in FM throughout Germany. The questionnaire covered four topics: attitudes towards telemedicine, barriers for the implementation of telemedicine, assessment of useful telemedical applications and telemedicine scenarios. A descriptive approach was used to analyze the data in order to derive determinants for the implementation of telemedicine. RESULTS: In total, 388 postgraduate trainees from 13 of the 16 federal states in Germany answered the survey. Seventy-eight percent were female. Participants' mean age was 36 years. The majority of participants believed that only a fraction of the already existing technology in telemedicine is being used (70 %). The largest perceived barrier to telemedicine was data safety concerns. More than half of the participants (54 %) believed that telemedicine would change the doctor-patient relationship. 51 % of the participants were interested in training in telemedicine. In this respect, it is important to note that 27 % of the postgraduate trainees said their willingness to practice in rural areas might be facilitated through the availability of telemedical backup for family physicians. CONCLUSIONS: Participating trainees in FM in Germany think that the potential for telemedicine is not yet fully exploited. Based on the results of this survey the next steps to be taken for the implementation of telemedicine applications can be addressed.