The prevalence of young carers - a standardised survey amongst school students (KiFam-study).

BACKGROUND: Children and adolescents who provide care, assistance or support for a chronically ill family member are called young carers. While there is a growing body of research about their specific situation, needs and impact of caring, only very few studies provide information on prevalence rates. OBJECTIVES: The aim was to provide prevalence data for young carers in Germany, and to describe and quantify the nature and extent of their help. DESIGN: A cross-sectional study. SETTINGS: Data collection took place between 2016 and 2017 in 44 secondary schools (fifth to 13th grade) in North Rhine-Westphalia, Germany. PARTICIPANTS: A total of 6313 students aged from 10 to 22 years participated in this study. They represent 0.5% of the basic population. METHODS: Based on the results of a preliminary qualitative study, a standardised electronic questionnaire was developed, which comprised four subject areas: socio-demographic information, general daily aids, health-related quality of life and chronic illness within the family. Statistical analyses included chi-square tests for nominal data and univariate analyses of variance for metrical data together with 95% confidence intervals. RESULTS: 19.6% (n = 1238) of all respondents state that someone in their family needs help due to a chronic illness. Nevertheless, not all of them are involved in caring activities. The prevalence of those defined as young carers in this study is 6.1% (n = 383), 64% are girls. They take on a wide range of activities. In addition to domestic work, they help their ill relatives with mobility, dressing and undressing, medication, feeding, personal hygiene and with intimate care. CONCLUSIONS: The data provide a good insight into the situation of young carers. The prevalence rate is higher than expected. It refers to the social relevance of this topic and the need for further investigations.

Caregiver exposure to critical events and distress in home-based palliative care in Germany a cross-sectional study using the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) scale.

BACKGROUND: Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient's care. Yet, to our knowledge, no study to date has examined the family caregivers' exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient's critical health events and relate that to the caregiver's own psychological distress to examine associations with general health within a home-based palliative care situation in Germany. METHODS: A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data. RESULTS: The frequency of the caregiver's exposure, or witness of, critical health events of the patient ranged from 95.2% "pain/discomfort" to 20.8% "family caregiver thought patient was dead". The highest distress scores assessing fear and helpfulness were associated with "family caregiver felt patient had enough'" and "family caregiver thought patient was dead". Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers. CONCLUSIONS: Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver's degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.

[Family Health Nursing - a challenge for education and training? Results of an European project]. / Family Health Nursing - eine Herausforderung für Aus- und Weiterbildung? Ergebnisse eines europäischen Projektes.

BACKGROUND: Since the WHO study "Family Health Nursing" (FHN) the concepts have been established different within Europe. Due to this, the international project "Family Health Nursing in European Communities" was started in order to develop a standardised educational concept. AIMS: The aim of this project was to gather the different requirements and to clarify problematic issues within the participating EU countries. METHOD: Thus, a literature review, a Delphi study in order to achieve consensus on definition of FHN, an analysis of competencies and requirements as well as an overview of available education/training with experts from the field of care was carried out. RESULTS: The results of the review reflect the varying level of occupation within the countries included in this analysis. Over the time, various conceptual orientations and professional designations have been established. Within this project the preferred job title was "Family Nurse" (46,3 %). Health promotion and prevention (85,8 %) were seen as main tasks of the Family Health Nurse. Therefore, the respondent experts state the need for more specialized training at an undergraduate (81,5 %) level. CONCLUSIONS: The project outlines the countries' effort towards a high-level in familial care which could be supported in long term by a consistent FHN concept.

Effects of requested, forced and denied shift schedule change on work ability and health of nurses in Europe -results from the European NEXT-Study.

BACKGROUND: Previous cross-sectional findings from the European Nurses Early Exit Study (NEXT) show that nurses who were dissatisfied with their work schedule tended to consider leaving the nursing profession. Mediating factors in this decision process may be caused by self-perceived poor work ability and/or health. The aim of this paper is to investigate changes in work ability and general health among nurses in relation to requested, forced and denied change of shift schedule. METHODS: Longitudinal data from the NEXT Study was used. In total 11,102 nurses from Belgium, Germany, Finland, the Netherlands, Poland, Slovakia, France and Italy completed both the 'basic questionnaire' (t1) and the '12 month follow-up questionnaire' (t2). To examine the time-effect (repeated measures) and the group-effect of five defined groups of nurses on the Work Ability Index (WAI) and general health (SF36), an adjusted 2-way analysis of covariance (ANCOVA) was performed. RESULTS: The nurses who wanted to, but could not change their shifts during the 12 month follow-up had the lowest initial and follow-up scores for WAI (t1: 37.6, t2: 36.6, p <0.001), lowest general health (t1: 63.9, t2: 59.2, p <0.001) and showed the highest decrease in both outcomes. Shift pattern change in line with the nurses' wishes was associated with improved work ability and to a lesser comparatively low extent with increased decline in health scores. A forced change of shift against the nurses' will was significantly associated with a deteriorating work ability and health. CONCLUSIONS: The findings would suggest that nurses' desire to change their shift patterns may be an indicator for perceived low work ability and/or low health. The results also indicate that fulfilling nurses' wishes with respect to their shift work pattern may improve their personal resources such as work ability and - to somewhat lesser extent - health. Disregarding nurses' preferences, however, bears the risk for further resource deterioration. The findings imply that shift schedule organization may constitute a valuable preventive tool to promote nurses' work ability and - to lesser extent - their perceived health, not least in aging nursing work forces.

Psychosocial work environment and intention to leave the nursing profession: a cross-national prospective study of eight countries.

Many countries throughout the world are facing a serious nursing shortage, and retention of nurses also is a challenge. The aim of this study was to compare the predictive contribution of a broad spectrum of psychosocial work factors, including job strain, effort-reward imbalance, and alternative employment opportunity, to the probability of intention to leave the nursing profession. A total of 7,990 registered female nurses working in hospitals in eight countries (Germany, Italy, France, The Netherlands, Belgium, Poland, Slovakia, and China) were included in the one-year prospective study. A standardized questionnaire on job strain, effort-reward imbalance, employment opportunity, and intention to leave the nursing profession was used in the survey. Multilevel logistic regression modeling was used to analyze the data. Results showed that an imbalance between high effort and low reward (in particular, poor promotion prospects) and good employment opportunity at baseline were independently associated with a new intention to leave the nursing profession at follow-up. However, job strain appeared to have relatively less explanatory power. Findings suggest that interventions to improve the psychosocial work environment, especially the reciprocity experienced between effort and reward, may be effective in improving retention of nurses and tackling the international nursing shortage.

[Exposure to aggressive patient behaviour and its' association with the nurses' "work ability" in Germany]. / Konfrontation mit aggressiven Klienten-- Auswirkungen auf die Arbeitsfähigkeit von Pflegekräften in Deutschland.

BACKGROUND: Aggressive behavior and violence in patients, residents or clients are growing challenges in nursing. Aggressive behavior can have both, physical and psychological consequences for nurses and can lead to a reduced performance at work, demotivation, sickness absence and the premature exit from the nursing profession. To develop purposive strategies and to deal with aggressive behavior and health promotion programs, it is crucial to know more about the prevalence of aggressive behavior from patients and the effect on the work ability of nurses in different types of institutions. METHOD: Data of 1735 German nurses was derived from the European NEXT-Study. Description and analysis of variance for each working area (hospital ward, Intensive Care Unit, psychiatric ward, nursing home and home care) were conducted. The work ability was measured with the Work Ability Index (WAI). The aggressive behavior was measured by one item developed by the NEXT Study Group. Linear regression models were applied to analyze the effect of aggressive behavior on the work ability of nurses in a comparison of the five different working areas. RESULTS: A total of 84.9 percent of the nurses were "sometimes" or "often/always" confronted with aggressive behavior from patients. In the comparison of the five working areas, nurses were exposed to different levels of aggressive behavior, while differences in the work ability of nurses were also observed. It was found that aggressive behavior from patients was associated with reduced work ability in nurses working in hospital wards, nursing homes and home care, but not nurses working in ICUs and psychiatric wards. CONCLUSIONS: The findings indicate that many nurses in Germany are exposed to aggressive behavior from patients, which has negative effect on the nurses' work ability. However, it is assumed that strategies to deal with aggressive behavior could play a buffer role between aggressive behavior and work ability of nurses, highlighting one possibility of intervention in future.

Use and Acceptance of Drinking Fountains: A Pilot Study in Two Secondary Schools in Dortmund, Germany.

(1) Background: Water drinking is essential to reduce obesity in children, but effective means for implementation remain controversial. Our study assesses students' and teachers' use of and attitudes towards drinking fountains in two urban secondary schools. (2) Methods: In a cross-sectional study, answers from students and teachers to a 28- and 19-item questionnaire, respectively, containing closed- and open-ended questions and short interviews with the schools' two principals were described and analysed using the question-specific number of responses as the denominator. (3) Results: Questionnaires of one hundred sixty-two students and ten teachers were analysed; 36.1% of students responded. Students viewed the schools' two fountains as a good idea (73.3%, n = 118), recommended them to other schools (73.1%, n = 117), and felt able to distinguish healthy from unhealthy drinks (70.5%, n = 110). In contrast, 55.7% (n = 88) reported using the fountains regularly; over a week, 39.8% (n = 47) used them less than once; 26.3% (n = 31) used them one to two times. Only about a third (26.5%, n = 43) reported consuming more water since the fountains' installation. Teachers' responses were similar to students'; principals stressed planning and costs. (4) Conclusions: A discrepancy between a good attitude towards and actual use of drinking fountains may exist; school communities may need to look for measures to overcome it.

[A comparison of general health and potential predictors of general health among nurses in different age groups in Germany]. / Vergleich der Gesundheit und Identifizierung von Prädiktoren der Gesundheit in verschiedenen Altersgruppen Pflegender in Deutschland.

The increasing need for certified nursing staff moves healthy ageing in the nursing profession into the focus of scientific consideration. The purpose of this investigation consisted a) in an age-differentiated, longitudinal consideration of the general state of health and b) in an age differentiated identification of variables which forecast the general state of health of the nursing forces after 12 months. The identification of suitable predictors should give indications in which areas interventions could begin. The investigation based on data of the NEXT study. The analysis of the general health situation by means of ANOVA proved that older persons showed a worse state of health than younger. Besides, the general state of health changed stronger in older nursing forces after one year. The identification of the health predictors was carried out by means of linear regression. Results exhibited that work family-conflict was a significant predictor in every age group. While leadership quality for younger persons was another important factor, quantitative demands and social support from colleagues forecasted the health situation after one year for medium old employees. For older nursing forces, a good relationship with the superiors seemed to be an important component for preservation of a good health status. The different results in the examined age groups indicate that intervention measures, which have the purpose to hold up the general state of health as long as possible, should be implemented age-differentiatedly.

Global child health in higher education in Germany: a mixed-methods study.

BACKGROUND: Germany has an ambitious global health strategy, yet its universities provide few opportunities for global child health researchers. Improved understanding of the reasons and the academic role of global child health is needed. OBJECTIVE: The objective of this study is to offer insights into Germany's academic global child health landscape by describing the actors and their priorities in research and education and by analysing perceived barriers and opportunities. METHODS: We used a sequential exploratory mixed-method design. Participants were selected purposively to represent German global child health academics. Information was gathered first from a 33-item online survey and from interviews conducted four to six months post-survey. Surveys were analysed descriptively. A joint thematic approach using content analysis was used to analyse interview transcripts. RESULTS: Four categories emerged: training and professional orientation; professional realities; representation and advocacy, and barriers. Of the 20 survey participants (median [IQR] age 55 years [17], five female), seven agreed to be interviewed. Research experiences abroad shaped individuals' career choices in global child health. They engaged in global child health education, primary health care and access to health services, frequently in clinical and humanitarian settings, but spent little time on global child health-related activities. Participants were active and valued in international networks and keen to extend their activities. Yet they felt under-represented academically and reported multiple structural and individual barriers in Germany. They perceived a lack of leadership positions, career paths, funding opportunities, and institutional and project support which limits academic advancement. CONCLUSIONS: Germany's global child health experts are motivated to engage with global child health-related topics but face difficulties in advancing academically. Academic actors may need to intensify research and training efforts in order to expand global child health's scientific base in Germany.

International medical electives for medical students at a German university: a secondary analysis of longitudinal data.

BACKGROUND: International medical electives (IMEs) are entry points to global health opportunities. IME uptake at German universities is unclear. We analyse 14 y of IME. METHODS: Student registry data were collected. Univariate linear regression examined relationships between enrolment year and IMEs. RESULTS: The median (IQR) number of IMEs of all enrolment years was 54 (32-80) and 51 (38-67)% of all students took an IME. Enrolment year significantly predicted IME frequency and the proportion of students taking IMEs. CONCLUSIONS: Student interest in IMEs is increasing. Universities should invest more broadly in IME opportunities for student, faculty and university enrichment.

[The effects of DRG introduction on nursing]. / Die Auswirkungen der DRG-einführung aus Sicht der Pflege.

UNLABELLED: Nursing personnel associate Diagnosis Related Groups (DRG), implemented in German hospitals in 2004, mostly with a higher workload and with work that is set apart from their patients. Between 2003 and 2005 the Institut für Pflegewissenschaft, Universität Witten/Herdecke, conducted a longitudinal study to measure changes of working structures before, throughout and after the introduction of the case-based lump sum. At three given dates a structured questionnaire was applied to nursing staff and, partially, to doctors in three hospitals in order to assess their subjective view on the effects of DRG introduction. RESULTS were compared to the actual output by multi-moment-recording. RESULTS: The amount of paperwork decreased against expectations. Nevertheless, extra requirements became more comprehensive, while the extent of genuine nursing tasks decreased. In 2005 these tasks were given a lower amount of time than paperwork and extra requirements. Because of methodical restrictions causal relations cannot be established, but this trend has to be monitored closely. Further studies have to be carried out to examine structural changes of nursing tasks and quality of care.

Reward frustration at work and intention to leave the nursing profession--prospective results from the European longitudinal NEXT study.

BACKGROUND: Many countries are facing a serious situation of nursing shortage, and retention of nurses is a challenge. OBJECTIVES: To examine whether reward frustration at work, as measured by the effort-reward imbalance model, predicts intention to leave the nursing profession, using data from the European longitudinal nurses' early exit study. DESIGN: A prospective study with one-year follow-up. METHODS: 6469 registered female nurses working in hospitals in seven European countries who did not have intention to leave the nursing profession at baseline were included in our analyses by multivariate Poisson regression. RESULTS: 8.24% nurses newly developed intention to leave during follow-up. High effort-reward imbalance at baseline predicted an elevated risk of intention to leave the profession (relative risk 1.33, 95% confidence interval 1.22-1.45), and reward frustration (poor salary and promotion prospects, lack of esteem) showed the strongest explanatory power. Findings were similar in a majority of the countries. CONCLUSIONS: Results suggest that improving the psychosocial work environment, and specifically occupational rewards, may be helpful in retaining nurses and consequently reducing nursing shortage in Europe.