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Background and Purpose: Alerting devices can provide rapid assistance after a fall and thus reduce serious consequences and suffering. In spite of this obvious advantage, the acceptance and utilization rate in community-dwelling older people remains low. However, little is known about the reasons for[for full text, please go to the a.m. URL], 1st International Conference of the German Society of Nursing Science

Aim of the study: The aim of this study was to investigate the relationship between the use of the National Nursing Expert Standard Pressure Ulcer Prevention and the pressure ulcer prevalence in German nursing homes and hospitals. Methods: Data were collected within two nationwide surveys conducted by the Department of Nursing Science of the Charite, Berlin, Germany. The surveys, designed as cross-sectional prevalence studies, serve as an investigation of the amount of clinically relevant nursing phenomena, i.e., pressure ulcers. Prevalence per facility in the at-risk group was explored by a ranking procedure of the 95 nursing homes and hospitals. The facilities were divided into two groups according to whether they used the German Expert Standard to develop the local protocol or not. Results: The pressure ulcer prevalence of the at-risk group ranged from 0 % to 24.6 % in nursing homes and from 7 % to 40 % in hospitals. In about 40 % of the hospitals and nursing homes the local protocol of pressure ulcer prevention was based on the German Expert Standard. The ranking figure indicates that there is no statistically significant relation between Expert Standard-based local protocols and the pressure ulcer prevalence in the at-risk group. Conclusion: A clear advantage to use the German Expert Standard compared with other sources cannot be shown with these data. However, a uniform pressure ulcer prevention is an essential quality feature of nursing care. The degree of implementation and the consequent transfer of the recommendations to daily practice should be evaluated regularly.

The aims of this study were to test the transfer and feasibility of a Dutch annual survey on malnutrition into German nursing homes and to gather first data about the prevalence of malnutrition, treatment and quality indicators in German resident homes.A cross-sectional multicentre study, using a standardised multilevel instrument (observation, questionnaire) developed in the University of Maastricht was applied. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and treatment initiatives.The sample consisted of 32 nursing homes with 2,444 participating residents. 26% of the residents show indicators of malnutrition, a risk of malnutrition can be found in another 28%. Only one quarter of the nursing homes use a standardised nutritional screening instrument. Significantly more people with dementia have indicators of malnutrition. Most facilities provide a protocol or a guideline for the prevention and treatment of malnutrition. Also most are training their staff regularly in questions of malnutrition, half the institutions employ dieticians or nutritionists. Special treatment was initiated in half of all residents having indicators of malnutrition or showing a risk.The Dutch instrument is applicable in German nursing homes. Its utilisation shows that malnutrition is still a problem in German nursing homes. The standardised assessment of nutritional status is the exception; the interventions carried out should be improved.

Institutionally acquired pressure ulcers are used as outcome indicators to assess the quality of pressure ulcer prevention programs. Determining whether quality improvement projects that aim to decrease the proportions of institutionally acquired pressure ulcers lead to real changes in clinical practice depends on the measurement method and statistical analysis used. To examine whether nosoconnial pressure ulcer prevalence rates in hospitals in the Netherlands changed, a secondary data analysis using different statistical approaches was conducted of annual (1998-2008) nationwide nursing-sensitive health problem prevalence studies in the Netherlands. Institutions that participated regularly in all survey years were identified. Risk-adjusted nosocomial pressure ulcers prevalence rates, grade 2 to 4 (European Pressure Ulcer Advisory Panel system) were calculated per year and hospital. Descriptive statistics, chi-square trend tests, and P charts based on statistical process control (SPC) were applied and compared. Six of the 905 healthcare institutions participated in every survey year and 11,444 patients in these six hospitals were identified as being at risk for pressure ulcers. Prevalence rates per year ranged from 0.05 to 0.22. Chi-square trend tests revealed statistically significant downward trends in four hospitals but based on SPC methods, prevalence rates of five hospitals varied by chance only. Results of chi-square trend tests and SPC methods were not comparable, making it impossible to decide which approach is more appropriate. P charts provide more valuable information than single P values and are more helpful for monitoring institutional performance. Empirical evidence about the decrease of nosocomial pressure ulcer prevalence rates in the Netherlands is contradictory and limited.

The early integration of palliative care (PC) into the trajectory of patients diagnosed with a life-limiting disease in the acute care setting may improve quality of care and lessen patients’ distress. The SENS structure (Symptoms, End-of-life decisions including advance care planning, Network and Support of caregivers) provides a structure for PC conversations with patients. Some patients found the PC conversations based on the SENS structure hard because of being confronted with the finiteness of their lives. Others were relieved to talk about their fears and expectations. Nurses can play an important role in early integrated PC and advance care planning. If trained appropriately they can have the responsibility to facilitate early integration of PC and advocate for patients’ wishes. An analysis showed that patients at the end of life in the acute care setting, who receive additional specialized PC services, require overall more nursing care time for direct and indirect care compared to patients receiving usual care alone.

Health systems around the globe are struggling with the shortage of health professionals, and stress at work further exacerbates this problem. This thesis investigated stressors, stress reactions and long-term consequences among different health professional disciplines and hierarchical positions, including health professionals’ self-reports and external observations. Existing work-private life conflicts, lacking opportunities for development and the behaviour of the direct line manager were identified as relevant stressors and associated with health professionals’ stress symptoms, job satisfaction as well as health and motivation to remain at work. In addition, health professional leaders play an important role in reducing work-related stress among their employees, and results of this thesis indicate where there is a need to intervene to improve working conditions. However, further knowledge is important regarding longitudinal data and intervention studies.