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Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

A brief, problem-oriented phase such as an inventing activity is one potential instructional method for preparing learners not only cognitively but also motivationally for learning. Student teachers often need to overcome motivational barriers in order to use computer-based learning opportunities. In a preliminary experiment, we found that student teachers who were given paper-based course material spent more time on follow-up coursework than teachers who were given a well-developed computer-based learning environment (CBLE), leading to higher learning outcomes. Thus, we tested inventing as an instructional method that may help overcome motivational barriers of teachers' use of computer-supported tools or learning environments in our main experimental study (N = 44). As a computer-based environment, we used the 'Assessment of Learning strategies in Learning journals'. The inventing group produced ideas about criteria to evaluate learning strategies based on student cases prior to the learning phase. The control condition read a text containing possible answers to the inventing problem. The inventing activity enhanced motivation prior to the learning phase and assessment skills as assessed by transfer problems. Hence, the inventing activity prepared student teachers to learn from a CBLE in a motivational as well as cognitive way. [ABSTRACT FROM AUTHOR]

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample ( n = 179) that met screening requirements, including subjects with and without mild cognitive impairment ( Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale ( HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective. [ABSTRACT FROM AUTHOR]

The present paper extends the needs-based model of reconciliation to contexts marked by status inequalities rather than by overt intergroup aggression. Specifically, we investigated whether and when members of high-status versus low-status groups experience divergent socio-emotional needs vis-à-vis members of the respective other status group. Building on research informed by social identity theory, we hypothesized that the groups' different positions in the social hierarchy only translate into divergent needs when the status differences are perceived as illegitimate. In Study 1 (N = 130), we tested this prediction by manipulating status and perceived legitimacy of status differences in a setting with artificially created groups. Results confirmed that the need to be socially accepted by members of the other status group was stronger in high-status compared with low-status group members but, as expected, only when the status differences were perceived to be illegitimate. Also as predicted, the need to be empowered by the other status group was stronger in low-status compared with high-status group members, again only under conditions of illegitimate status differences. Study 2 (N = 169) further corroborated our perspective by replicating these findings in a naturalistic intergroup context. Implications for the role of legitimacy perceptions in determining differential socio-emotional needs and for the promotion of sustainable social change are discussed. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To participate in shared decision making (SDM), patients need to understand their options and develop trust in their own decision‐making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference‐sensitivity (Study 1) and showing possible personal motives for decision making (Study 2) in addition to providing information about the treatment options. Methods: Participants (Study 1: N = 117; Study 2: N = 217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video and were randomized into one of three groups where they received additional information in the form of (a) narrative patient testimonials; (b) non‐narrative decision strategies; and (c) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P <.001, ηP2 = 0.43; Study 2: P <.001, ηP2 = 0.57) and evaluated the decision‐making process more positively (Study 2: P <.001, ηP2 = 0.13) than participants in the control condition. Decision certainty (Study 1: P <.001, ηP2 = 0.05) and satisfaction (Study 1: P <.001, ηP2 = 0.11; Study 2: P =.003, d = 0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P <.001, ηP2 = 0.05). Discussion: Decision aids that explain preference‐sensitivity and personal motives can be beneficial for improving people's feelings of being prepared and their perception of the decision‐making process. To reach decision certainty and satisfaction, being well informed of one's options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs. [ABSTRACT FROM AUTHOR]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

Individuals consider abstract values and principles important aspects of their identities. Nonetheless, they often make judgments and decisions that contradict these values and principles for the sake of pragmatic benefits. Assuming that the process of weighting idealistic and pragmatic concerns is context sensitive, the present research argues that affect influences the relative weight of idealistic versus pragmatic concerns in decision situations owing to its influence on the level of abstraction at which individuals represent situations mentally. Studies 1 and 2 demonstrate that more positive affect increases the prominent weighting of idealistic over pragmatic concerns while less positive affect leads to less differentiation between the relevance of idealistic and pragmatic concerns. Studies 3 and 4 test the assumption that affective influences on mental abstraction are crucial for affect-dependent shifts in the weighting of idealistic and pragmatic concerns. By bringing together theorizing on affect and cognition with recent theorizing on the role of mental abstraction for decision processes, this article highlights a mechanism through which decisions can be influenced by feelings that goes beyond the mechanisms that have typically been discussed in the affect and cognition literature so far. [ABSTRACT FROM AUTHOR]

Using a sample of 602 Turkish Muslims from Germany and the Netherlands, we examined the influence of ingroup norms and perceived discrimination on religious group identification and host national identification. Participants experiencing pressures from their ingroup to maintain an ethnoreligious lifestyle as well as those who perceived discrimination by natives identified more strongly with their religious group and, in turn, identified less with the host country. Further, the positive relationship between discrimination and religious group identification and the negative relationship between religious and national identification were especially strong for participants who perceived incompatibility between Western and Islamic ways of life. It is concluded that Muslim and host national identities are not always mutually exclusive and that it is important to study the conditions that reconcile and contrast them. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. Methods Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. Results We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. Conclusion Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care. [ABSTRACT FROM AUTHOR]

When unknown groups and equal status groups are compared by contrasting one group ('the effect to be explained') against another ('the linguistic norm'), the group positioned as the norm is sometimes perceived as more powerful, more agentic, and as less communal. Such perceptions may contribute to status-linked stereotypes, as group differences are spontaneously described by positioning higher-status groups as the linguistic norm. Here, 103 participants considered gender differences in status to be larger and more legitimate and applied gender stereotypes more readily upon reading about gender differences in leadership that were framed around a male rather than a female linguistic norm. These effects did not generalize to 113 participants who read about gender differences in leisure time preferences framed around either norm. Jointly, these results suggest that the effects of linguistic framing on perceived group status and power and on group stereotypes generalize to domains where there are real differences in status, and contexts in which higher-status groups are the default standard for comparison. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To test age differences in the prevalence of DSM-IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour. Design and setting Cross-sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two-stage probability sampling design. The survey used self-administered questionnaires and telephone interviews (mixed-mode design; 45% response rate). Participants The analytical sample consisted of n = 6984 individuals aged 18-64 years reporting alcohol consumption within the previous year. Measurements Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio-economic variables. Findings When controlling for drinking behaviour, 18-24-year-olds were more likely to meet the criteria 'tolerance', 'larger/longer' and 'time spent' relative to older age groups. In contrast, the likelihood of experiencing 'withdrawal' symptoms increased with age. There was no significant age effect on the diagnosis of AD. Conclusions Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as 'tolerance', 'drinking larger amount or for longer than intended' and 'time spent recovering' cannot be fully explained by differences in drinking behaviour. [ABSTRACT FROM AUTHOR]