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Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study Abstract. Background: Numerous tools for detecting postoperative delirium are available. Guidelines recommend the 4 A's Test (4AT). However, there is little evidence on the validity and reliability of the German version of 4AT. Aim: To assess the interrater reliability of the German version of 4AT test for the detection of postoperative delirium in general surgical and orthopedic-traumatological patients, and the concurrent validity with the Delirium Observation Screening Scale (DOS). Methods: The present work is part of a prospective cohort study with a sample of 202 inpatients (≥ 65 years) who underwent surgery. The interrater reliability of the 4AT (intraclass coefficients) was determined with a subsample of 33 subjects who were rated by two nurses. Concurrent validity between the DOS scale and the 4AT was calculated using Pearson's correlation coefficient. Results: Interrater reliability for the 4AT total score and dichotomized total score were 0.92 (95% CI 0.84-0.96) and 0.98 (95% CI 0.95-0.98), respectively. The correlation between DOS and 4AT (Pearson) was 0.54 (p < 0.001). Conclusions: The 4A test can be used by nurses as a screening instrument for the detection of postoperative delirium in older patients on general surgery and orthopedic traumatology wards. In case of positive 4AT results further assessment by nurse experts or physicians is required.

Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study Abstract., Background: Specialized registered nurses play a key role in the insertion and management of peripherally inserted central catheters (PICCs) and midline catheters in Anglo-Saxon countries. From the German-speaking area no data on the use of PICCs and midline catheters are available., Aim: The aim of this study was to describe the types and frequencies of complications of PICCs and midline catheters which were inserted by specialized registered nurses in a South Tyrolean district hospital., Methods: We performed a retrospective cohort study of PICCs and midline catheters inserted between 2013 and 2015 in one surgical unit in the district hospital Bruneck (South Tyrol / Italy)., Results: Data from 900 catheters (421 midline catheters and 479 PICCs) inserted in 686 adult patients (404 women, 282 men) were analysed. The cumulative incidence was 29.2 % complications for midline catheters (incidence rate: 13 complications / 1000 catheter days) and 16.0 % for PICCs (incidence rate: 3 complications / 1000 catheter days). The most frequent complication was the removal of the catheter by the patients (PICCs: 6.7 %, midline catheters: 15.7 %). Other less frequent complications were mechanical complications, occlusions, infections and thromboses., Conclusions: This study in one district hospital revealed similar types and frequencies of complications as previous international studies. Specialized and clinically competent nurses in German-speaking countries could develop advanced roles in the insertion and management of PICCs and midline catheters.

In the RN4CAST (Nurse forecasting in Europe) study all 35 participating Swiss hospitals received a study report, which allowed them to anonymously compare findings in relation to structure, process and outcome variables. Thus, this benchmarking allowed the hospitals to identify potentials for improvement and to plan counter measures for developing the quality of their practice environment. We surveyed the RN4CAST hospitals 18 months after submitting the study report and asked chief nursing officers if the results of the RN4CAST study report had been discussed and analysed within their hospitals and if the results had led to any quality improvement or practice development projects. Out of 35 questionnaires 30 were returned (response rate = 85 %). The study report was discussed and analysed in 27 hospitals (90 %), whereby the quality (n = 27) and the usefulness (n = 22) were rated as good or very good. Less then half of the hospitals (41 %) discussed the results with the hospital units. The study report stimulated practice development and quality improvement efforts in view of the nurses' work environment (n = 20) and safety culture/climate (n = 16). Replicating the RN4CAST study in the participating hospital would allow evaluating changes on the measured variables, e. g., due to this quality improvement and practice development projects.

In home-care situations, the caring family members of people suffering from dementia are exposed to a great number of physical, mental and social burdens, and restrictions, putting themselves at risk of falling ill. Caring family members need adequate forms of relief in order to be able to care for the family member at home for as long as possible, and with the best possible physical and psychological status. In the present paper, interventions of relief and promotion and their effects on family members caring for dementia patients have been investigated and described on the basis of a systematic literature review. The presentation of the results shows that psycho-educational, relieving, supportive, psychotherapeutic and multimodal offers as well as counselling and case/care management among caring family members have significant effects on parameters such as burdens, level of depression, subjective well-being, skills/knowledge as well as symptoms and institutionalisation of the person in need of care. None of the interventions investigated, however, covers the entire range of parameters. In order to be able to ensure the individual support of caring family members, a superordinate organisational concept (case/care management, family health nursing) which meets the needs of the caring family members, combines and interlinks tailor-made offers for caring family members is required. Registered nurses could play a central role as care managers or family health nurses in ensuring home-based care for people with dementia. Further investigations on multimodal offers and case/care management are needed. In this context, it is essential to take well-considered decisions on study design, sample size, and result parameters (assessment instruments) in order to gain significant results and homogeneous data.

As part of their Master's degree course in Nursing Science at the Private University for Health Sciences, Medical Informatics and Technology (UMIT), the authors carried out a quantitative (written questionnaire) and qualitative (semi-structured interviews) research on parents in South Tyrol caring for their severely handicapped young and adolescent children. The aim of the study was to assess the extent and cause of burden in care-giving parents. The extent of burden was assessed using the the "FaBel"-questionnaire (Impact on Family Scale). Semi-structured interviews were used to investigate the phenomenon of burden in these parents. By triangulation of current literature with the quantitative and qualitative data, an attempt was made to reveal the complexity of the problem. The present contribution is a report on the results of the qualitative part of the study. As shown by the category system of the investigation, families with severely handicapped children and adolescents are exposed to a variety of burden in social (everyday life and public institutions), physical, psychological (impairment of health) as well as financial and emotional (future perspectives) areas. These parents find relief with their own families (partner and children) and public institutions (school, kindergarten, care facilities). Nursing interventions such as schooling, training and empowerment programmes must be adjusted by professional care givers (family health nurse) to the special needs of the care giving parents. Federal, provincial and social institutions should implement and optimise appropriate support possibilities and offers.