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Copyright of ZFA: Zeitschrift für Allgemeinmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration. [ABSTRACT FROM AUTHOR]

Employees are a very important source of innovation and essential for the generation, dissemination and implementation of these ideas throughout the organization. This is especially relevant when considering innovation in services during service (co-) creation such as within the healthcare sector. However, perceived employee involvement in innovation (EII) and between stakeholder group interactions in hospitals has not yet been studied in detail. This paper addresses the following research questions: "How do different employee groups perceive their involvement in the innovation process in hospitals and how do their actual involvement levels differ?" and (2) "How do different employee groups perceive their interaction with other employee groups in the innovation process and how do their actual interactions differ?" We analyzed a single typical German research hospital and conducted episodic interviews with employees representing different staff groups. We revealed that while all groups of employees are involved in innovation activities, perception of their involvement in innovation activities differs widely. There is a gap between perception and actual involvement particularly for lower level employees such as nurses. Further, their interaction differs among employee groups and innovation takes place in-group, rather than through group interaction. With our paper, we add to the understanding of perceived EII in hospitals and discuss measures for hospital management to increase EII. [ABSTRACT FROM AUTHOR]

Background: Caring for terminally ill patients with minor children can be very stressful. The perceived quality of life is significantly influenced by the Meaning in Life (MiL). No studies were found that focus on the prioritized special needs of this patient group. Objectives: The aim is to compare and contrast terminally ill parents with minor children and palliative care patients in Germany, in order to provide appropriate support beyond medical, nursing or therapeutic interventions. Methods: Terminally ill parents diagnosed were surveyed using a validated instrument 'Schedule for Meaning in Life Evaluation (SMiLE)'. The study listed various areas that contribute to the MiL, followed by an evaluation of their importance and satisfaction levels. The researchers then compared these findings with data collected from palliative care patients. Results: In Germany, 54 patients, mostly female and with a mean age of 43, were included in this study between February 2017 and September 2020. The median age of the 96 children during the survey phase was 7 years. The comparison group consists of 100 palliative care patients in Germany; mostly aged 50 years and older. For terminally ill patients most important areas were in decreasing order family (100%), social relations (80%), leisure time (61%), nature/animals (39%) and home/garden (30%). Although the overall indices are close between both groups, there are significant and highly correlated differences between them. Parents felt limited by their illness in being a mother or father, as they wanted to be. Conclusion: The involvement with SMiLE led patients to consider their coping resources. The areas relevant to terminally ill parents differed from those relevant to palliative care patients. All participants identified family as the most important factor for MiL. The results suggest that evaluating MiL can serve as a coping strategy and help terminally ill parents with minor children. Plain language summary: A comparison of answers to the meaning in life from seriously ill parents with young children with the answers of other seriously ill patients Background: Caring for seriously ill patients with young children can be very stressful. The quality of life depends on meaning in life. No studies were found that focus on the needs of this patients. Objectives: The aim was to explore similarities and differences between seriously ill parents with young children and palliative care patients in Germany to find the best way to support them. Methods: The Meaning in Life questions were used to find this out. Two researchers asked seriously ill parents about different things that make their lives meaningful. The researchers then compared the results with data from other seriously ill patients in need of palliative care. In Germany, 54 seriously ill parents with young children were interviewed between February 2017 and September 2020. The children were usually seven years old. The compared group consisted of 100 palliative care patients and was mostly older than 49 years. For seriously ill patients most important were family, social relations, leisure time, nature/animals, and home/garden. The values seemed similar, but there are clear differences between the groups. Parents felt their illness limited them in being a mother or a father. Conclusion: The questions helped patients helped to remember meaning in life and set goals. The things that mattered to seriously ill parents were different from those that mattered to palliative care patients. All participants said that family was the most important thing for meaning in life. The results show that thinking about meaning in life can help. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method: One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results: The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion: These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. [ABSTRACT FROM AUTHOR]

A rise in the number of flood-affected people and areas has increased the interest in new methods and concepts that account for this change. Citizens are integrated into disaster risk reduction processes through participatory approaches and can provide valuable up-to-date local knowledge. During a field study in Eberbach (Baden–Wuerttemberg, Germany) sketch maps and questionnaires were used to capture local knowledge about flooding. Based on a previous study on urban flooding in Santiago de Chile, the tools were adapted and applied to river flooding in the city of Eberbach, which is regularly flooded by the Neckar River, a major river in southwest Germany. The empirical database of the study comprises 40 participants in the study area and 40 in a control area. Half of the participants in each group are residents and half are pedestrians. Purposive sampling was used, and the questionnaires aimed to gather demographic information and explore what factors, such as property, influence the risk perception of the study participants. The results show that residents identify a larger spatial area as at risk than pedestrians, and owning property leads to higher risk awareness. The flood type influenced the choice of the base maps for the sketch maps. For river flooding, one map with an overview of the area was sufficient, while for urban flooding a second map with more details of the area also enables the marking of small streets. The information gathered can complement authoritative data such as from flood models. This participatory approach also increases the communication and trust between local governments, researchers, and citizens. [ABSTRACT FROM AUTHOR]

Background: In the last phase of their lives, people living with dementia often indicate restlessness, anxiety or pain. Further, their care is considered inadequate, as they are, for example, sometimes overtreated for curative care or undertreated for pain management. These patients also face multiple barriers in accessing palliative care. This qualitative study explores the perception of experts about how people living with dementia in Germany are cared for at home toward the end of their lives. Methods: A total of 12 experts involved in outpatient/palliative care were recruited to constitute a purposive, heterogeneous sample. Interviews, which were structured using an interview guide, were conducted with physicians, nurses, representatives of health insurance funds, welfare associations, municipal counselling centres, scientists and coordinators of outpatient palliative care and voluntary work; the interviews were transcribed and analysed via thematic content analysis, based on Kuckartz's method. Results: The analysis of the results led to the establishment of four main categories that focused on formal care arrangements, the roles of relatives in care arrangements, the specifics of dementia, and restrictions on access to palliative care. Conclusions: Suitable end-of-life care for people living with dementia and support for their relatives require resources and the conceptualisation of specific care arrangements to help minimise potential barriers that prevent access to palliative care. [ABSTRACT FROM AUTHOR]

Purpose: The unexpected and rapid outbreak of the COVID-19 pandemic increased the vulnerability of forcibly displaced (migrant) women, who were a social group already at risk of health inequities and poorer health outcomes. This study aims to examine the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic in Germany using a multidimensional health literacy model as a framework. Design/methodology/approach: A grounded theory methodology was implemented including interviews with 33 forcibly displaced (migrant) women from July to September 2021. An experienced female researcher interviewed all forcibly displaced (migrant) women, and apart from one telephone interview, all interviews were conducted in person. Findings: Following data analysis, the category, "Use of health information in the context of the COVID-19 pandemic of forcibly displaced (migrant) women", was identified as a core category. The findings provide valuable insight into the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic. Societal and environmental determinants, personal determinants and situational determinants were identified as factors impacting health literacy. Furthermore, health literacy was distinguished as competence to make informed decisions in the health domains "health care" and "disease prevention". Originality/value: Although previous research often focuses on the deficits of forcibly displaced (migrants), this study highlights the resources forcibly displaced (migrant) women use to deal with health-related difficulties, especially during a crisis such as the COVID-19 pandemic. Importantly, such resources were available even if the study participants did not speak the language of the immigration country. [ABSTRACT FROM AUTHOR]

Background. Strong evidence supports the beneficial impact of exercise on cancer patients. However, the provision of exercise programs in Germany is highly heterogeneous. Therefore, the network OnkoAktiv (OA) enables patient consultations and referrals from coordinating regional OA centers (RE) into community-based exercise programs (CBEP). Objective. The aim of this study was to identify barriers and facilitators for the implementation of OA network structures from the perspective of RE and certified CBEP. Methods. This evaluation was executed in a sequential mixed methods design. We conducted 16 qualitative interviews with each leader in RE and the certified CBEP. Then, 89 certified CBEP were invited to a quantitative, cross-sectional survey. Results. We identified 11 facilitators each for RE and certified CBEP, 7 barriers for RE and 5 for certified CBEP. Barriers dealt with, for example, financing OA network structures, a lack of knowledge of exercise trainers, inadequate patient referral, and missing collaborations by healthcare professionals (HCPs). Most of the named facilitators were adequate internal organizational resources, support and reachability of OA staffs, and collaboration with HCPs. Conclusion. Our findings indicate different challenges for the implementation of OA network structures. Future implementation efforts should consider the evaluation of individual barriers and the development of specific solutions. [ABSTRACT FROM AUTHOR]

Objective Because of the increasing number of people with disabilities and the lack of awareness of disability prevention methods in developing countries, creating a proper rehabilitation structure and providing appropriate services are among the important goals of every health system. Conducting comparative studies is one of the research methods for reviewing the structure of the rehabilitation system in the country's health system. This study aimed to compare the rehabilitation structure in Iran with 5 other countries. Materials & Methods This research is a comparative study conducted in 2022. In this study, sampling was purposeful. Five countries of Germany, Japan, Canada, Turkey, and South Africa were compared in terms of organizational and health management, financial and legal components, and social policy components with Iran. Reliable databases and related resources in the rehabilitation structure were used to collect data. In this study, the obtained data were analyzed using the Bereday model containing four stages: Description, interpretation, proximity, and comparison. The findings were evaluated in a comparative table. Results The findings indicated that in terms of organization and health management, the Ministry of Health should be responsible for health management and rehabilitation, but in Iran, in addition to the Ministry of Health, the Red Crescent, the Martyr Foundation, and Exceptional Education Organization are also involved in the management of rehabilitation. Financial issues and problems are significant barriers for people with disabilities to access rehabilitation services in these countries. In Iran, a large part of these costs is paid from the pockets of families. Regarding legal components in Iran, as in other countries, specific rules exist to provide services to people with disabilities. But sometimes, these rules are not properly implemented. From the sociodemographic perspective, Iran has an aging population, welcomes immigrants, and holds diverse cultures. The access of all people in need of rehabilitation in this diverse population to the services needed is limited. In terms of policy components, regulating national health policy requires review and, if necessary, changes in existing health system policies. Conclusion The existence of a specific position for rehabilitation in the Iranian health system, provision of services, and management of rehabilitation affairs by a single organization such as the Ministry of Health, as well as proper implementation of laws and policies, can lead to structural improvement and management of the health system and rehabilitation. Financial obstacles and problems to rehabilitation services should be reduced, and government and insurance must cover most of the costs of rehabilitation services. Also, a review of national health policies and legislation in the country should be done to improve the access of all people with disabilities to health and rehabilitation services. Therefore, it is necessary to fundamentally review and reform the structure, value, and process of providing rehabilitation services. [ABSTRACT FROM AUTHOR]

Background: The need to care for a loved one in a palliative state can lead to severe physical as well as psychological stress. In this context, Last Aid courses have been developed to support caring for relatives and to stimulate the public discussion on death and dying. The purpose of our pilot study is to gain an understanding of the attitudes, values, and difficulties of relatives caring for a terminally ill person. Methods: A qualitative approach was used in form of five semi-structured guided pilot interviews with lay persons who recently attended a Last Aid course. The transcripts of the interviews were analyzed following Kuckartz's content analysis. Results: Overall, the interviewed participants have a positive attitude toward Last Aid courses. They perceive the courses as helpful as they provide knowledge, guidance, and recommendations of action for concrete palliative situations. Eight main topics emerged during analysis: expectations regarding the course, transfer of knowledge, reducing fear, the Last Aid course as a safe space, support from others, empowerment and strengthening of own skills, and the improvement needs of the course. Conclusions: In addition to the expectations before participation and the knowledge transfer during the course, the resulting implications for its application are also of great interest. The pilot interviews show initial indications that the impact, as well as supportive and challenging factors regarding the ability to care for relatives to cope, should be explored in further research. [ABSTRACT FROM AUTHOR]

Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance. [ABSTRACT FROM AUTHOR]

Background people aged 80 and over frequently have diverse and complex health trajectories, which has been well studied. But their oral health is seldom included in care models. To realise comprehensive healthcare, both general and oral ambulatory (i.e. outpatient) healthcare need to be explored and conceptualised equally. Objective to elicit what matters to very old people regarding ambulatory health and oral healthcare. Methods interviews were conducted with non-institutionalised people aged 80 and over living in the area of Cologne, Germany. They were interviewed regarding their experiences of and views on ambulatory healthcare and oral healthcare care, respectively. Thematic analysis was performed to understand their motives and elicit relevant characteristics of desirable health services. Results from the interviews with 22 participants, 16 characteristics of good healthcare were described. These were generally similar for both general and oral healthcare and had a particular focus on patient–provider interaction and the organisation of care. However, regarding oral healthcare, the participants focused more strongly on the technical–medical skills of professionals and the perceptible treatment results and were more concerned about costs. It was noticeable that older people had the urge to differentiate themselves from 'others unnecessarily using health services'. They were unaware of possible future oral health deterioration and the resulting future needs. Conclusions characteristics of good health and oral healthcare from the perspective of older people should be incorporated to ensure patient-centredness in care models. Older patients, as well as healthcare providers, need to be sensitised to their oral health needs to realise comprehensive healthcare. [ABSTRACT FROM AUTHOR]

Background: Medical rehabilitation plays an important role in the health care of chronically ill children and adolescents. During medical rehabilitation, supporting illness‐related self‐regulation is a central goal. Beliefs about illness and beliefs about treatment are core elements of patients' self‐regulation, and there is evidence that these beliefs are relevant predictors of different health‐ and treatment‐related outcomes such as adherence. However, little is known about adolescents' beliefs about rehabilitation. This study therefore explores adolescents' treatment beliefs in the context of inpatient medical rehabilitation. Methods: A qualitative study was conducted in a German rehabilitation clinic for children and adolescents. Using a purposive sampling method, 13 adolescents (12–16 years old) were recruited. Semi‐structured, audiotaped interviews were conducted and analysed using content analysis. Results: Results demonstrate that adolescents have differentiated rehabilitation‐related treatment beliefs. Twelve themes, with various subthemes, emerged, which include access to and knowledge about rehabilitation, the rehabilitation‐related individual position and normative aspects, expectations of oneself, as well as in respect of the social context (fellow patients, contact with family and friends), expectations of the structure, process and outcome of rehabilitation, concerns and barriers and emotional aspects. Conclusions: Our explorative study revealed a broad range of rehabilitation‐related treatment beliefs in adolescents, indicating parallels, but also differences, to research results with adults. Treatment beliefs are assumed to be an influencing factor for various health‐ and treatment‐related outcomes. Thus, implications of our findings for clinical practice and further research are discussed. [ABSTRACT FROM AUTHOR]

Sustaining informal care‐giving for people living with dementia (PWD) is a common objective of societies worldwide. Families can contribute substantially to the support of care‐giving relatives. However, a deeper understanding of the impact of informal care‐giving for PWD on family life is needed. Interviewing of multiple family network members—in addition to the primary carer—provides more insight into familial contexts of care‐giving. This pilot study aims to explore how informal carers reconcile dementia care‐giving and family life from a family network perspective. Therefore, we conducted 14 narrative interviews with family carers from seven care‐giving networks in Germany, which we interpreted using the documentary method. The yielded relational typology describes five types of family carers of PWD. These types reflect the way the families deal with dementia care‐giving based on the interrelation between relationship quality and the distribution of care‐giving tasks within the family. Depending on the constellation of this interrelationship, family carers either experience care as a joint project, as co‐operation with external support or within the family, as disappointment or as a predicament without alternatives. Finally, if the care‐giving tasks are not shared, or if the distribution is perceived as unequal, relationship break downs can occur, especially in family ties that are already strained. However, joint care‐giving and strong ties can also bring the family closer together and enhance care experiences. Care professionals and social workers should be aware of the family network of dementia carers and support the development of a sense of family unity. This can contribute to positive care experiences among family carers and thus increase the maintenance of informal dementia care. [ABSTRACT FROM AUTHOR]

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care‐ and case‐management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care‐ and case‐management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community‐based care‐ and case‐management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care‐ and case‐managers. A care‐ and case‐management affected caregiving per se as well as the patient's and family caregiver's well‐being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care‐ and case‐managers. Establishing networks between the patients, family caregivers, care‐ and case‐managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community‐based care‐ and case‐management can play an important role in detecting, facilitating and preventing family caregiver burden. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Purpose: Prior research provides limited information on the roles that leisure can play among Western international students studying in Eastern countries. Exploring this directional difference can provide its implications for Western international student support. Therefore, the purpose of this study is to explore leisure behaviours and leisure benefits associated with acculturation among Western international students residing in South Korea.Method: Using a purposeful criterion sampling strategy, a total of 18 participants (7 males and 11 females) were recruited. This study employed semi-structured in-depth interviews and a content mapping and content mining question strategy was incorporated.Results: The following core themes were associated with the health benefits of leisure activities experienced by international students living in South Korea: (a) promoting mental health, (b) experiencing dynamics of inter-and intra-group friendships, and (c) facilitating acculturation.Conclusions: The findings showed that participants developed friendships with the host individuals and other international students, became well acculturated into a new culture and experienced benefits to their mental health, indicating that leisure participation can be instrumental in improving social and psychological wellbeing. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Information continuity, on which our study focuses, is especially important when relational continuity is not given, which is often the case at hospital admission or hospital discharge. The aim of this study is to provide insight into the information flows between general practices and hospitals in Germany, and to identify factors associated with these flows of information. Methods: This is a qualitative interview study in a purposeful sample of staff from hospitals and general practices (general practitioners, care assistants in general practice, hospital management, hospital physicians, and nursing staff). Interviews were conducted via telephone or face-to-face using a self-developed semi-structured interview guide. Stepwise systematic content analysis was used to structure collected material into themes and sub-themes that related to the study aim. Data was analysed by two researchers in several cycles, alternating between inductive and deductive approaches. Results: A total of 49 interviews were conducted. Duration of the interviews varies between 21 and 78 min (mean duration 43 min). Across all groups, more than two thirds of participants were female (n = 34, 69%). The analysis highlighted six interdependent main themes regarding factors that affect information flows between hospitals and general practices: organisational, legal, financial, patient factors, individual characteristics, and emotional & social factors. The latter theme emerged as particularly rich and was therefore divided into four subthemes: appreciation and understanding of the respective other, (intrinsic) motivation, socialisation, and relationships. Organised meetings and events were mentioned as strategies to address emotional and social factors. Conclusions: Digitalisation can facilitate information flows between care providers. However, knowing each other and good personal relations remain important for effective collaboration. Cooperation between all stakeholders is needed to aim to achieve continuity of care. Trial registration: DRKS00015183 on DRKS/ Universal Trial Number (UTN): U1111-1218–0992. Date of registration 23/08/2018. [ABSTRACT FROM AUTHOR]

Aim: To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis. Background: Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place. Method(s): An international qualitative descriptive study based on the positive deviance approach conducted in 2019−2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. Results: Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. Conclusion: Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other. Implications for Nursing Management: Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required. [ABSTRACT FROM AUTHOR]

Summary: This study examines the experiences of German social workers who provided services to refugees during the refugee crisis of 2014–2016. Interviews were conducted in 2016 in two regions of Germany, Berlin/Brandenburg (n = 18) and Würzburg (Bavaria; n = 16). Researchers used a semi-structured interview guide complemented by a five-item Likert-type instrument. Questions explored Social Service Provider's Background and Training, Refugees' Needs, Role of Faith in Coping, and Recommendations for Universities and Churches and measure Effectiveness of Services, Adequacy of Resources, Benefits to Refugees, and Extent of Work-Related Stress. Findings: A thematic analysis indicates social workers feel Germany has effectively responded to paramount refugee needs. Social workers emphasize the importance of learning to see people "eye-to-eye," cultivating empathy, cross-cultural competence, overcoming personal biases, and self-reflection. Applications: Findings suggest social workers who practice with refugees should devote attention to the development of personal attributes to facilitate effective service delivery (e.g. learning to respond empathetically, practicing self-reflection, and treating refugees as equals) and refining practical skills (e.g. study of refugee and immigration law nationally and internationally and development of cross-cultural knowledge and understanding). Suggestions include learning a greeting in another language or understanding gender roles in different cultures. The usefulness of cultural immersion gained by spending time abroad was highlighted; such experiences allow one to cultivate the ability to be open-minded, encourage the development of a capacity to empathize with members of under-represented groups, and prevent the tendency of seeing refugees or migrants as "the Other" (Said, 1978). [ABSTRACT FROM AUTHOR]

Music therapists are expected to attain and maintain a broad range of multicultural competencies. In order to do so, a group of students participated in a study-abroad program in music therapy, involving classroom learning, community building, a clinical placement, and attendance at an international conference. A sample of these students participated in a qualitative interview study to explore what they learned. Results suggest that the program led to changes in students’ views of music therapy practice, the music therapy profession, and their definition of music therapy. The profession of music therapy is thus viewed as culturally situated, underscoring the importance of cultural self-awareness. The discussion contextualizes the results of these learning experiences using a Piagetian framework. Recommendations for music therapy faculty and organizations are drawn from the study findings. [ABSTRACT FROM AUTHOR]

Background and Purpose: In Germany, life story work, an approach which acknowledges humans as narrative beings and honors biographies, is required by health authorities to be integrated in care provided in nursing homes. Insufficient attention to life story work could place residents at risk of dehumanization, particularly residents with dementia, who depend on support of others to tell and make meaning of their life experiences. Methods: We conducted a qualitative study to gain insights into care providers' perceptions and practices of life story work with persons with dementia. Thirty-six care providers in 7 nursing homes participated in semi-structured interviews or group discussions. We derived subjective theories (individual understandings) of care providers and higher-order concept patterns following the principles and processes of grounded theory. Results: We found a great variation in participants' understandings of life story work. Some participants were unsure if and how life story work impacts persons with dementia. Starting points for improving the integration of life story work into practice are discussed. Implications for Practice: We conclude that care providers need a better understanding of life story work as a nursing intervention. The importance of the notion of humans as narrative beings and the multiple ways in which we story our lives as well as embody life stories needs to be further developed. Knowledge is required about the practical and systemic challenges of integrating life story work in the care of persons with dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. Background Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients' perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. Design A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. Methods Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. Results Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. Conclusions Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as 'feeling someone is there for you'. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. Relevance to clinical practice Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended. [ABSTRACT FROM AUTHOR]

Background: Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions. Aim: Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents. Design: We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis. Setting/participants: We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender. Results: The decisions about medical indication were based on considerations relating to the individual patient, to the family, and to other patients. Individual patient factors included clinical aspects and benefit–burden considerations. Physicians’ individual views and feelings influenced their decision-making. Different factors were applied or weighed differently in the two cases. In case of conflict with parents, physicians preferred solutions aimed at establishing consensus. Conclusion: The pediatricians defined medical indication on a case-by-case basis and were influenced by emotional reasoning. In contrast to prevailing ethico-legal principles, they included the interests of other persons in their decisions. Decision-making strategies should incorporate explicit discussions of social aspects and physicians’ feelings to improve the transparency of the decision-making process and reduce bias. [ABSTRACT FROM AUTHOR]

Background: Medical errors have been recognized as a relevant public health concern and research efforts to improve patient safety have increased. In palliative care, however, studies on errors are rare and mainly focus on quantitative measures. We aimed to explore how palliative care patients perceive and think about errors in palliative care and to generate an understanding of patients' perception of errors in that specialty. Methods: A semistructured qualitative interview study was conducted with patients who had received at least 1 week of palliative care in an inpatient or outpatient setting. All interviews were transcribed verbatim and analysed according to qualitative content analysis. Results: Twelve patients from two centers were interviewed (7 women, median age 63.5 years, range 22-90 years). Eleven patients suffered from a malignancy. Days in palliative care ranged from 10 to 180 days (median 28 days). 96 categories emerged which were summed up under 11 umbrella terms definition, difference, type, cause, consequence, meaning, recognition, handling, prevention, person causing and affected person. A deductive model was developed assigning umbrella terms to error-theory-based factor levels (definition, type and process-related factors). 23 categories for type of error were identified, including 12 categories that can be considered as palliative care specific. On the level of process-related factors 3 palliative care specific categories emerged (recognition, meaning and consequence of errors). Conclusion: From the patients' perspective, there are some aspects of errors that could be considered as specific to palliative care. As the results of our study suggest, these palliative care-specific aspects seem to be very important from the patients' point of view and should receive further investigation. Moreover, the findings of this study can serve as a guide to further assess single aspects or categories of errors in palliative care in future research. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors. Design:A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis. Results:Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants’ current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits ‘openness’ and ‘conscientiousness’, belief in medical progress, characteristics of the medication, level of trust in one’s physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events. Conclusion:The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants’ ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers. [ABSTRACT FROM PUBLISHER]

Background: The Integrated Palliative care Outcome Scale is a newly developed advancement of the Palliative care Outcome Scale. It assesses patient-reported symptoms and other concerns. Cognitive interviewing is recommended for questionnaire refinement but not adopted widely in palliative care research. Aim: To explore German- and English-speaking patients’ views on the Integrated Palliative care Outcome Scale with a focus on comprehensibility and acceptability, and subsequently refine the questionnaire. Methods: Bi-national (United Kingdom/Germany) cognitive interview study using ‘think aloud’ and verbal probing techniques. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis and pre-defined categories. Results from both countries were collated and discussed. The Integrated Palliative care Outcome Scale was then refined by consensus. Setting/participants: Purposely sampled patients from four palliative care teams in palliative care units, general hospital wards and in the community. Results: A total of 15 German and 10 UK interviews were conducted. Overall, comprehension and acceptability of the Integrated Palliative care Outcome Scale were good. Identified difficulties comprised the following: (1) comprehension problems with specific terms (e.g. ‘mouth problems’) and length of answer options; (2) judgement difficulties, for example, due to the 3-day recall for questions; and (3) layout problems. Combining the results from both countries (e.g. regarding ‘felt good about yourself’) and discussing them from both languages’ perspectives resulted in wider consideration of the items’ meaning, enabling more detailed refinement. Conclusion: Cognitive interviewing proved valuable to increase face and content validity of the questionnaire. The concurrent approach in two languages – to our knowledge the first such approach in palliative care – benefited the refinement. Psychometric validation of the refined Integrated Palliative care Outcome Scale is now underway. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effects of a nurse-led, hospital-based heart failure specific education session with a three-month telephone follow-up on self-care behaviour, care dependency and quality of life for patients with chronic heart failure. Background Patient education in patients with heart failure is able to promote heart failure-specific self-care, to reduce mortality, morbidity and rehospitalisation rates and to enhance quality of life, especially if heart failure education is embedded in a multidisciplinary approach. Evidence of the effect of a nurse-led self-care education, quality of life and care dependency in addition to standard medical treatment in Germany is lacking. Design Nonblinded, prospective, single-centre, randomised controlled trial. Method Sixty-four patients were allocated either to the intervention group or to the control group. Patients in the intervention group received education about heart failure self-care with a consecutive telephone follow-up over three months in addition to standard medical treatment. Patients in the control group received standard medical treatment only. Results Data of 110 patients (58 in the intervention group and 52 in the control group) with a mean age of 62 years and mean left ventricular ejection fraction of 28·2% could be analysed. Self-care education had a significant influence on overall heart failure self-care but not on quality of life and care dependency. Conclusion A single education session with a consecutive telephone follow-up is able to improve overall self-care behaviours but not quality of life. Care dependency was not influenced by the education session. Relevance to clinical practice The easy to implement and short educational intervention has a positive effect on self-care behaviour for patients with heart failure. However, there was no effect on quality of life and care dependency. To improve quality of life and to influence care dependency, different measures have to be applied. [ABSTRACT FROM AUTHOR]

Secondary transfer effects ( STEs) of intergroup contact refer to the generalization of contact effects from a primary encountered outgroup to attitudes towards secondary outgroups (Pettigrew, 2009). Using two large, cross-sectional data sets from Germany ( N = 1,381) and Northern Ireland ( N = 1,948), this article examined the extent to which STEs of intergroup contact on attitudes towards a range of secondary outgroups occur via a previously unexplored psychological construct, social identity complexity (operationalized as similarity complexity and overlap complexity). Study 1 found primary outgroup contact to be associated with greater similarity complexity, but no indirect effects on secondary outgroup attitudes via complexity emerged. Study 2, however, revealed indirect positive relationships between primary outgroup contact and secondary outgroup attitudes via increased similarity complexity and overlap complexity. These relationships were obtained while controlling for two previously tested mediating mechanisms, attitude generalization (operationalized as primary outgroup attitude) and deprovincialization (operationalized as ingroup attitude and identification). We discuss the theoretical implications of these findings and the contribution of social identity complexity to understanding processes underlying STEs of contact. [ABSTRACT FROM AUTHOR]

The social amplification of risk framework highlights the role which the news media play in risk communication by interacting with other agents in amplifying risk. However, the precise ways in which the media and other social agents actually amplify risks in public debates are unclear. In this article we draw on insights from the sociology of news to examine whether and to what extent social agents and news media amplify an emerging health risk. We use the debate about theEscherichia colioutbreak in Germany in 2011 to examine three issues: the amount of risk reporting by news media and social agents in their function as news sources; their evaluation of risk; and how they contribute to the escalation of risk, also known as ripple effects. In this article we draw on data from a content analysis of press releases from public health authorities and affected stakeholders and of news items in leading German news media. We found that the affected stakeholders were amplifying the risk to the greatest extent. We also found that there was a shift over time in the use of dominant frames. At the start of the debate the risk was framed as a public health issue and linked to medical-scientific progress. As the debate developed, more attention was given to political and economic consequences of the outbreak and the original health risk event was layered by other risk-related events. [ABSTRACT FROM PUBLISHER]

The article discusses an ethnographic research conducted between summer 2007 and winter 2010/11 and included interviews with rejected black African asylum seekers about their illness experiences, living conditions, and interactions with health staff and administrators in eastern Germany. It looks at the racialization of asylum seekers and the bureaucratic challenges they faced at the Social Office to access health care. It also explores German asylum law and the policy context of health care.

Background: Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. Aim: To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. Design: Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. Setting/Participants: Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. Results: In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. Conclusions: The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making. [ABSTRACT FROM AUTHOR]

Aim: We investigate opinions regarding which preventative services should be given priority funding; the importance of primary, secondary and tertiary prevention; and bivariate associations between the respondents’ sociodemographics, health status and lifestyle and their preferences. Subjects and methods: Computer-assisted personal interviews (CAPI) were conducted with participants from a regional quota sampling by sex, age and socioeconomic status (SES) in Germany. Participants were asked to indicate whether they would keep the status quo, expand or reduce health-care provision for eight primary, six secondary and four tertiary preventative services. Furthermore, they stated the importance of primary, secondary and tertiary prevention on a four-point Likert scale. Data were evaluated using contingency analysis and correspondence analyses. Results: One hundred and three people completed the survey. The majority of participants opted for expanding non-medical primary preventative services like health education and counselling and for expanding secondary preventative services like cancer screening. For tertiary prevention, like rehabilitation, the desired service distribution depends on the specific preventative services. There were few differences in answers to the questions on the importance of the provision in primary, secondary and tertiary prevention. Bivariate associations between the respondents’ characteristics like age, SES, health status and lifestyle and their preferences could be observed. Conclusion: Primary preventative services and disease detection should receive more funds. No consistent pattern could be detected for tertiary prevention. Respondents expressed some differences of opinion on the importance of types of prevention. The differences are related to knowledge, personal circumstances and interests of the respondents. [ABSTRACT FROM AUTHOR]

Aims (1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship. Background Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses. Design The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability. Methods Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1) . Results Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability . The positive relationship was stronger for older nurses. Conclusion Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers. [ABSTRACT FROM AUTHOR]

Background: Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term “integrative medicine” with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a “conventional framework of thinking”. The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general.Methods: We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software max qda.Results: Overall the current terminology was seen as a problem, although most experts agreed that the term“integrative medicine” (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When intervieweesdiscussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine.Conclusion: The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems"should look like in the future. [ABSTRACT FROM AUTHOR]

This article argues that a sense of local belonging and emotional attitudes to one’s neighbourhood are inherently interconnected. It explores immigrant children’s emotional experiences of their neighbourhoods in Paris and Berlin through subjective maps drawn by the children. The article highlights the social and spatial nature of immigrant children’s belongings, and how their different emotional geographies are connected to differential access to material resources, extra-curricular education and their migration histories. [ABSTRACT FROM AUTHOR]

Background: To ensure high quality patient care an effective interprofessional collaboration between healthcare professionals is required. Interprofessional education (IPE) has a positive impact on team work in daily health care practice. Nevertheless, there are various challenges for sustainable implementation of IPE. To identify enablers and barriers of IPE for medical and nursing students as well as to specify impacts of IPE for both professions, the ‘Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania’ (Care-N Study M-V) was conducted. The aim is to explore, how IPE has to be designed and implemented in medical and nursing training programs to optimize students’ impact for IPC. Methods: A qualitative study was conducted using the Delphi method and included 25 experts. Experts were selected by following inclusion criteria: (a) ability to answer every research question, one question particularly competent, (b) interdisciplinarity, (c) sustainability and (d) status. They were purposely sampled. Recruitment was based on existing collaborations and a web based search. Results: The experts find more enablers than barriers for IPE between medical and nursing students. Four primary arguments for IPE were mentioned: (1) development and promotion of interprofessional thinking and acting, (2) acquirement of shared knowledge, (3) promotion of beneficial information and knowledge exchange, and (4) promotion of mutual understanding. Major barriers of IPE are the coordination and harmonization of the curricula of the two professions. With respect to the effects of IPE for IPC, experts mentioned possible improvements on (a) patient level and (b) professional level. Experts expect an improved patient-centered care based on better mutual understanding and coordinated cooperation in interprofessional health care teams. To sustainably implement IPE for medical and nursing students, IPE needs endorsement by both, medical and nursing faculties. Conclusion: In conclusion, IPE promotes interprofessional cooperation between the medical and the nursing profession. Skills in interprofessional communication and roles understanding will be primary preconditions to improve collaborative patient-centered care. The impact of IPE for patients and caregivers as well as for both professions now needs to be more specifically analysed in prospective intervention studies. [ABSTRACT FROM AUTHOR]