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AIM: Nurse-led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self-care abilities. This study compared patients' improvements of self-care abilities and frequency of readmission rate between nurse-led care and regular nursing care within the acute hospital setting. DESIGN: A quasi-experimental design within a real-world setting was used for this work. METHODS: We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse-led care). After propensity score matching, the study cohort consisted of 612 patients. RESULTS: From admission to discharge, nurse-led care patients showed superior improvements of total self-care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse-led care were furthermore less frequently readmitted to hospital compared with the control group patients. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. ispartof: NURSING OPEN vol:10 issue:6 ispartof: location:United States status: Published online

Aim: To gain insight into the experiences of family caregivers who accompanied a loved one during voluntary stopping of eating and drinking and to identify similarities and differences between cases of voluntary stopping of eating and drinking to develop a conceptual model. Design: A qualitative holistic multiple case study. Methods: We conducted narrative interviews with family caregivers (N = 17). We first analysed them inductively within the cases, followed by a cross-case analysis to merge the experiences into a conceptual model. Results: Family caregivers who could accept their loved one's wish to die stood up for the last will, especially when the cognitive abilities declined. They had to take on the role of an advocate to protect their self-determination from others who tried to interrupt the process. In their advocacy, they found themselves constantly in moral discrepancies. Usually without support, they provided nursing care until death. The subsequent processing phase was characterized by evaluating the dying situation and placing voluntary stopping of eating and drinking in their value scheme.

Background: In Switzerland, health professionals in Advanced Practice (AP) roles care to fulfil their patients’ unmet needs, despite lack of a legal basis for the AP scope of practice. In 2016, the Swiss parliament voted against establishing a framework for AP regulation, contributing to informal practice and lack of role clarification. Despite this, universities in Switzerland continue to train Nurses, Midwifes and Physiotherapists in Advanced practice at a master level, such as in the Master of Science programs at ZHAW Zurich University of Applied Sciences. Since 2019, students acquire competencies in interprofessional collaboration and the development, implementation and evaluation of AP-roles in an interprofessional education module. The purpose of this research was to evaluate the education module for Advanced Practice competencies and to explore how well it prepares students for their future AP including the development and implementation of their roles. Methods: Data was collected between 2020-2022 using standardized questionnaires, students’ reflective notes and focus group discussions with students and lecturers. Data were analyzed using descriptive statistics and content analysis techniques. Findings: In total, 67 students participated in the standardized questionnaires and 114 reflective notes were included in the analysis. 8 focus group discussions were performed involving 28 students and 37 lecturers. Students described the education module as having high clinical relevance. They were able to complete a work shadowing in different institutions and develop a role description as part of their assignment. The interprofessional elements across the module facilitated role clarity by allowing discussions and critical reflections. Exchanges with other health professionals made it possible for students to take on new perspectives on AP roles and raised their awareness of the importance of stakeholder involvement in practice development projects. Students felt prepared to outline strategies for implementing AP roles within a specific context and health care setting. Conclusion: This education module prepares students for the development and implementation of new AP roles while also facilitating reflection and interprofessional collaboration. As health professionals in AP roles are expected to continue to play an important role in the Swiss health care system, it remains important to evaluate their education and its clinical relevance and practice impact.

Aim: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. Design: A cross-sectional survey. Methods: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. Findings: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

Aims: We aim to evaluate the effectiveness of the Integrated Palliative Care Outcome Scale for people with dementia-based case studies to improve the caring quality for people with dementia in nursing homes by frontline staff and family members. Background: Swiss nursing homes mostly care for people with dementia. This population is at high risk of receiving little to no palliation for their complex needs. The majority of Swiss frontline healthcare staff do not systematically report on the needs of their residents. Additionally, family members do not routinely participate in assessment processes. Design We will conduct a stepped-wedge cluster randomized trial of repeated assessment using the Integrated Palliative Care Outcome Scale for people with dementia (IPOS-Dem) and subsequent case studies. Clusters will consist of Swiss nursing homes randomly assigned to one of three sequential intervention time points. Methods: The study population will consist of people with dementia living in nursing homes with and without specialized dementia care facilities. Over 16 months, staff working at the frontline and family members will assess the needs and concerns of people with dementia using IPOS-Dem. Depending on sequence allocation, facilitated case studies will start after 3, 6 or 9 months. The primary outcome will be caring quality measured by QUALIDEM. The secondary outcome will be symptoms and concerns, as indicated by the IPOS-Dem sum-score. The Zürich Ethics Committee approved the study in 2019 (2019-01847). Impact: The results of this study will contribute to improving the effectiveness of person-centred care for people with dementia. Collaboration between healthcare staff and family members will be systematically developed and built upon thorough assessment using the IPOS-Dem and related case studies. The use of IPOS-Dem will offer all frontline staff a systematic approach to have an independent voice within the nursing process, regardless of their qualification or grade.

Purpose: Patient-centeredness, evidence-based interventions, and interdisciplinary teamwork have been described as key in neurological rehabilitation nursing. In order to develop future action plans, a group of Swiss rehabilitation nurses sought agreement on concrete principles that led the efforts to develop a common understanding of rehabilitation nursing care in Switzerland. Design : A three-round Delphi study was conducted. Methods: Literature-based statements were formulated and sent out twice to 54 rehabilitation nursing stakeholders. In the third round, the participants ranked the three most important statements out of 13. Findings: Highest priority reached the statements: Rehabilitation nursing care (1) considers the uniqueness of the patients and their family, (2) offers support that promises the greatest potential for patients and their family, and (3) uses evidence-based knowledge. Conclusion: Statements on patient- and family-centeredness were ranked highest. Patients and families’ preferences have to be considered as much as evidence-based knowledge and interventions to support patients and family. Clinical Relevance: The study supported the discussion on action plans and enlivened new services and nursing interventions in a Swiss nursing community.

While our knowledge on the occurrence of rationed and missed nursing care and its associations with patient and nurse outcomes has increased, we still know very little on how we can effectively reduce and limit the level of rationed and missed nursing care. There are several interventions reported in the literature (e.g., staff planning and teamwork development) that have the potential to reduce and limit rationed and missed nursing care, as well as positively influence the performance of selected nursing care activities. Yet, the number of studies and the level of evidence is low. There are currently no studies dealing with interventions focused on safety climate, ethical climate, or nurse education and experience, all of which might offer a potential benefit as they have shown to predict rationed and missed nursing care. Moreover, there is a lack of studies on the use of technology (e.g., telehealth, robotics) to support nurses, e.g., in the process of decision-making and priority setting. Implementation science could provide guidance on the development, implementation, and evaluation of effective interventions to reduce and limit rationed and missed nursing care and help tackle some of the methodological challenges to generate the needed evidence to understand, when, why, and how such interventions work. The aim of this chapter is to provide a synthesis of the literature and give some future perspectives on interventions that may reduce or limit rationed and missed nursing care.

Background: Voluntary stopping eating and drinking (VSED) is an option for people wishing to bring about premature death. In Switzerland, VSED is considered a controversial action at the end of life in the guidelines for “Management of dying and death,” which states that the decision to support or oppose VSED must be made individually by health care professionals; so far there are no instructions for action. The aim of this research was to explore the experiences of people who play an important role in VSED accompaniment, and to explain how the people involved in the process deal with VSED. Methods: This convergent mixed methods study included a national survey (n=1,681) and five focus group interviews (n=47). Data integration was conducted using the four-stage pillar integration process. Results: Given Swiss society interest, VSED has already established itself in the health system without the institutions having addressed the issue, whereupon health professionals make individual decisions when a person willing to die comes to them with a VSED wish. Health professionals are open to VSED, but are also ambivalent and would like to know more about it before being confronted with a VSED case. Conclusions: In Switzerland, VSED has become a rare but desired option for ending life prematurely. While health professionals are already being confronted with the phenomenon, there is a lack of discussion at the level of health institutions about how to deal with it.

Einleitung: Ziel dieser Arbeit ist zu beschreiben, worum es sich bei der Schichtübergabe am Patientenbett (BSR) handelt, sowie aufzuzeigen und zu begründen, welche Outcomes in aktueller Forschungsliteratur bei der Implementierung von BSR ersichtlich sind. Methodik: Zwischen August und Oktober 2020 fand eine systematisierte Literaturrecherche statt, in welcher nach Studien mit quantitativen und qualitativen Daten sowie Reviews recherchiert wurde. Rechercheergebnisse: Für die Bearbeitung der Fragestellung wurden zwei Reviews und fünf Studien einbezogen, in welchen Outcomes nach der Implementierung von BSR untersucht wurden. Outcomes zur Patientensicherheit, zur Privatsphäre von Patient_innen und zu personenzentrierter Pflege (PCC) kommen in den gewählten Forschungsartikeln wiederholt vor. Diskussion: Es ist unklar, welche Auswirkungen BSR auf die Patientensicherheit hat. Während der Schichtübergabe sind drei Rollen erkennbar, die antretende und abtretende Pflegefachperson und der_die Patient_in. Pflegefachpersonen benötigen Skills, um BSR und Patientenpartizipation effektiv umzusetzen und zu fördern, wobei am häufigsten die Gefährdung des Datenschutzes von Pflegefachpersonen als Barriere gesehen wird. Schlussfolgerung: BSR erfüllt viele Kriterien der PCC nach dem Person-Centred Practice Framework von McCormack und McCance (2010). Es muss weiter erforscht werden, wie Pflegefachpersonen auf die Implementierung von BSR und die damit einhergehenden Barrieren vorbereitet werden können.

Background: Public involvement is increasingly considered a prerequisite for high-quality research. However, involvement in palliative care is impeded by limited evidence on the best approaches for populations affected by life-limiting illness. Aim: To evaluate a strategy for public involvement in palliative care and rehabilitation research, to identify successful approaches and areas for improvement. Design: Co-produced qualitative evaluation using focus groups and interviews. Thematic analysis undertaken by research team comprising public contributors and researchers. Setting/participants: Researchers and public members from a palliative care and rehabilitation research institute, UK. Results: Seven public members and 19 researchers participated. Building and maintaining relationships, taking a flexible approach and finding the ‘right’ people were important for successful public involvement. Relationship building created a safe environment for discussing sensitive topics, although public members felt greater consideration of emotional support was needed. Flexibility supported involvement alongside unpredictable circumstances of chronic and life-limiting illness, and was facilitated by responsive communication, and opportunities for in-person and virtual involvement at a project- and institution-level. However, more opportunities for two-way feedback throughout projects was suggested. Finding the ‘right’ people was crucial given the diverse population served by palliative care, and participants suggested more care needed to be taken to identify public members with experience relevant to specific projects. Conclusion: Within palliative care research, it is important for involvement to focus on building and maintaining relationships, working flexibly, and identifying those with relevant experience. Taking a strategic approach and developing adequate infrastructure and networks can facilitate public involvement within this field.

ContextThe unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs.ObjectiveIdentify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.MethodsWe conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool’s relationship to delivering defined palliative interventions, and the number of palliative care domains covered.ResultsThe majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research.ConclusionA new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.

To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.Scoping review.We searched for eligible studies, published between 1980-2019, in six electronic databases.Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.目的: 整理归纳已发布的关于已制定并予以测试的干预措施的研究,避免或减少护理机构中护理服务受限或缺失的比例。 背景: 服务受限和缺失的护理已进行过广泛研究,包括其预测因子和对患者和护士影响的相关性。 设计: 范围评估。 数据来源: 我们在六个电子数据库中查询了1980年至2019年期间所有符合条件的研究。 评估方法: 研究员利用纳入和排除标准独立筛选了所检索的研究摘要,并基于共识决定是否包含某项给定研究。 结果: 本研究共筛选了1815条研究记录,共纳入13条。其中三项研究报告了结构性干预,即,增加护士人员配置,加强护理团队,这两项措施均大大减少了护理服务受限或缺失的比例。其余10项研究涉及过程干预:其中4项与提醒机制有关(通过技术手段或指定人员),7项研究说明了采取干预措施可以改变甚至优化相关护理过程。全部10项过程干预研究均得出结论,可以极大降低护理缺失的比例。 结论: 范围评估的结果说明,特定干预可以对选定护理活动的绩效产生积极影响,例如,预防跌倒。但尚无证据表明这些干预措施可以全面降低护理服务受限和缺失比例。 影响: 临床医生、管理人员和研究员可以利用这些结果修改并实施干预,从而减少护理服务受限和缺失的情况。.

Editorial

Background The phenomenon of unfinished nursing care is gaining increasing interest among nursing researchers. While survey studies on the underlying concepts, e.g., implicit rationing of nursing care, revealed frequencies, antecedents and consequences, little is known about how nurses experience care rationing in clinical practice. Objectives The aim of this study was to explore nurses’ experiences with implicit rationing of nursing care in acute-care hospitals. Design We conducted a qualitative study using interpretive description methodology. Methods Using a convenience sample of 31 frontline nurses (i.e., registered nurses, nurse assistants) and 19 ward nurse managers from acute care units in seven hospitals in [Blinded], eight semi-structured focus group interviews were conducted, transcribed verbatim and analyzed via thematic analysis. Results Our findings indicate three interconnected themes: (a) maintaining stability within complexity; (b) applying strategies to limit rationing; and (c) nursing care between ideal and reality. According to study participants, implicit rationing of nursing care results when nurses cannot otherwise maintain stability for their patients and their units. Nurses reported several strategies, including postponing tasks or reducing quality, to prevent or limit rationing. Rationing accentuates the gap between ideal nursing care and day-to-day practice. Conclusions In absence of guidelines on implicit rationing of nursing care nurses rely on intuitive and situational processes of decision-making and priority setting. Technical activities addressing patients’ instability receive higher priority than relational ones. As quality may be an earlier casualty of implicit rationing than quantity, it challenges us to broaden the current focus of how care rationing manifests. In addition to encouraging open discourse on implicit and non-transparent rationing at all organizational levels, this qualitative study provides new insights that will inform the development and implementation of interventions to support nurses’ priority setting and ultimately to limit rationing of nursing care.

Aim To identify 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 minimize 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.

Einleitung: Erlebte Aggressionen durch Patientinnen und Patienten stellen weltweit ein zunehmendes Problem für Gesundheitsfachpersonen, insbesondere für Pflegende, dar. Erlebte Aggressionen gehen mit verschiedenen psychischen und physischen Folgen einher. Eine Möglichkeit, um der Problematik und deren Folgen entgegenzuwirken, sind Schulungen im Aggressionsmanagement. Fragestellung: Welchen Effekt haben Schulungen im Aggressionsmanagement für Pflegende im Akutspital auf deren Umgang mit Aggressionen ausgehend von Patientinnen und Patienten? Methode: Um die Fragestellung zu beantworten, wurden in den Fachdatenbanken Cinahl Complete, Pubmed, Psycinfo, Pubpsych und Cochrane Library eine systematisierte Literaturrecherche durchgeführt. Die inkludierten Studien wurden zusammengefasst, gewürdigt und deren Ergebnisse diskutiert. Anhand der gewonnenen Erkenntnisse wurden Implikationen für die Pflegepraxis und die Pflegeforschung abgeleitet. Ergebnisse: Die Ergebnisse zeigten, dass die Schulungen mehrheitlich positive Effekte auf die Aspekte Sicherheitsgefühl, Kompetenzerwartung, Einstellung gegenüber Aggressionen und Gewalt, Selbstvertrauen und Veränderungen in den praktischen Fähigkeiten haben. Schlussfolgerung: Pflegende können durch Schulungen im Aggressionsmanagement gestärkt werden im Umgang mit erlebten Aggressionen durch Patientinnen und. Die regelmässige Durchführung der Schulungen werden für die Praxisinstitutionen und die Bildungsinstitutionen empfohlen.

Hintergrund: Ein Intensivaufenthalt ist für die Angehörigen von kritisch Erkrankten belastend und kann längerfristig zu einem Symptomkomplex, dem Post Intensive Care Syndrome Family (PICS-F), führen. Das Syndrom schliesst Angst, Depression, posttraumatische Belastungsstörung (PTSD) und komplizierte Trauer mit ein und hat eine erhebliche Einschränkung der Lebensqualität zur Folge. Aktuell bestehen auf den Intensivstationen Wissenslücken bezüglich des Syndroms, was zu einer mangelnden Prävention und Behandlung dessen führt. Fragestellung: Welche pflegerischen Massnahmen können einem PICS-F bei Angehörigen von erwachsenen Patienten und Patientinnen auf einer Intensivstation vorbeugen? Methode: Durch eine systematisierte Literaturrecherche in den Datenbanken PubMed, CINAHL und PsycINFO wurden Studien ausgewählt und kritisch gewürdigt, deren Resultate anhand von weiterer Fachliteratur und des Evidence-based Nursing Modells nach Rycroft-Malone et al. (2004) diskutiert und Praxisempfehlungen abgeleitet. Ergebnisse: Neun Studien wurden eingeschlossen, die empfehlenswerte pflegerische Interventionen aufzeigen, um psychischen Belastungen bei Angehörigen vorzubeugen. Die Ergebnisse wurden in Interventionskategorien zusammengefasst: Intensivtagebücher, Familienkonferenzen, Strategien für Kommunikationsprozesse und Hilfsmittel zur Informationsvermittlung. Schlussfolgerung: Der Fokus der Praxisempfehlung liegt explizit auf der Edukation von Pflegefachpersonen und der Verbesserung von strukturierten Kommunikationsprozessen. In der Literatur sind begrenzt präventive Interventionen für ein PICS-F beschrieben, welche ein tiefes Evidenzlevel aufweisen.

Darstellung des Themas: Schweizweit wurden 2017 12.2% der Bevölkerung hospitalisiert, 0.92% (2013: 0.83%) aufgrund einer substanzbedingten Störung (Bundesamt für Statistik, 2019b). Im europäischen Vergleich ist der Kokain-, Ecstasy- und Crystal-Meth-Konsum in Schweizer Städten sehr hoch. Von 2015 bis 2017 verdoppelte sich der Kokainkonsum in Zürich (Lahrtz, 2018). Akutspitäler werden folglich zunehmend mit substanzabhängigen Personen konfrontiert. Pflegerische Interventionen zur Linderung von Entzugssymptomen werden unbedingt benötigt. Ziel: Pflegerische Interventionen zur Linderung von im Akutspital auftretenden Entzugssymptomen ermitteln. Methode: Mittels systematisierter Literaturrecherche in fünf Datenbanken vom 07.2019 bis 02.2020 wurden fünf Fachartikel und sechs quantitative Studien gefunden. Relevante Ergebnisse: Ohrakupressur und integrative Meditation verringern Entzugssymptome und verbessern Behandlungsretentionsraten. Assessmentinstrumente, Kunsttherapie, Musiktherapie, Bewegung, Kommunikationstechniken und Umgebungsgestaltung zeigen ebenfalls einen positiven Effekt. Substanzmittelabhängige Personen profitieren von einer professionellen Beziehungsgestaltung durch Pflegende. Behandlungsverträge sind hingegen kontraproduktiv. Pflegende und Gesundheitsinstitutionen fühlen sich unzureichend für die Behandlung gerüstet. Zum Beleg der Wirksamkeit der Interventionen wird mehr Forschung benötigt. Schlussfolgerungen: Es existieren kostengünstige, effektive und praktikable Ansätze pflegerischer Interventionen. Pflegende spielen bei der Betreuung im Akutspital eine entscheidende Rolle, sollten aber im Umgang mit dieser Patientengruppe durch Sensibilisierung, Aus- und Fortbildung gestärkt werden.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Objective: Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment — Acute Care (ePA-AC), this study evaluates the cognitive and associated domains. Methods: In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs). Results: Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2–10.6) and ability to acquire knowledge (OR 5.5–11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2–22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6–7.6), displayed reduced self-initiated activities (OR 6.5–6.9) and challenging behaviors (OR 6.2), as well as sleep–wake disturbances (OR 2.2–5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2–4.4), and sensory perception impairment (OR 3.9–5.8). Significance of results: Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.

Einleitung: Mit jährlich 4500 Neudiagnosen gehört Epilepsie zu den häufigsten neurologischen Erkrankungen der Schweiz. Epilepsie beeinflusst die Lebensqualität der Betroffenen individuell, weshalb das Krankheitsmanagement zentral ist. Pflegerische Interventionen können dabei Unterstützung bieten, jedoch werden solche Interventionen nur selten angeboten und sind bisher wenig etabliert. Fragestellung: «Welche pflegerischen Interventionen bieten einem Erwachsenen mit Epilepsie wirksame Unterstützung zur Verbesserung der Lebensqualität?» Methode: Zur Erarbeitung der relevanten Thematik wurde eine systematische Literaturübersicht erstellt. Es wurden in verschiedenen Datenbanken Literaturrecherchen durchgeführt und anhand konkreter Ein- und Ausschlusskriterien acht Studien ausgewählt. Aus diesen Studien wurden relevante Ergebnisse abgeleitet und eine Praxisempfehlung formuliert. Ergebnisse: Aus den Studien ging hervor, dass das Selbstmanagement bei Epilepsie zentral ist. Es zeigten sich mehrere Aspekte, welche dieses fördern können: Gruppenschulungen geleitet von Pflegefachpersonen mit vertieften Informationen zur Krankheit und dazugehörigen schriftlichen Edukationsmaterialien, Austausch mit anderen Betroffenen und kontinuierlicher Kontakt mit Pflegefachpersonen. Schlussfolgerung: Gruppenschulungen in Kombination mit Telefon- und Internetzugang erwiesen sich in dieser Arbeit als die effektivsten Interventionen zur Verbesserung des Selbstmanagements sowie der Lebensqualität und der Patientenzufriedenheit. Pflegefachpersonen können mit ihren Beratungskompetenzen die Durchführung solcher Interventionen übernehmen. Die Evidenz dazu konnte aber bis dato noch nicht genügend belegt werden.

Aim To have at hand a reliable and valid questionnaire to assess performed and missed nursing care in a Swiss acute care context. Background Regular monitoring of performed and missed nursing care is crucial for nurse leaders to make evidence‐based decisions. As foundation, we developed a conceptual definition. Based on this, we decided to translate and adapt the MISSCARE. Method In this methodological study, our newly developed German MISSCARE and previously used BERNCA‐R were tested in a pilot study using a quantitative crossover design in a sample of 1,030 nurses and midwives in three Swiss acute care hospitals. Data were analysed descriptively, then using exploratory factor analysis and Rasch modelling. Results We obtained preliminary evidence that the German MISSCARE is sufficiently reliable and valid to measure performed and missed nursing care in our context but would benefit from structural adjustments. In contrast, the BERNCA‐R proved insufficiently reliable for our purposes and context. Conclusion Our conceptual definition was essential for the development of the German MISSCARE. Our results support the decision to use this questionnaire. Implication for nursing management The adapted German MISSCARE will allow both monitoring of performed and missed nursing care over time and benchmarking of hospitals.

AIM OF THE STUDY Delirium is a frequent intensive care unit (ICU) complication, affecting 26% to 80% of ICU patients, often with serious consequences. This study aimed to evaluate the effectiveness, costs and benefits of following a standardised multiprofessional, multicomponent delirium guideline on eight outcomes: delirium prevalence and duration, lengths of stay in ICU and hospital, in-hospital mortality, duration of mechanical ventilation, and cost and nursing hours per case. It also aimed to explore the associations of delirium with length of ICU stay, length of hospital stay and duration of mechanical ventilation. METHODS This retrospective cohort study used a pre-post design. ICU patients in an historical control group (n = 1608) who received standard ICU care were compared with a postintervention group (n = 1684) who received standardised delirium management – delirium risk identification, preventive measures, screening and treatment – with regard to eight outcomes. The delirium management guideline was developed and implemented in 2012 by a group of experts from the study hospital. As appropriate, descriptive statistics and multivariate, multilevel models were used to compare the two groups and to explore the association between delirium occurrence and the selected outcomes. RESULTS Twelve percent of the 1608 historical controls and 20% of the 1684 postintervention patients were diagnosed with delirium according to the ICD-10 delirium diagnosis codes. Patients being treated for heart disease, and those with septic shock, ARDS, renal insufficiency (acute or chronic), older age and higher numbers of comorbidities were significantly more likely to develop delirium during their stay. Multivariate models comparing the historical controls with the post intervention group indicated significant differences in delirium period prevalence (odds ratio 1.68, 95% confidence interval [CI] 1.38–2.06; p

Zusammenfassung.Hintergrund: Um den zukünftigen Bedarf der Bevölkerung an medizinischen Leistungen abzudecken, sind neue Versorgungsmodelle gefragt. Der Aufbau von Advanced Nursing Practice (ANP) bietet eine Möglichkeit, diesen Herausforderungen mit neuen Angeboten zu begegnen. Im Inselspital, Universitätsspital Bern werden seit 2011 ANP-Angebote und entsprechende Advanced Practice Nurse-Rollen aufgebaut. Ziel: Es wird angestrebt, innovative und evidenzbasierte ANP-Angebote zu entwickeln, um die Versorgung für spezifische Patient(inn)engruppen und ihre Angehörigen auszubauen und mehr Sicherheit sowie bessere Ergebnisse zu erreichen. Methode: ANP-Angebote werden im Rahmen von Projekten, in enger Zusammenarbeit von Klinik und Bereich Fachentwicklung (BFE) der Direktion Pflege entwickelt. Zur Evaluation werden Struktur-, Prozess- und Ergebnisdaten erhoben. Ergebnisse: Heute sind fünf ANP-Angebote etabliert, acht weitere befinden sich im Aufbau. Die meisten Angebote sind auf eine langfristige Betreuung von Patient(inn)en mit chronischen Erkrankungen und ihre Angehörigen ausgerichtet. Zehn APN haben Anstellungen von 10 % bis 80 %, drei führen ein ANP-Team. Sie arbeiten zu über 50 % in der direkten klinischen Praxis, primär beratend. Ein ANP-Netzwerk verbindet APN und BFE, um Synergien und Austausch zu fördern. Schlussfolgerungen: Herausfordernd bei der Entwicklung von ANP-Angeboten sind oft die Ressourcen. Wesentlich für den nachhaltigen Erfolg sind ein adäquater Stellenumfang, die Unterstützung durch die Klinikleitung, das spitalweit gültige Konzept und der Aufbau im Rahmen von Projekten.

Background: Family members, or others, often assume the role of informal (unpaid) carers of people with chronic illnesses. Care-giving, however, can impact profoundly on the quality of life of carers and can cause carer worry, stress and guilt. Implementing interventions that positively affect the lives of carers is important; however, carers as a group are often difficult to reach. We embedded a study within a pilot-feasibility trial of a mindfulness based intervention to determine and prioritise the key motivators and challenges influencing informal carers’ decisions for participating in a trial. Methods: We used a multi-method approach involving interviews with participants from a ‘host trial’ and data from systematic reviews to develop a survey that was distributed to informal carers in Ireland. The survey consisted of 28 motivator and 17 challenge statements. Participants rated how important they thought each statement was when deciding to take part in a trial on a 5-point Likert Scale. Mean scores and standard deviations were calculated for each statement and arranged in descending order to provide the priority lists. Results: Thirty-six carers responded to the survey. Helping to create awareness about carers was the top ranked motivator, followed by four study design statements related to the time at which the study occurs, the study location, format of delivery and venue. The least important motivator related to how carers were invited to take part in a study. Difficulties in planning due to the caring role emerged as the most important challenge, followed by being unable to leave the care recipient on his/her own. Conclusions: Insight into decision-making for research participation will assist trial developers tailor trial processes for informal carer populations. We recommend that trialists should consider these motivators and challenges when designing future trials involving informal carers so as to enhance trial feasibility and success.

Objective For people with diabetes, severe hypoglycaemia is the most common reason for emergency service usage and emergency department (ED) presentations. Brief interventions (BI) are a recognised intervention strategy in the ED for other conditions but to date, they have not been applied to those with hypoglycemia. This review aims to identify components and outcomes of BI for people with diabetes mellitus to inform the development of BI in the ED. Method A systematic review of randomized controlled trials was undertaken in MEDLINE, CINAHL, PsychINFO and EMBASE. Studies that examined brief interventions for people with diabetes were considered. Eligible studies were critically appraised and included in a narrative synthesis. Results A total of 2475 citations were identified, 171 full papers were reviewed and four articles were included for review. The components ‘advice' and ‘assistance' from the five A Framework were the most frequently used BI components. Statistically significant improvements were achieved in psychological, functional, and satisfaction outcomes. However, clinical outcomes were not improved and economic outcomes like costs of BI were not evaluated. Conclusions The literature review demonstrated a lack of evidence related to BI in diabetes within the emergency setting despite the ED being an ideal environment. Future research needs to be conducted to investigate the effectiveness of BI for patients with diabetes.

Background Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life. Methods We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time. Results Between April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28–0.55; P

Background: When capturing patient-level outcomes in palliative care, it is essential to identify which outcome domains are most important and focus efforts to capture these, in order to improve quality of care and minimise collection burden. Aim: To determine which domains of palliative care are most important for measurement of outcomes, and the optimal time period over which these should be measured. Design: An international expert consensus workshop using nominal group technique. Data were analysed descriptively, and weighted according to ranking (1–5, lowest to highest priority) of domains. Participants’ rationales for their choices were analysed thematically. Setting/participants: In all, 33 clinicians and researchers working globally in palliative care outcome measurement participated. Two groups (n = 16; n = 17) answered one question each (either on domains or optimal timing). This workshop was conducted at the 9th World Research Congress of the European Association for Palliative Care in 2016. Results: Participants’ years of experience in palliative care and in outcome measurement ranged from 10.9 to 14.7 years and 5.8 to 6.4 years, respectively. The mean scores (weighted by rank) for the top-ranked domains were ‘overall wellbeing/quality of life’ (2.75), ‘pain’ (2.06), and ‘information needs/preferences’ (2.06), respectively. The palliative measure ‘Phase of Illness’ was recommended as the preferred measure of time period over which the domains were measured. Conclusion: The domains of ‘overall wellbeing/quality of life’, ‘pain’, and ‘information needs/preferences’ are recommended for regular measurement, assessed using ‘Phase of Illness’. International adoption of these recommendations will help standardise approaches to improving the quality of palliative care.

Voluntary stopping of eating and drinking (VSED) is a well-known phenomenon among palliative care professionals. This study intent to distinguish between different forms of VSED. In a qualitative interview study 18 relatives were interviewed about their experiences of caring a person during VSED. Different forms of oral nutrition refusal and different forms of VSED were found and described. The study results help members of the multidisciplinary team to manage the situation appropriately.

Hintergrund: Präoperative Angst (PA) manifestiert sich bei bis zu 80 % der Patienten/-innen. Sie kann schwerwiegende Folgen haben und sich ungünstig auf den Operations-, Narkose- und Genesungsverlauf auswirken. Ziel: Das Identifizieren von wirksamen, pflegerischen, nichtmedikamentösen Interventionen bei Erwachsenen zur Reduktion von PA und das Ableiten von Implikationen für die klinische Praxis. Methode: Im November 2018 wurde eine systematisierte Literaturrecherche in den Datenbanken PubMed®, CINAHL®, PsychINFO und Cochrane Library durchgeführt. Die betrachteten Studien wurden mit dem Critical Appraisal Skills Programme sowie den Quantitative Review Form Guidelines von Law u. a., (1998) gewürdigt. Ergebnisse: Es wurden 15 quantitative Studien eingeschlossen, welche alle eine angstreduzierende Wirkung aufzeigen. Drei Ansätze mit zehn Subansätzen wurden identifiziert. Ein Ansatz untersucht Entspannungsinterventionen, welche Musikintervention, multimodale Intervention, Massage, Fotovideodarstellung, Entspannungsübungen und Naturklänge beinhalten. Der zweite Ansatz stellt die Informationsvermittlung anhand einer Informationsbroschüre und eines Informationsvideo dar. Im dritten Ansatz, der psychosozialen Unterstützung, wird Bezug auf eine psychosoziale Kurzzeitintervention, ein patientenzentriertes Gespräch und die Pflegevisite genommen. Schlussfolgerung: Die eingeschlossene Literatur zeigt drei angstreduzierende Ansätze auf. Alle Interventionen können in der klinischen Praxis zur Angstreduktion angewendet werden.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Nursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.

Work orientations have attracted increased attention in recent years. The shift in focus away from manual factory workers, rising levels of qualification (e.g. Gallie and White 1998; Rose 2005), and intensified attempts by management to exert more control over workers’ subjectivity (e.g. Baldry et al. 2007) have led to a growing interest in the factors that produce and reproduce work attitudes and behavior. However, despite numerous studies – for example on job satisfaction (Kalleberg 1977) and work commitment (Lincoln and Kalleberg 1985) – knowledge of the significance of work orientations for the social relations within professional groups themselves remains limited.

Zusammenfassung. Hintergrund: Angehörige stellen für ältere Menschen, die nach einer Hospitalisation entlassen werden, eine große Ressource dar. Aus Studien ist bisher sehr wenig über die Pflegebereitschaft von Angehörigen bekannt. Ziel: Die Studie untersuchte, ob es bei Angehörigen einen Zusammenhang zwischen der Bereitschaft zur Pflege und der Zufriedenheit mit dem Austrittsmanagement sowie Gruppenunterschiede zwischen gut informierten und weniger gut informierten Angehörigen gibt. Methode: Mittels einer retrospektiven Querschnittstudie wurden neben den demografischen Daten die Bereitschaft zur Pflege, die Zufriedenheit und Informiertheit von Angehörigen erhoben. Analysen wurden zum Zusammenhang zwischen der Bereitschaft und der Zufriedenheit sowie zu Gruppenunterschieden zwischen informierten und weniger informierten Angehörigen, in Bezug auf ihre Bereitschaft, Pflege zu übernehmen, gemacht. Ergebnisse: 111 Angehörige, mehrheitlich erwachsene Nachkommen (55,9 %) und Partner (32,4 %), nahmen an der Studie teil. Es konnte eine schwache Korrelation zwischen der Zufriedenheit mit der Austrittsplanung von Angehörigen und deren Bereitschaft, Pflege zu übernehmen, nachgewiesen werden (rs = −0,113, p = 0,267). Die Gruppenunterschiede zwischen gut informierten und weniger gut informierten Angehörigen waren signifikant (t(102) = 2,301, p = 0,023). Schlussfolgerung: Angehörige, die sich als besser informiert zeigten, fühlten sich auch eher in der Lage, Pflege zu übernehmen. Deshalb ist es notwendig, Angehörige vermehrt in die Austrittsplanung einzubeziehen und besser zu informieren. Experimentelle Studien sind notwendig, um herauszufinden, ob die Pflegebereitschaft, mithilfe einer guten Austrittsplanung und gezielter Informationsabgabe, erhöht werden kann.

Die Palliative Care hat den Auftrag, den religiösen und spirituellen Bedürfnissen von Sterbenden entgegenzukommen. Doch welche Form kann religiöse Betreuung in einem Umfeld, das von naturwissenschaftlicher Medizin bestimmt wird, annehmen? Welche Rolle spielt dabei die Spiritual Care? Und findet alternative Spiritualität im Krankenhaus vielleicht eher Platz als konfessionell gebundene Religiosität? Mirjam Mezger geht diesen Fragen nach und liefert mit ihrer qualitativen Studie praxisnahe Antworten.

Diversity of the nursing workforce and multiculturalism of European cities have mandated the need for culturally sensitive nurses and midwives able to provide effective, engaging, high quality and socially just healthcare. The Florence Network is a professional network that aims to bring together like-minded professionals and to cultivate relationships amongst nurses and midwives from different European Union (EU) countries to create synergies on matters of common interest by transcending national and cultural barriers. A qualitative study based upon a focus group interview was conducted with six former Presidents and one present President of the Florence Network, each with a tenure of two years. The study explored the impact of the Florence Network in advancing cultural awareness and promoting educational, research and professional synergies. The outcome of the study identified that from the Presidents perspectives networks create awareness of cultural diversity, enable the delivery of multicultural nursing care and develop future leaders regarding global health-related issues. Furthermore, professional networks contribute to the refining of educational curricula, in developing applicable research evidence, and in sharing formal and informal professional knowledge.

Background Language plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice. Objectives This critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing. Design A critical review of the literature was performed and 24 relevant research papers were included. Data sources A search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA). Review methods Both authors independently screened the titles (n = 299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP). Findings In total, 24 publications met the inclusion criteria. Most of the studies (n = 20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language. Conclusions Health care institutions should provide more strategies for clinical practice to overcome language discordance.

Purpose The purpose of this paper is to explore the literature regarding work intensification that is being experienced by nurses, to examine the effects this is having on their capacity to complete care. The authors contend that nurses’ inability to provide all the care patients require, has negative implications on their professional responsibility. Design/methodology/approach The authors used institutional ethnography to review the discourse in the literature. This approach supports inquiry through the review of text in order to uncover activities that remain institutionally accepted but unquestioned and hidden. Findings What the authors found was that the quality and risk management forms an important part of lean thinking, with the organisational culture influencing outcomes; however, the professional cost to nurses has not been fully explored. Research limitations/implications The text uncovered inconsistency between what organisations accepted as successful cost savings, and what nurses were experiencing in their attempts to achieve the care in the face of reduced time and human resources. Nurses’ attempts at completing care were done at the risk of their own professional accountability. Practical implications Nurses are working in lean and stressful environments and are struggling to complete care within reduced resource allocations. This leads to care rationing, which negatively impacts on nurses’ professional practice, and quality of care provision. Originality/value This approach is a departure from the standard qualitative review because the focus is on the textual relationships between what is being advocated by organisations directing cost reduction and what is actioned by the nurses working at the coalface. The discordant standpoints between these two juxtapositions are identified.

Background Chronically ill persons experience conditions of life that can become unbearable, resulting in the wish to end their life prematurely. Relatives confronted with this wish experience ambivalence between loyalty to the person’s desire to die and the fear of losing this person. Caring for a person during the premature dying process can be morally challenging for nurses. One way to end one’s life prematurely is Voluntary Stopping of Eating and Drinking (VSED). Methods This embedded single case study explored the experiences of registered nurses (embedded units of analysis: ward manager, nursing manager, nursing expert) and relatives who accompanied a 49-year-old woman suffering from multiple sclerosis during VSED in a Swiss long-term care institution (main unit of analysis). By means of a within-analysis, we performed an in-depth analysis of every embedded unit of analysis and elaborated a central phenomenon for each unit. Afterwards, we searched for common patterns in a cross-analysis of the embedded units of analysis in order to develop a central model. Results The following central concept emerged from cross-analysis of the embedded units of analysis: As a way of ending one’s life prematurely, VSED represents an unfamiliar challenge to nurses and relatives in the field of tension between one’s personal attitude and the agents' concerns, fears and uncertainties. Particularly significant is the personal attitude, influenced on the one hand by oneˊs own experiences, prior knowledge, role and faith, on the other hand by the VSED-performing person's age, disease and deliberate communication of the decision. Depending on the intention of VSED as either suicide or natural dying, an accepting or dismissing attitude evolves on an institutional and personal level. Conclusions To deal professionally with VSED in an institution, it is necessary to develop an attitude on the institutional and personal level. Educational measures and quality controls are required to ensure that VSED systematically becomes an option to hasten death. As VSED is a complex phenomenon, it is necessary to include palliative care in practice development early on and comprehensively. There is a high need of further research on this topic. Particularly, qualitative studies and hypothesis-testing approaches are required.

Einleitung: Laut Lobsiger, Kägi und Burla (2016) ist jede vierte Pflegefachperson aus dem Beruf ausgetreten und jede sechste nicht mehr erwerbstätig. Belastende Situationen im Berufsalltag führen bei vielen Pflegefachpersonen zu Stress. Hält dieser über längere Zeit an, leidet die Arbeitszufriedenheit und die Gesundheit der Pflegefachpersonen. Im Extremfall droht gar ein Burnout. Eine Methode von Stressbewältigung ist der Humor. Richtig eingesetzt könnte dieser, Kündigungen und damit verbundene Fluktuationen innerhalb eines Pflegeteams reduzieren. Handlungsmethoden sind notwendig um präventives und gesundheitsförderndes Verhalten zu erzielen. Ziel: In dieser Arbeit sollen Empfehlungen für den Einsatz von Humor gegeben werden, die im Berufsalltag von Pflegefachpersonen eingesetzt werden können. Methode: Durch systematisierte Literaturrecherchen wurden sechs für das Thema relevante Studien identifiziert, zwei qualitative und vier quantitative. Diese Studien wurden kritisch beurteilt und Evidenzlevels zugeordnet. Ergebnisse: Die aus der Literatur gefilterten Ergebnisse wurden Kategorien zugeteilt: Humorverstehen, Work-Life-Balance, Kommunikation und Zeit. Schlussfolgerung: Zur Messung des Stresslevels von Pflegefachpersonen empfiehlt sich die Implementierung eines Assessmentinstruments. Humorvolle Bewältigungsstrategien werden für jede und jeden Einzelnen sowie für Pflegeteams abgegeben. Zur professionellen Anwendung von Humor sind Offenheit und der Wille notwendig. Richtig eingesetzter Humor ist eine Form der Bewältigung.

Darstellung des Themas: Laut WHO (2017) gilt die Depression weltweit als führende Ursache für Krankheit und Behinderung im Alltag, deren inadäquate Behandlung durch das Fachpersonal als Behinderungslast der Depressionsdienstleistung gilt. Zielsetzung: Die frühzeitige Identifizierung von Depressionen im Akutspital und die Sensibilisierung des Pflegefachpersonals für das Thema. Die Pflege soll um die psychische Dimension erweitert werden. Methode: Es erfolgte eine systematisierte Literaturrecherche in drei Datenbanken. Acht Studien wurden mit Hilfe eines Arbeitsinstruments analysiert. Ergebnis: Es ist auf eine fehlende Expertise bei der Identifizierung von Depressionen sowie Einleitung von Massnahmen im Verdachtsfall zu schliessen. Die Anwendung von Screening-Instrumenten zur Identifizierung einer Depression im klinischen Alltag des Akutspitals findet kaum statt. Selbst bei offensichtlicher Depression scheint dies vom Pflegefachpersonal nicht als Problematik betrachtet zu werden, die einer Behandlung wert wäre. Schlussfolgerung: Es gilt, die Expertise schon während der Ausbildung und überdies durch regelmässige Fortbildungsmöglichkeiten in Bezug auf psychische Fachkenntnisse zu verbessern und Screening-Instrumente zur Identifizierung einer Depression im klinischen Alltag zu involvieren. Das Pflegefachpersonal sollte mehr auf die eigene Rolle bei der Leistung von Depressionsdiensten sensibilisiert werden.

Die Menschen in unserer Gesellschaft werden durch verbesserte Umweltbedingungen und erhöhtem Gesundheitsbewusstsein immer älter. Dies hat zur Folge, dass trotz der fortschrittlichen medizinischen Versorgung mehr Menschen an Demenzerkrankungen leiden. Im Rahmen der Erkrankung treten zusätzlich zu den Zeichen der Demenz behaviorale und psychologische Symptome auf. Diese zeigen sich als Agitationen, Unruhe, Schreien, Umherlaufen, Aggressionen, Beschimpfungen, Depressionen und andere. Treten sie in den Nachmittags- und Abendstunden wiederholt auf, spricht man vom Sundowning. Welche non-pharmakologischen Interventionen können Pflegende durchführen, um diese belastenden Symptome zu lindern? Ziel dieser Arbeit ist es, durch eine systematisierte Literaturrecherche wirksame Interventionen identifizieren zu können. Diese sollen in dieser Arbeit vorgestellt, kategorisiert und diskutiert werden. Viele dieser Interventionen können leicht und ohne grossen Aufwand durch Pflegefachpersonen, aber auch von Angehörigen in die Praxis implementiert werden. Hervorzuheben ist hier im Vorfeld, dass Schulungen für Pflegende der Schlüssel für die erfolgreiche Umsetzung dieser Massnahmen sind.

Background: Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented. Objective: This scoping review will explore the findings on successful preparation, realisation and maintenance of interventions in nursing and midwifery. Method: Based on an existing systematic approach, relevant data bases were accessed to identify original studies relating to implementation research in nursing and midwifery. The process of study selection and the characteristics of the included studies were charted. Findings: In the four reviews and 38 studies which met the inclusion criteria, various factors leading to successful implementation are identified. Based on the included studies, four facilitating factors can be pinpointed: (1) workplace culture (16 entries), (2) leadership culture (28 entries), (3) resources (4 entries), and (4) training (22 entries). Depending on the specific phase of the implementation process (preparation, realisation, or maintenance), these factors will vary in importance. Conclusion: This scoping review provides an orientation for the field of implementation research and it maps the design, themes and results of the studies included. It should be noted that few studies take into consideration the relevant theories, as well as the influence that the researchers and the target group may have on the implementation process, or provide an exact description of the setting in which the implementation takes place.

Background Emotional exhaustion among healthcare workers is a widely investigated, well-recognized problem, the incidence of which has recently been linked to work environment factors, particularly work/family conflict. However, another environmental feature that may be equally influential, but that is more amenable to nurse manager action, remains less recognized: shift schedule flexibility. Objectives This study's main purposes were to assess variations in work schedule flexibility between Swiss acute care hospital units, and to investigate associations between psychosocial work environment (e.g. work schedule flexibility) and self-reported emotional exhaustion among registered nurses. Methods This is a secondary analysis of data collected for the multi-center observational cross-sectional Match RN study, which included a national sample of 23 hospitals and 1833 registered nurses across Switzerland. Results Overall, self-reported work schedule flexibility among registered nurses was limited: 32% of participants reported little or no influence in planning their own shifts. Work schedule flexibility (β −0.11; CI −0.16; −0.06) and perceived nurse manager ability (β −0.30; CI −0.49; −0.10) were negatively related to self-reported emotional exhaustion. Work-family conflict (β 0.39; CI 0.33; 0.45) was positively correlated to emotional exhaustion. Conclusions The study results indicate that managerial efforts to improve working environments, including special efforts to improve work schedule flexibility, might play an important role in promoting nurses' emotional health.

Aim To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. Background The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Design Hybrid model of concept development and embedded mixed-methods design. Methods The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire ‘Complexity of Nursing Care’ over a one-month period. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research program as unproblematic in December 2014 and May 2015. Discussion Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. This article is protected by copyright. All rights reserved.

Aim Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German‐speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German‐language version of the Moral Distress Scale. Design We chose a sequential explanatory mixed methods design, followed by a second quantitative cross‐sectional survey. Methods An American moral distress scale was chosen, translated, culturally adapted, tested in a pilot study and subsequently used in 2011 to conduct an initial web‐based quantitative cross‐sectional survey of nurses in all inpatient units at five hospitals in Switzerland's German‐speaking region. Data were analysed descriptively and via a Rasch analysis. In 2012, four focus group interviews were conducted with 26 nurses and then evaluated using knowledge maps. The results were used to improve the questionnaire. In 2015, using the revised German‐language instrument, a second survey and Rasch analysis were conducted. Results The descriptive results of the first survey's participants (n = 2153; response rate: 44%) indicated that moral distress is a salient phenomenon in Switzerland. The data from the focus group interviews and the Rasch analysis produced information valuable for the questionnaire's further development. Alongside the data from the second survey's participants (n = 1965; response rate: 40%), the Rasch analysis confirmed the elimination of previous deficiencies on its psychometrics. A Rasch‐scaled German version of the Moral Distress Scale is now available for use.

Ausgangslage: In der Schweiz erleiden jährlich ungefähr 8’000 Menschen einen Herz-Kreislauf-Stillstand. Weniger als 6 bis 7% der Betroffenen überleben diesen. 5 bis 13% der Personen, welche ausserhalb eines Spitales einen Herzstillstand erleiden und danach in einem Spital behandelt werden, überleben nach der Wiederbelebung bis zum Spitalaustritt. Über die psychischen Folgen einer Reanimation und deren Bedeutung im Akutspital ist wenig bekannt. Fragestellung: Wie wirkt sich das Erleben einer Reanimation psychisch auf erwachsene Patienten und Patientinnen aus und wie können diplomierte Pflegefachpersonen im stationären Setting eines Akutspitals diese Menschen unterstützen? Methode: Es wurde eine Literaturrecherche in den Datenbanken CINAHL, Pubmed, Cochrane Library und PsycInfo durchgeführt. Anschliessend wurden die Studien zusammengefasst, inhaltlich diskutiert und ein Theorie-Praxis-Transfer durchgeführt. Ergebnisse: Die Ergebnisse der Literaturrecherche ergaben, dass es eine deutliche Prävalenz von Angst und Depressionen nach einer Reanimation gibt. Das Thema an sich ist noch zu wenig erforscht, sodass es noch keine standardisierten Behandlungsschemas, Interventionen oder Assessmentinstrumente für Betroffene gibt. Schlussfolgerung: Um die Fragestellung zu beantworten, ist weitere Forschung nötig, da aktuell keine Interventionen in Schweizer Akutspitälern bestehen. Eine Sensibilisierung der Pflegefachpersonen wird benötigt, um psychische Folgen nach einer Reanimation zu erkennen und Interventionen einleiten zu können.

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.

Background: Caring for palliative patients at home is complex and challenging. Specialist palliative care exists to provide high quality of care in complex situations. This study aimed to describe the characteristics of a specialist nurse-led palliative care service in an urban Swiss region. Methods: A qualitative study design adopting a grounded theory approach was used. Semi-structured interviews were conducted with 41 participants including family caregivers, home care nurses, referring services, treating physicians, specialist nurses and external politicians. In addition, statistical information was included. Findings: Specialist nurses played an important role in building and maintaining an interdisciplinary network of care, necessary for the management of complex palliative situations. They performed tasks such as to “include” members and to “negotiate” the network of care with the family and providers. They “tailored” the support to patients and families' needs and as a result “empowered” the network of care. Conclusion: A nurse-led palliative care service facilitated interdisciplinary palliative home care to the benefit of all agents involved.

Purpose: This study evaluated the effectiveness of constipation prophylaxis administered with the support of an advanced practice nurse. Design: A quasi‐experimental study with a historical control group of 112 pediatric (age 1–18) orthopedic patients and an intervention group of 59 patients was conducted in a surgical ward in Switzerland. Results: The implementation of a standardized constipation prophylaxis led to an absolute risk reduction (27%) of constipation. Fisher's exact test showed a significant difference in the prevalence of constipation in the two samples, p = .001. Practice Implications: Constipation prophylaxis is a necessity in pediatric orthopedics.

Aims and objectives To explore the experiences of being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy. Background Overt hepatic encephalopathy is a common complication in patients with liver cirrhosis. It is associated with decreased quality of life for patients, and presents a major burden for caregivers. The involvement of informal caregivers in medical care is recommended, but it has not been clearly described. An understanding of the experience of caregivers is needed to improve the support provided to them by healthcare professionals. Design A qualitative, interpretative, phenomenological approach was used. Methods Twelve informal caregivers participated in qualitative interviews. The analysis followed the six steps of the interpretative phenomenological approach. Results Caregivers' experiences were described using five themes: (1) feeling overwhelmed by their loved one having unexplainable symptoms and behaviours; (2) learning that this and previous experiences were complications of liver disease; (3) becoming aware of the symptoms of hepatic encephalopathy; (4) having feelings of being tied down and (5) experiencing and overcoming obstacles in working with healthcare professionals. Conclusions This study provides insight into caregivers' experiences and the consequences for their lives. The first occurrence of symptoms was a shock, but receiving the diagnosis was seen as an important step in understanding and learning. Caregivers provide daily assessments of their relatives' conditions, and they feel responsible for medication management. Over time, the caregivers impressively showed how they were able to incorporate their personal experiences into caregiving and to accept more accountability in managing the disease. Relevance to clinical practice Nurses should acknowledge caregivers as experts in caring for their loved ones. Nurses can assist caregivers in managing an episode of hepatic encephalopathy and can provide individualised interventions to ease the future burden.

Zusammenfassung. Hintergrund: Elektronische Pflegedokumentationssysteme mit hinterlegter standardisierter Pflegefachsprache erfassen den Pflegeprozess IT-gestützt. Sie haben das Potenzial, die Qualität der Dokumentation des Pflegeprozesses zu verbessern und die Pflegenden in dessen Durchführung zu unterstützen. Fragestellung/Ziel: Dieser Artikel beschreibt die Entwicklung und erste Validierung eines Instruments (UEPD), das die subjektiv wahrgenommene Unterstützung Pflegender in der Umsetzung des Pflegeprozesses durch eine elektronische Pflegeprozessdokumentation misst. Methode: Die Validität des UEPD wurde anhand einer Evaluationsstudie in einem Krankenhaus (n = 94) in der Deutschschweiz untersucht. Die psychometrische Testung des Instruments wurde anhand einer Hauptkomponentenanalyse durchgeführt. Ergebnisse: Die ersten Hinweise zur Validität des Instruments konnten vorgestellt werden. Die Analyse ergab eine stabile vier Faktorenstruktur (FS = 0,89) mit 25 Items, die Faktorladungen ≥ 0,50 aufwiesen. Die Skalen zeigten hohe interne Konsistenzen (Cronbachs α = 0,73 – 0,90). Die Hauptkomponentenanalyse zeigte folgende vier Dimensionen der Unterstützung: Beim Stellen von Pflegediagnosen und -zielen; beim Erfassen von Anamnese/Assessment und im Dokumentieren des Pflegeprozesses; in der Implementierung und Evaluation sowie im Informationsaustausch. Schlussfolgerungen: Die Ergebnisse sollen in größeren Stichproben sowie mit verschiedenen Dokumentationssystemen weitergetestet werden. In einem weiteren Schritt könnte das UEPD zum Vergleich verschiedener elektronischer Dokumentationssysteme eingesetzt werden.