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Background: Patients with dementia (PwD) are a vulnerable group and caring for these patients in acute care hospitals is challenging. Structural conditions and standardized treatment procedures in hospitals often do not correspond to the needs of this patient group. Physicians may not be well prepared for caring for PwD.Objective: This study aimed to ascertain physicians’ experiences and attitudes in caring for PwD or cognitive disorders and their subjective workload. This describes physicians’ estimation of the share of the overall workload resulting from caring for PwD on the ward. Furthermore, we identified factors that are most likely to contribute to the workload.Material and methods: An online survey was conducted using a self-developed standardized questionnaire with 29 questions based on a systematic literature review. The questionnaire was pretested in several steps and finally sent out via e‑mail to 610 physicians in 9 hospitals in northern Germany. Aspects surveyed were: physicians’ confidence in caring for PwD and resulting workload, challenges in caring for PwD, collaboration with relatives and other professionals and educational needs. Important influencing factors were determined by multiple linear regression analyses.Results: A total of 192 hospital physicians completed the questionnaire (response rate 32%). According to respondents the proportion of PwD in acute care hospitals increased significantly during the last 3 years. Only one third of respondents reported feeling confident in caring for PwD and 65% stated that they do not feel confident in caring for PwD especially in situations of nutrition in cases of food refusal and distinguishing between delirium and dementia. The strongest influencing factors were increased efforts in terms of time and support needs, complex medical situations, difficult collaboration with relatives and lack of patient compliance. A successful collaboration with other professionals was associated with increased confidence in caring for PwD. Legal and ethical aspects as well as drug therapies were mentioned as desirable topics for educational programs.Conclusion: A relevant number of hospital physicians feel insecure and burdened in caring for PwD. The study provides important information for the design of educational programs and for potential changes in structural and procedural aspects. The results may be used as starting points for improving hospital care for PwD. [ABSTRACT FROM AUTHOR]

Physical restraints such as bedrails and belts are used regularly in care facilities and home care, despite a lack of evidence for their effectiveness in preventing falls and injuries in care recipients. We aimed to implement a guideline-based multicomponent programme on physical restraints reduction that has been shown to be effective in nursing home care. Material and Methods Before-after study conducted in home care services and nursing homes of the "Workers Welfare Association" in northern Germany. Intervention materials, originally developed for nursing homes, were adapted for use in home care. A total of four one-day training courses for nurses were conducted. Participants received the guideline on physical restraints, associated materials (e.g. leaflet and brochures) and structured telephone counselling for 12 months. Prior to the intervention and after one year, prevalence of physical restraint use was assessed by direct observation. The primary endpoint was the percentage of care recipients with at least one physical restraint after one year. Results Nine home care facilities and 15 nursing homes took part in the study and 34 nurses were trained. In nursing homes, the number of residents with physical restraints was reduced from 13.4% (15 facilities, 103/771 residents) to 6.8% (13 facilities, 49/719 residents), ARR 6.6% (p = 0,001). In home care, the number of clients with physical restraints was reduced from 5.3% (7 services, 38/719 clients) to 4.3% (8 services, 26/605 clients), ARR 1% (p = 0.4). Conclusions The guideline-based programme could successfully be adapted and implemented for the needs of home care services and nursing homes of the "Workers Welfare Association", a large care provider in Germany. However, not all invited services agreed to take part in the intervention. Regular training and updates are necessary for permanent implementation. The limited data on home care suggest that the programme could also be effective here, warranting evaluation by a randomised controlled trial. [ABSTRACT FROM AUTHOR]

The relevance of nurses' attitudes for establishing an evidence-based nursing practice (EBP) has been proven internationally. For German-speaking countries so far only few data are available. The present survey aims at assessing nurses' perceptions of relevant context factors for implementing an EBP. Therefore, 1384 nurses in 21 hospitals in Northern-Germany received a self-developed questionnaire based on established instruments in March and April 2012. 1023 (74 %) nurses responded. In principal, results show a positive attitude towards EBP. The majority of participants regards research as relevant for nursing practice. Support from superiors and colleagues is seen as important prerequisite. However, implementation remains a challenge. Nurses are not informed about recent research results. Original articles are hardly used. Only a minority is prepared to spend own money on congresses or to start academic nursing training in the near future. For the first time in German-speaking countries, the study provides meaningful data on nurses' attitudes towards EBP. Nurses confirm the value of research for their own practice. However, there is a lack of basic requirements to identify and implement relevant research findings as for example the use of recent scientific evidence. Nursing education in Germany should therefore focus more strongly on building competencies required for EBP, for example through properly designed academic nursing training.