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Stefan Köberich,1,2 Riitta Suhonen,3 Johanna Feuchtinger,4 Erik Farin1 1Institute for Quality Management and Social Medicine, Medical Center – University of Freiburg, Freiburg, Germany; 2Pflegedirektion, Heart Center – University of Freiburg, Freiburg, Germany; 3Department of Nursing Science, University of Turku, Turku, Finland; 4Quality and Development in Nursing Care, Medical Center – University of Freiburg, Freiburg, Germany Aim: To assess validity and reliability of the German version of the Individualized Care Scale (ICS). Background: Individualized nursing care plays a pivotal role in establishing patient-centered care. To assess individualized nursing care and to compare it in different settings and countries, valid and reliable instruments are needed. No psychometric-tested instrument for comparing individualized nursing care with other countries is available in Germany. Design: Cross-sectional study. Methods: Data were collected between September 2013 and June 2014 from 606 patients in 20 wards in five hospitals across Germany. Unidimensionality of the ICS scales ICSA (patients’ views on how individuality is supported through nursing interventions) and ICSB (patients’ perceptions of individualized nursing care) was analyzed by confirmatory factor analysis. Internal consistency was assessed by calculating Cronbach’s alpha. The Smoliner Scale (patients’ perceptions of the decision-making process in nursing care) and results from participating hospitals’ assessment of the nursing care delivery systems were used to assess known-groups validity and concurrent validity. Results: Fit indices of confirmatory factor analysis indicate unidimensionality of the ICSA (Comparative Fit Index: 0.92; Tucker-Lewis Index: 0.902; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05) and the ICSB (Comparative Fit Index: 0.91; Tucker-Lewis Index: 0.89; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05). Internal consistency using Cronbach’s alpha was 0.95 (95% confidence interval: 0.94–0.95) for ICSA and 0.93 (95% confidence interval: 0.92–0.94) for the ICSB. Concurrent validity was established by a significant relationship between the Smoliner Scale and ICSA (r=0.66; P

Antje Ullrich, Johannes Hauer, Erik Farin Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany Background: Communication with patients with fibromyalgia syndrome (FMS) is often considered difficult. The primary objective of this explorative study was to describe the communication preferences of FMS patients in comparison with other chronic diseases, and the secondary objective was to identify patient-related predictors of those communication preferences. Methods: A total of 256 FMS patients were asked to fill out the KOPRA [(Kommunikationspraeferenzen), communication preferences of patients with chronic illness] questionnaire at the beginning of their rehabilitation, answering questions about their communication preferences. The KOPRA’s descriptive parameters were calculated and compared with other diagnosis groups. In order to include as many influencing factors as possible, data on patient-related sociodemographic, medical, pain impact and psychologic variables were gathered. A hierarchical regression analysis with four steps was performed to identify patient-related predictors of patients’ communication preferences. Results: FMS patients consider an open and patient-centered communication style to be especially important. Emotionally supportive communication and communication about personal circumstances are important for FMS patients, but the preferences of individual patients vary widely. FMS patients reveal higher values in all the subdimensions of communication preferences compared with patients with low back pain or chronic ischemic heart disease. Only a few variables appear to predict patient communication preferences. The explained variance ranged from 3.1% to 9.7%. Psychologic variables have been identified as predictors in conjunction with all communication preferences. Conclusion: Health care providers who communicate with FMS patients should employ an open and patient-centered communication style, and affective communication components should be adapted to accommodate each patient. Keywords: patient–provider communication, fibromyalgia syndrome, patient communication preferences, predictors

Erik Farin, Lukas Gramm, Erika SchmidtUniversity Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, GermanyBackground: The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances).Methods: Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics). The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed.Results: On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs), extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician's communicative behavior.Conclusion: Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion) is needed.Keywords: patient-physician relationship, patient-physician communication, preferences, low back pain, rehabilitation

Multilingualism in Education in Germany – a Discourse Analysis. In the Republic of Germany, language acquisition for children with a mother tongue other than German has been a widely discussed topic in education science as well as in public and political discourse over the last decades. Annual studies on preschool and primary education point to the ongoing disadvantage – or even discrimination – suffered by multilingual children in the German education system. Given Germany’s history as a country of immigration, and in light of recent public discussions on the increased immigration of refugees, the question of the problematic’s socio-political background arises. This leads to the issue of linguistic concepts among society and their influence on domestic language policies. This article presents analysis of discourse around languagepolitical concepts and practices among stakeholders in language promotion in the state of North-Rhine Westphalia. Five semi-structured interviews with state employees were analysed following a discourse analytical approach. The analysis, deploying frameworks from the field of Critical Discourse Analysis, focused on the discursive practice of legitimation in the evaluation of multilingualism. Multilingualism as a phenomenon in society appeared to be evaluated according to differing standards (for example correctness or properness) depending on the language. As for evaluation, the analysis indicated an additional dimension in discourse which assigns different groups of speakers a belonging to particular languages. All in all, the collected data pointed to a diverse and ever-changing discourse in the field of language promotion in North-Rhine Westphalia. The presented analysis aims to stimulate a debate and suggests some directions for future research.