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

Aim: To describe the incidence, time in days and risk factors for postoperative delirium in elderly patients., Design: Prospective cohort study., Methods: Patients over 65 years were daily screened with the 4A's Test and the Delirium Observation Screening Scale for postoperative delirium. A psychiatrist assessed according to the DSM-V. We performed descriptive and logistic regression analyses., Results: From 202 patients, 7.5% (N = 15) had a diagnosed postoperative delirium, whereby 73.3% (N = 11) developed the delirium during the first 48 hr after surgery. The median duration was 1 day. Patients over 80 years suffering from heart failure with surgical drains, bladder catheter, central venous catheter had higher odds for developing a postoperative delirium. The incidence of postoperative delirium in our sample was lower compared with other surgical and ortho-geriatric populations. Despite age, several modifiable postoperative factors were associated with the occurrence of postoperative delirium., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

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., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered., Research Aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors., Research Design: An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much')., Participants and Research Context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions., Ethical Considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee., Findings: Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues., Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

Background: Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers., Objective: To explore nursing students' handover involvement during their clinical rotations and associated factors., Method: This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement., Results: Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p < 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p < 0.001) in units with high 'quality of the learning environment' (β = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (β = -0.279, p < 0.001), or by a nurse on a daily basis (β = -0.253, p = 0.004), or by the staff (β = -0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience., Conclusions: Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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

Background: Easy-to-access tools have been demonstrated to improve evidence-based practice (EBP) competences among nursing students. However, students' perception of access to EBP tools (e.g., clinical practice guidelines [CPGs], protocols) is unknown., Aims: To explore: (1) nursing students' opportunity to access EBP tools during their education, and (2) associated factors., Methods: A national cross-sectional study including all Italian nursing programs. Nursing students were deemed eligible according to the following inclusion criteria: Those who (1) were attending or just ended their practical rotation lasting at least 2 weeks at the time of the survey, and (2) expressed through written informed consent their willingness to take part in the study. Participants were asked about their perceived opportunity to access EBP tools during their most recent clinical learning experience (from 0 - not at all to 3 - always). A set of explanatory variables was collected at the individual, nursing program, and regional levels by using a questionnaire., Results: Nine thousand six hundred and seven (91.6%) out of 10,480 nursing students took part in the study. Overall, 4,376 (45.6%) students perceived not at all or only a small opportunity to access EBP tools during their most recent clinical rotation. In the multilevel analysis, factors promoting access were mainly set at the clinical learning environment level (high safety and nursing care quality, high self-directed learning opportunities, high quality of the learning environment, and being supervised by a clinical nurse). In contrast, male gender and lower academic class were associated with a lower perception of accessibility to EBP tools. A consistent variability in the perceived opportunity to access EBP tools emerged across regions., Linking Evidence to Action: Evidence-based decision-making is increasingly expected from nurses. Therefore, nursing faculties should safeguard and continuously improve students' competence regarding EBP, by implementing strategies mainly at the nursing program and regional levels., (© 2018 Sigma Theta Tau International.)

. Extent and type of implicit rationing of nursing care in seven South Tyrolean hospitals: a descriptive study., Introduction: Implicit rationing of nursing care is an international phenomenon, defined as withholding of or failure to carry out necessary nursing interventions due to a lack of nursing resources., Aims: To describe the extent and type of nursing care implicitly rationed in South Tyrolean hospitals, and to explore differences across clinical areas and between registered nurses (RNs) and support staff., Methods: The Basel Extent of Rationing of Nursing Care (BERNCA) questionnaire was completed between September and November 2015, by 934 RNs and support staff of the seven hospitals, involved in direct adult patient care (24 medical, 13 surgical, 5 rehabilitation, 4 intensive care units). Descriptive and explorative analyses were performed., Results: The most rationed activities concerned "nursing care planning" (37.3%), "surveillance of confused patient" (30.7%), "providing emotional support" (30.1%) and "talking with patients and family" (28.4%). Of the ten most rationed activities, seven were common to RN and support staff, and across clinical areas, although with different frequencies. Significant differences between clinical areas were observed for: "nursing care planning", "rehabilitation care", and "comfort/talking with patients and family"., Discussion: Implicit rationing of nursing care occurs in South Tyrolean hospitals, mainly related to care planning and documentation. Higher priority is given to activities related to direct patient care. Further investigations on priority setting to increase the awareness among frontline nurses of what is rationed, and to guarantee the safety and quality of care is warranted.

Background: Interprofessional education (IPE) interventions are not always successful in achieving learning outcomes. Team-Based Learning (TBL) would appear to be a suitable pedagogical method for IPE, as it focuses on team performance; however, little is known about interprofessional TBL as an instructional framework for patient safety. In this pilot-study, we aimed to (1) describe participants' reactions to TBL, (2) observe their achievement with respect to interprofessional education learning objectives, and (3) document their attitudinal shifts with regard to patient safety behaviours., Methods: We developed and implemented a three-day course for pre-qualifying, non-medical healthcare students to give instruction on non-technical skills related to 'learning from errors'. The course consisted of three sequential modules: 'Recognizing Errors', 'Analysing Errors', and 'Reporting Errors'. The evaluation took place within a quasi-experimental pre-test-post-test study design. Participants completed self-assessments through valid and reliable instruments such as the Mennenga's TBL Student Assessment Instrument and the University of the West of England's Interprofessional Questionnaire. The mean scores of the individual readiness assurance tests were compared with the scores of the group readiness assurance test in order to explore if students learned from each other during group discussions. Data was analysed using descriptive (i.e. mean, standard deviation), parametric (i.e. paired t-test), and non-parametric (i.e. Wilcoxon signed-rank test) methods., Results: Thirty-nine students from five different bachelor's programs attended the course. The participants positively rated TBL as an instructional approach. All teams outperformed the mean score of their individual members during the readiness assurance process. We observed significant improvements in 'communication and teamwork' and 'interprofessional learning' but not in 'interprofessional interaction' and 'interprofessional relationships.' Findings on safety attitudes and behaviours were mixed., Conclusion: TBL was well received by the students. Our first findings indicate that interprofessional TBL seems to be a promising pedagogical method to achieve patient safety learning objectives. It is crucial to develop relevant clinical cases that involve all professions. Further research with larger sample sizes (e.g. including medical students) and more rigorous study designs (e.g. pre-test post-test with a control group) is needed to confirm our preliminary findings.

Background: anorectal malformations an at first glance invisible disorder - triggers the affected children and young people and their parents strong unease and is therefore often concealed and secretive. The problems are not less if the affected children grown up. Incontinence can affect quality of life and massive psychosocial developmental disorders can arrive (Jenetzky & Black 2008). Affected children and adolescents must make diets, they suffer from abdominal pain, incontinence and constipation, feel impaired in their body image and often they have feelings of fear and shame. In the social sphere, the children have to get difficulties to get in contact with their classmates and they are in school often absent or distracted (Grano et al. 2013). Objective: The aim of the present literature review is to describe the quality of life of children and adolescents with anorectal malformations and show developmental change in physical, psychological and social area. Method: To answer the question, a literature search was conducted. For this the relevant databases PubMed". " CINAHL with full text", ,,PsycInfo" and ,,Cochrane" were used. Results: The literature research shows, that children and young people with anorectal malformations have a worse quality of life than their healthy peers. They are ashamed, feel different than others and are afraid that they smell badly, They see themselves as unattractive and are often dissatisfied with their bodies. Among the adolescents there are significant gender differences: female adolescents, whether health or with anorectal malformations, have a worse quality of life than male adolescents (Michel et al 2009, cited by Grano et al 2013). Obviously pubertal development specificities of the two genders are responsible for this result (Patton et al. 2007, Petersen et al. 1991, cited in Grano et al. 2013). Children with fecal incontinence are in their behavior more prominent than their healthy peers and have more psychological/ psychosocial problems as their classmates in the exercise of activities of daily living, for example during routine school activities, during sports or if they say with friends (Hamid et al. 2007, cited by Grano et al. 2012). Conclusion: The multiple problems in the social, physical and psychological area make it necessary for children and adolescents with anorectal malformations to get early support (bowel management program, psychologist, group therapy). For example, affected children may begin already with 3¹/₂ years with a bowel management program to prevent negative consequences and/or to avoid social exclusion (Bischoff et al. 2009. cited in Grano et al. 2012). For parents, it is important that they learn to accept the child's illness and to help the children to cope their illness better. With this support in childhood it will be possible to accept the disease better and to integrate it into their self-image (Schmidt et al. 2010).

. The Clinical Learning Quality Evaluation Index for nursing students., Introduction: The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool., Aim: A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students., Methods: A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students., Results: 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment., Conclusions: The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

Background Migraine is one of the most common pain symptoms in childhood, a chronic disease with recurrent symptoms that lead to a reduction of daily activities during the intercritical periods, with an impact of the quality of life. Objective The aim of this publication is to investigate, in which extent migraine affects the quality of life of children and adolescents, how strong they are restricted in everyday life and in which areas such restrictions can be found. Results The parents of children with FSH (frequent or severe headaches) reported that the children had difficulties with emotions, concentration, behaviour, and were unable to get along with others. Children with FSH were significantly more likely to be upset or distressed by their difficulties, while experiencing disappointments, and to have these difficulties interfere with home life, friendships and classroom learning (Strine et al., 2006). Moreover, mothers described children with migraine as evidencing higher levels of internalizing behaviour and symptoms of anxiety and depression. Children with migraine indicated more negative self-perceptions of their physical appearance (Vannatta et al., 2008). Children with migraine lost school activity and performance, household tasks and leisure. Furthermore, it was observed that children with migraine went to school but didn't show a good performance because of physical or mental health problems (Ferracini, Dach & Speciali, 2013). Conclusion Compared to children without migraine, children and adolescents with migraine have generally poorer qualities of life in different areas.

Unlabelled: . Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol., Introduction: Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning., Aim: To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted., Methods: The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.

Tonsillectomy and adenotomy are the most common pediatric surgical procedures, with approximately five millions performed each year worldwide (O'Mathúna, Wiffen & Conlon, 2010). However, this procedure is accompanied by significant postoperative morbidity, which may include postoperative pain, postoperative nausea and vomiting (PONV), poor oral intake with consequent dehydration and postoperative bleeding (Hanasono et al., 2004). If pain is not treated effectively, it can cause avoidance behaviors related to further healthcare. Inadequate pain management has been found to increase morbidity and mortality rates in postoperative patients of all ages (O'Mathúna, Wiffen & Conlon, 2010). In addition, there is an increase in the incidence of PONV: 40% in children with pain compared to 16% in children without pain. PONV also disturbs significantly the wellbeing and patient satisfaction, it can lead to a substantial prolongation of time in the recovery room with increased costs of personal care. In pediatric patients PONV is the most common cause of the approximately 1% to 2% of unplanned hospitalizations following outpatient surgery (Rüsch et al., 2010). The incidence of bleeding after tonsillectomy is approximately 0.5-10%, with deaths occurring in 1 in 20,000 patients (Kim et al., 2011). In recent years, several scientists have explored the effect ofcorticosteroids in the reduction of morbidity after tonsillectomy. In this publication, the question is addressed to what extent perioperatively administered corticosteroids can reduce pain, PONV and postoperative bleeding in the context of tonsillectomy in children and adolescents. For this purpose, a narrative literature analysis of the electronic databases and journals was conducted. There is evidence that corticosteroids can reduce postoperative morbidity. However, no evident and clear recommendation can be drawn from the advices of the various studies.

Children, adolescents and young adults with end-stage renal disease need a renal replacement therapy (dialysis) or a renal transplant to survive. The dialysis is related to a very complex care, which includes invasive and painful procedures. Chronic diseases have a strong influence not only on the physical but also on the psychological development of children and adolescents. The most important psychological consequences include social isolation, differences in body image, limited lifestyle, as well as the changed personal relationships with family and friends. Therefore, caregivers should also have knowledge about the psychological consequences, being able to provide adequate help and support to children, adolescents and young adults.

Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future.

Unlabelled: Chorea Huntington is an autosomal dominantly inherited, neurodegenerative brain disorder that leads to involuntary hyperkinesia, psychotic symptoms and dementia. The illness not only changes the life of the person itself but also the world of the caregivers. The challenges in the care of a person which is affected by Chorea Huntington have an effect on the daily living as an assemblage of natural and social conditions., Method: a multiple case study was conducted. It included semi-structured interviews with three caregivers of people with Chorea Huntington in South Tyrol. The qualitative data was analyzed using the qualitative structured analysis of Mayring (2007)., Objective: The objective of this study was to describe the phenomenon of change of life from family members that care people affected by Chorea Huntington in a specific cultural setting (South Tyrol, Italy)., Results: The caregivers reported that the diagnosis of Chorea Huntington leads to negative changes in "relationship and family". Particularly, frustration, aggression, impatience and apathy were perceived as stressful. At the same time they highlight the positive changes through home care. They report that the relationship became more intimate and integral and it was characterized by more cohesion. Family caregivers get valuable support from the home care service, however, they complain that there is no facility in South Tyrol, which is specialized to care people with Chorea Huntington. Therefore, the caregivers have to "give up a lot" and don't have any personal desires, dreams and expectations for the future., Conclusions: The caregivers have learned independently to deal with their changed life step by step, and to see also the positive effects of the caring role. The life of family caregivers of a person which is affected by Chorea Huntington is characterized by abandonment. A continuous and professional care would be important for the affected and his caregiver. A continuous and professional care is important for both, addressing the care needs of the persons affected by Chorea Huntington and preparing their caregivers for the changing life.

Background: Children under six years of age are most frequently involved in poisoning accidents at home. They are caused by medications, household cleaners and plants. Socio-economic factors have an influence on the risk of poisoning. Passive and active measures are useful for the prevention of poisoning., Objective: This study shows the precautionary measures and their effectiveness in relation to the risks and the factors of poisoning accidents., Methods: A literature review searched in relevant databases for studies that relate to the risk of poisoning on children under six years and that represent the effectiveness of prevention measures., Results: Solely education of the parents is not enough, therefore it is combined with prevention programs, followed by home visits or with child resistant containers. The combination with home visits is effective because the parents get encouraged to make their household safe for children. The education has to be directly with the parents, because the measures can be customized. Short education programs with specific objectives, in written form, are more effective than longer ones. They contain informations about the correct storage and use of child resistant containers, and the behavior in case of emergency. This safety measures must be already implemented at the birth of the child. It's not clear if public education through mass media is effective. Nurses have to educate parents and to advise them to all dangers in the household., Conclusion: The education programs must be carried out individually with the parents. In families with several children, the implementation of passive prevention strategies is more effective. The nurse plays an important role in relation to the poisoning prevention.

When entering the nursing home, elderly people are afraid of losing their independence and identity. That is why the entry into a nursing home turns out be a critical experience for the people affected. A systematic literature research on this topic illustrates that the impacts of a nursing home entry on the identity of these people have only scarcely been investigated so far. In the present study, 20 problem-centred interviews with residents of three different nursing homes were conducted and analysed according to the summarizing content analysis developed by Mayring (2007). The result shows that moving into a nursing home is accompanied by a strong emotional burden as these people have to leave behind their friends, families, pets, long-time neighbours and property. Moreover, other residents of the nursing home create fear through their need of care. The test persons participating in the present study do not want to have their decisions and actions imposed from outside because of their need of nursing care. They protest against it. They draw enough strength from the social network they maintain, from conversations and from their faith in order to fight for their independence. They develop a new identity close to their former identity by maintaining autonomy and mobility, and they stay future-oriented.

A considerable number of cancer patients use complementary medicine therapies in order to alleviate different symptoms such as pain, anxiety, and depression, occurring in connection with cancer. This paper explores the question to what extent massage therapies are able to reduce the amount of pain, anxiety, and depression. For this purpose, a systematic literature analysis was carried out in the electronic databases and specialist journals. There is already evidence that massage therapies can influence the symptoms of pain, anxiety, and depression in a positive way.

Background: The scientific literature shows, that caring parents of children with chronic kidney disease experience profound changes of life-world in terms of their welfare and their health. The different experiences that by the child's illness influenced the life-world of the parents in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" have not yet been described in the German literature., Methodology: To study the changing life-world in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" of the child, a single case study was carried out. The mother was interviewed using a problem-centered-interview. The analysis of the interview was based on Mayring's technique of content analysis (2002)., Results: The category system shows that mother's life-world is influenced by different experiences in both stages of life. Subjectively, the mother saw her greatest challenge during the "life with peritoneal dialysis" in following the hygienic rules and the prevention of peritation" was her fear that the donor kidney would be rejected by her child., Implications: The results of this study correspond to the results of previous studies in the English literature. Healthcare professionals, including nurses can use the results of this study to build up a professional relationship, for empathic support and for improvement of parental well-being. Further qualitative research should focus on healthcare professionals' view regarding the experiences and needs of caring parents of children with chronic kidney disease in order to compare with parents' view.

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

Within the framework of a pilot project in the sanitary district of Bruneck (sanitary establishment of South Tyrol), the concept of care management is being investigated both practically and scientifically for informal caregivers of elderly people in need of care since 2009 the results of the qualitative assessment of the homecare situation. The assessment before the intervention will form the basis for further design and implementation of individual stress-reducing and supportive offers for the informal caregivers. Using a semi structured interview guideline twelve problem-centered interviews with informal caregivers were conducted and analysed according to Mayring's content analysis technique (2007). Informal caregivers are exposed to burdens in social, physical and mental areas. Own resources, family ties and support reduce stress and burdens caused by the homecare situation. The need of individual and continuous support of families and implications for further measures of care management can be deduced from the results. There is a need of support in the areas coping strategies, empowerment and direct stress reduction with regard to the homecare situation through education, training, counselling and the interconnection of social and health services.

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

In palliative care between 13.9 and 25 percent of all patients suffering from cancer show signs of anxiety disorders. Up to 75 percent of these patients suffer from non-pathologic anxiety, which has a negative impact on the patients' quality of life. Therefore it is important to provide interventions that are able to reduce anxiety of cancer patients. Massage and music therapy are effective interventions for minimizing anxiety of cancer patients in palliative care. An empathic attitude of the nurse increases the effect of the mentioned interventions. While there is evidence of the interventions mentioned it is yet necessary to further explore these in additional clinical trials to consolidate the already existing results.