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The aim was to generate a framework for dementia care in acute hospitals.Framework development with logic modelling.In phase one, we identified relevant elements of the framework by analysing several sources and by critically discussing them within the research team. We created the framework with logic modelling. In phase two, we adapted the framework in expert workshops and by reanalysing the included sources. We used the first stage of CReDECI 2 checklist for reporting.The framework describes necessary activities within four main bundles of measures: "developing structures and processes," "developing competences and attitudes," "building relationships" and "ensuring a social environment and adequate stimulation." The overarching outcome is a person-centred hospital culture, manifesting itself on different levels. The framework illustrates the necessity of an organization-wide person-centred culture for achieving positive outcomes for people with dementia, their relatives and health professionals.

To investigate the nutrition-related care needs of older patients in hospitals.A qualitative multimethod study was performed. By purposive sampling, older patients were included for observations of the nutrition process and interviews from a perioperative unit, an internal Medicine unit, and one acute geriatric care ward of an acute care hospital. Preliminary findings were discussed, validated, and further explored in two focus group discussions with interprofessional nutritional healthcare experts.Seventeen women and five men with a mean age of 86 years participated in patient observations and interviews. Eight experts with at least 10 years of professional experience who were employed in this setting for 3 years or more participated in interviews. Three themes of nutrition-related care needs were elaborated: The need to assess and address older patients' attitudes toward life, the need for nutrition-related education, and the need for food intake support. These care needs added to the development and validation of a new nursing diagnosis "risk for inadequate protein energy nutrition" and in consequence to develop a complex nursing intervention to optimize the nutrition of older patients.It is crucial to assess and understand the patients' attitudes toward life, which affect purposes of treatment, diet, and menu choices.Implementation of assessing nutrition-related care needs of older inpatients is needed. Addressing these care needs within the Advanced Nursing Process can lead to appropriate nursing diagnoses, nursing outcomes, and interventions, which enhance person-centered care, patients' self-care abilities, and consequently patients' nutritional status.ZIEL: Untersuchung der ernährungsbezogenen Pflegebedürfnisse älterer Patient*innen im Krankenhaus.Es wurde eine qualitative Multimethodenstudie durchgeführt. Mittels zielgerichteter Rekrutierung wurden ältere Patient*innen aus den Abteilungen allgemeine Chirurgie, innere Medizin und universitäre Klinik für Akutgeriatrie eines Krankenhauses für Beobachtungen des Ernährungsprozesses und Interviews einbezogen. Die vorläufigen Ergebnisse wurden in zwei Fokusgruppengesprächen mit Expert*innen aus verschiedenen Berufsgruppen diskutiert, validiert und weiter analysiert.Siebzehn Frauen und fünf Männer mit einem Durchschnittsalter von 86 Jahren nahmen an Patient*innenbeobachtungen und -interviews teil. Es wurden drei Themen ernährungsbezogener Pflegebedürfnisse herausgearbeitet: Das Bedürfnis, die Lebenseinstellung älterer Patient*innen zu erfassen; das Bedürfnis, ernährungsbezogene Informationen zu erhalten und das Bedürfnis nach Unterstützung bei der Nahrungsaufnahme. Diese Pflegebedürfnisse unterstützten die Entwicklung und Validierung einer neuen Pflegediagnose “Risiko für inadequate Protein-Energie-Ernährung” und infolgedessen einer komplexen pflegerischen Intervention zur Optimierung der Ernährung älterer Patient*innen.Es ist von entscheidender Bedeutung, die Lebenseinstellung der Patient*innen einzuschätzen und zu verstehen, da sich diese auf die Behandlungsziele, die Ernährung und die Menüwahl auswirkt.Die Erfassung der ernährungsbezogenen Pflegebedürfnisse älterer stationärer Patient*innen muss implementiert werden. Die Berücksichtigung dieser Pflegebedürfnisse im Rahmen des Advanced Nursing Process kann zu angemessenen Pflegediagnosen, Pflegeergebnissen und Interventionen führen, welche die personenzentrierte Versorgung, Selbstpflegefähigkeiten der Patient*innen und damit deren Ernährungszustand verbessern.

Funding Information: This research was funded through the Doctoral Fellowship Programme of the Austrian Academy of Sciences. Publisher Copyright: © 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd. Problem: Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. Aims: This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. Design: A quantitative cross-sectional study. Methods: The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. Results: The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent “resource allocation: labor” had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. Conclusion: In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC. Patient or Public Contribution: No patient or public contribution. publishersversion inpress

The increase in the number of young and middle-aged adult patients (19 – 65 years) with multimorbid and/or complex chronic conditions has created new challenges for healthcare systems and services. Considering their competencies and scope of practice, Advanced Practice Nurses (APNs) play an essential role in treating these patients because of their expertise, competencies, and advanced nursing skills. Several nurse-led care models have been identified to describe the characteristics, differences, and implications of multimorbidity in older adult patients (65+) in community and hospital settings. However, little is known about scope of practice, competencies, and impact of APNs within APN-led care models for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings. Therefore, this scoping review aimed to include studies that concentrated on APN-led care models for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings. The focus is on the competencies of APNs (e.g., central and core competencies), their scope of practice (e.g., interventions and area of responsibilities), and the impact of APNs on patient, provider, and service outcomes for adult patients in hospital settings. This scoping review will be performed using the scoping review methodology developed by Arksey and O'Malley and will also incorporate the methodological enhancement of Levac et al. It will comply with the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews’ guidelines of Tricco et al. Systematic research will be conducted in the electronic databases MEDLINE (PubMed), CINAHL (EBSCO), EMBASE (Ovid), CENTRAL, and PsycINFO (Ovid) using all recognized keywords, index terms and search strings. Grey literature will also be scanned, and the bibliography of all selected studies will be hand searched. Studies are selected based on defined inclusion and exclusion criteria. These are then screened by title and abstracts, and data from the full-text articles that meet the inclusion criteria are extracted independently by two authors. Disagreements in the evaluation are discussed and resolved by consensus. Results are reported in the form of descriptive tables as appropriate. Narrative analysis is used to present the results of the review in the context of the study's objectives and questions.

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.