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Schippers P, Gercek E, Wunderlich F, Wollstädter J, Afghanyar Y, Arand C, Drees P, Eckhard L. [Disproportionately increased incidence of proximal femoral fractures in a level one trauma center : Epidemiological analysis from 2016 to 2022]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:221-227. [PMID: 37642687 PMCID: PMC10891192 DOI: 10.1007/s00113-023-01359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Proximal femoral fractures represent the most frequent fracture entity in Germany accounting for more than 20% of all fractures. According to a decision of the Federal Joint Committee from 2019, proximal femoral fractures also have to be surgically treated within 24 h. In order to quantify a subjectively perceived increase in workload in trauma surgery at a supraregional trauma center, a retrospective analysis of the number of surgically treated proximal femoral fractures was performed. Proximal femoral fractures were chosen due to their high incidence and homogeneous treatment. METHODS Using ICD-10 codes, all surgically treated proximal femoral fractures from 2016 to 2022, including the patient's zip code, were retrieved from the database of the trauma center. RESULTS The number of surgically treated proximal femoral fractures doubled from 2016 to 2022. The highest increase (60%) was recorded from 2020 to 2022. Heat maps show an increase in the catchment area radius as well. CONCLUSION When compared (inter)nationally, a disproportionate increase in the amount of surgically treated proximal femoral fractures was recorded at the trauma center studied. The increase of the catchment area radius and the number of patients treated in the urban area show that less and less hospitals participate in emergency treatment. Possible explanations are a lack of resources aggravated by the recent COVID-19 pandemic and a lack of qualified personnel, interface problems between the federal states or the strict requirements of the Federal Joint Committee in the treatment of proximal femoral fractures. It must be assumed that there is a clearly increased workload for all professions involved in the trauma center investigated, although the infrastructure has remained unchanged.
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Affiliation(s)
- Philipp Schippers
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Erol Gercek
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Felix Wunderlich
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Jochen Wollstädter
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Yama Afghanyar
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Charlotte Arand
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Philipp Drees
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Lukas Eckhard
- Zentrum f. Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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De Biasi J, Reininghaus E, Schoberer D. [Delirium superimposed on dementia : Early detection and treatment]. Z Gerontol Geriatr 2023; 56:587-592. [PMID: 36301325 PMCID: PMC10589128 DOI: 10.1007/s00391-022-02125-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Delirium superimposed on dementia (DSD) is a widespread but often undetected problem. Additional delirium significantly reduces the quality of life in patients with dementia. Awareness of this condition must be increased among professionals to recognize its development at an early stage, distinguish it from dementia and treat it accordingly. OBJECTIVE This review describes the current state of diagnostic, preventive, and therapeutic methods in dealing with DSD. MATERIAL AND METHODS A comprehensive literature search was conducted in the PubMed database using the terms "dementia", "delirium", "delirium superimposed on dementia" and "DSD". An additional literature search was performed via Google Scholar. RESULTS The diagnostic techniques for detecting DSD are currently limited to delirium-only diagnostic tools, such as the confusion assessment method. A multiprofessional screening of high-risk patients on a regular basis is essential for the early detection and prevention of this disease. An interdisciplinary approach is also required for treatment. Pharmacological therapy is indicated when nonpharmacological measures are insufficient or to treat delirium-inducing causes. The focus lies on the mental and physical care of the patient and on the elimination of risk factors for developing DSD. CONCLUSION DSD is a serious syndrome, however, there is still no gold standard for diagnosis and treatment. Multicomponent nonpharmacological intervention programs have been shown to reduce the incidence of delirium. Their benefit in DSD must be verified in large multicenter studies.
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Affiliation(s)
| | - Eva Reininghaus
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich.
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Schubert M, Ausserhofer D, Schaffert-Witvliet B, Radtke FM, Neuner B. [Prevention of Post-operative Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:482-493. [PMID: 37725990 DOI: 10.1055/a-2065-3748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Postoperative delirium (POD) is an adverse but often preventable complication of surgery and surgery-related anaesthesia, and increasingly prevalent. This article provides an overview on non-pharmacological preventive measures, divided into individualized and non-individualized measures. Non-individualized measures, such as the most minimally invasive surgical procedure, avoidance of unnecessary fasting before surgery, and the most tolerable anaesthesia are used to minimize the risk of POD in all patients. Based on the results of preoperative screenings for risk factors such as frailty or cognitive impairment, individualized measures may encompass prehabilitation, treatment of specific risk factors, operation room companionship or cognitive, motor, and sensory stimulation as well as social support. This article additionally lists several examples of best practice approaches already implemented in German-speaking countries and websites for further readings.
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Blättler N, Schaffert B, Schubert M. [Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study]. Pflege 2023. [PMID: 36749189 DOI: 10.1024/1012-5302/a000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study Abstract. Background: Delirium is burdensome for the affected patients, their relatives, hospital staff and the health care system. Preventing delirium with targeted multicomponent interventions is therefore essential. Aim: To investigate the implementation of defined non-pharmacological, preventive, and supportive measures in patients with an increased risk of delirium and/or delirium by the hospital's directions. Methods: In this observational study, routine data from 175 hospitalized patients were included. Data on delirium prevention, treatment and presence of delirium were extracted from the patient records and analyzed using appropriate statistical methods. Group comparisons were made between the medical/surgical clinic and the delirium/no delirium group. Results: Of the 175 patients, 31 had delirium. For delirium prevention, measures to improve oxygen supply, excretion, pain and mobility were most frequently implemented and measures such as improving cognition and communication were least frequently implemented. In the case of delirium, measures to modify risk factors, ensure safety, as well as prophylaxis were applied most frequently. Between the two clinics and between the delirium/no delirium group significant differences in the frequency of these measures were shown. Conclusion: The differences in frequency of implementation provide preliminary evidence that clinic-specific delirium prevention, early detection, and treatment may be needed.
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Affiliation(s)
- Nadia Blättler
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Bianca Schaffert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Maria Schubert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
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Klöppel S, Savaskan E, Annoni JM, Berruex JL, Bohli L, Eder M, Hemmeter U, Hirsbrunner T, Leyhe T, Neyenhuys A, Popp J, Rauen K, Schuster JP, Sulaj V, Vögeli S, Gunten AV, Zavorotnyy M, Zullo L, Roth F, Lötscher C. [Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly]. PRAXIS 2021; 110:816-825. [PMID: 34702057 DOI: 10.1024/1661-8157/a003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly Abstract. Psychotic disorders in the elderly cover a wide range of causes and manifestations. They often occur as part of a depression, dementia, substance abuse or delirium. While psychosis can occur with a first manifestation in advanced age, many patients with chronic psychotic disorders reach a high age. Many elderly individuals are also affected by cognitive impairment and somatic conditions, making a third-party history most relevant. The associated changes in life and the complexity of the individual situation needs to be integrated into the diagnosis and treatment. The presented recommendations have been developed under the lead of the Swiss Society of Old Age Psychiatry (SGAP) in collaboration with the Swiss Association of Nurses (SBK) and the subcommittees for gerontological and psychiatric nursing of the association of nursing science (VFP) as well as further professional societies. We aim to make current knowledge concerning diagnosis and treatment available to the interprofessional teams working in in- and outpatients' settings.
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Affiliation(s)
- Stefan Klöppel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern, Bern
- Schweizerische Gesellschaft für Alterspsychiatrie (SGAP), Weggis
| | - Egemen Savaskan
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich
- Schweizerische Gesellschaft für Alterspsychiatrie (SGAP), Weggis
| | - Jean-Marie Annoni
- Département des Neurosciences, Université et Hôpital de Fribourg, Fribourg
- Schweizerische Neurologische Gesellschaft (SNG), Basel
| | - Jean-Luc Berruex
- Département des Neurosciences, Université et Hôpital de Fribourg, Fribourg
| | | | - Maria Eder
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern, Bern
| | - Ulrich Hemmeter
- Psychiatrie St. Gallen Nord, St. Gallen
- Schweizerische Gesellschaft für Alterspsychiatrie (SGAP), Weggis
| | - Therese Hirsbrunner
- Solothurner Spitäler AG, Psychiatrische Dienste, Solothurn
- Schweizerischer Verein für Pflegewissenschaft (VfP): Akademische Fachgesellschaft für gerontologische Pflege und Akademische Fachgesellschaft für psychiatrische Pflege, Bern
| | - Thomas Leyhe
- Universitäre Altersmedizin Felix Platter, Basel
- Universitäre Psychiatrische Kliniken, Basel
- Verstorben
| | | | - Julius Popp
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich
- Service Universitaire de Psychiatrie de l'Âge Avancé, CHUV, Prilly-Lausanne
| | - Katrin Rauen
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich
| | | | - Vita Sulaj
- Psychiatrische Dienste Aargau AG, Klinik für Konsiliar, Alters- und Neuropsychiatrie, Windisch
- Schweizerische Gesellschaft für Alterspsychiatrie (SGAP), Weggis
- Schweizerische Gesellschaft für Interventionelle Psychiatrie (SGIP), Bern
| | - Samuel Vögeli
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich
- Schweizerischer Verein für Pflegewissenschaft (VfP): Akademische Fachgesellschaft für gerontologische Pflege und Akademische Fachgesellschaft für psychiatrische Pflege, Bern
| | - Armin von Gunten
- Service Universitaire de Psychiatrie de l'Âge Avancé, CHUV, Prilly-Lausanne
- Schweizerische Gesellschaft für Alterspsychiatrie (SGAP), Weggis
| | - Maxim Zavorotnyy
- Psychiatrische Dienste Aargau AG, Klinik für Psychiatrie und Psychotherapie, Windisch
- Klinik für Psychiatrie und Psychotherapie der Philipps-Universität Marburg, Marburg, Deutschland
- Schweizerische Gesellschaft für Interventionelle Psychiatrie (SGIP), Bern
| | - Leonardo Zullo
- Service Universitaire de Psychiatrie de l'Âge Avancé, CHUV, Prilly-Lausanne
| | - Fabienne Roth
- Universitäre Psychiatrische Kliniken, Basel
- Schweizerischer Verein für Pflegewissenschaft (VfP): Akademische Fachgesellschaft für gerontologische Pflege und Akademische Fachgesellschaft für psychiatrische Pflege, Bern
- Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmännern (SBK Schweiz/ASI Suisse), Bern
| | - Claudia Lötscher
- Universitäre Psychiatrische Kliniken, Basel
- Schweizerischer Verein für Pflegewissenschaft (VfP): Akademische Fachgesellschaft für gerontologische Pflege und Akademische Fachgesellschaft für psychiatrische Pflege, Bern
- Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmännern (SBK Schweiz/ASI Suisse), Bern
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Cohen C, Pereira F, Kampel T, Bélanger L. Integration of family caregivers in delirium prevention care for hospitalized older adults: A case study analysis. J Adv Nurs 2020; 77:318-330. [PMID: 33078872 DOI: 10.1111/jan.14593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/16/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care. DESIGN Multiple case study. METHODS The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 - April 2018 through various instruments, including semi-structured interviews and family caregiver logs. Within- and across-case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore-Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272). RESULTS Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care. CONCLUSION The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further. IMPACT Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient- and family-centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.
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Affiliation(s)
- Christine Cohen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
| | - Thomas Kampel
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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Graf S, Hediger H, Knüppel Lauener S. [Delirium at the Hospital - Nursing effort and risk of falling: A Routine data analysis]. Pflege 2020; 33:133-142. [PMID: 32370662 DOI: 10.1024/1012-5302/a000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Delirium at the Hospital - Nursing effort and risk of falling: A Routine data analysis Abstract. Background: In order to reduce the risks and symptoms of delirium, a total hospital guideline for delirium prevention and management was established. To date, there have been few findings on the implementation of the guideline. Question / Aim: The aim of this study was to analyse data collected by application of the Delirium Observation Screening Scale and on the use of care measures for the prevention and treatment of delirium. As part of this analyses, also associations between the screening outcomes (symptoms of confusion) and the implementation of care measures and the rate of fall events, respectively, were examined in patients aged 70 and older. Method: In a non-experimental correlative cross-sectional study, routine data from the patient administration program PatWeb and the patient documentation system WiCare-Doc were analyzed over a period of four months. Results: Patients with symptoms of confusion received twice the duration of delirium-specific care compared to patients without symptoms of confusion. Their risk of falling was 4.4 times higher and after a fall event they received a significantly longer period of delirium specific care. Conclusions: The results show that the care of patients with delirium is intensive. Time is the prerequisite for care adapted to this patient group. The transfer of knowledge into practice must be strengthened to further enable nurses in implementing the prevention and management of delirium. The development of an "Advanced Practice Nurse Delirium" is also recommended for practice development and as support for every day nursing care.
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Affiliation(s)
- Silvia Graf
- Pflege Departement Chirurgie, Kantonsspital Winterthur
| | - Hannele Hediger
- Departement Pflege, ZHAW, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur
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Fröhlich MR, Meyer G, Spirig R, Bachmann LM. Comparison of the Zurich Observation Pain Assessment with the Behavioural Pain Scale and the Critical Care Pain Observation Tool in nonverbal patients in the intensive care unit: A prospective observational study. Intensive Crit Care Nurs 2020; 60:102874. [PMID: 32389396 DOI: 10.1016/j.iccn.2020.102874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/21/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the concordance of Zurich Observation Pain Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU patients. DESIGN Prospective observational study [BASEC-Nr. PB_2016-02324]. SETTING A total of 49 ICU patients from cardiovascular, visceral and thoracic surgery and neurology and neurosurgery were recruited. Data from 24 patients were analyzed. MAIN OUTCOME MEASUREMENTS Three independent observers assessed pain with the BPS, the CPOT or ZOPA prior, during and after a potential painful nursing intervention. Tools were randomized concerning the pain management after each pain assessment. Frequency of nine additional pain indicating items from a previous qualitative, explorative study was calculated. RESULTS ZOPA was positive in 32 of 33 measuring cycles (97.0%; 95%CI: 84.2-99.9%), followed by the CPOT (28/33 cycles, 84.8%; 95%CI: 68.1-94.9%) and the BPS (23/33 cycles, 67.0%; 95%CI: 51.3-84.4%). In 22/33 cycles all tools were concordant (66.7%; 95%CI: 48.2-82.0%). Analgesics were provided in 29 out of 33 cycles (87.9%; 95%CI: 71.8-96.6%). Additional pain indicating items were inconsistently reported. CONCLUSION ZOPA is concordant with the BPS and the CPOT to indicate pain but detects pain earlier due to the low threshold value. Inclusion of further items does not improve pain assessment.
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Affiliation(s)
- Martin R Fröhlich
- Kantonsspital Aarau (Switzerland), Department of Clinical Nursing Science & Department of Perioperative Medicine; Martin Luther University Halle-Wittenberg (Germany), Institute for Health and Nursing Science.
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg (Germany), Institute for Health and Nursing Science
| | - Rebecca Spirig
- University of Basel (Switzerland), Institute for Nursing Science
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Enabling interprofessional collaboration in delirium management / Interprofessionelle Zusammenarbeit im Delir-Management gestalten. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2020. [DOI: 10.2478/ijhp-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Interprofessional collaboration (IPC) is dependent on different expectations and communication styles. IPC is a meaningful approach to accomplish treatment goals, especially in patients with delirium. Delirium affects approximately 50 % of patients older than 65 years in acute care settings. The constant attention and effort needed to care for patients suffering from delirium is challenging and cannot be provided by one profession alone. Instead, there is a need for IPC.
Aim
This study aims to analyse the structure of IPC in the treatment of patients suffering from delirium.
Method
Data was collected by conducting three group interviews and six individual interviews with members of different professions in an acute care hospital, and analysed by Charmaz's (2014) grounded theory approach.
Results
A model called enabling IPC in delirium management was developed. This model shows how mutual respect and appreciation, being in dialog and dealing with challenges in IPC interact with each other and also affect each other. Mutual respect and appreciation are common baseline values that have a pivotal effect on the dialog between professions and the management of IPC challenges. Being in dialog and dealing with challenges in IPC are essential values for enabling IPC, as well as mutual respect and appreciation.
Conclusion
Mutual respect and appreciation is fundamental for enabling IPC in the treatment of patients suffering from delirium. Interprofessional education, structured interprofessional care conferences and standardised communication can offer opportunities to foster mutual respect and appreciation which, in turn enable IPC.
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Klöppel S, Savaskan E, Kuhn R, Egeli G, Indermaur E, Lima SS, Ulrich A, Vögeli S, Wiesli U, Zemp L, Zúñiga F, Georgescu D. [Recognition of Psychiatric Symptoms in Inpatient Long-Term Care]. PRAXIS 2020; 109:301-308. [PMID: 32183657 DOI: 10.1024/1661-8157/a003394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recognition of Psychiatric Symptoms in Inpatient Long-Term Care Abstract. As part of the Swiss national strategy on dementia, we investigated to which extent the needs assessment instruments RAI and BESA can early detect symptoms of depression, delirium, and behavioral and psychological symptoms of dementia (BPSD) in long-term care facilities. While we decided that the RAI sufficiently detected depressive symptoms, we suggest to add the two-questions-test and the geriatric depression scale to the BESA assessment. The BESA evaluation had more targeted focused assessments, allowing for better identification of delirium. Neither RAI or BESA cover the whole spectrum of behavioral and psychological symptoms of dementia. We consider the continuous application of these assessment instruments an important step towards interdisciplinary exchange and a better treatment of residents with psychiatric symptoms.
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Affiliation(s)
- Stefan Klöppel
- Schweizerische Gesellschaft für Alterspsychiatrie und -psychotherapie (SGAP) - Projektleitung
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
| | - Egemen Savaskan
- Schweizerische Gesellschaft für Alterspsychiatrie und -psychotherapie (SGAP) - Projektleitung
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - René Kuhn
- Schweizerische Fachgesellschaft für Geriatrie (SFGG) - Projektleitung
- Reusspark, Zentrum für Pflege und Betreuung
| | - Gabriela Egeli
- Q-Sys AG, St. Gallen
- Q-Sys AG, Pflegefachfrau AKP, DAS Demenz und Lebensgestaltung
| | - Esther Indermaur
- SBK Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK)
- Spitex Zürich Limmat AG
| | | | - Anja Ulrich
- Akademische Fachgesellschaft (AFG) Gerontologische Pflege, Verein für Pflegewissenschaft (VFP)
- Universitätsspital Basel
| | - Samuel Vögeli
- SBK Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK)
- Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Ursula Wiesli
- Akademische Fachgesellschaft (AFG) Gerontologische Pflege, Verein für Pflegewissenschaft (VFP)
- Stiftung Drei Tannen Wald
| | | | - Franziska Zúñiga
- Akademische Fachgesellschaft (AFG) Gerontologische Pflege, Verein für Pflegewissenschaft (VFP)
- Pflegewissenschaft, Departement Public Health, Universität Basel
| | - Dan Georgescu
- Schweizerische Gesellschaft für Alterspsychiatrie und -psychotherapie (SGAP) - Projektleitung
- Klinik für Konsiliar-, Alters- und Neuropsychiatrie, Psychiatrische Dienste Aargau AG
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Fröhlich MR, Meyer G, Spirig R, Rettke H. Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten auf der Intensivstation? - Eine qualitative Studie. Pflege 2019; 32:249-258. [PMID: 31432750 DOI: 10.1024/1012-5302/a000687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
When and how do intensive care nurses consider pain in the treatment process of ICU patients? A qualitative study Abstract. Background: Pain management is important in the therapeutic spectrum of the intensive care unit. However, guideline recommendations are not consistently implemented. Strategies in clinical reasoning and decision-making regarding pain are hardly described. AIM Guided by the question "When and how do intensive care nurses consider pain in the treatment process of patients with impaired consciousness and cognition?", we wanted to explore their patterns of thought and decision-making in the context of pain management. METHODS As part of a Mixed Methods research program on pain assessment in nonverbal intensive care patients we performed a secondary analysis of data from the qualitative substudy using qualitative content analysis according to Mayring. RESULTS Pain plays an important but subordinate role in the treatment process. After vital functions have been initially stabilized, intensive care nurses assess patients' consciousness and cognition in order to receive further information directly from them. Intensive care nurses differentiate between pain, anxiety, stress and discomfort. Their decisions are based on experience and intuition. CONCLUSIONS Education promotes intensive care nurses' knowledge and awareness in pain management. Observational pain assessment instruments provide valid information. They support an analytical approach and thus the development of competence in clinical reasoning and decision-making.
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Affiliation(s)
- Martin R Fröhlich
- Institut für Intensivmedizin, Universitätsspital Zürich.,Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg
| | | | - Horst Rettke
- Zentrum Klinische Pflegewissenschaft, Universitätsspital Zürich
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Schlögl M, Schietzel S, Kunz R, Savaskan E, Kressig RW, Riese F. [The Physical Examination of an 'Uncooperative' Elderly Patient]. PRAXIS 2018; 107:1021-1030. [PMID: 30227797 DOI: 10.1024/1661-8157/a003038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Physical Examination of an 'Uncooperative' Elderly Patient Abstract. The physical examination of uncooperative elderly patients regularly presents physicians in the private practice, in the hospital or nursing home with great challenges. The lack of cooperation itself can be an important indication of an underlying medical problem. Important elements to improve the patient's cooperation include ensuring basic needs, sufficient time and patience, adequate communication and good cooperation with relatives and other healthcare professionals. Targeted clinical observation as well as thinking in geriatric syndromes and unmet needs can help to raise physical findings despite limited cooperation. Pathological findings are indicators of impaired organ and functional systems and must be supplemented by a detailed examination.
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Affiliation(s)
- Mathias Schlögl
- 1 Klinik für Geriatrie, Universitätsspital Zürich
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Simeon Schietzel
- 1 Klinik für Geriatrie, Universitätsspital Zürich
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Roland Kunz
- 3 Universitäre Klinik für Akutgeriatrie, Stadtspital Waid, Zürich
| | - Egemen Savaskan
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Reto W Kressig
- 4 Universitäre Altersmedizin Basel, Felix Platter-Spital, Klinische Professur für Geriatrie, Universität Basel
| | - Florian Riese
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
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