[User-oriented needs assessment of the potential use of assistive robots in direct nursing care: A mixed methods study]

User-oriented needs assessment of the potential use of assistive robots in direct nursing care: A mixed methods study Abstract. Background: So far, hardly any robots have been used in nursing that take over patient-related activities and thereby reduce the physical strain on the caregivers. Using user-centered design approaches, the interdisciplinary project "PfleKoRo" was therefore developing a robotic assistance system that can be used in the direct care of bedridden patients requiring intensive or very intensive care. Aim: The aim of this study was to identify nursing activities with the greatest support potential for an assistant robot for the direct care of bedridden patients. Method: Focus groups (n = 3) with nursing professionals (n = 14) from acute and long-term care were conducted first in an explorative mixed method design and then evaluated by means of content analysis. A selection of nursing activities was then prioritized by the participants of the focus groups (n = 10) with regard to their potential for support from an assistant robot in a standardized survey. Results: The highest priority was given to turning and holding patients in a lateral position as well as holding their legs in order to perform nursing tasks. Further support was needed, among other things, for repositioning the patient to the head of the bed and for tasks such as the transfer of patients. Conclusion: Turning patients and holding them in a lateral position as well as holding the leg are seen as target activities with the greatest support potential for "PfleKoRo", presenting the starting point for further development.

Pflegefachpersonen denken über eine Definition von "durchgeführter und versäumter Pflege" nach

Nurses reflect upon a definition of "performed and missed nursing care" - A qualitative study Abstract. Background: It is known that necessary nursing interventions are repeatedly omitted respectively only carried out partially or at a time that is not appropriate. In the literature, this is referred to as "missed nursing care". In the German-speaking region, there is no critically reflected definition of what is meant by "performed and missed nursing care", using qualitative methods. Therefore, we developed one in a three-phase study. Aim: The aim of phase 2, which is the focus of this article, was to critically reflect on the literature-based definition developed in phase 1 with nurses working in acute care hospitals in German-speaking Switzerland in order to specify it in phase 3. Methods: We conducted two focus group interviews with a total of 17 participants. We provided the participants with the preliminary definition and asked them for their reflections. We analysed the interviews content-analytically with the knowledge mapping technique as well as according to Mayring. Results: The participating nurses described that the contents of the definition were relevant and comprehensible for them. However, they also noticed differences from their understanding and gave indications for refining the definition, especially in relation to terms that include a time-related aspect. Conclusions: By involving nurses in the development of the definition, there is now a practical description of "performed and missed nursing care" that can be useful for quality assurance and development of care.

[Patients with psychiatric comorbidities in the acute hospital - a field of tension with interprofessional need for action - results from a pilot study]

Patients with psychiatric comorbidities in the acute hospital - a field of tension with interprofessional need for action - results from a pilot study Abstract. Background: Psychiatric comorbidities are frequent in patients hospitalized in an acute care hospital. They often remain undetected or, if diagnosed, neglected. As long as the somatic disease can be properly cared for and treated, this usually remains unproblematic. However, the situation can quickly tip over if psychiatric comorbidities interfere with care and treatment leading to a higher level of care and adverse consequences for patients. Aim: We investigated the need for action for this patient group from the nurses' perspective in a Swiss-German university hospital. Method: In two group discussions, nurses described intense situations, followed by an evaluation of determining factors, insights gained and measures taken to control these situations and prevent them. Results: Nurses experience the described situations as stressful and express a great need for action for themselves and for the interprofessional team. Key points are vigilance in everyday clinical practice, specific knowledge acquisition and an easily accessible local support system. Conclusions: In an acute care hospital, psychiatric comorbidities must be taken into account. However, this requires advanced skills and an organizational, interprofessional approach.

[The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study]

The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study Abstract. Introduction: To deal with the complexity of the situation of people with dementia in acute hospitals, it is necessary to develop tailored interventions. In doing so, it is important to consider the perspectives of all relevant persons, including health care teams.

AIM

The aim of this study was to explore the situation of people with dementia in three Swiss acute hospitals from the perspective of health care teams.

METHODS

We conducted three focus group interviews with health care teams consisting of medical doctors, nurses and therapists. Data were analysed by means of summarising content analysis according to Mayring.

RESULTS

A total of 20 health professionals took part. Three main categories were identified: "People with dementia confront the hospital system", "The hospital system fails to meet the needs of people with dementia" and "Necessary changes take place in the hospital system". The results show a lack of intention in the hospital system to address the specific needs of people with dementia. Health care teams feel forced to intensify their teamwork. This occurs unsystematically and with little organisational support.

CONCLUSION

It seems of paramount importance to systematically support the teams' initiatives for enhanced teamwork in caring for people with dementia. Teamwork should be considered as a key aspect when developing interventions.

[Counselling approaches to assistive technologies in nursing care for people with dementia - A focus group study with informal carers]

Counselling approaches to assistive technologies in nursing care for people with dementia - A focus group study with informal carers Abstract. Background: Assistive technologies may support caregiving relatives of people with dementia. Presently, counselling and training courses are lacking as well as concrete considerations for didactic and methodical implementation.

AIM

To convey the perspectives of caring relatives on the development of knowledge and competences in assistive technologies.

METHODS

Six interview-guided focus groups with 46 caring relatives of people with dementia were conducted. For analysis the documentary method was applied.

RESULTS

Assistive technologies currently do not seem to play a role in care-relevant information and counselling structures. The early development of competences as part of a guided support process is explicitly requested by caregiving relatives. The respondents favoured to try out assistive technologies, e. g. by moderated test possibilities.

CONCLUSION

The interviewed caregiving relatives consider the existing approaches to get access to assistive technologies as inadequate. Access to knowledge and competence development of caregiving relatives must be more clearly integrated into the design of the care process. Counselling formats focusing on experience, reflection and usage of assistive technologies might be the didactic basis of structured competence achievement for sustainable integration of useful technologies in daily nursing care.

Pictures in health information and their pitfalls: Focus group study and systematic review

BACKGROUND

Health information often includes different categories of pictures. This study comprises: A) exploration of the perception of photos presented in a brochure on the prevention of osteoporosis and B) a systematic review on the effects of pictures in health information.

METHODS

A) We conducted four focus groups. Participants with heterogeneous cultural and educational background were included. The interviews were subjected to qualitative content analysis. B) We searched PubMed, CENTRAL, PSYNDEX, PsycINFO, CINAHL, Campbell Collaboration and DIMDI. Randomized controlled trials (RCTs) on predefined cognitive and affective outcomes were included. Two reviewers independently extracted data and assessed the quality of evidence. Descriptive data synthesis was conducted.

RESULTS

A) Within the focus groups comprising 37 participants, four generic categories were identified: comprehension, perception, congruence between photos and content, and alternatives. Identification with portrait photos and the connection between photos and text were important to participants. B) In total, 13 RCTs were included. Quality of evidence was moderate. Types of pictures and their intention varied between studies. Cartoons enhanced comprehension, satisfaction and readability. Photos did not improve cognitive or affective outcomes. Effects of anatomical pictures, pictographs, and drawings were ambiguous.

CONCLUSION

The overall effect of using pictures in health information remains unclear. The type of pictures and readers' characteristics may influence both perception and interpretation. Type, amount, and intention of the pictures should be considered carefully.

Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

[Nursing care in the run-up to Swiss DRG – Nurses' experiences with interprofessional collaboration, leadership, work load and job satisfaction]

BACKGROUND

The literature reports critically on the consequences of the introduction of case-based hospital reimbursement systems, which hamper the delivery of professional nursing care. For this reason, we examined the characteristics of nursing service context factors (work environment factors) in acute care hospitals with regards to the introduction of the new reimbursement system in Switzerland.

AIM

This qualitative study describes practice experiences of nurses in the context of the characteristics of the nursing service context factors interprofessional collaboration, leadership, workload and job satisfaction.

METHODS

Twenty focus group interviews were conducted with a total of 146 nurses in five acute care hospitals.

RESULTS

The results indicated that for quite some time the participants had observed an increase in complexity of nursing care and a growing invasiveness of clinical diagnostics and treatment. At the same time they noticed a decrease in patient length of stay. They strived to offer high quality nursing care even in situations where demands outweighed resources. Good interprofessional collaboration and supportive leadership contributed substantially to nurses' ability to overcome daily challenges. Job satisfaction was bolstered by interactions with patients. Also, the role played by the nursing team itself is not to be underestimated.

CONCLUSIONS

From the participants' point of view, context factors harbor great potential for attaining positive patient outcomes and higher job satisfaction and have to be monitored repeatedly.

["All of us actually practice EBM!" - Attitudes of German GPs towards evidence-based medicine and clinical guidelines in daily practice: a focus group study]

BACKGROUND

Implementation of guidelines in general practice is difficult. Do general practitioners (GPs) reject evidence-based medicine (EBM) in general? Which attitudes do GPs have towards EBM and guidelines, and which value do they attach to EBM in daily routine?

METHODS

We conducted a qualitative study using five focus groups with 53 GPs. The study was set in the German federal states of Bavaria, Saxony, North Rhine-Westphalia, Hesse and Hamburg. Participants were selected according to area (rural/urban), region (North/South, East/West) and grade of professionalisation. Focus groups were digitally recorded and fully transcribed. Data were analysed in a multidisciplinary team using qualitative content analysis.

RESULTS

Most participants felt positive towards EBM. Lack of feasibility was explicitly mentioned: the participants distinguished between "practised" and "true" EBM. Guidelines are often considered unsuitable for general practice. The GPs felt confident that their treatment of patients was evidence-based.

CONCLUSIONS

Compared to older studies, German GPs have an increasingly favourable opinion about EBM. In order to enhance the practical application of EBM and guidelines the attitudes of GPs need to be considered.