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Employed family caregivers in health care: from a logic of care to a logic of reconciliation / Berufstätige Angehörige im Gesundheitswesen: Von der Versorgungslogik zur Vereinbarkeitslogik

Abstract

Introduction: In the context of illness, disability, and longevity, reconciliation of employment and family caregiving is evolving - in Switzerland termed „work & care“. Due to time, local, and personal restrictions, employed family caregivers need an organizational culture in health care which acknowledges their specific needs for reconciliation in order to remain employed and secure their financial situation.

Aim: To identify how organizational cultures in health care institutions influence reconciliation of employment and family caregiving.

Method: Within a larger study, case studies in three Swiss health care institutions were conducted within acute, long-term and homecare settings. Data triangulation included document analysis, expert interviews (N=13), field observations, and group discussions (N=5 each with 4-5 participants). The latter are focused in the analysis of this article.

Results: Three core categories are discussed: employed family caregivers providing care and receiving care, and how they are perceived physically present and absent, either employed or not employed. Employment of family caregivers was only marginally identified.

Discussion: Across all core categories, family caregivers are dominated by institutional rules in all care settings. This can foster or hinder reconciliation. Specific approaches, e. g. care coordination, enhance a sense of reconciliation within the health care system. Hence, health professionals can develop strategies that positively affect employment of family caregivers.

Conclusion: Health care institutions focus primarily on patients or residents. Thus, they follow predominantly a logic of care. This primacy should be complemented by a logic of reconciliation, in order to reinforce the lived reality of employed family caregivers.

Open access
Diagnostic Validity of the Basler Vegetative State Assessment - BAVESTA / Diagnostische Validität des Basler Vegetative State Assessments - BAVESTA

Abstract

Clinical assessments should meet the general psychometric properties of reliability and validity. Furthermore there are requirements in matters of diagnostic validity and usability. In regards to patients with severe brain damage, both issues can mainly be implemented by detecting and assessing returning abilities as early as possible, in order to use them for treatment planning. Main aim of this article is to investigate whether the newly developed and validated interprofessional Basel Vegetative State Assessment (BAVESTA) meets these practice criteria.

Data were collected as part of validity assessment of BAVESTA. Using the Glasgow Coma Scale as a reference, predictive parameters and measures of effect are calculated. Moreover, expert users were interviewed and results are presented in a descriptive way. With a sensitivity of .84 and a specificity of .85, the BAVESTA can be regarded as suitable in differentiating between Vegetative State and further states of remission such as the Minimally Conscious State.

Expert users regard BAVESTA as eligible for mapping rehabilitative process of patients with severely impaired consciousness. They agree upon the fact that all relevant areas are covered by BAVESTA.

The BAVESTA displays high levels of differentiation, in regards to both sensitivity and specificity. However, measures of effect ought generally to be regarded with caution, as reference standards have not been developed for the area of rehabilitation. Considering time expenditure, BAVESTA is rated as only marginally feasible by expert users.

It should be continued to investigate BAVESTA in regards to its diagnostic quality, integrating electrophysical diagnostic tools as reference standards.

Open access
Comparison of Supervised-learning Models for Infant Cry Classification / Vergleich von Klassifikationsmodellen zur Säuglingsschreianalyse

Abstract

Cries of infants can be seen as an indicator for several developmental diseases. Different types of classification algorithms have been used in the past to classify infant cries of healthy infants and those with developmental diseases. To determine the ability of classification models to discriminate between healthy infant cries and various cries of infants suffering from several diseases, a literature search for infant cry classification models was performed; 9 classification models were identified that have been used for infant cry classification in the past. These classification models, as well as 3 new approaches were applied to a reference dataset containing cries of healthy infants and cries of infants suffering from laryngomalacia, cleft lip and palate, hearing impairment, asphyxia and brain damage. Classification models were evaluated according to a rating schema, considering the aspects accuracy, degree of overfitting and conformability. Results indicate that many models have issues with accuracy and conformability. However, some of the models, like C5.0 decision trees and J48 classification trees provide promising results in infant cry classification for diagnostic purpose.

Open access
Scoping review of nursing-related dissemination and implementation research in German-speaking countries: Mapping the field / Scoping Review zum Stand der pflegebezogenen Disseminations- und Implementierungsforschung in deutschsprachigen Ländern: eine Bestandsaufnahme

Abstract

Implementing evidence-based innovations into care practice is a complex, slow and haphazard process. Dissemination and implementation (DI) research seeks to understand and optimize that process, to close gaps between research and practice and to improve quality of care. While there is a growing body of international DI research, little is known about the number and types of DI research studies and the DI topics studied in German-speaking nursing settings. This scoping review therefore evaluates the state of nursing-related DI research in German-speaking countries, discusses these results in light of the international state of DI research and provides directions for future research. We searched international databases (Web of Knowledge including Medline, CINAHL, PsycInfo, and GeroLit), German library meta-search engines, six German-language key trade journals, and reference lists of included articles. In total, 186 references representing 140 research projects were included in our review. Quality appraisal used five validated checklists. Methodological quality of the included studies was generally low. A total of 92 studies assessed the effects of DI strategies, 67 studied DI barriers and facilitators, 64 evaluated the impact or characteristics of DI processes, and 5 reported on the development or validation of DI research tools. None of the included studies focussed on methodological questions of DI research or on development and testing of DI theories and models. Future nursing-related DI research in German-speaking countries should particularly focus on these latter topics. Taking into account the international state of DI research will be especially crucial for those research activities.

Open access
Editorial
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The effect of inpatient treatment on the stress experienced by parents with an excessively crying infant / Die Auswirkungen eines Spitalaufenthaltes auf die Belastung von Eltern mit einem exzessiv schreienden Kind

Abstract

Introduction

Up to 40% of families are faced with a fussy, inconsolable high need infant in the first three months postpartum. A major reason for parents to seek professional help is the trying aspect of the situation with these children. The supportive role of health professionals has the greatest potential to reduce the parent’s stress and burden. To our knowledge, there are no studies on inpatient treatment for families with such infants so far.

Aim

The aim of this study is to show how an inpatient setting may reduce the stress and burden of parents with an inconsolably crying infant.

Method

A grounded theory approach (Charmaz) was used to analyse semi-structured interviews of 13 parents from a total of 9 families.

Results

Two core categories emerged from the data: “To get out of hand” describes how parents lose the ability to control and direct family life. “To find one’s way into daily routine” describes how they once again gain confidence and develop coping strategies.

Conclusion

An inpatient treatment reduces the burden on families with inconsolably crying infants. The change in the environment is helpful. Guidance and support enhance the parents’ skill and ability to handling the infant. The stress on the parents can increase again upon hospital discharge. Therefore, improvement is needed in treatment planning and parental support at the conclusion of the hospital stay as well as upon hospital discharge.

Open access
Perceived competences in everyday activities: Children’s self-report and parents’ and teachers’ report using the first Austrian-German Perceived Efficacy and Goal Setting System (AG-PEGS) version / Einschätzungen kindlicher Kompetenzen in Alltagstätigkeiten durch Kinder, deren Eltern und Pädagogen/-innen, basierend auf der ersten deutschsprachigen PEGS (Perceived Efficacy and Goal Setting System)-Version

Abstract

Introduction: A systems-oriented approach in contemporary health-care requires health professionals to include clients’ and their proxies’ perceptions to design specific, efficient, and cost-effective interventions. This influences the choice of appropriate methods and means for assessment and intervention. To learn more about the benefits of a systems-approach in assessment and intervention planning, there is a need to study how children and their proxies describe children’s abilities. Aims: This study aimed to explore, describe, and compare perceived competences in everyday activities as reported by children with difficulties in their occupational performance, their parents and teachers, using the first Austrian-German version of the Perceived Efficacy and Goal Setting System (AG-PEGS). Method: Forty-two children, their parents and teachers completed the AG-PEGS. Data analysis included descriptive statistics, calculation of inter-rater agreement, differences between groups, and correlations between categories. Results: Overall, adults scored children’s competences lower than the children themselves. Statistically significant differences of the perception of children, parents and teachers were found in single items, total scores and life areas (productivity, self-care, leisure), respectively. Differences in perceived competence were also found related to gender and schooling. Agreement in children’s and adults’ scorings varied depending on shared life areas (children and parents showing most agreement in self-care). Conclusion. Agreement and differences in perceived competences support the importance of children’s and proxies’ participation in assessment in order to gain a comprehensive picture and a better understanding of a child’s situation and conditions, address a child’s and his/her proxies’ concerns, and provide individualized and context-relevant intervention. Children - assessment - self-efficacy - perceived competence - parents - teachers - participation

Open access
Access to Psychotherapy in the Era of Web 2.0 – New Media, Old Inequalities? / Zugang zur Psychotherapie in der Ära des Web 2.0 – Neue Medien, Alte Ungleichheiten?

Abstract

Background: Currently, the debate on regional and socio-structurally related treatment gaps in psychotherapeutic care increases the interest in e-mental health interventions such as the Internet-based psychotherapy, online self-help and new approaches for self-empowerment. Thus, health professionals could support informed decision-making by knowing the latest developments. However, if the ‘digital revolution’ fails to reach patients not familiar with Web 2.0, access to psychotherapies is unlikely to improve. Therefore, the objective of this review is to clarify whether online therapies should be recommended as an effective alternative to conventional psychotherapy in primary care.

Methods: To investigate the research evidence of online therapies in adults within the last decade (2004-2014), a rapid review of literature was conducted by using electronic databases (i.e. Medline/PubMed, PubMed Central, Cochrane Library) to find systematic reviews, meta-analysis and clinical trials. Furthermore, a hand search in journals and grey literature was undertaken.

Results: A search in PubMed for clinical trials on ‘online psychotherapy’ resulted in a total number of 245 publications. So, eight reviews and several clinical trials were chosen. Overall, mostly positive findings on the effectiveness and acceptance of online psychotherapy, primarily in the treatment of depression and anxiety disorders, were identified.

Discussion: In sum, Internet-based psychotherapies have been effective in reducing symptoms of mood and anxiety disorders in clinical trials. However, due to the limited range of treatable disorders and non-representative samples (young female college graduates), external validity remains insufficient. Thus, further research is needed to determine if online therapies will be capable of improving access to psychotherapy.

Open access
Blended learning versus traditional teaching-learning-setting: Evaluation of cognitive and affective learning outcomes for the inter-professional field of occupational medicine and prevention / Blended Learning versus traditionelles Lehr-Lernsetting: Evaluierung von kognitiven und affektiven Lernergebnissen für das interprofessionelle Arbeitsfeld Arbeitsmedizin und Prävention

Abstract

Blended learning is characterised as a combination of face-to-face teaching and e-learning in terms of knowledge transfer, students’ learning activities and reduced presence at the teaching facility. The present cohort study investigated long-term effects of blended learning regarding cognitive outcomes as well as self-indicated estimates of immediate learning effects on the affective domain in the inter-professional field of occupational medicine. Physiotherapy students (bachelor degree) at FH Campus Wien – University of Applied Sciences completed the course Occupational Medicine/Prevention either in a traditional teaching-learning setting entirely taught face-to-face (control-group, n=94), or with a blended learning model (intervention-group, n=93). Long-term effects (1.5 year follow-up) on the cognitive learning outcomes were assessed according to four levels of Bloom’s learning objectives. In addition, students estimated potential benefits resulting from blended learning based on four Krathwohl’s learning objectives for the affective domain by means of a six-option Likert scale (n=282). Concerning cognitive outcomes, significant results favouring both groups were found with effect sizes from small to medium. The traditional teaching-learning setting resulted in significantly better results in the upmost aspired learning objective (analysis) at the long-term (p<0,01; r=-0,33). In contrast, the intervention group resulted in significantly better long-term results on learning objective levels 1 (knowledge) and 2 (understanding) (p=0,01; r=-0,20 and, p=0,02; r=-0,17, respectively). Hence, no general recommendation favouring either the classical setting or blending learning can be drawn regarding the cognitive domain. However, students’ self-indications on the affective domain give preference to blended learning, particularly if inter-professional teamwork is a course objective.

Open access
Development and evaluation of interdisciplinary preoperative patient education in foot and ankle surgery: immediate effects on knowledge, satisfaction and anxiety / Entwicklung und erste Evaluation eines präoperativen interdisziplinären Schulungskonzeptes für Patienten/-innen der Fußchirurgie: unmittelbare Effekte auf Wissenszuwachs, Zufriedenheit und Angst

Abstract

Background and objective

Foot and ankle surgery is increasing due to demographic and lifestyle changes. Most often, patients are required to unload their foot postoperatively, resulting in signifcant impairment of activities of daily living without adequate preparation for this situation. The aim of the study was the development and evaluation of a preoperative patient education intervention.

Methods

Based on current research, a patient education intervention was developed. To investigate immediate effects, a longitudinal study with two points of measurement before and after the education session was conducted. Outcomes were increase in knowledge, satisfaction and preoperative anxiety, which were measured with a selfdeveloped questionnaire. Additionally, five short interviews were conducted.

Results

56 patients (63% female) with a mean age of 56,7 (SD=14,8) years were included. Patients had a signifcant increase in knowledge following the intervention from mean 3,93 (SD=1,78) to 5,48 (SD=2,29) correctly answered questions (out of 10). Patients felt that they were better informed and more satisfied with the information provided. Patients evaluated the way of information delivery, the content of information, the group and the location as positive.The expectations of patients relating to postoperative load-bearing capacity and coping with everyday life as well as preoperative anxiety did not change following the intervention.

Conclusion

The education intervention could be implemented in the clinical routine and showed positive effects. However, regarding realistic expectations and preoperative anxiety no change was observed. Long-term post operative effectivity and effciency of patient education should be further examined within a randomized controlled trial.

Open access