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Delirium-Prevention Programs in German and Austrian Hospitals – Views on Goals, Barriers, Facilitators and Implementation Procedures: A Qualitative Telephone Study / Programme zur Delirprävention in deutschsprachigen Krankenhäusern: eine qualitative, telefonische Befragung zu den Zielstellungen, Barrieren, Förderbedingungen und Umsetzungsschritten in der Implementationsphase

Abstract

Objectives

Analysis of barriers, facilitators and concepts to implement delirium prevention programs in German and Austrian hospitals.

Materials and Methods

Qualitative, semi-structured expert interviews with 9 leaders of delirium prevention programs in Germany and Austria.

Results

Leaders described delirium incidence reduction, higher standards in hospital care for older patients, and improvement of employee satisfaction as goals for their delirium prevention pro-gram. Barriers were described with fragmented hospital care structures – regarding sections and professional background of the staff – and lack of financial resources. Facilitators were named with acknowledging delirium prevention successes of known community leaders and building interest groups and networks. For the implementation of their delirium prevention program, hospitals used working groups and networks to benefit from outside perspectives on their implementation process.

Conclusion

Although delirium prevention is associated with cost savings in hospital procedures, program leaders described a lack of financial resources to implement delirium prevention programs. To face the demographic shift in hospital care, it is vital to implement national health care funding for delirium prevention programs. Currently, hospital leaders described an undersupply of older patients with delirium in German and Austrian hospital care.

Open access
Health literacy of students. Results of an online survey at the Bochum health university (Germany) / Gesundheitskompetenz Studierender – Ergebnisse einer Online-Befragung an der Hochschule für Gesundheit Bochum

Abstract

Background

Health literacy is of growing importance in public health research in Germany. People with good health literacy are likely to make better health decisions. A large proportion of the German population, not just vulnerable groups, has a problematic or insufficient health literacy.

Aims

The study describes the health literacy of students at a German health university. It investigates the influence of sociodemographic and course-related factors on health literacy. The results are compared with those of the general population from Germany.

Methodology

Study participants were recruited by email. 203 students took part in the online survey (response rate 20.2%). From the European Health Literacy Questionaire 16 (HLS-EU-Q16) 127 datasets of students were completely available and were analyzed in this study. In addition to health literacy, sociodemographic and course-related factors were ascertained.

Results

39 (30.7%) of the students have a sufficient or excellent health literacy. On average, health literacy is lower in the group of students of health-related courses (M=30.6) than in the normal German population (M=34.5). The levels are particularly low in the dimensions of appraising and applying of health information.

Conclusion

The results must be interpreted with care. They can be used as a base for long-term monitoring of students’ health literacy and provide starting points for health promotion within the academic setting. Students of health-related degree should be encouraged to reflect on their own and others health literacy, as this is important for their future work with patients or clients.

Open access
Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie

Abstract

Background

Elderly patients often need post-acute care after hospital discharge. Involvement of social workers can positively affect the discharge planning process.

Aim

To investigate the effect of screening patients at risk for post-acute care needs by social workers on time with respect to social workers’ notification, length of stay and delays in discharge compared to usual care.

Methods

Cluster randomized stepped wedge trial design for five clusters (wards) and two steps (control to intervention) was used. A total of 400 patients (200 per period) with high risk of post-acute care needs (defined as Post-Acute Care Discharge score, PACD ≥ 7) were included. Social workers performed a screening to decide about self-referral to their services (intervention period), which was compared to a highly structured standard SW notification by physicians and nurses (control period). A Generalized Estimating Equations model adjusted the clustering and baseline differences.

Results

A total of 139 patients were referred to social services (intervention: n = 76; control: n = 63). Time to social workers’ notification was significantly shorter in the intervention period when adjusted for all the differences in baseline (Mdn 1.2 vs 1.7, Beta = -0.73, 95%-CI 1.39 to -0.09). Both the length of stay and the delayed discharge time in nights showed no significant differences (Mdn 10.0 vs 9.1, Beta = -0.12, 95%-CI 0.46 to .22 nights 95%-CI, resp. Mdn 0.0 vs 0.0, Beta = .11, 95%-CI -0.64 to 0.86).

Conclusion

Screening speeded up social workers’ notification but did not accelerate the discharge processes. The screening by social workers might show process improvement in settings with less structured discharge planning.

Open access
A diversity-sensitive long-term care for gay and lesbian elders in need of care – Results of the research project GLESA / Eine diversitätssensible Pflege für schwule und lesbische Pflegebedürftige – Ergebnisse des Forschungsprojekts GLESA

Abstract

This paper presents results of the research project „Gleichgeschlechtliche Lebensweisen und Selbstbestimmung im Alter“ (GLESA) by the Alice Salomon University of Applied Sciences, Berlin, and the Berlin School of Economics and Law concerning the needs of gay and lesbian elders regarding long-term care. The main focus is on the expectations and perceptions of long-term care (facilities) of the interviewees living in a gay housing project in Berlin, Germany. The study is based on 26 interviews: with eleven gay, one lesbian and three heterosexual tenants – two of them lived in a shared community with long-term care services. Another eleven interviews were conducted with experts (five cis-female, four cis-male and two transgender) working in social and health services (social workers, carers and psychologists). The data was gathered via problem-centered interviews (Witzel 2000) and analysed with Mayrings‘ (2007) qualitative content analysis. Long-term care aspects were one out of five dimensions of the analysis. The study illustrates the discomfort of LGB elders regarding regular care services. The interviewees prefer LGB(T*I)-friendly facilities, in part because they demonstrate overt signs of diversity and promise a high competence of LGB(T*I) personnel in terms of self-determination, awareness, visibility and knowledge about LGBT*I communities. Finally, the authors advocate enhancing the concept of culture-sensitive long-term care according to diversity-sensitive aspects. A better understanding of diversity will help to better consider individuality and biographies in long-term care (facilities) and to support the social inclusion of LGB(T*I) elders in need of care.

Open access
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
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
The International Classification of Functioning, Disability and Health (ICF) in neurorehabilitation in Austria. Comparison of the healthprofessions occupational therapy, speech-and language therapy and physiotherapy / Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit in der Neurorehabilitation in Österreich. Vergleich der Berufsgruppen Ergotherapie, Logopädie und Physiotherapie

Abstract

Introduction

The International Classification of Functioning Disability and Health (ICF) provides the language and a framework applying a unified and standardized form to describe health and conditions related to health. Teams who work in an interdisciplinary and multi professional way, as it is the case in neuro rehabilitation, can profit from integrating the ICF. The aim of this paper was to show how well implemented the ICF is in Austria with occupational therapists, speech and language therapists and physiotherapists working in neuro rehabilitation.

Methods

The present paper is a follow-up project of the APPEAR study. An extended questionnaire, which has been sent to 109 therapists working in Austrian neurologic rehabilitation facilities forms the basis for the results presented here.

Results

64 questionnaires were returned from occupational therapists, speech and language therapists and physio therapists and were used for evaluation. 50% of the therapists who answered the questionnaire (n=25) stated that the ICF has already been implemented in their institution. Therapists often applied ICF (n=35) when using common documentation systems. Additionally, therapists consider the ICF an aid to support interdisciplinary and multi professional work. The therapists also stated (n=27) that they are not satisfied with the ICF when inpatients become outpatients.

Conclusions

Many therapists answering the questionnaire consider the ICF an important tool for optimizing the rehabilitation process. Barriers contributing to hindering an implementation of the ICF should be eliminated in the future. In order to achieve that aim, institutions should provide time and financial resources to further the education of their employees.

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
Augmentative and Alternative Communication – Scoping Review / Unterstützte Kommunikation – Scoping Review

Abstract

Introduction

The effective use of Augmentative and Alternative Communication is challenging, not only for persons with complex communication needs, but also for their significant others. There is a need, therefore, for interprofessional collaboration in order to effectively assess, provide, and evaluate services.

Aim

The aim of this scoping review was to summarize current evidence in the field of Augmentative and Alternative Communication and reveal the demands for further research.

Method

We searched in the electronic databases Pubmed, AMED, and CINAHL using following keywords child*, disability, cerebral palsy, augmentative and alternative communication, intervention, and therapy to identify relevant literature. We summarised the content of the included studies.

Results

We included 16 literature reviews and 36 studies in this review. The 36 studies included 11 intervention studies, 20 descriptive studies, two experimental studies, and three studies evaluating assessments. Most of the studies were focussing on children with cerebral palsy and autism in the contexts of home, hospital, and primary school. There were no intervention studies, focusing on secondary and/or tertiary level of education or work. Moreover, we have not found any evidence from German speaking Europe.

Conclusion

In order to support the use of Augmentative and Alternative Communication and to enable participation of persons with complex communication needs, various endeavours are needed: in the practice of care settings interprofessional collaboration is required. Further research is needed in order to evaluate the effectiveness of interventions, focussing on youth and the contexts of secondary and/or tertiary education or work, or on assessments.

Open access
Postpartum midwifery care and familial psychosocial risk factors in Switzerland: A secondary data analysis / Hebammenbetreuung im Wochenbett und familiäre psychosoziale Risikofaktoren in der Schweiz: eine Sekundäranalyse

Abstract

Introduction

Psychosocial resources of parents are vital for the health and development of their children. Families in stressful circumstances should receive early seamless care to strengthen their parental resources. Independent midwives provide ambulant postpartum care in most families in Switzerland, and hence could play an important role in the early assessment and care of families at risk.

Methods

Comprehensive routine data of Swiss independent midwives were used for secondary analysis. Frequencies of known psychosocial risk factors were derived and compared to other data sources. Group comparisons were made with respect to family characteristics and midwifery care.

Results

Only some of the considered risk factors are representable in the midwives‘ data. 18.6% of all families have one and 6.25% have multiple such representable risk factors. Immigrant mothers from developing and emerging countries, very young or older mothers and large families are thereby particularly often affected. Burdened families receive more home visits, but have a later onset of ambulant postpartum care. They suffer more often from breast-feeding problems and are more frequently referred to other disciplines.

Discussion

Independent midwives in Switzerland document some of the known psychosocial risk factors and adapt their care in routine practice. The collection of data with a better coverage of the known psychosocial risk factors, ideally using validated assessment instruments, is recommended, and further research is required for a more in-depth understanding of the current interdisciplinary collaboration and the needs of families and care providers.

Open access