[Generalist palliative care in hospitals during the first wave of the COVID-19 pandemic]. / Allgemeine Palliativversorgung im Krankenhaus während der ersten Welle der COVID-19-Pandemie.

BACKGROUND: In the research network of German university palliative care centers (PallPan), as part of Network University Medicine (NUM), recommendations for action were developed in regard to the care provided for seriously ill and dying patients during a pandemic. For this purpose, the experiences and needs of hospital staff working closely with patients outside of specialized palliative care units during the first wave of the COVID-19 pandemic were also examined. MATERIALS AND METHODS: Nationwide online survey of 8,882 physicians, nurses and therapists working in acute inpatient care in the period from December 2020 to January 2021 by means of a newly developed and piloted questionnaire on changes, burdens and cooperation with specialized palliative care. Grouping based on the changes in the number of seriously ill and dying people in the first wave of the pandemic. Due to the exploratory character of the survey, the data were analyzed descriptively. RESULTS: 505/8882 completed questionnaires were evaluated (5.7 %). 167/505 (33.1 %) of the respondents reported a lower quality of care for the critically ill and dying. 464/505 (91.8 %) reported exemptions in place for visiting the dying. The most frequently mentioned stress factor was the perceived loneliness of the seriously ill and dying 437/505 (86.5 %), followed by stricter hygiene rules 409/505 (81 %), increased workload 372/505 (73.3 %) and perceived psychological stress on relatives and survivors 395/505 (78.2 %). 141/505 (27.9 %) of respondents used Tablet PCs to support patient-family communication. 310/505 (61.4 %) involved palliative care professionals in patient care, and 356/505 (70.5 %) of respondents found other palliative care services helpful. CONCLUSION: Experiences and suggestions for improving palliative care in pandemic times are integrated into the PallPan recommendations for action. Family visits should be allowed and supplemented by digital offers. Palliative Care should also be integrated into both pandemic and contingency plans.

Allgemeine Palliativversorgung im Krankenhaus während der ersten Welle der COVID-19-Pandemie Generalist palliative care in hospitals during the first wave of the COVID-19 pandemic

Zusammenfassung Einleitung  Im Forschungsverbund deutscher universitärer Palliativzentren (PallPan) im Netzwerk Universitätsmedizin (NUM) wurden Handlungsempfehlungen für die Versorgung von Schwerkranken und Sterbenden in Pandemiezeiten erarbeitet. Dazu wurden auch die Erfahrungen und Bedürfnisse von patientennah tätigen Mitarbeitenden im Krankenhaus außerhalb von spezialisierten Palliativstationen während der 1. Welle der COVID-19-Pandemie untersucht. Methode  Bundesweite Online-Befragung von 8882 akutstationär tätigen Ärzt*innen, Pflegenden und Therapeut*innen im Zeitraum von Dezember 2020 bis Januar 2021 mittels eines neu entwickelten und pilotierten Fragebogens zu Veränderungen, Belastungen und zur Zusammenarbeit mit der spezialisierten Palliativmedizin. Gruppenbildung anhand der Veränderungen der Anzahl von Schwerkranken und Sterbenden in der ersten Welle der Pandemie. Aufgrund des explorativen Charakters der Studie wurden die Daten deskriptiv analysiert. Ergebnisse  505/8882 vollständig bearbeitete Fragebögen wurden ausgewertet (5,7 %). 167/505 (33,1 %) der Befragten berichteten über eine verschlechterte Versorgungsqualität von Schwerkranken und Sterbenden. 464/505 (91,8 %) berichteten über Ausnahmeregelungen für Besuche von Sterbenden. Der meistgenannte Belastungsfaktor war die wahrgenommene Vereinsamung der Schwerkranken und Sterbenden 437/505 (86,5 %), gefolgt von den verschärften Hygieneregeln 409/505 (81 %), der erhöhten Arbeitsbelastung 372/505 (73,3 %) und der wahrgenommenen psychischen Belastung von Angehörigen und Hinterbliebenen 395/505 (78,2 %). Tablet-PCs zur Unterstützung der Patienten-Angehörigen-Kommunikation wurden von 141/505 (27,9 %) der Befragten genutzt. 310/505 (61,4 %) des in die Patientenversorgung involvierten palliativmedizinischen Fachpersonals und 356/505 (70,5 %) der Befragten hielten weitere palliativmedizinische Angebote für hilfreich. Folgerung  Die Erfahrungen und Vorschläge zur Verbesserung der Palliativversorgung in Pandemiezeiten sind in die PallPan-Handlungsempfehlungen integriert. Angehörigenbesuche sollten ermöglicht und um digitale Angebote erweitert werden. Palliativversorgung sollte in Pandemie- und Krisenpläne integriert werden.

Needs and Needs Communication of Nursing Home Residents with Depressive Symptoms: A Qualitative Study.

Nursing home residents are affected by depressive symptoms more often than elders living at home. There is a correlation between unmet needs and depression in nursing home residents, while met needs positively correlate with greater satisfaction and well-being. The study aims to examine the needs of nursing home residents with depressive symptoms and the communication of those needs, as no previous study has explicitly addressed the needs of this group of people and the way they are communicated. We conducted semi-structured interviews with 11 residents of three nursing homes and analyzed them using content-structuring content analysis. The residents reported diverse needs, assigned to 12 categories. In addition, barriers such as health impairments prevented the fulfillment of needs. As to the communication of needs, various interlocutors, facilitators, and barriers were identified. The findings reveal that residents can express their needs and are more likely to do so if the interlocutors are patient and take them seriously. However, lack of confidants, missing or non-functioning communication tools, impatience and perceived lack of understanding on the part of caregivers, and residents' insecurities limit communication of needs.

[Living wills of residents in nursing homes - which treatment situations and treatment measures are decreed?] / Patientenverfügungen von Bewohnenden in Pflegeeinrichtungen ­ welche Behandlungssituationen und Behandlungsmaßnahmen werden vorausverfügt?

BACKGROUND: The possibility of using a living will to influence later treatment in the event of incapacity to consent is nowadays an important element in safeguarding patients' autonomy at the end of life. Refusing or consenting treatment measures in advance of treatment is of particular importance for nursing home residents, not only against the background of the COVID-19 pandemic. METHODS: We conducted a survey of all resident-documents in 13 nursing homes of different sizes and service providers in the city and district of Wuerzburg. The documents were analysed according to a deductive-inductive procedure using categorical summaries and descriptive frequency counts. RESULTS: In 265 recorded living wills, 2072 treatment situations and 1673 treatment measures could be identified. Residents largely agree to symptom-relieving and nursing measures and often reject life-prolonging or life-substaining treatment measures, the latter mostly being limited to specific, defined situations. The reference to certain treatment situations regarding resuscitation attempts, both in the form of refusal and consent, was identified in 88.6 % of the living wills. 62 % of the living wills could be assigned to a template. DISCUSSION: The study provides information about the content of living wills of nursing home residents. It thus provides information on medical treatment preferences in the case of incapacity to consent and shows that treatment measures (including resuscitation) are mostly related to specific treatment situations.

[Experiences and perspectives of nursing home residents with depressive symptoms during the COVID-19 pandemic: a qualitative study]. / Erfahrungen und Sichtweisen von Pflegeheimbewohnenden mit depressiver Symptomatik während der COVID-19-Pandemie: eine qualitative Studie.

BACKGROUND: The COVID-19 pandemic requires extensive health protection interventions in order to prevent infections in the long-term care setting. These interventions impact residents' lives, including an increase in depressive symptoms and other negative concomitants. OBJECTIVE: The study aimed to explore the experiences and perspectives of nursing home residents with depressive symptoms during the pandemic. METHODS: In this study nine guideline-based interviews were conducted with residents. These were analyzed using the content-structured content analysis according to Kuckartz. RESULTS: Three main themes were identified: perceptions and emotions related to the pandemic, changes and limitations due to the interventions and wishes in terms of the pandemic. The residents reported both emotional distress and not being afraid of infection and its consequences. In addition, some respondents reported unpleasant restrictions, such as wearing masks. In some cases their usefulness was critically questioned. Furthermore, various wishes of the residents in relation to the pandemic, such as leaving the nursing home, were identified. CONCLUSION: The study showed complex perceptions, changes, and wishes due to the pandemic and its interventions. Therefore, an individual approach to residents with depressive symptoms is necessary to avoid an increase in mental health problems. Against this background, there is a need for participatory implementation of health protection measures for the particularly vulnerable group of nursing home residents.