[Handover between home and respite care facilities : Delphi survey within the context of continuity of care for people with dementia]. / Überleitung zwischen Häuslichkeit und Kurzzeitpflege : Delphi-Befragung im Rahmen der Versorgungskontinuität von Menschen mit Demenz.

BACKGROUND: Criteria for the handover between healthcare settings were identified based on a review and on results of empirical data. AIM: This study was carried out to select the most relevant criteria for defining the quality of continuity of care of people with dementia (PwD) in the context of the handover between care at home and respite care facilities. MATERIAL AND METHODS: A modified classical two-step Delphi design was used in combination with a group Delphi design. RESULTS: A total of 28 core criteria with a consensus strength of > 60 % are presented. Safety-relevant information, especially the personal habits of PwD and the role of informal caregivers in the handover between care settings are important. Furthermore, the following general principles to ensure the quality of continuity of the care of PwD were deduced: completeness, verification, multipath communication, timeliness and topicality, accessibility and defined responsibilities, roles and standardization. DISCUSSION: A successful transition of PwD to respite care facilities relies on the provision of relevant information, considering personal habits, before the day of transition. Furthermore, a timely preparation for discharge is important. The individual needs of the informal caregivers with regard to their support should be considered. Professionals who are responsible in handover processes should have solid communication competence in order to collect relevant information from informal caregivers, who have a strong individual care experience with the PwD.

[Low-threshold support services for people with dementia--the viewpoint of volunteers]. / Niedrigschwellige Betreuungsangebote für Menschen mit Demenz aus der Sicht der Betreuungskräfte.

AIM OF THE STUDY: The aim of the study was to investigate the perspective of volunteers on low-threshold support services. The volunteers were asked to estimate their engagement in care and the constitution of these services in considera-tion of their employment position. METHODS: In an explorative cross-sectional study we collected data using standardised questionnaires in 2 regions of North Rhine-Westphalia (Germany). The analysis was descriptive. RESULTS: The results show that the employment position differed: half of the volunteers were really honorary involved. The others were regularly salaried. In general all volunteers searched for a meaningful and fulfilling activity and benefitted from it. The aspects related to the constitution of the services (concerning the services in general, with organisational character, concerning the behaviour of the volunteer) were all important. The most important aspect was the needs of the people with dementia. These estimations hardly differed according to the employment position. CONCLUSION: The volunteers involved in low-threshold support services show a high commitment. They hold a lot of potential but they also have to be defended from excessive demands. Because of the salaried employment of the volunteers, the services providers have a planning reliability and can offer a continuous care. Thus shows a tendency towards a professionalisation of these voluntary workers.

[People with dementia between home and respite care: quality assurance for cross-over communication, a systematic review]. / Menschen mit Demenz zwischen Häuslichkeit und Kurzzeitpflege: Qualitätssicherung settingübergreifender Kommunikation, ein systematischer Review.

INTRODUCTION: To identify safety-relevant communication structures and processes considering the handover between home and respite care for people with dementia (PwD). METHOD: In a systematic review, MEDLINE, -EMBASE, Cochrane Library, CINAHL, PsycINFO and GeroLit were searched for publications indexed until April 2011 including a search via Google and Google scholar. An update for publications indexed between May 2011 and December 2012 was added. OUTCOMES: A total of 1 832 search results were identified and one relevant publication of a project for PwD to improve the handover between settings was included. With regard to that project, additional literature was identified. CONCLUSION: The practice-based project identified through the literature search could be suitable to improve handover communication between home and respite care for PwD after further validation. A large gap in the evidence with regard to the research question was identified.

[Malnutrition and dementia in the elderly in German nursing homes. Results of a prevalence survey from the years 2008 and 2009]. / Mangelernährung und Demenz bei Bewohnern in Einrichtungen der stationären Altenpflege in Deutschland : Ergebnisse von Prävalenzerhebungen aus den Jahren 2008 und 2009.

BACKGROUND AND OBJECTIVE: Dementia is one of most challenging problems for the care of older people in Germany. Although malnutrition in nursing homes is also associated with dementia, few systematic studies have described health care structures in German nursing homes for people with dementia and their individual nutritional status. Therefore, the aim of this study was to determine dementia-specific differences concerning the nutrition situation for the elderly in German nursing homes. METHODS: A cross-sectional multicenter study was performed using a standardized multilevel instrument (observation, questionnaire) developed at the University of Maastricht. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and types of interventions. RESULTS: In the 2008 and 2009 surveys, 53% of 4,777 participants (77.9% women, 22.1% men, mean age 82 years) were identified (based on care documentation) as having dementia. More than one third of this population (n = 759, 85.1% women, 14.1% men, mean age 85 years) was probably malnourished; thus, the prevalence rate in the group of people with dementia was 10% higher compared to the group without dementia. People with dementia showed a higher risk in all relevant risk indicators (weight history, body mass index, and food intake) for malnutrition compared to those without dementia. Furthermore, people with dementia had higher care dependency rates and required more assistance for eating and drinking. CONCLUSION: The study results confirm the relationship between malnutrition and dementia. The use of standardized nutrition screening tools is not common practice in German nursing homes yet. However, the results suggest that with an increasing risk for malnutrition combined with dementia the proportion of nursing interventions also increases, which means that nurses must react adequately. Nevertheless, the interventions concerning malnutrition should be improved especially with respect to preventive measurements.

Associated factors of different nutrition indicators in German nursing home residents: comparative results of a multicenter cross-sectional study.

BACKGROUND: Malnutrition is one of the most important care problems in the nursing home care sector. The subject of this analysis is the investigation of associative factors for different indicators of malnutrition of residents in nursing homes in Germany. METHODS: A secondary data analysis was conducted using data from 4,478 nursing home residents. Unintended weight loss or reduced intake and BMI ≤ 20 were analysed as indicators for malnutrition. The influence of age, sex, co-morbidities and care dependency were investigated in logistic regression models. RESULTS: Residents with a high care dependency had a higher risk of suffering weight loss/reduced intake. With regard to BMI ≤ 20, residents aged > 85 years, female gender, cancer, musculoskeletal disease as well as high care dependency had a higher risk. CONCLUSION: In both models, care dependency plays a major role in explaining malnutrition. Associative factors for malnutrition must be interpreted according to the indicators used to define malnutrition.

[Improvement of oral health care in geriatric care by training of nurses and nursing assistants for the elderly]. / Verbesserung der zahnmedizinischen Betreuung in der Altenpflege durch Schulungen von Pflegekräften.

Because oral health among residents of German nursing homes is inadequate, this intervention study evaluated the effects of dental training for nurses and nursing assistants (RN and RA) in homes for the elderly on their assessment of oral health in residents and, as a consequence, on the status of residents' oral health. 53 residents and the RNs and RAs from three homes for the elderly participated in this study. The nursing staff received training in dental health care. As primary outcome, the competence in performing the Brief Oral Health Examination (BOHSE) was measured at baseline date and four months after training. Additional outcome measures were dental and denture hygiene in residents, functional status of dentures, and treatment needs. Dental training was shown to improve the nursing staff's competences in oral health assessment in tendency. Residents' oral hygiene improved significantly, whereas no relevant effects on hygiene and functional status of dentures were registered. The need for dental treatment turned out to be considerable at both measurements. Modifications in test tools with identification of dental treatment needs seem to be indicated in order to improve cooperation between nursing staff and dentists in homes for the elderly.

Validity, reliability, and feasibility of a quality of life questionnaire for people with dementia.

The present study investigates the validity, reliability, and applicability of the German version of the QUALIDEM, which is used to measure the quality of life of people with dementia in nursing homes. The sample consists of data from 203 people (average age 84 ± 9 years, 74% female) with mild to moderate dementia and 283 persons (average age 86 ± 8 years, 79% female) with severe to very severe dementia. These are baseline data from two lighthouse projects on dementia (STI-D and InDemA). The investigation of the feasibility is based on four expert interviews. The construct validity of the 37-item version of the QUALIDEM shown by the factors satisfied behavior, unapproachable and unsatisfied behavior, positive self-image, negative affect, social relations, feeling at home, restless tense behavior, and having something to do were identified. Furthermore, for the 18-item version the following four factors were computed: satisfied behavior, unapproachable and unsatisfied behavior, restless tense behavior, and negative affect. Cronbach's α values for the determined factors are between 0.64 and 0.87 (37-item version) and between 0.61 and 0.83 (18-item version), which corresponds with a medium to high reliability (internal consistency). Furthermore, the student assistants assessed the QUALIDEM as applicable and practical.

[Quality management in ambulatory care nursing and inpatient nursing in Germany. Specifics and current trends]. / Qualitätsmanagement in der ambulanten und stationären Pflege : Aktuelle Entwicklungen und Besonderheiten.

In principle, quality management in nursing care follows the concepts used in medicine. Occasionally, professionals develop quality requirements and pursue quality improvements by using various tools. Specific features in Germany's nursing care are related to the binding character of seven so-called expert standards and to mandatory, external quality assessments that began in 2009 and will be conducted and published yearly. Preliminary results of these assessments show that both home health agencies and nursing homes provide on average good quality nursing care. However, assessments also revealed a huge demand for improvements concerning the quality criteria and the procedures used to calculate the results. Currently, nursing scientists, providers of care, and long-term care insurance companies are controversially discussing that matter.

[Prevalence of malnutrition, interventions and quality indicators in German nursing homes - first results of a nationwide pilot study]. / Prävalenz von Mangelernährung, Maßnahmen und Qualitätsindikatoren in deutschen Altenpflegeheimen - erste Ergebnisse einer landesweiten Pilotstudie.

AIM OF THE STUDY: The aims of this study were to test the transfer and feasibility of a Dutch annual survey on malnutrition into German nursing homes and to gather first data about the prevalence of malnutrition, treatment and quality indicators in German resident homes. METHODS: A cross-sectional multicentre study, using a standardised multilevel instrument (observation, questionnaire) developed in the University of Maastricht was applied. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and treatment initiatives. RESULTS: The sample consisted of 32 nursing homes with 2,444 participating residents. 26% of the residents show indicators of malnutrition, a risk of malnutrition can be found in another 28%. Only one quarter of the nursing homes use a standardised nutritional screening instrument. Significantly more people with dementia have indicators of malnutrition. Most facilities provide a protocol or a guideline for the prevention and treatment of malnutrition. Also most are training their staff regularly in questions of malnutrition, half the institutions employ dieticians or nutritionists. Special treatment was initiated in half of all residents having indicators of malnutrition or showing a risk. CONCLUSION: The Dutch instrument is applicable in German nursing homes. Its utilisation shows that malnutrition is still a problem in German nursing homes. The standardised assessment of nutritional status is the exception; the interventions carried out should be improved.

[Equipment and use of equipment in nursing homes]. / Hilfsmittelausstattung und -nutzung in der stationären Altenpflege.

AIM OF THE STUDY: The aim of this research study was to describe the provision of aids and their use in the transport of residents. The study was also intended to analyse prior experience with the methods and concepts of resident transfer, paying due attention to back problems. The resulting knowledge is to support work on the implementation of procedures in geriatric in-patient care which are suited to workers with back problems. METHODS: This is a cross-sectional study, in which 217 nurses and 43 superior nurses were interviewed, with the help of a standardised questionnaire which they are expected to complete. RESULTS: The majority of those questioned felt that they were not well informed about the availability of aids. This is reflected both in the deficient equipment with the aids and in how rarely they are used. The superior nurses regarded themselves as being rather better informed. In general, there are fewer small than large aids in the institutions and these are also used more rarely. "Lack of time" and "lack of acceptance by the residents" were the main reasons given for lack of use. About half of the superior nurses and nurses feel that they are well or very well informed about mobility concepts and working methods which spare the back. According to this, these concepts are only applied in a quarter of old people's homes, although training is more frequent. Instruction in the use of aids takes place too rarely. This can be concluded from the evaluation of the data from the superior nurses and the 109 spontaneous comments from the nurses, who not only advocated the purchase of the aids, but also emphasised the need for more information and training. CONCLUSIONS: The results indicate that current work on equipment with aids and training in their use must be optimised and must also incorporate recent advances in scientific knowledge. Implementation of specific risk assessment analyses of stress at work and regular training in dealing with aids could help to support the use of aids for geriatric in-patients.

[Measuring nursing care times--methodologic and documentation problems]. / Die Messung von Pflegezeiten--methodische und inhaltliche Probleme.

The time for needed nursing care is one important measurement as a basic for financing care. In Germany the Long Term Care Insurance (LTCI) reimburses nursing care depending on the time family care givers need to complete selected activities. The LTCI recommends certain time ranges for these activities, which are wholly compensatory, as a basic for assessment. The purpose is to enhance assessment justice and comparability. With the example of a German research project, which had to investigate the duration of these activities and the reasons for differences, questions are raised about some definition and interpretation problems. There are definition problems, since caring activities especially in private households are nearly never performed as clearly defined modules. Moreover, often different activities are performed simultaneously. However, the most important question is what exactly time numbers can say about the essentials of nursing care.

[Development of nursing science in Germany]. / Zur Entwicklung der Pflegewissenschaft in Deutschland.

This essay investigates the following two questions: Why did it take so long to become apparent that nursing has an important role in our society? What influenced the growing importance of nursing? Since this essay was part of a habilitation process, it begins with a review of the first German habilitation in nursing in 1895. In retrospect, this document reveals ideas of nursing that are important and still valid today, even though it was written by a physician. However, nursing as a profession practised by nurses or nuns was hidden in the invisible corners of health care and developed as a marginal category. For religious reasons nurses, as women, were encouraged to obey and not think for themselves. Only during the last few decades did nursing acquire a new meaning due to structural changes in morbidity and population, as well as a belated new sense of self-confidence in a profession still predominantly female. Within these new demands, nursing science also gained in significance. Its first substantial ideas came from North America. The difficulties in developing the nursing science lie in the nature of nursing, which often seems to be near omnipotence.