Specific item patterns in comparison to generalized sum score-the Care Dependency Scale (CDS) as a screening tool for specific care problems.

AIMS: The aim of this study is to identify items of the Care Dependency Scale (CDS) with overriding importance for the specific nursing care problems of pressure ulcers, falls, and malnutrition. METHOD: Secondary data analysis of 5 multicentre consecutive annual cross-sectional surveys from 2008 to 2012. For the study, data were analysed from 19 787 individuals in 262 long-term care facilities throughout Germany. Based on a standardized study protocol and international definitions, data regarding care dependency and care problems were gathered by direct examination. To identify the most relevant items of the CDS regarding pressure ulcers, falls, and malnutrition, classification trees (Classification and Regression Trees) were calculated. The validity of the identified items was then confirmed by applying "area under the receiver operating characteristic curve (AUC)" statistics. RESULTS: The Classification and Regression Tree analysis showed a total of 6 nodes for pressure ulcer prevalence on 2 levels. Both levels provided the CDS item mobility as the most important predictor for the prevalence of pressure ulcers with a prevalence of 9.0% for these being completely dependent. The most important CDS item to determine malnutrition is completely dependent on eat and drink with a malnutrition prevalence of 25.2%. Of all CDS items that have been entered into the model, the item mobility showed the strongest association with falls. For pressure ulcers, the CDS items mobility (0.72) and body posture (0.71) provided a higher AUC than the total CDS sum score. Furthermore, for malnutrition, we measured an AUC of 0.63 for item eat and drink while the total CDS provided an AUC of 0.62. CONCLUSIONS: The results of our study suggest that the CDS may be a useful tool for screening patients regarding the risk of pressure ulcers and/or malnutrition. According to our study, the CDS can be used as an assessment for many different care problems.

[Centrally and non-centrally designed exams in nursing: Comparisons of the final exams in 2008 to 2013 in Berlin focusing on different concepts of professional nursing education]. / Zentral und dezentral verortete Prüfungen in der Krankenpflege. Vergleich der Abschlussnoten der Jahre 2008 ­ 2013 im Land Berlin unter Berücksichtigung unterschiedlicher Ausbildungskonzepte.

INTRODUCTION: In Germany, nursing education ends with a final written, oral and practical exam. In the federal state of Berlin, Germany, all nursing students take centrally standardized written exams, while the practical and oral exams are developed by each individual nursing school or university and conducted without standardized protocols (non-central). Comparability might be seriously limited by this procedure. Since there is no official statistics available, the objective of this study is to compare the results of the final written, oral and practical exams of different nursing education institutions with an additional focus on different educational concepts. METHODS: In a secondary data analysis, the final grades (written, oral, practical) of 4,342 nursing students in all 16 educational institutions in Berlin from 2008 to 2013 were analyzed. RESULTS: The mean (SD) of all written, oral and practical exams taken was 2.9 (0.7), 2.6 (1.1) and 2.2 (1.0), respectively. In each type of exam, the trend in grades was stable over the observation period. There was a statistically significant increase in the prevalence of initially failed exams from 2008 (7.9 %) to 2013 (12.0 %). In institutions following a traditional concept of education, the difference in grades between oral/practical exams on the one hand and written exams on the other ranged from 0.1 to 0.9, while in generalist (academic) institutions it ranged between -0.1 and 0.3 (-0.1 to 0). CONCLUSION: In nursing schools with a traditional approach to education, there was a big difference in grades between written and oral/practical exams. Standardization of oral and practical exams should be initiated to ensure greater comparability between different educational institutions.

Effectiveness of nurse-delivered patient education interventions on quality of life in elders in the hospital: A systematic review.

BACKGROUND: Nurse-delivered education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. To our knowledge, no systematic review has addressed the effects of nurse-delivered education interventions on the quality of life in a general elderly inpatient population. OBJECTIVES: To evaluate the effectiveness of nurse-delivered education interventions compared to usual care with regard to the quality of life in elders in the hospital. METHODS: A systematic review was performed to identify randomized controlled trials examining the effects of nurse-delivered educational interventions on the quality of life in elders in the hospital. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p-values were extracted to determine the effectiveness of the interventions. RESULTS: Four studies were included in the review. One study testing multicomponent interventions showed positive effects on quality of life. Two studies showed no effect, and one study showed a negative effect of the intervention on quality of life. Methodological appraisal revealed single biases in most of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Because of the scarcity of positive findings, methodological issues, and heterogeneity between studies, this review could not provide evidence of the effectiveness of nurse-delivered education interventions in elders in the hospital for improving quality of life. Nurse-delivered education may be more effective as a part of multifactorial interventions. Further studies should examine interventions that focus on quality of life using validated measures.

Effectiveness of educational nursing home visits on quality of life, functional status and care dependency in older adults with mobility impairments: a randomized controlled trial.

RATIONALE, AIMS AND OBJECTIVES: Facilitating and maintaining functional status (FS) and quality of life (QoL) and avoiding care dependency (CD) are and will increasingly become major tasks of nursing. Educational nursing home visits may have positive effects on FS and QoL in older adults. The aim of this study was to determine the effectiveness of educational home visits on FS, QoL and CD in older adults with mobility impairments. METHOD: We performed a randomized controlled trial. The study was conducted in the living environments of 123 participants with functional impairments living in Hamburg, Germany. The intervention group received an additional nursing education intervention on mobility and QoL; the control group received care as usual. Data were collected from August 2011 to December 2012 at baseline, 6 months and 12 months of follow-up. The main outcomes were FS (Barthel Index), QoL (WHOQOL-BREF) and CD (Care Dependency Scale). Data were analyzed using descriptive statistics and generalized linear models. RESULTS: In total, 113 participants (57 in the intervention and 56 in the control group) were included in the study. The intervention had no statistical significant effect on FS, QoL and CD. CONCLUSIONS: The intervention did not show the benefits that we assumed. Further studies on the effects of educational nursing interventions should be performed using different concepts and rigorous research methods.

Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.

BACKGROUND AND AIM: Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS: A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS: Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION: These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.

Effects of a hospital-based education programme on self-care behaviour, care dependency and quality of life in patients with heart failure--a randomised controlled trial.

AIMS AND OBJECTIVES: To evaluate the effects of a nurse-led, hospital-based heart failure specific education session with a three-month telephone follow-up on self-care behaviour, care dependency and quality of life for patients with chronic heart failure. BACKGROUND: Patient education in patients with heart failure is able to promote heart failure-specific self-care, to reduce mortality, morbidity and rehospitalisation rates and to enhance quality of life, especially if heart failure education is embedded in a multidisciplinary approach. Evidence of the effect of a nurse-led self-care education, quality of life and care dependency in addition to standard medical treatment in Germany is lacking. DESIGN: Nonblinded, prospective, single-centre, randomised controlled trial. METHOD: Sixty-four patients were allocated either to the intervention group or to the control group. Patients in the intervention group received education about heart failure self-care with a consecutive telephone follow-up over three months in addition to standard medical treatment. Patients in the control group received standard medical treatment only. RESULTS: Data of 110 patients (58 in the intervention group and 52 in the control group) with a mean age of 62 years and mean left ventricular ejection fraction of 28·2% could be analysed. Self-care education had a significant influence on overall heart failure self-care but not on quality of life and care dependency. CONCLUSION: A single education session with a consecutive telephone follow-up is able to improve overall self-care behaviours but not quality of life. Care dependency was not influenced by the education session. RELEVANCE TO CLINICAL PRACTICE: The easy to implement and short educational intervention has a positive effect on self-care behaviour for patients with heart failure. However, there was no effect on quality of life and care dependency. To improve quality of life and to influence care dependency, different measures have to be applied.

Mobility is the key! Trends and associations of common care problems in German long-term care facilities from 2008 to 2012.

BACKGROUND: Although enormous efforts have been made in auditing the quality of care, there are only few epidemiological studies available about the actual occurrence of immobility, malnutrition, urinary incontinence, cognitive impairment, falls and pressure ulcers in long-term care facilities. OBJECTIVE: The objective of this study was to provide prevalence estimates of common nursing care problems in long-term care facilities and to investigate any associations between them. DESIGN: Secondary data analysis of five consecutive annual cross-sectional multicenter studies from 2008 to 2012. SETTING: 262 different long-term care facilities throughout Germany. PARTICIPANTS: 14,798 residents older than 18 years who gave informed consent. METHODS: Health conditions were rated based on direct resident examinations according to the current international definitions. Demographic characteristics were compared with available national population statistics. Apart from descriptive statistics, Chi(2) tests were carried out for bivariate and log-regression models were performed for multivariate associations. RESULTS: Prevalence rates were stable over the years with the highest prevalence of 73.5% (95% CI 72.8-74.2) being found for urinary incontinence, for cognitive impairment it was 54.1% (95% CI 53.3-54.9) and for immobility it was 36.5% (95% CI 35.7-37.3). The lowest prevalence rates were established for the risk of malnutrition with 13.0 (95% CI 12.4-13.5), for pressure ulcers with 4.8% (95% CI 4.5-5.1) and for falls (4.4% 95% CI 4.1-4.8). In the multivariate model, immobility was most strongly associated with all of the other conditions. No statistically significant associations were found between pressure ulcers and falls, pressure ulcers and urinary incontinence, pressure ulcers and cognitive impairment and between malnutrition and urinary incontinence. CONCLUSION: Decision-makers and clinical practitioners may primarily focus on the maintenance and enhancement of mobility, because this seems to be the key predictor for many other health conditions in the context of care dependency in the nursing home setting.

Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals.

AIMS AND OBJECTIVES: The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. BACKGROUND: Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. DESIGN: A nonparticipant observational descriptive design was used. METHODS: A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. RESULTS: A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. CONCLUSION: This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. RELEVANCE TO CLINICAL PRACTICE: This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Mobility and quality of life after discharge from a clinical geriatric setting focused on gender and age.

PURPOSE: The purpose of this study was to assess the long-term functional status and quality of life of older individuals with functional mobility impairment. DESIGN: A prospective longitudinal study was conducted. METHODS: The study sample consisted of elderly patients who had been admitted to a rehabilitation facility in Hamburg, Germany. Data were collected from February 2008 to August 2009 in the rehabilitation center and the living environment of the participants after discharge. Quality of life was assessed using the WHO Quality of Life-BREF; activities of daily living were measured using the Barthel-Index (BI). FINDINGS: Functional status and overall quality of life increased from admission (BI = 73.33) to 6 months postadmission (BI = 89.29) but decreased at 12 months postadmission (BI = 85.71). Quality of life significantly increased in the psychological domain from admission (57.85) to 6 months follow-up (67.85) (p = .010). Men showed a better functional status over time (p = .010) than women. Higher quality of life scores were associated with higher MMSE (p = .031) and self-efficacy scores (p = .019) at admission. CONCLUSION: The findings of this study suggest a need for interventions to improve functional status and quality of life in this population, especially following 6 months after discharge. CLINICAL RELEVANCE: Special interventions should address physical quality of life and physical functioning. Gender differences should be considered in planning and implementing programs.

Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies.

AIM: The aim of this study was to compare the degree of care dependency between hospitalised patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD). METHODS: Secondary data analysis of five German prevalence studies from 2007 to 2011. Care dependency was measured using the Care Dependency Scale. RESULTS: Hospitalised patients with CHF or COPD are to a limited extent care dependent, and their overall care dependency does not differ (p = 0.56). Care dependency items with the lowest mean were mobility, hygiene, getting (un)dressed, continence, avoidance of danger and daily activities. Patients with CHF or COPD did not differ statistically significantly in those items. Only the items 'eating and drinking' almost achieved statistical significance (p = 0.06). CONCLUSION: Patients with CHF or COPD did not differ in levels of care dependency. Both patient populations are restricted in engaging in activities potentially associated with physical condition and possibly influenced by perceived dyspnoea. Furthermore, comorbidities like incontinence and cognitive impairment seem to play an important role regarding the degree of care dependency.

Dealing with aggressive behaviour in nursing homes: caregivers' use of recommended measures.

AIMS AND OBJECTIVES: To identify groups of caregivers in terms of their use of measures for dealing with resident aggression and the differences between these groups related to their characteristics. BACKGROUND: Caregivers in nursing home are confronted with a major challenge when faced with the aggressive behaviour of residents. Therefore, the application of recommended measures is important in supporting caregivers and promoting safety for residents. DESIGN: Cross-sectional survey. METHODS: A total of 804 caregivers working in 21 Swiss nursing homes provided data. The questionnaire used was based on published recommendations regarding management of aggressive behaviour and amendments by experts. RESULTS: The most widely used measure aimed to calm down the resident and to understand the meaning of aggressive behaviour. Physical activities were applied by around 50% of the respondents, and interdisciplinary case reviews as well as standardised instruments for assessment and documentation were used by <50%. Caregiver characteristics such as employment level, support from superiors, institutionalised support for affected caregivers and training in aggression management are associated with their use of recommended measures. Furthermore, caregivers' competence in empathising with the residents' perspective in connection with their professional experience has a positive influence on applying recommended measures. CONCLUSION: Caregivers use multifaceted measures in understanding the meaning of underlying aggression, but there is a certain failure to use standardised instruments. Caregivers differ significantly in the frequency of their application of recommended measures. Support from superiors and assistance for affected caregivers positively influence their use of measures, whereas training in aggression management leads to less use. RELEVANCE TO CLINICAL PRACTICE: Findings show the importance of support from superiors and institutionalised assistance for affected caregivers. Caregiver competence in empathising with the residents' perspective is important in using person-centred approaches in the care of residents with aggressive behaviour.

Effectiveness of a nursing consultation intervention for older people with functional mobility impairments: a prospective, longitudinal study.

BACKGROUND: There is a need for prevention strategies in elderly individuals with mobility impairments. PURPOSE: The aim of this study was to determine the effects of nursing consultations on the functional abilities and quality of life of elderly individuals with mobility impairments after discharge from a rehabilitation facility. METHODS: A single-site, prospective, longitudinal study with a nonequivalent control group pretest-posttest design was conducted in a geriatric rehabilitation facility and in the living environments of the patients after discharge. The intervention consisted of nurse-delivered consulting home visits and follow-up telephone calls. Patient quality of life and functional status were the primary outcomes, and self-efficacy was the secondary outcome. Data were collected at admission, at discharge, and at a 6-month follow-up visit. RESULTS: A cohort of 124 patients participated in the study. The intervention group showed a nonsignificant improvement in functional status compared with the control group. The intervention did not affect quality of life, except for a trend toward significance in the social domain (p = .060). CONCLUSIONS: The findings of this study suggest that nursing consultations do not significantly improve functional status and have almost no effect on quality of life.

Effectiveness of nurse-delivered patient education interventions on quality of life in outpatients: a systematic review.

BACKGROUND: Nursing education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. No review has addressed the effects of overall nursing education interventions on the quality of life in a general outpatient population. OBJECTIVES: The objective of this study is to evaluate the effectiveness of nurse-delivered education interventions compared with usual care with regard to the quality of life of outpatients. METHODS: A systematic search was performed to identify randomized controlled trials that examined the effects of nurse-delivered educational interventions on the quality of life of outpatients. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p values were extracted to determine the effectiveness of the interventions. RESULTS: Twenty-nine studies were included in the review. Approximately 70% of the studies included showed no effects on quality of life. The studies that showed positive effects each used different types of interventions. A methodological appraisal revealed biases in most of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Because of an overall lack of effectiveness and heterogeneity between studies, no evidence for the effectiveness of nursing education interventions in outpatients was observed. Further studies should examine interventions that focus on quality of life using validated measures.

[Nurses' experiences with aggressive behaviour of nursing home residents: a cross sectional study in Swiss nursing homes]. / Erfahrungen und Umgang der Pflegenden mit aggressivem Verhalten von Bewohner(inne)n: eine deskriptive Querschnittstudie in Schweizer Pflegeheimen.

The present exploratory descriptive cross-sectional study with the participation of 814 (51.8%) caregivers in 21 Swiss nursing homes provides insight into caregivers' experiences and handling of residents' aggressive behaviour. Moreover, caregiver burden with regard to resident aggression and the consequences on the caregiver-resident-relationship were investigated. The survey was carried out by means of validated questionnaire. Approximately 38% of participants experienced aggressive incidents during the last seven days prior to data collection. In most cases aggressive behaviour was caused by residents suffering from dementia and/or depression and occurred during nursing interventions involving physical contact. As a trigger for aggressive behaviour participants predominately assumed "non-understanding and excessive demand" of residents. Reassuring conversation and keeping oneself at a distance were most often used to calm the situation. Approximately 40% of participants experienced physical attacks as especially distressing and circa 23% were frightened, particularly when aggressive behaviour occurred without warning. Approximately 4% of caregivers avoided contact with residents after an aggressive incident and 12.3% perceived a disturbed relationship. It can be assumed that caregivers do not adequately perceive emotions possibly underlying aggressive behaviour in the escalation phase and therefore may not identify early signs of beginning aggression.

Does the care dependency of nursing home residents influence their health-related quality of life?-A cross-sectional study.

BACKGROUND: Studies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission. METHOD: Eleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains "Physical Mobility", "Energy", "Pain", "Social Isolation", "Emotional Reaction" and "Sleep". Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL. RESULTS: 120 residents were included in total. HRQOL was mostly reduced in the domains "Physical Mobility" and "Energy" (mean scores >43.0), while impairment differences in the domains "Pain", "Social Isolation", "Emotional Reaction" and "Sleep" were only moderate (≤25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain "Pain" than men (mean score women: 29.5 ± 31.5; males: 14.9 ± 17.2; p = 0.011). Care dependency had an influence on the domain "Sleep" (ß = -0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain "Sleep" than residents with a high care dependency (mean score 15.3; SD ± 19.0 versus mean score 32.8 SD ± 33.2; p < 0.02). CONCLUSION: The level of care dependency has no influence on the HRQOL from the nursing home residents' perspective apart from the domain "Sleep". High care dependency residents have a lower HRQOL in the domain "Sleep" compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain "Pain".

Validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale.

BACKGROUND: The promotion of self-care in patients with heart failure (HF) is a promising strategy for maintaining health and preventing exacerbation of HF and a continuous need for healthcare services. To assess patient self-care, valid and reliable instruments are needed, but there is no psychometrically tested instrument for use in a German HF population. AIM: The aim of this study was to determine the validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale (G9-EHFScBS). Construct validity including factor analysis and discriminant validity, concurrent validity, test-retest reliability and internal consistency were analysed. METHODS AND RESULTS: The G9-EHFScBS was translated into German, and its validity and reliability were tested with 109 patients. The item-total correlation ranged from 0.09 to 0.63. Internal consistency was fair, with a Cronbach's alpha of 0.71 (95%CI: 0.63 to 0.77). Test-retest reliability using an intra-class correlation coefficient showed substantial agreement for the entire scale (ICC: 0.69; 95%CI: 0.56 to 0.79). The G9-EHFScBS was able to distinguish patients with and without extra HF education at a statistically significant level (t = 2.105; p = 0.04). A factor analysis did not show the theoretical assumed dimensions of the scale. CONCLUSION: The G9-EHFScBS is deemed a valid and reliable instrument to assess HF-specific self-care in a German HF population.

Factors associated with supportive care needs of patients under treatment for breast cancer.

PURPOSE: This study aimed at gaining insight into supportive care needs and cancer treatment-related symptoms, and to determine factors associated with supportive care needs. Breast cancer and its treatment cause emotional trauma and health complaints. These lead to supportive care needs in some patients, while others are more able to cope with these consequences themselves. To be able to address these needs, it is important to identify patients' needs at the time they arise. METHODS: Women (n = 175) with newly-diagnosed breast cancer, under treatment in two Swiss breast cancer clinics, participated in a cross-sectional survey. Standardized instruments were used: Supportive Care Needs Survey, Cancer- and Cancer Treatment-related Symptom Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, and Interpersonal Relationship Inventory. RESULTS: The patients' most needed help with psychological issues. Many had treatment-related symptoms like fatigue (87.7%), hot flashes (71.5%), and a changed body appearance (55.8%). The majority suffered from distress (56.2%), fewer from anxiety (24.1%) and depression (12.1%). Physical and social impairment, impaired body image, distress, anxiety and depression, a lack of social support and conflicts in their personal relationships were associated with supportive care needs. CONCLUSIONS: The findings can help to identify more vulnerable patients with unmet needs and a higher demand for support. Assessment of patients enables health care professionals to provide support and counselling. In these assessments, the patients' relationship to close relatives should also be addressed.

Risk factors associated with patient and visitor violence in general hospitals: results of a multiple regression analysis.

BACKGROUND: Patient and visitor violence (PVV) is the most dangerous occupational hazard that health professionals must contend with. Staff training is recommended to prevent and manage PVV. There is minimal research focusing on risk factors associated with PVV in general hospital settings. Therefore, staff training is mostly based upon expert knowledge and knowledge from psychiatric and emergency settings. OBJECTIVES: This study investigates health professionals' experiences with PVV in order to describe risk factors related to PVV that occur in general hospital settings. DESIGN: A retrospective cross-sectional survey was conducted in 2007. SETTING: A university general hospital in Switzerland. PARTICIPANTS: 2495 out of 4845 health professionals participated (58.0% nurses & midwives, 19.2% medical doctors, 3.6% physical therapists, occupational therapists & nutritionists, 6.1% ward secretaries, medical & radiology assistants, 6.3% nursing assistants or less qualified nursing staff and 5.1% other staff). All had direct patient contact and 82% were female. METHODS: Data were collected via questionnaires using the Survey of Violence Experienced by Staff German-Version-Revised, the German version of the shortened Perception of Aggression Scale and the Perception of Importance of Intervention Skills Scale. Descriptive statistics and multiple logistic regression analyses were used. RESULTS: Risk factors associated with PVV depend upon the form of violence. Those trained in aggression management and/or those who work predominantly with patients over 65 years of age experience twice as much PVV as others. Health professionals working in emergency rooms, outpatient units, intensive care units, recovery rooms, anesthesia, intermediate care and step-down units also experience PVV more often. When health professionals are older in age, are from the medical profession, are students, or when they have an attitude rating preventive measures as being less important and aggression as emotionally letting off steam, they experience less PVV. CONCLUSION: Training could change the perception and the recognition of PVV, and could therefore increase the risk of experiencing PVV. The health professionals' specific occupation along with attitude and age, the patients' age, the communication and the workplace are all relevant risk factors. Further studies should investigate the impact of aggression management training and other measures that would reduce PVV.