[Experiences of Advanced Practice Nurses with a clinical postgraduate education program in the context of their professional development]. / Erfahrungen von Advanced Practice Nurses mit einem klinischen Weiterbildungsstudiengang im Kontext ihrer beruflichen Entwicklung.

Experiences of Advanced Practice Nurses with a clinical postgraduate education program in the context of their professional development Abstract. Background: The Diploma of Advanced Studies in Advanced Nursing Practice (DAS ANP-plus), which has been offered at the University of Basel since 2012, is a clinically oriented postgraduate education program for the still poorly established professional group of the Advanced Practice Nurse (APN). The acquisition of clinical skills plays a central role in the professional biography and for the APN's work in patient healthcare. Aim: The qualitative study aims to explore the experiences of APNs during and after a clinically oriented postgraduate education program in Switzerland and what significant changes they experienced in their professional practice. Methods: Reflexive thematic analysis with a constructivist orientation was used. With fourteen APNs, guided interviews were conducted and analyzed considering the professional biography. Results: "Pursuing the vision for a better care" is the constitutive theme. The graduates all seem to be driven by a strong vision: from striving to know more, to implementing the concept of Advanced Nursing Practice, to initiating changes in the healthcare system. The vision is shaped by three themes: "the challenges of gaining a foothold as an APN" before the program, "gaining security by strengthening clinical skills" during the program and on longer terms "breaking new ground in the healthcare system with allies". Conclusions: The DAS ANP-plus increases the clinical skills of APNs within clinical supervision plays an important role.

Experience of adult patients and professionals with a program for the prevention of alcohol withdrawal delirium in the acute care setting-A case study.

PURPOSE: To investigate the experiences of adult patients and professionals with the prevention of alcohol withdrawal delirium program DESIGN AND METHODS: A simple, descriptive case study with several units of analysis was chosen as the study design. PARTICIPANTS: Six patients, 15 nurses, one family member, and two physicians METHODS: Semi-structured interviews and observation sessions. The Braun and Clarke thematic analysis method was used for the data analysis. RESULTS: Three main themes were identified: "Talking about alcohol," "Monitoring withdrawal symptoms," and "Collaboration with the Advanced Practice Nurse for delirium management." CONCLUSION: The program is highly beneficial in this field of practice and is widely accepted by all those involved. The Advanced Practice Nurse played an important role to facilitate the processes.

Zwischen Anspruch und Wirklichkeit - Perspektive von fallverantwortlichen Pflegefachpersonen zur Rationierung in der spitalexternen Pflege.

Between demand and reality - Perspectives of case-leading nurses on rationing in home care Abstract. Background: The demand for home care services in Switzerland (Spitex) is growing at an annual rate of 8 %. With increasingly complex client situations, lack of time and professional resources, the risk of rationing care is rising. Objective: This study explores how case-leading nurses (CLNs) experience rationing of care and how they deal with this in their daily practice. Methods: We chose a qualitative approach with an interpretative description. Between September and December 2018, we conducted semi-structured interviews with 12 CLNs from seven Spitex organisations in the German-speaking part of Switzerland. The data were analysed according to the thematic analysis of Brown and Clarke. Results: CLNs often experience not having enough time to fully oversee a client's care plan from the assessment to the evaluation of care needed. They show a high level of commitment to providing good quality of care, but have to walk a tightrope between demand and reality. Additionally, they are under pressure to defend the financing of needed services from health insurance companies. Conclusions: Rationing is an everyday experience of CLNs' practice and they invest a lot of effort in reducing its effects for their clients. CLNs work under pressure, thus targeted measures are necessary both at the political and Spitex organizational level, to reduce rationing of care.

Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

BACKGROUND: Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. AIM: The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. METHODS: The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. RESULTS: The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. CONCLUSION: This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. RELEVANCE TO CLINICAL PRACTICE: The German CPOT version can be recommended for ICUs in German-speaking countries.

Individuals With Opioid Dependence Using Polysubstances: How Do They Experience Acute Hospital Care and What Are Their Needs? A Qualitative Study.

BACKGROUND: Opioid dependence accompanied by polysubstance use is a chronic illness with severe somatic, psychological and social consequences for those affected. International studies have shown that healthcare provision is inadequate for this population because of stigmatization and lack of expertise among medical professionals. It must be assumed that this is also the case in acute care settings of hospitals in German-speaking areas of Switzerland. To date, there are few studies addressing these patients' experiences that could provide data for targeted interventions. AIMS: This qualitative study explored this patient population's perspective in terms of their experiences and needs regarding care provision in acute hospitals. The results should offer potential adaptations to care provision for this vulnerable group of individuals. METHODS: Twelve individuals with opioid dependence using polysubstances were interviewed in two urban substitution centers. The data analysis of the material obtained was undertaken using qualitative content analysis according to Mayring. RESULTS: As a whole, individuals with opioid dependence using polysubstances are not dissatisfied with care provided in acute hospitals as long as their relationship with health professionals is positive. Substitution medication is critically important to their treatment, but this group's experiences with its management during hospitalization continue to show widespread stigmatization along with inadequate knowledge and interprofessional collaboration and a failure to integrate these patients and their expertise into treatment and care. CONCLUSIONS AND FUTURE DIRECTIONS: The treatment of individuals with substance-related disorders in acute hospitals requires staff with somatic and psychiatric training. In this regard, the principles of evidence-based models of reducing harm and multiprofessional treatment teams should be seen as particularly well suited and promising.

Nurses' Recognition of Hospitalized Older Patients With Delirium and Cognitive Impairment Using the Delirium Observation Screening Scale: A Prospective Comparison Study.

The aim of the current study was to report findings about delirium detection when ward nurses screened for delirium in patients with cognitive impairment using the Delirium Observation Screening Scale (DOSS) in comparison to the Confusion Assessment Method (CAM). A secondary analysis was performed of research data collected in 2010 at a Swiss tertiary university hospital. During the first 5 days after admission, patients 70 and older with cognitive impairment were screened for delirium using the DOSS. Throughout patients' hospital stay, research assistants also completed the CAM on a daily basis. A total of 138 patients who did not have delirium initially participated in the study. Of these patients, 44 (32%) developed delirium with a median duration of 3 days (Q1 = 1.25; Q3 = 5.00). Ward nurses correctly identified delirium using the DOSS in 56% of cases (sensitivity) and no delirium in 92% of cases (specificity). Although the DOSS was 100% correct in detecting patients with hyperactive delirium, the identification rate decreased to 60% for patients with mixed delirium subtype and 38% for patients with hypoactive delirium. Delirium screening using observational methods may be insufficiently sensitive and should be supplemented with a formal attention test. [Journal of Gerontological Nursing, 44(12), 35-43.].

Using Reflexive Thinking to Establish Rigor in Qualitative Research.

BACKGROUND: Reflexivity can be helpful in developing the methodological rigor necessary to attaining trustworthy qualitative study results. OBJECTIVES: The aim of this study was to evaluate strategies of critical reflexive thinking during a qualitative enquiry rooted in a mixed-methods study. METHODS: Guided by the questions of Rolfe and colleagues from 2001 ("what," "so what," and "now what"), we applied reflexive thinking to all aspects of the investigation. RESULTS: Critical reflexive thinking strongly supported our efforts to establish methodological rigor and helped reveal shortcomings. DISCUSSION: Effective strategical use of reflexive thinking takes concerted effort. Both time and space are essential to applying reflexive thinking throughout the qualitative research process.

Taking One's Own Life in Hospital? Patients and Health Care Professionals Vis-à-Vis the Tension between Assisted Suicide and Suicide Prevention in Switzerland.

In Switzerland, the practice of lay right-to-die societies (RTDS) organizing assisted suicide (AS) is tolerated by the state. Patient counseling and accompaniment into the dying process is overtaken by RTDS lay members, while the role of physicians may be restricted to prescribing the mortal dose after a more or less rigorous exploration of the patient’s decisional capacity. However, Swiss health care facilities and professionals are committed to providing suicide prevention. Despite the liberal attitude in society, the legitimacy of organized AS is ethically questioned. How can health professionals be supported in their moral uncertainty when confronted with patient wishes for suicide? As an approach towards reaching this objective, two ethics policies were developed at the Basel University Hospital to offer orientation in addressing twofold and divergent duties: handling requests for AS and caring for patients with suicidal thoughts or after a suicide attempt. According to the Swiss tradition of “consultation” (“Vernehmlassung”), controversial views were acknowledged in the interdisciplinary policy development processes. Both institutional policies mirror the clash of values and suggest consistent ways to meet the challenges: respect and tolerance regarding a patient’s wish for AS on the one hand, and the determination to offer help and prevent harm by practicing suicide prevention on the other. Given the legal framework lacking specific norms for the practice of RTDS, orientation is sought in ethical guidelines. The comparison between the previous and newly revised guideline of the Swiss Academy of Medical Sciences reveals, in regard to AS, a shift from the medical criterion, end of life is near, to a patient rights focus, i.e., decisional capacity, consistent with the law. Future experience will show whether and how this change will be integrated into clinical practice. In this process, institutional ethics policies may—in addition to the law, national guidelines, or medical standards—be helpful in addressing conflicting duties at the bedside. The article offers an interdisciplinary theoretical reflection with practical illustration.

Patient complaints as a means to improve quality of hospital care. Results of a qualitative content analysis / Patientenrückmeldung als Möglichkeit die Versorgungsqualität von Spitalpatienten zu verbessern. Ergebnisse einer qualitativen Inhaltsanalyse

Background: Many hospitals have defined procedures for a complaint management. A systematic analysis of patient complaints helps to identify similar complaints and patterns so that targeted improvement measures can be derived (Gallagher & Mazor, 2015). Aim: Our three-month, nurse-led practice development project aimed 1) to identify complaints regarding communication issues, 2) to systemise and prioritise complaints regarding communication issues, and 3) to derive clinic-specific recommendations for improvement. Method: We analysed 273 complaints of patients documented by the quality management (secondary data analysis). Using content analysis and applying the coding taxonomy for inpatient complaints by Reader, Gillespie and Roberts (2014), we distinguished communication-related complaints. By further inductive differentiation of these complaints, we identified patterns and prioritised fields of action. Results: We identified 186 communication-related complaints divided into 16 subcategories. For each subcategory, improvement interventions were derived, discussed and prioritised. Conclusions: Thus, patient complaints provided an excellent opportunity for reflection and workplace learning for nurses. The analysis gave impulse to exemplify the subject "person-centered care" for nurses.

Patient-related complexity of care: a challenge or overwhelming burden for nurses - a qualitative study.

BACKGROUND: Patient-related complexity of nursing care in acute care hospitals has increased in recent years, in part due to shorter hospital stays and the increase in multimorbid patients. However, little research has been conducted on how nurses experience complex nursing care situations. AIMS: The aim of this study was to gain a better understanding of how nurses experience complex nursing care situations in Swiss acute care hospitals. METHODS: This qualitative study utilised focus group interviews and thematic analysis. Focus groups facilitate different perspectives of the topic. Thematic analysis is suitable for the analysis of everyday stories. Participants were 24 Registered Nurses with experience in their field, from four Swiss hospitals. The evaluation was performed in six steps according to themes. Participation was voluntary. This study was part of a multicentre research project that had been approved by the responsible ethics committees. RESULTS: Three main themes regarding the experience of complex nursing care situations were found: complexity as a challenge, complexity as an overwhelming burden and mediating factors. Mediating factors included time resources and teamwork and interprofessional collaboration as contextual conditions. Additionally, nurses' individual characteristics such as their professional experience and expertise, as well as their personal and professional values and beliefs were considered as mediating factors. These mediating factors may determine whether complex nursing care situations are experienced as challenging or overwhelming. LIMITATIONS: The findings from this study are limited as only experienced nurses participated in the study. CONCLUSIONS: Nurses are ambivalent with regard to how they experience complex nursing care situations. The contextual conditions and the nurses' personal characteristics play a key role in whether nurses perceive complex nursing care situations as positive challenges or overwhelming burdens. These findings are important for managers, as they can support nurses to master complex nursing care situations.

Analysis of adverse events as a contribution to safety culture in the context of practice development / Die Analyse unerwünschter Ereignisse als Beitrag zur Sicherheitskultur im Kontext der Praxisentwicklung.

Background: Analysing adverse events is an effective patient safety measure. Aim: We show, how clinical nurse specialists have been enabled to analyse adverse events with the "Learning from Defects-Tool" (LFD-Tool). Method: Our multi-component implementation strategy addressed both, the safety knowledge of clinical nurse specialists and their attitude towards patient safety. The culture of practice development was taken into account. Results: Clinical nurse specialists relate competency building on patient safety due to the application of the LFD-tool. Applying the tool, fosters the reflection of adverse events in care teams. Conclusion: Applying the "Learning from Defects-Tool" promotes work-based learning. Analysing adverse events with the "Learning from Defects-Tool" contributes to the safety culture in a hospital.

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

RATIONALE: Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. AIMS: The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. METHODS: Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. RESULTS: The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. CONCLUSIONS AND LIMITATIONS: Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members.

[Between intent and inability-management of malnutrition on medical wards of a centre hospital in Switzerland: patients' experience and perceptions]. / Wollen und nicht können. Malnutritionsmanagement in medizinischen Kliniken eines schweizerischen Zentrumsspitals: Erleben und Sichtweisen von Patient(inn)en.

BACKGROUND: Malnutrition is a common phenomenon in acute care institutions accounting for many negative health consequences for the patient. In many hospitals, therefore, malnutrition risk screening and nutrition management programs were established; however, programs were commonly developed without integrating the patients' perspective. It is unknown if the program covers the patients' needs and if the interventions are worthwhile. AIM: Because patient experience is known solely from everyday conversations, the aim of the study was to explore affected patients' experience regarding nutrition management. METHOD: The study has a qualitative, inductive approach. From September 2011 till May 2012, seven women and one man were interviewed. To analyse the guided interviews, content analysis was used. RESULTS: The analysis shows that patients find themselves between 'to want but not be able to eat'. Patients at risk encounter barriers due to their physical condition, such as swallowing- and chewing pain, nausea and dysgeusia and barriers associated with the system when ordering meals, such as fixed mealtimes, a limited variety of the menu and non-tasting supplements. To overcome these barriers patients are left to develop self-management strategies and to be in charge of their nutrition. CONCLUSIONS: Therefore, targeted training for caregivers is a key, enabling them to support patients individually in their nutrition management. At the same time, institutional barriers must be removed.

[Family members' experiences of caring for persons with dementia and outreach counseling--an interpretative phenomenological study]. / Erfahrungen Angehöriger mit der Betreuung von Menschen mit Demenz und zugehender Beratung. Eine interpretierende phänomenologische Studie.

BACKGROUND: Almost two-thirds of the 110,000 people living with dementia in Switzerland receive home care from family members. Outreach counselling can reduce the burden for family caregivers and delay nursing home placement. However, little is known of how this works and how caregivers experience the counselling. The Canton of Aargau Alzheimer's Association has been conducting a pilot project to demonstrate the necessity, effectiveness and practicability of outreach counselling in (their canton). AIM: As a part of the evaluation of the project this study explored how family members experience the process of caring for a relative with dementia and outreach counselling. METHOD: Interpretive phenomenology­a qualitative approach­was used to analyse data from interviews with twelve family caregivers. RESULTS: Most family members felt supported in caregiving by outreach counselling. Three aspects of the counselling were especially important to the participants: being understood and taken seriously by the counsellor; receiving answers to their most pressing questions concerning the illness and being supported when difficult decision had to be taken; regaining personal time and learning how to better interact with the person with dementia. Two participants would have wished for more help by the counsellor. CONCLUSIONS: To meet the needs of the family members, consultants should have sufficient experience in dementia patient care and should be strongly networked across the local health and welfare system. This study shows that family members can experience outreach counselling as a great support in their caregiving roles.

[Acute care nurses' ethical reasoning: a thematic analysis]. / Ethische Reflexion von Pflegenden im Akutbereich--eine Thematische Analyse.

BACKGROUND: In the day-to-day course of nursing, ethical issues are being openly articulated to a growing extent. However, nurses only rarely systematically address these issues. This subject was explored in interviews with professionals who have a particular focus on ethics. OBJECTIVE: Gain input for further developing the skills of nursing staff in ethical reasoning. METHOD: In two focus groups and four individual interviews, we questioned 14 professionals, including nine nurses, who have a special interest in ethics. RESULTS: Nurses find it ethically problematic when the wishes of patients are not respected or something is forced on them, creating the impression that the care being given is exacerbating rather than alleviating the patient's suffering. These problematic aspects are often overlooked because the consequences of the action in question are not immediately apparent. Ethical issues in nursing are often addressed in informal, non-systematic discussions among nursing staff. Nurses actively and confidently engage in discussions on treatment goals, and the teamwork with doctors is usually experienced as being based on mutual respect and partnership. The inherent hierarchical role differences between nursing and medical staff nevertheless manifest in ethical issues. CONCLUSION: Through the practical application of ethical reasoning in day-to-day nursing, structured discussions of the ethical aspects of cases and dedicated further education, nurses should learn to better recognise ethical issues in nursing and effectively analyse them and find solutions.

[Nursing care in the run-up to Swiss DRG ­ Nurses' experiences with interprofessional collaboration, leadership, work load and job satisfaction]. / Pflege im Vorfeld von SwissDRG - Erfahrungen von Pflegenden mit interprofessioneller Zusammenarbeit, Führungsverhalten, Arbeitslast und Arbeitszufriedenheit.

BACKGROUND: The literature reports critically on the consequences of the introduction of case-based hospital reimbursement systems, which hamper the delivery of professional nursing care. For this reason, we examined the characteristics of nursing service context factors (work environment factors) in acute care hospitals with regards to the introduction of the new reimbursement system in Switzerland. AIM: This qualitative study describes practice experiences of nurses in the context of the characteristics of the nursing service context factors interprofessional collaboration, leadership, workload and job satisfaction. METHODS: Twenty focus group interviews were conducted with a total of 146 nurses in five acute care hospitals. RESULTS: The results indicated that for quite some time the participants had observed an increase in complexity of nursing care and a growing invasiveness of clinical diagnostics and treatment. At the same time they noticed a decrease in patient length of stay. They strived to offer high quality nursing care even in situations where demands outweighed resources. Good interprofessional collaboration and supportive leadership contributed substantially to nurses' ability to overcome daily challenges. Job satisfaction was bolstered by interactions with patients. Also, the role played by the nursing team itself is not to be underestimated. CONCLUSIONS: From the participants' point of view, context factors harbor great potential for attaining positive patient outcomes and higher job satisfaction and have to be monitored repeatedly.

[Monitoring of nursing service context factors: first descriptive results of a cross-sectional Swiss study prior the introduction of SwissDRG]. / Monitoring von Pflegekontextfaktoren - Erste deskriptive Studienresultate einer Querschnittserhebung der schweizerischen DRG Begleitforschung Pflege vor Einführung der SwissDRG.

BACKGROUND: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. AIM: The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. METHOD: The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. RESULTS: The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. CONCLUSIONS: The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.