[Development of a decision aid on post mortem organ donation - somewhere between evidence uncertainty, fears, and ethical and moral values]. / Entwicklung einer Entscheidungshilfe "Organspende nach dem Tod" - im Spannungsfeld zwischen Evidenz, Ungewissheit, Ängsten und ethisch-moralischen Wertvorstellungen.

The recently revised German transplantation law provides that people are to be supported to make informed decisions on post-mortem organ donation by implementing broad education campaigns. A comprehensive web-based decision aid "organ donation after death" was developed, evaluated and optimised utilising multiple methodological phases. The decision aid comprises 1) factual information in a question-answer format, 2) tools for the individual assessment of this information, and 3) narratives addressing attitudes and emotional aspects. The website content was compiled by participating experts and potential users of the decision aid. Potential users also participated in the usability evaluation. Version 1.0 was made publicly available on the Internet in April 2012. Currently, version 2.0 of the decision aid is being updated step-by-step, based on the results of the evaluation.

Competence training in evidence-based medicine for patients, patient counsellors, consumer representatives and health care professionals in Austria: a feasibility study.

BACKGROUND: Informed and shared decision-making require competences for both partners - healthcare professionals and patients. There is a lack of training courses in evidence-based medicine for patients and counsellors. OBJECTIVE: We investigated feasibility, acceptability and the potential effects of a 2 x 2.5 days training course on critical health competences in patients, patient counsellors, consumer representatives and healthcare professionals in Austria. METHODS: We adapted a previously developed curriculum for patient and consumer representatives. The adaptation comprised the specific needs of our target group in Austria and was founded on Carl Rogers' theory of person-centred education. For the formative evaluation a questionnaire was applied to address the domains: 1) organisational conditions (time and duration of the course, location, and information given in advance, registration); 2) assistance outside the courses; 3) teaching methods (performance of lecturers, teaching materials, structure of modules and blocks) and 4) satisfaction; 5) subjective assessment of competences. Participants evaluated the course, using a 5-point Likert scale. Long-term implementation was assessed using semi-structured interviews three to six months after the course. To estimate the increase in critical health competences we used the validated Critical Health Competence Test (CHC test). RESULTS: Eleven training courses were conducted including 142 participants: patients (n=21); self-help group representatives (n=17); professional counsellors (n=29); healthcare professionals (n=10); psychologists (n=8); teachers (n=10) and others (n=29). 97 out of 142 (68 %) participants returned the questionnaire. On average, participants strongly agreed or agreed to 1) organisational conditions: 71 % / 23 %; 2) assistance outside the courses: 96 % / 10 %; 3) teaching methods: 60 % / 28 %; and 4) satisfaction: 78 % / 20 %, respectively. Interviews showed that the training course raised awareness, activated and empowered participants. Participants passed the CHC test with mean person parameters of 463±111 (pre-test, n=120) and 547±135 (post-test, n=91). For participants who returned both tests (n=71) person parameters were comparable: pre-test 466±121 versus post-test 574±100, p<0,001. CONCLUSION: Training in evidence-based medicine for patients, patient counsellors, consumer representatives and healthcare professionals is feasible. For a broad implementation, train-the trainer courses and further research are needed.

Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: a randomized controlled trial.

CONTEXT: Despite unambiguous legal regulation and evidence for lack of effectiveness and safety, physical restraints are still frequently administered in nursing homes. OBJECTIVE: To reduce physical restraint prevalence in nursing homes using a guideline- and theory-based multicomponent intervention. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized controlled trial of 6 months' duration conducted in 2 German cities between February 2009 and April 2010. Nursing homes were eligible if they had 20% or more residents with physical restraints. Using external concealed randomization, 18 nursing home clusters were included in the intervention group (2283 residents) and 18 in the control group (2166 residents). INTERVENTION: The intervention was based on a specifically developed evidence-based guideline and applied the theory of planned behavior. Components were group sessions for all nursing staff; additional training for nominated key nurses; and supportive material for nurses, residents, relatives, and legal guardians. Control group clusters received standard information. MAIN OUTCOMES MEASURES: Primary outcome was percentage of residents with physical restraints (bilateral bed rails, belts, fixed tables, and other measures limiting free body movement) at 6 months, assessed through direct unannounced observation by blinded investigators on 3 occasions during 1 day. Secondary outcomes included restraint use at 3 months, falls, fall-related fractures, and psychotropic medication prescriptions. RESULTS: All nursing homes completed the study and all residents were included in the analysis. At baseline, 30.6% of control group residents had physical restraints vs 31.5% of intervention group residents. At 6 months, rates were 29.1% vs 22.6%, respectively, a difference of 6.5% (95% CI, 0.6% to 12.4%; cluster-adjusted odds ratio, 0.71; 95% CI, 0.52 to 0.97; P = .03). All physical restraint measures were used less frequently in the intervention group. Rates were stable from 3 to 6 months. There were no statistically significant differences in falls, fall-related fractures, and psychotropic medication prescriptions. CONCLUSION: A guideline- and theory-based multicomponent intervention compared with standard information reduced physical restraint use in nursing homes. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN34974819.

[Breast Care Nurses - nursing experts for breast cancer care. A path to "Advanced Nursing Practice" in Germany?]. / Breast Care Nurses - Pflegeexpertinnen für Brusterkrankungen. Ein Weg zur «Advanced Nursing Practice¼ in Deutschland?

The role of Breast Care Nurses (BCNs) has been discussed since Breast Centres have been opened in Germany. This article introduces the concept of the Breast Care Nurses on a national and an international level in the context of Advanced Nursing Practice (ANP). Within a descriptive study, graduates of a German BCN-education programme were interrogated regarding their current work, their main activities as a BCN, about general conditions in their work environment, experienced barriers, and supporting factors. 122 questionnaires were evaluated. The return rate was 71 % (n = 171). Results showed that 58.1 % (n = 71) of the graduates were employed as a Breast Care Nurse, however only 28.1 % (n = 20) in a full-time and 35.2 % (n = 25) in a part-time position. This first German study about BCN-services showed a lack of basic work conditions, for example regarding a consultation room, access to literature, or templates for documentation. In the discussion part, the situation of the BCNs is reviewed in the German context and in relation to ANP concepts as well as regarding future demands for the position of a BCN.

Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial [ISRCTN34974819].

BACKGROUND: Physical restraints are regularly applied in German nursing homes. Their frequency varies substantially between centres. Beneficial effects of physical restraints have not been proven, however, observational studies and case reports suggest various adverse effects. We developed an evidence-based guidance on this topic. The present study evaluates the clinical efficacy and safety of an intervention programme based on this guidance aimed to reduce physical restraints and minimise centre variations. METHODS/DESIGN: Cluster-randomised controlled trial with nursing homes randomised either to the intervention group or to the control group with standard information. The intervention comprises a structured information programme for nursing staff, information materials for legal guardians and residents' relatives and a one-day training workshop for nominated nurses. A total of 36 nursing home clusters including approximately 3000 residents will be recruited. Each cluster has to fulfil the inclusion criteria of at least 20% prevalence of physical restraints at baseline. The primary endpoint is the number of residents with at least one physical restraint at six months. Secondary outcome measures are the number of falls and fall-related fractures. DISCUSSION: If successful, the intervention should be implemented throughout Germany. In case the intervention does not succeed, a three-month pre-post-study with an optimised intervention programme within the control group will follow the randomised trial. TRIAL REGISTRATION: ISRCTN34974819.

[Methods paper on the development of a practice guideline for the avoidance of physical restraints in nursing homes]. / Methodenpapier zur Entwicklung einer Praxisleitlinie zur Vermeidung von freiheitseinschränkenden Massnahmen in der beruflichen Altenpflege.

Physical restraints are routinely used in nursing home residents in Germany. Bedrails are applied to at least one of four residents. Belts, fixed tables and other measures are less frequent but are still used as routine measures. So far, beneficial effects of the use of physical restraints have not been shown, negative effects are likely. A recently completed observational study in 30 nursing homes in Hamburg showed great variations between centres concerning the frequency of restraint use. An evidence-based practice guideline could be the appropriate measure to reduce physical restraints and overcome centre variations. Currently, there are no evidence-based practice guidelines for the avoidance of physical restraints in nursing homes. This applies to nursing practice in Germany in general. The "German Network for Quality Development in Nursing (DNQP)" deliberately distinguishes their so-called "national expert standards" from "medical" practice guidelines. Funded by the German Ministry of Education and Science, a project aiming to develop an evidence-based practice guideline on the avoidance of physical restraints in nursing homes, for the first time applies internationally discussed methods to a nursing guideline in Germany. This article describes the methodological framework, instruments and processes of the guideline's development.