Effect of an educational intervention on nurses' competence in activities of daily living support in end-of-life care using a pretest-posttest repeated measures design.

BACKGROUND: Most patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients' movement and protects nurses' musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the "Advanced Kinaesthetics in Palliative care (AdKinPal) program" on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units. METHODS: A pretest-posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention - the AdKinPal program - is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants' demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints. RESULTS: Fifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses' perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence. CONCLUSIONS: The AdKinPal program can raise nurses' Kinaesthetics competence. Thereby, patients' autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses' self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff's musculoskeletal health can be promoted by enhancing their Kinaesthetics competence. TRIAL REGISTRATION: DRKS00015908. Registration Date 23.11.2018.

The self-reported and observed competence of nursing staff in mobility care based on Kinaesthetics in nursing homes - A cross-sectional study.

BACKGROUND: The majority of care-dependent persons living in nursing homes have mobility impairment affecting the physical, psychological, and social aspects of the persons' lives. Therefore, nursing staff needs competence to provide good mobility enhancing care. AIM: This study assesses the self-reported and observed competence of nursing home staff in mobility care based on Kinaesthetics in order to increase attention about nursing staff's impact on nursing home residents' mobility. METHODS: A cross-sectional study design involving a survey and an observational study was employed. Survey data were collected using the Kinaesthetics Competence Self-Evaluation (KCSE) scale. For the observational study, data were collected with a video camera and rated using the Kinaesthetics Competence Observation (KCO) instrument. Data were analysed using descriptive statistics, correlation methods and a generalised linear model. RESULTS: The majority of survey participants (n = 180) indicated their competence in mobility care based on Kinaesthetics as very good (mean score 13, SD 1.44, on a scale from 4 to 16). The observed competence of nursing staff (n = 40) was good (mean score 10.8, SD 2.44, out of a possible score from 4 to 16). Positive correlations were found between self-reported or observed competence in mobility care based on Kinaesthetics and employment rate, work experience in nursing home care and Kinaesthetics training. CONCLUSION: A combined assessment of self-evaluation and observation is recommended in order to get a comprehensive picture of knowledge, skills, attitude and dynamic state of nursing staffs' competence in mobility care based on Kinaesthetics.

Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale.

BACKGROUND: Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care. METHODS: The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015. RESULTS: The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted. CONCLUSION: The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.

Effects of a mobility monitoring system on the cost of care in relation to reimbursement at Swiss nursing homes: learnings from a randomized controlled trial.

BACKGROUND/OBJECTIVE: Nursing homes in Switzerland are under pressure to efficiently coordinate staff activities to cover their personnel costs under the care financing system. In this study, the use of a mobility monitoring system accompanied with case conferences was investigated in order to improve sleep quality and estimate the cost benefit of this intervention. METHOD: In an open two-phase randomized controlled trial at three nursing homes, residents with cognitive impairment were randomly assigned to an intervention group and a control group. In the intervention group, a 10-week period of intensive use of the monitoring system and case conferences led by an advanced nurse practitioner (Phase I) was followed by 3 months of reduced use of the monitoring system and case conferences led by an internal registered nurse (Phase II). In the control group, the monitoring system was only used for data acquisition. Nurses reported the activities with a specifically developed tool. Based on the recorded activities, the cost of care was calculated. The correlating reimbursement per patient was calculated from the care levels in the Swiss reimbursement system. Data from 44 residents was included in the analysis with a linear mixed model. RESULTS: Although analysis revealed no statistically significant effects, results indicate that the use of a monitoring system can guide nurses in organizing their tasks to increase effectiveness. Information systems such as the mobility monitor can help to identify single outliers that do not correspond with the overall situation. CONCLUSION: In the health care system, problematic individual cases can account for a disproportionally high cost levels. It was shown that information systems can have a significant economic impact in the long run. TRIAL REGISTRATION: The study is registered at the German Clinical Trials Register under the Nr. DRKS-ID: DRKS00006829 .

Nurses' competence in kinaesthetics : A concept development.

AIM: This study was carried out to systematically describe nurses' competence in kinaesthetics. BACKGROUND: In elderly care the kinaesthetics program for nurses has been taught for over 25 years; however, the competence that nurses should gain through kinaesthetics training from a theoretical perspective has not yet been systematically described. MATERIAL AND METHODS: The method was modelled after the three phases of the hybrid model of concept development by Schwartz-Barcott and Kim (2000). In the theoretical phase a working definition was established and a literature review conducted. We searched the online databases PubMed and CINAHL and the reference lists up to February 2016. In the empirical phase experts defined the attributes during a workshop in October 2013. In the analytical phase the results from the theoretical and empirical phase were combined in order to define antecedents, attributes and consequences of the concept. RESULTS: The concept of nurses' competence in kinaesthetics includes two antecedents: (1) nurses' kinaesthetics training and (2) care recipients' need for mobility support in activities of daily living. This concept includes a set of attributes in the areas of knowledge, skills, attitudes and dynamic state. It contributes towards (1) movement competence and (2) physical and psychological well-being of both care recipients and nurses. CONCLUSION: The concept of nurses' competence in kinaesthetics might support awareness and communication about mobility-enhancing gerontological care. Based on the attributes of nurse' competence in kinaesthetics an assessment instrument will be developed that can be used to evaluate nurses' competence in kinaesthetics in clinical practice. Further research is needed to evaluate the consequences of the developed concept.

Assessing nursing staff's competences in mobility support in nursing-home care: development and psychometric testing of the Kinaesthetics Competence (KC) observation instrument.

BACKGROUND: Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff's interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff's competences in kinaesthetics. METHODS: The Kinaesthetics Competence (KC) observation instrument was developed between January and June 2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated with two expert panels (n = 5, n = 4) regarding content validity, usability and inter-rater agreement. Content validity was assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional study in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In this study nursing staff (n = 48) was filmed during mobilization situations. Based on this video data two observers independently assessed nursing staff's competences in kinaesthetics with the KC observation instrument. Inter-rater reliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage of agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was evaluated using Cronbach's alpha coefficient and item analysis. RESULTS: The final version of the KC observation instrument comprised of four domains (interaction, movement support of the person, nurses' movement, environment) and 12 items. The final instrument showed an excellent content validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole scale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach's alpha coefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct validity of the instrument was supported by a significant discrimination of the instrument between nursing staff with no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales. CONCLUSIONS: The KC observation instrument showed good preliminary psychometric properties and can be used to assess nursing staff's competences in mobility care based on the principles of kinaesthetics.

Changes in health-related quality of life in older patients one year after an intensive care unit stay.

AIMS AND OBJECTIVES: This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND: Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN: Prospective non-randomised longitudinal study. METHODS: The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS: Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS: Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE: Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.

Long-term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay.

AIMS AND OBJECTIVES: This study investigated whether an intensive care unit (ICU) stay is associated with persistent pain, anxiety and agitation in critically ill older patients. BACKGROUND: Patients hospitalised in the ICU are at risk for experiencing pain, anxiety and agitation, but long-term consequences for older patients have rarely been investigated. DESIGN: Prospective nonrandomised longitudinal study. METHODS: Pain, anxiety and agitation, measured with a numeric rating scale (0-10), were assessed in older patients (≥65 years) hospitalised in the medical-surgical ICU of a university hospital. Agitation during the ICU was assessed with the Richmond Agitation-Sedation Scale. Data collection occurred during the ICU, one week after the stay and six and 12 months after hospital discharge. Data were collected from an age-matched community-based comparison group at recruitment and after six and 12 months. Study recruitment took place from December 2008-April 2011. RESULTS: This study included 145 older patients (ICU group) and 146 comparison group participants. Pain was higher in the ICU group one week after discharge, although pain levels in general were low. Both groups reported no or low levels of pain after six and 12 months. Anxiety levels in general were low, although higher in the ICU group one week after ICU discharge. After six and 12 months, anxiety in both groups was comparable. Throughout the study, levels of agitation were similar in both groups. CONCLUSIONS: Critically ill older patients did not experience increased pain, anxiety or agitation 12 months after an ICU stay. RELEVANCE TO CLINICAL PRACTICE: This study positively shows that an ICU stay is not associated with persistent pain, anxiety and agitation thus providing additional information to older patients and their families when making intensive care treatment decisions. Adequate management of pain during and after an ICU stay may minimise the suffering of older patients.

Healthcare resource utilisation by critically ill older patients following an intensive care unit stay.

AIMS AND OBJECTIVES: This study examines the utilisation of healthcare resources by critically ill older patients over one year following an intensive care unit stay. BACKGROUND: Information on healthcare resource utilisation following intensive care unit treatment is essential during times of limited financial resources. DESIGN: Prospective longitudinal nonrandomised study. METHODS: Healthcare resource utilisation by critically ill older patients (≥65 years) was recorded during one year following treatment in a medical-surgical intensive care unit. Age-matched community-based participants served as comparison group. Data were collected at one-week following intensive care unit discharge/study recruitment and after 6 and 12 months. Recorded were length of stay, (re)admission to hospital or intensive care unit, general practitioner and medical specialist visits, rehabilitation program participation, medication use, discharge destination, home health care service use and level of dependence for activities of daily living. RESULTS: One hundred and forty-five critically ill older patients and 146 age-matched participants were recruited into the study. Overall, critically ill older patients utilised more healthcare resources. After 6 and 12 months, they visited general practitioners six times more frequently, twice as many older patients took medications and only the intensive care unit group patients participated in rehabilitation programs (n = 99, 76%). The older patients were less likely to be hospitalised, very few transferred to nursing homes (n = 3, 2%), and only 7 (6%) continued to use home healthcare services 12 months following the intensive care unit stay. CONCLUSIONS: Critically ill older patients utilise more healthcare resources following an intensive care unit stay, however, most are able to live at home with no or minimal assistance after one year. RELEVANCE TO CLINICAL PRACTICE: Adequate healthcare resources, such as facilitated access to medical follow-up care, rehabilitation programs and home healthcare services, must be easily accessible for older patients following hospital discharge. Nurses need to be aware of the healthcare services available and advise patients accordingly.

A systematic review of observational instruments used to assess nurses' skills in patient mobilisation.

AIMS AND OBJECTIVES: The aim of this study was to identify and describe the existing observation instruments that are used to assess nurses' skills in patient mobilisation and to evaluate the psychometric properties of the included instruments. BACKGROUND: Structured knowledge about instruments for assessing nurses' skills in patient mobilisation is limited. DESIGN: Systematic review. METHODS: Studies were identified via electronic database searches and reference lists and were included based on the eligibility criteria. Data regarding the type of instrument, the number of items/domains and the psychometric properties of the instruments were extracted, and the quality of the instruments were appraised according to Zwakhalen et al.'s (BMC Geriatrics, 2006) proposed criteria. RESULTS: A total of 26 studies, reporting on 16 instruments, were included in this review. The instruments differed in terms of: (1) type of patient-mobilisation task, (2) focus of the instrument, (3) level of structure and (4) use by the observer. Most of the instruments were developed and used in evaluation studies that measured nurses' mobilisation techniques as an outcome of an educational intervention. The total quality score of the included instruments varied between 6-11 points out of a maximum quality score of 19. CONCLUSION: Although patient mobilisation is part of nurses' everyday work, we suggest from the results of this review that no common consensus exists about the best way to perform patient-mobilisation tasks. The results from this study further show that no instrument measured all of the important aspects of effective patient mobilisation. RELEVANCE FOR CLINICAL PRACTICE: Most of the instruments that were reviewed were able to detect differences in patient-mobilisation techniques. However, convincing evidence is lacking with regard to the content, psychometric properties and practicability of these instruments for use in clinical practice. We suggest the development and validation of a new comprehensive instrument.

[Trapped in the body - lived experience and coping of individuals having Parkinson and their relatives with changed movement pattern caused by the disease]. / Im Körper gefangen sein - Das Erleben und die Bewältigung der krankheitsbedingt veränderten Bewegungsmuster von Menschen mit Parkinson und ihren Angehörigen.

People with Parkinson's disease suffer from various symptoms. Changed movement patterns frequently represent the prevailing symptom experience and influence the everyday life of the affected persons and their relatives. This qualitative study explores how persons with Parkinson's disease and their relatives experience the changed movement patterns and how they manage the consequential problems in their daily life. Eight persons with Parkinson's disease and six partners were interviewed. The interviews were analysed by means of content analysis according to Mayring. The qualitative analysis resulted in two main categories: "effects on the changed movement patterns on everyday life" and "coping skills for dealing with changed movement patterns". The experience of the affected person can be characterised by "being trapped in the body" as well as by a constantly slowing down daily life. The coping strategies are diverse, but all respondents seek to maintain mobility. Partners naturally support the affected persons and take over many tasks. This is associated with elevated distress and the feeling of having to be permanently present. Various coping strategies have to be promoted and included in daily care for people with Parkinson's disease. Consideration of the individual experience of the changed movement patterns is very important in the development of strategies and also the support of the affected persons and relatives that they can keep up with their movements.

[Caregivers' needs concerning mobility support of a family member with terminal cancer - a narrative review]. / Bedürfnisse pflegender Angehöriger betreffend der Mobilität ihres krebskranken Familienmitgliedes am Lebensende: Ein narrativer Review.

BACKGROUND: Care for cancer patients is often provided by family caregivers. The terminal care period is usually associated with restricted mobility. AIM: The aim of this literature review is to analyse the needs of caregivers concerning mobility support and encouragement in everyday care of a cancer patient at the end of life. METHODS: Relevant articles were identified via electronic database searches in Cochrane, PubMed, PsychINFO, ERIC, and CINAHL. Studies examining needs concerning mobility support and encouragement for terminal cancer care provided by family caregivers at home, published in English or German, have been included. The methodological quality of the included studies was assessed by two authors. RESULTS: A total of eleven studies with various designs have been included. The results show a need for information, guidance and support regarding mobility in two areas: i) activities of daily living including personal hygiene and ii) usage of equipment including transport. CONCLUSION: The literature review indicates that practical needs of family caregivers concerning mobility support and encouragement have been assessed unsystematically and not yet adequately studied. This should be done in future studies, in order to implement well-defined interventions for teaching nursing skills subsequently.

Nurses' experiences with the implementation of the Kinaesthetics movement competence training into elderly nursing care: a qualitative focus group study.

BACKGROUND: Supporting the movement of older people is one among the daily duties of geriatric nurses. Nurses exhibit a high risk of developing musculoskeletal disorders. Nurses should also possess interaction skills to support active participation of older people in their own daily activities. Kinaesthetics movement competence training claims to be a recommendable approach that benefits both nurses and nursing home residents. However, implementing Kinaesthetics into daily practice is a challenging process. AIM: This study aimed to examine nurses' experiences with regard to the implementation of Kinaesthetics movement competence training into a nursing home. DESIGN: Qualitative descriptive design with focus groups' interviews. METHOD: Thirty-two (three men) geriatric nurses from a Swiss nursing home who participated first time in Kinaesthetics training were interviewed in three focus groups (average 79 minutes). Interviews were analysed using inductive coding, categorisation and abstraction. The ethics committees of the cantons Basel-Stadt and Basel-Land (Switzerland) approved the study on 16 September 2010 (reference no. 224/10). FINDINGS: Nurses' experiences with the implementation of Kinaesthetics were divided into two categories: nurses' attitudes with regard to the implementation of Kinaesthetics and nurses experience of Kinaesthetics with regard to integration into daily practice. Even though the participants showed a positive attitude towards the design and structure of the Kinaesthetics training, its implementation into daily practice initially posed a noticeable challenge for the participating nurses. The results indicate that various factors exist that may either promote or impede the implementation of Kinaesthetics in nursing. CONCLUSION: The successful implementation of Kinaesthetics can be promoted by the structural integration of the concept at various levels of nursing home as well as complementary supporting measures. Regular professional support and education after Kinaesthetics training appears to be a necessary approach to sustainably implement the concepts into daily nursing practice.

[Hospital discharge preparation: enhancing self-care competence of patients after minimally invasive hip arthroplasty]. / Austrittsvorbereitung: Selbstpflegekompetenz fördern bei Patient(inn)en nach minimal-invasiver Hüftendoprothetik.

Increasing numbers of hip replacement implant surgeries in Switzerland today are minimally invasive. Patients undergoing such procedures become mobile faster and are discharged from hospital to home within an average of four days. Using a qualitative descriptive design, this study examined how post-operative self-care is taught to patients in the orthopaedic department of a rehabilitation hospital after a minimally invasive hip arthroplasty and explored ways to optimise such teaching methods. Data were collected by conducting three focus groups with nine nursing professionals and expert interviews with the chief surgeon and the assigned physiotherapist. Data were analysed by using qualitative content analysis procedures. Results showed that teaching to enhance self-care competence of patients was not carried out systematically. Instead, the primary focus was to inform and prescribe rather than empower patients. Empowerment, however, would be necessary to assure adherence to the treatment regime. Hospital discharge often takes place surprisingly early and prevents assessment-based counselling of patients. The researchers concluded that the introduction of the minimally invasive surgical technique requires that the multidisciplinary rehabilitation team adapts its teaching methods. Self-care confidence in patients should be enhanced by following participatory clinical pathways. This demands modification in discharge and rehabilitation teaching plans to make them patient-oriented, and the plans should be supported by the entire team and the management.

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.