Silicone adhesive multilayer foam dressings for preventing facial pressure injuries in COVID-19 patients in prone position.

The development of facial pressure injury (PI) during prone position is frequently described. During the COVID-19 pandemic, the number of patients with facial PIs increased. This quality improvement project describes the effectiveness of using silicone adhesive multilayer foams for preventing facial PIs in COVID-19 patients in need of prone position therapy. After introduction of foam dressing on chin and forehead to the standard protocol procedures for PI prevention, the decrease in number of patients developing facial PIs was statistically significant. Based on these results, the use of silicone adhesive multilayer foam will be implemented as a standard procedure for facial PIs prevention.

Coming to consensus: the Delphi technique.

Delphi techniques are used in health care and nursing to systematically bring together explicit and implicit knowledge from experts with a research or practical background, often with the goal of reaching a group consensus. Consensus standards and findings are important for promoting the exchange of information and ideas on an interdisciplinary and transdisciplinary basis, and for guaranteeing comparable procedures in diagnostic and therapeutic approaches. Yet, the development of consensus standards using Delphi techniques is challenging because it is dependent on the willingness of experts to participate and the statistical definition of consensus.

Methodological quality of studies assessing validity and reliability of the European Heart Failure Self-care Behaviour Scale: a systematic review using the COSMIN methodology.

AIMS: The European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology. METHODS AND RESULTS: To identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality. CONCLUSION: Although the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS.

A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Despite effective treatment, it is characterized by frequent recurrences. Optimal therapeutic management of AF requires active participation and self-management from patients. Two major components of self-management are self-monitoring and sign-and-symptom management. Pulse self-palpation (PSP) is a method of self-monitoring; however, not all AF patients are capable of successfully performing PSP. Due to a lack of interventions on this topic, a nurse-led intervention for patients with AF (PSPAF intervention) was developed to foster self-monitoring and to enhance self-management through PSP. The purpose of this pilot study was to test the acceptability, feasibility, and potential effects of this intervention on the capability of patients' PSP and sign-and-symptom management. Moreover, we aimed at gathering data on the feasibility of applied research methods to aid in the design of future studies. METHODS: The pilot trial involved 20 adult patients with AF, randomized to an intervention or usual care group. At baseline and during a home visit 3-5 weeks later, we collected data using questionnaires, checklists, field notes, a mobile ECG device, and a diary. Acceptability and feasibility measures were validated through predefined cut-off points. Effect size estimates were expressed as relative risks (RR) and the number needed to treat (NNT). RESULTS: The PSPAF intervention seemed feasible, but only partly acceptable. There were limitations in terms of potential effectiveness, suitability, addressing participants' willingness to implement its content in daily life, and adherence. Estimations of effect sizes suggest a large effect of the intervention on patients' PSP capability (RR = 6.0; 95% CI = [0.83, 43.3]; NNT = 2.4), but almost no effect on sign-and-symptom management (RR = 1.5; 95% CI = [0.7, 3.1]; NNT = 4.0). The feasibility of applied research methods showed minor limitations on recruitment and participant burden. CONCLUSIONS: Despite some limitations, the intervention seemed to be applicable and promising. Taking into account the suggestions and amendments we have made, we recommend conducting a full-scale trial to examine the efficacy of the PSPAF intervention. TRIAL REGISTRATION: This pilot study was registered in the German Clinical Trials Register at September 4, 2017 (Main ID: DRKS00012808).

[Measures for Overcoming Barriers to Palliative Care of Patients with Chronic Heart Failure: A Delphi Method]. / Entwicklung von Maßnahmen zur Überwindung von Barrieren bezüglich einer palliativmedizinischen Versorgung von Patienten mit chronischer Herzinsuffizienz: Eine Delphi-Studie.

Patients with chronic heart failure receive less palliative care than those suffering from malignant diseases, even though they experience a similar disease burden. Studies found that this might be caused by the cyclic course of disease, which makes determination of the appropriate time difficult, lack of knowledge regarding content and structure of palliative care, and insufficient interprofessional communication. However, research suggests that patients with chronic heart failure benefit from palliative care. In this study, academic experts and experienced clinical practitioners developed measures in order to overcome the previously identified barriers. Furthermore, measures were evaluated regarding their relevance and practicability. In a next step, measures rated as both relevant and practical were ranked regarding their importance. Those perceived as important and practical mainly focused on better education for and better cooperation between professionals.

Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals.

BACKGROUND: Compared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers' (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure. METHODS: We conducted an online-survey with 315 nurses and physicians of different medical disciplines. RESULTS: Even though heart failure patients' need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration. CONCLUSIONS: In order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers. TRIAL REGISTRATION: DRKS00007119.

Health care professionals' attitudes regarding palliative care for patients with chronic heart failure: an interview study.

BACKGROUND: Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals' attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients' access to palliative care in Germany. METHOD: Problem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring's qualitative content analysis. RESULTS: Most interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients', public's, and professionals' lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients' concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited. CONCLUSIONS: Palliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients. TRIAL REGISTRATION: DRKS00007119 .

Factors influencing hospitalized patients' perception of individualized nursing care: a cross-sectional study.

BACKGROUND: Individualized care is a cornerstone of patient-centered nursing care. To foster individualized care, influencing factors should be known. The aim of this study was to identify the individual and organizational factors influencing hospitalized patients' perception of individualized care. METHODS: A cross-sectional study was conducted of 606 patients from 20 wards from five hospitals across Germany. Individualized care and potential influencing factors were assessed via structured questionnaires. To identify influencing factors, we applied a hierarchical linear model with two levels. RESULTS: Self-rated health, length of ward stay, educational level and shared decision-making process about nursing care were perceived to influence individualized care. A higher rating of health and longer ward stay correlated with improved perceptions of individualized nursing care. In addition, an educational level of nine or fewer years and a perceived shared decision-making process about nursing care positively influenced the perception of nursing care as being tailored to individual needs. CONCLUSIONS: Several factors influence patients' perception of individualized care. However, only the decision-making process can be actively influenced by nurses. Therefore, nurses should be encouraged to promote shared decision-making regarding patients' nursing care. TRIAL NUMBER: DRKS00005174 (Date of registration: 2013/08/01).

Barriers and Facilitators to Palliative Care of Patients with Chronic Heart Failure in Germany: A Study Protocol.

BACKGROUND: Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. DESIGN AND METHODS: Tripartite study. First part of this study evaluates health care providers' (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. EXPECTED IMPACT FOR PUBLIC HEALTH: The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients. Significance for public healthPatients with chronic heart failure suffer from similar symptoms and symptom burden than patients with malignant diseases. However, palliative care differs between these groups in a quantitative and qualitative way. This study will help to understand why patients with chronic heart failure receive less palliative care than patients with malignant disease. In addition, measures to overcome barriers and to promote facilitators of palliative care in patients with chronic heart failure will be developed. These recommendations could provide a basis for quality improvement projects or studies aiming at improving symptoms and symptom burden of heart failure patients. The recommended measures could also be used to reduce caregiver burden.

The German version of the Individualized Care Scale - assessing validity and reliability.

AIM: To assess validity and reliability of the German version of the Individualized Care Scale (ICS). BACKGROUND: Individualized nursing care plays a pivotal role in establishing patient-centered care. To assess individualized nursing care and to compare it in different settings and countries, valid and reliable instruments are needed. No psychometric-tested instrument for comparing individualized nursing care with other countries is available in Germany. DESIGN: Cross-sectional study. METHODS: Data were collected between September 2013 and June 2014 from 606 patients in 20 wards in five hospitals across Germany. Unidimensionality of the ICS scales ICSA (patients' views on how individuality is supported through nursing interventions) and ICSB (patients' perceptions of individualized nursing care) was analyzed by confirmatory factor analysis. Internal consistency was assessed by calculating Cronbach's alpha. The Smoliner Scale (patients' perceptions of the decision-making process in nursing care) and results from participating hospitals' assessment of the nursing care delivery systems were used to assess known-groups validity and concurrent validity. RESULTS: Fit indices of confirmatory factor analysis indicate unidimensionality of the ICSA (Comparative Fit Index: 0.92; Tucker-Lewis Index: 0.902; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05) and the ICSB (Comparative Fit Index: 0.91; Tucker-Lewis Index: 0.89; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05). Internal consistency using Cronbach's alpha was 0.95 (95% confidence interval: 0.94-0.95) for ICSA and 0.93 (95% confidence interval: 0.92-0.94) for the ICSB. Concurrent validity was established by a significant relationship between the Smoliner Scale and ICSA (r=0.66; P<0.01) and ICSB (r=0.72; P<0.01). Known-groups validity was approved by ICSA/ICSB score differences related to nursing care delivery systems and patients' perceptions of decision-making style. CONCLUSION: The German version of the ICS is deemed a valid and reliable instrument for use in practice and research with hospitalized patients.

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.

A systematic review of instruments measuring patients' perceptions of patient-centred nursing care.

This systematic review identified and evaluated instruments measuring patients' perceptions of patient-centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client-Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician-patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research is needed regarding test-retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis.

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.

Comparison of self-care behaviors of heart failure patients in 15 countries worldwide.

OBJECTIVE: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

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.