Core competencies for ethics experts in health technology assessment.

OBJECTIVES: There is no consensus on who might be qualified to conduct ethical analysis in the field of health technology assessment (HTA). Is there a specific expertise or skill set for doing this work? The aim of this article is to (i) clarify the concept of ethics expertise and, based on this, (ii) describe and specify the characteristics of ethics expertise in HTA. METHODS: Based on the current literature and experiences in conducting ethical analysis in HTA, a group of members of the Health Technology Assessment International (HTAi) Interest Group on Ethical Issues in HTA critically analyzed the collected information during two face-to-face workshops. On the basis of the analysis, working definitions of "ethics expertise" and "core competencies" of ethics experts in HTA were developed. This paper reports the output of the workshop and subsequent revisions and discussions online among the authors. RESULTS: Expertise in a domain consists of both explicit and tacit knowledge and is acquired by formal training and social learning. There is a ubiquitous ethical expertise shared by most people in society; nevertheless, some people acquire specialist ethical expertise. To become an ethics expert in the field of HTA, one needs to acquire general knowledge about ethical issues as well as specific knowledge of the ethical domain in HTA. The core competencies of ethics experts in HTA consist of three fundamental elements: knowledge, skills, and attitudes. CONCLUSIONS: The competencies described here can be used by HTA agencies and others involved in HTA to call attention to and strengthen ethical analysis in HTA.

"Theory Does Not Get You From Bed to Wheelchair": A Qualitative Study on Patients' Views of an Education Program in Spinal Cord Injury Rehabilitation.

PURPOSE: The aim of this study was to evaluate a new nurse-guided patient education program in spinal cord injury rehabilitation with particular focus on the patients' perspectives and experiences. DESIGN: Longitudinal qualitative study. METHODS: We conducted face-to-face interviews with 10 rehabilitation patients and used the content analysis method to analyze the data. FINDINGS: Patients emphasized the importance of the practical training of the education program. This impacted their well-being as well as their autonomy. They rated discussions with primary nurses and peers about physical or psychological concerns. However, after discharge, the learning process was ongoing, and patients experienced the transition to living at home as a major challenge. CONCLUSIONS AND CLINICAL RELEVANCE: This research provides valuable information from the patients' perspective for enhancing spinal cord injury patient education. Situational learning, based on the practical parts of patient education and working with peers, is highlighted.

Experience of patients waiting for a hip or pelvic fracture surgery ­ a qualitative study / Wie Patient(inn)en mit einer Hüft- oder Beckenfraktur das Warten auf die Operation erleben - eine qualitative Studie

Background: In Swiss hospitals, patients are waiting for a hip fracture surgery due to a variety of reasons, despite the guidelines recommending a rapid surgical treatment. Quantitative studies show that long delays have a negative impact on the physical and psychological health. Caregivers are confronted directly with waiting patients. Often they feel insecure and helpless, because little is known about how patients experience their waiting period. Aim: In order to derive implications for nursing care, the study describes the experiences of patients with hip fracture while waiting for this specific surgery. Method: A qualitative approach with semi-structured interviews was chosen. The data were analysed with the open coding method by Saldaña. Results: Due to recruitment problems, patients with pelvic fracture were subsequently included. The participants ­ 33 to 89 year old ­ had an average waiting time of 68 hours. This condition has been perceived as a standstill and waste of time. Adequate information and attentive care, improved the confidence in the medical team and understanding of the situation, eased the waiting period, while physical and psychological distress such as pain, immobility or worries influenced it negatively. Under these circumstances, patients could hardly occupy themselves. They let time pass and appreciated distraction by their relatives. Conclusions: Consequently, reliable, consistent information and a compassionate, attentive care are core elements in caring for patients with delayed surgery.

[Complex drug regimen in multimorbid elderly patients after hospital discharge - a qualitative study]. / Komplexe Medikamentenregime bei multimorbiden älteren Menschen nach Spitalaufenthalt - eine qualitative Studie.

BACKGROUND: Older people often have multimorbidity requiring a complex regime of medications, which may change following hospital discharge, thus presenting new challenges. The experiences of older people, who manage their own medications, in particular following hospital discharge, have rarely been studied. AIM: This study investigates the experiences of older people with multimorbidity taking multiple medications after hospital discharge and how they cope with medication-taking. METHOD: A qualitative-descriptive approach with ten interviews was chosen. The data were coded openly into two groups according to Saldaña (2013). RESULTS: It is important for older people, in spite of their multimorbidity, to maintain their independence and maintain responsibility for taking their medications. Routines are developed from taking medications over many years and the new medications are easily integrated. Unclear information by the medical staff and the inability of the older people to obtain the medications after discharge may lead to mistakes or interruptions in the drug therapy at home. The key person for this group is the general practitioner, even concerning the drug therapy initiated in hospital. CONCLUSION: It is advisable to adapt discharge education to the needs of older people, especially with regard to their drug therapy, to its integration into their daily routine, and to any possible shortcomings in their medication management.

[Resources and their meaning for caregivers--a gap in research? Health sociological and empirical approach to a hitherto neglected field of research]. / Ressourcen pflegender Angehöriger - eine Forschungslücke? Gesundheitssoziologische und empirische Annäherung an ein bislang vernachlässigtes Forschungsfeld.

Family caregiving changes everyday life. Caregivers deal with the new situation in different ways and they feel more or less stressful. Actually there is little knowledge about possible causes of this situation. But there is an assumption that using varied resources and coping strategies lead to differences in health outcomes and well-being. As caregiving is a phase of life with special stressors, the caregiver needs specific resources to cope with these requirements. According to Antonovsky (1997) and Hobfoll (1989), this research asks which resources caregivers poses and use to deal with the unusual situation. On the basis of a salutogenetic and resource-orientated theoretical approach and additional qualitative analysis of interviews important resources for caregivers will be identified. The results lead on the one hand to the construction of an assessment instrument and on the other hand facilitate nurses to get to know more about the individual approach of resources and their specific meaning for caregivers.