Preparing, conducting, and analyzing Delphi surveys: Cross-disciplinary practices, new directions, and advancements.

Delphi is a scientific method to organize and structure an expert discussion aiming to generate insights on controversial topics with limited information. The technique has seen a rise in publication frequency in various disciplines, especially over the past decades. In April 2021, the term Delphi method yielded 28,200 search hits in Google Scholar for the past five years alone. Given the increasing level of uncertainty caused by rapid technological and social change around the globe, collective expert opinions and assessments are likely to gain even more importance. Therefore, the paper at hand presents technical recommendations derived from a Delphi study that was conducted amid the outbreak of the COVID-19 pandemic in 2020.•The paper comprehensively demonstrates how to prepare, conduct, and analyze a Delphi study. In this regard, it combines several methodological advancements of the recent past (e.g., dissent analyses, scenario analyses) with state-of-the-art impulses from other disciplines like strategic management (e.g., fuzzy clustering), psychology (e.g., sentiment analyses), or clinical trials (e.g., consensus measurement).•By offering insights on the variety of possibilities to exploit Delphi-based data, we aim to support researchers across all disciplines in conducting Delphi studies and potentially expand and improve the method's field of application.

Transfer market activities and sportive performance in European first football leagues: A dynamic network approach.

Professional football is a globalized game in which players are the most valuable assets for clubs. In this study, we explore the evolution of the football players' transfer network among 21 European first leagues between the seasons 1996/1997 and 2015/2016. From a topological point of view, we show that this network achieved an upper limit expansion around season 2007/2008, thereafter becoming more connected and dense. Using a machine learning approach based on Self-Organizing Maps and Principal Component Analysis we confirm that European competitions, such as the UEFA Champions League or UEFA Europa League, are indeed a "money game" where the clubs with the highest transfer spending achieve better sportive performance. Some clubs' transfer market activities also affect domestic performance. We conclude from our findings that the relationship between transfer spending and domestic or international sportive performance might lead to substantial inequality between clubs and leagues, while potentially creating a virtuous (vicious) circle in which these variables reinforce (weaken) each other.

[Satisfaction with the quality of care in nursing homes--the nurses' perspective]. / Zufriedenheit mit der Qualität der Pflege in stationären Altenpflegeeinrichtungen aus Sicht der Pflegenden.

BACKGROUND: In Germany, the number of residents in Nursing Homes (NH) has increased in recent years, residents become older, increasingly multimorbid and suffer more from dementia. In parallel demands concerning the quality of care in NH have increased. The vivid poltical and public debate about quality of care, however, widely disregards the perception of nurses. The aim of this study is to investigate the nurses' satisfaction with the quality of care in their NH and potential psychological consequences. METHODS: Secondary questionnaire data from 1489 nurses in 88 NH of the German 3Q-study (www.3q-studie.de) were used from the 2011 investigation. Questions regarding satisfaction enquire satsifaction in five nursing work domains. Descriptive analyses as well Chi2-tests were performed. RESULTS: The majority of nurses were satisfied in the subdomain "overall quality of care" and "physical care" (80% each). 67% were satisfied with "the quality of care for residents with dementia" and 64% with "end-of-life care". Only 56% of the nurses were satisfied with "mental care". If nurses were unsatisfied with the quality of care, this was mostly perceived as a psychological stressor. Subgroup analysis showed a pattern for four of the five domains: dissatisfied nurses were older, better qualified, worked more than 25 hours per week and worked in larger NH. No such pattern was found for "quality of care for residents with dementia". CONCLUSIONS: Nurses' satisfaction with the quality of care has shown to be a relevant work factor and potential stressor deserving more scientific and clinical attention. For NH it could constitute a core indicator for internal quality management as well as for human resource management. Research in work, health and economy in NH should also consider this factor.

The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes.

BACKGROUND: The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability. METHOD: Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs. RESULTS: 58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability. DISCUSSION: The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.

[Exposure to aggressive patient behaviour and its' association with the nurses' "work ability" in Germany]. / Konfrontation mit aggressiven Klienten-- Auswirkungen auf die Arbeitsfähigkeit von Pflegekräften in Deutschland.

BACKGROUND: Aggressive behavior and violence in patients, residents or clients are growing challenges in nursing. Aggressive behavior can have both, physical and psychological consequences for nurses and can lead to a reduced performance at work, demotivation, sickness absence and the premature exit from the nursing profession. To develop purposive strategies and to deal with aggressive behavior and health promotion programs, it is crucial to know more about the prevalence of aggressive behavior from patients and the effect on the work ability of nurses in different types of institutions. METHOD: Data of 1735 German nurses was derived from the European NEXT-Study. Description and analysis of variance for each working area (hospital ward, Intensive Care Unit, psychiatric ward, nursing home and home care) were conducted. The work ability was measured with the Work Ability Index (WAI). The aggressive behavior was measured by one item developed by the NEXT Study Group. Linear regression models were applied to analyze the effect of aggressive behavior on the work ability of nurses in a comparison of the five different working areas. RESULTS: A total of 84.9 percent of the nurses were "sometimes" or "often/always" confronted with aggressive behavior from patients. In the comparison of the five working areas, nurses were exposed to different levels of aggressive behavior, while differences in the work ability of nurses were also observed. It was found that aggressive behavior from patients was associated with reduced work ability in nurses working in hospital wards, nursing homes and home care, but not nurses working in ICUs and psychiatric wards. CONCLUSIONS: The findings indicate that many nurses in Germany are exposed to aggressive behavior from patients, which has negative effect on the nurses' work ability. However, it is assumed that strategies to deal with aggressive behavior could play a buffer role between aggressive behavior and work ability of nurses, highlighting one possibility of intervention in future.

Distress experienced by nurses in response to the challenging behaviour of residents - evidence from German nursing homes.

AIMS AND OBJECTIVES: The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability). BACKGROUND: Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood. DESIGN: Cross-sectional study. METHOD: Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources. RESULTS: The mean score for residents' challenging behaviour-related distress was 41·3 (SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels. CONCLUSION: Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability. RELEVANCE TO CLINICAL PRACTICE: Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working conditions for nurses. The development of preventive concepts for nursing staff and residents is recommended.

[Work related predictors for "satisfaction with dementia care" among nurses working in nursing homes]. / Arbeitsbedingte Prädiktoren für Zufriedenheit in der Demenzversorgung bei Pflegenden in stationären Altenpflegeeinrichtungen.

In German nursing homes dementia care is gaining increasing relevance. Dementia care is known to bear the high risk of a substantial occupational burden among nursing staff. Within this context, the "nurses' satisfaction with the care for residents with dementia" is investigated. Secondary data of the German 3q-study is used to assess degrees of nurses' satisfaction with the care for residents with dementia and potential work related predictors. Data from 813 nurses and nursing aides working in 53 nursing homes were included. 42% of all nursing staff was dissatisfied with the care for residents with dementia in their institution, however, pronounced differences were found between the institutions. Registered nurses and nurses in leading positions were more dissatisfied. A multiple regression analysis indicates that high "quantitative demands", low "leadership quality" and "social interaction with other professions" are strong predictors for nurses' satisfaction with the care for residents with dementia. No association was found for "emotional demands" and "possibilities for development". The results indicate that the "nurses" satisfaction with the care for residents with dementia" may be a highly relevant work factor for nursing staff in nursing homes which deserves additional attention in practice and research. The high predictive power of several work organisational factors implies that preventive action should also include work organisational factors.

Psychosocial work load and stress in the geriatric care.

BACKGROUND: Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. METHODS: The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain.Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database).Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. RESULTS: In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration).Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity.A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties. CONCLUSIONS: Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs.

Diabetes foot self-care practices in the German population.

AIM: The object of this study was to find out which self-care activities patients with diabetes perform to prevent diabetic foot syndrome (DFS) and to look for differences between patient groups (diabetes education and foot at risk). BACKGROUND: Besides the importance of screening patients at risk to develop a DFS and the clinical interventions, it is also necessary to involve the patient with diabetes in the self-care of their feet. There is no information in Germany concerning self-care activities carried out by patients for the prevention of DFS. DESIGN: A cross-sectional study. METHOD: A secondary analysis of the data used in the study for the development of the 'Frankfurter Catalogue of Foot Self-Care - Prevention of Diabetic Foot Syndrome'. Two hundred and sixty-nine patients with type 1 and type 2 diabetes were included. The study population was divided into different training experience groups and foot at risk groups based on self-reported data. RESULTS: Patients who had participated in more than three education programmes performed significantly better self-care than patients who had no or only one training programme. Patients with a foot at risk for the development of diabetic foot ulcer perform more adequate self-care regarding professional assistance in foot care, but are not more active in the self-control of the feet, shoes and socks. CONCLUSIONS: There are self-care deficits regarding self-control of feet, shoes and socks. Based on the data it seems to be that more than three education programmes are needed to lead to performance of adequate self-care. Especially patients with a foot at risk need more professional support for their daily self-care activities to prevent DFS or further foot complications. RELEVANCE TO CLINICAL PRACTICE: The first findings support that it might be helpful to identify patients with self-care deficits and therefore to improve patients daily foot self-care.

Differential effects of K(ATP) channel blockers on [(3)H]-noradrenaline overflow after short- and long-term exposure to (+)-oxaprotiline or desipramine.

To test whether prolonged uptake blockade can lead to changes in the function of ATP-dependent potassium (K(ATP)) channels we investigated in rat neocortex slices the effects of K(ATP) channel blockers on electrically evoked [(3)H]-noradrenaline ([(3)H]-NA) overflow after short- (45 min) and long-term (210 min) exposure to the NA uptake blockers (+)-oxaprotiline or desipramine (1 microM each). The K(ATP) channel blocker glibenclamide (1 micro M) increased the evoked [(3)H]-NA overflow by 42% after short-term uptake inhibition. This effect was confirmed by tolbutamide and glipizide, two other K(ATP) channel antagonists. The evoked [(3)H]-NA overflow was enhanced by 73% following short-term uptake blockade (15 min) and by 110% following long-term blockade (180 min). After long-term blockade (210 min), however, glibenclamide failed to further enhance the overflow of [(3)H]-NA. The alpha(2)-autoreceptor-mediated feedback control was not involved in the glibenclamide-induced increase in [(3)H]-NA overflow after short-term uptake blockade or in the increase in [(3)H]-NA overflow due to long-term uptake blockade per se. The Na(+)/K(+)-ATPase inhibitor ouabain diminished the glibenclamide-induced enhancement of [(3)H]-NA overflow after short-term uptake blockade, suggesting that an operative Na(+)/K(+)-ATPase is the prerequisite of activation of K(ATP) channels. These results suggest that short-term uptake blockade activates the Na(+)/K(+)-ATPase, thereby reducing intracellular ATP which allows transient opening of K(ATP) channels. Activation of the Na(+)/K(+)-ATPase may increase the Na(+) gradient, probably over the membrane of noradrenergic nerve terminals. The resulting hyperpolarisation leads to inhibition of the evoked overflow which can be reversed, i.e. enhanced, by K(ATP) channel blockers. In contrast, longer lasting uptake blockade seems to reduce the activity of the Na(+)/K(+)-ATPase and hence the consumption of ATP. As a consequence, reduced Na(+) and K(+) gradients may facilitate transmitter release. Closure of K(ATP) channels by accumulating ATP may further promote membrane depolarisation and transmitter release. The unexpected effect of longer exposure to uptake blockers could be somehow related to the clinical time latency of the antidepressant efficacy of monoamine uptake blockers.