[Patient-related complexity in nursing care - Collective case studies in the acute care hospital]. / Patientenbezogene Komplexität in der Pflege ­ Kollektive Case Studies im Akutspital.

Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. BACKGROUND: Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. AIM: We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. METHODS: In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. RESULTS: The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. CONCLUSIONS: Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

Introduction of the distress thermometer on an oncological ward / Einführung des Belastungsthermometers auf einer onkologischen Station.

Background: Patients suffering from oncological diseases experience physical, mental, social, and spiritual distress. 20 to 40 % show increased stress and need professional support. Therefore, we implemented the distress thermometer (DT) as a screening instrument on an inpatient oncological ward. Method: We chose an action research approach ("look"-"think"-"act"-cycle) for this practice development project. Firstly, we examined the current assessment of psychosocial distress and conducted a literature research ("look"). On this basis we elaborated an instruction for the DT ("think") and implemented the instrument ("act"). We evaluated the project by analyzing the completed DT questionnaires and by conducting a survey of patients and nurses ("look"). Results: After implementing the DT, mentions of psychosocial distress in patient records increased by 40 %. Before the implementation, distress was documented in only 39.5 % of patient records and 4.5 % of all patients were referred to the psycho-oncology service. After introducing the DT, psychosocial stress was mentioned in 86 % of patient records and 7.3 % of patients received psycho-oncological counselling. 49.6 % of patients were screened. Nurses considered the screening tool as useful and supportive. Conclusions: By means of the DT, a systematic screening of psychosocial distress is feasible. The instrument can be easily implemented and applied in daily practice.

[Optimizing medication intake in patients with chronic liver disease]. / Medikamenteneinnahme optimieren bei Patienten mit chronischen Lebererkrankungen.

Non-adherence in patients with chronic liver disease is a problem resulting in various consequences ranging from disease deterioration to death. Insufficient medication adherence leads to enormous health care costs. Family caregivers can essentially contribute to improving adherence. The aim of this project was to develop a work instruction specifically dedicated to optimize adherence in this patient group and their family caregivers. The project team utilized the principles of participatory action research. A systematic literature research aimed at identifying interventions for improving medication adherence in patients with chronic liver disease. Findings of patient experiences from literature as well as clinical experience of nurses were evaluated for their practicability in the local context. Research revealed that information for patients and family caregivers, supportive relationships with health care professionals, helpful communication, the use of memory aids and integration of medication intake into everyday life were the most helpful adherence-enhancing interventions. The work instruction serves to integrate these interventions into clinical practice in order to ensure optimal medication adherence.