[Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives]. / Unterstützungsbedarfe pflegeempfangender Menschen : Erhebung allgemeiner und spezieller Informations­, Hilfe- und Unterstützungsbedarfe pflegeempfangender Menschen und ihrer Angehörigen.

BACKGROUND: In 2009, statutory regulations on information and counselling regarding nursing care needs, performed by so-called care advisors have been implemented for persons in need of long-term care and their relatives. In order to adequately prepare these care advisors, contemporary needs and requirements must be determined. The aim of the study was to determine the different needs of persons in need of long-term care and their relatives. METHOD: Care advisors were interviewed via an online survey tool using a standardized questionnaire. A 5-point Likert scale was used to determine the needs regarding information and advice on 16 specific topics. In general, overall needs regarding information and advice of care recipients and relatives were recorded using a 10-point scale (1 low and 10 high). Using classification and regression trees (CRT) and random forest, the correlation between the individual main topics and the general need for advice was analyzed. RESULTS: The participating care advisors (n = 276) rated the general demand for information of people in need of care and their relatives with a mean of 7.8 and 9.2, respectively. For those in need of care, the strongest association of general information needs was the topic of housing advice For the relatives, the topic social law aspects and benefits was the most relevant association. CONCLUSION: The general demand for information was rated very high. Since differences became obvious between those in need of care and their relatives, it is necessary to adjust care advice for these two groups.

Patient safety in home care: A multicenter cross-sectional study about medication errors and medication management of nurses.

Studies assume that up to 30% of home care recipients are exposed to a possible medication error. For the home care sector, the study situation regarding such errors is limited. The aim of the study was to find out how often medication errors occur and whether they are related to training, quality assurance measures (use of the double-check principle (DCP)), and other structural conditions of home care services. A cross-sectional study was conducted, comprising 485 fully trained nurses of 107 randomly selected home care services. Potential influencing factors were analyzed in a multiple logistic regression model. Of 485 fully qualified nurses, 41.6% reported medication errors within a 12-month period, while 14.8% did not answer this question. Nurses who had attended medication training within the last 2 years compared to a longer period (frequently to rather rarely applied DCP); the odds ratio of not making medication-related errors was 1.79[1.42-3.09] (OR 3.13; [1.88-5.20]). Years of professional experience, amount of patients per shift, and type of work contract (full/part-time) were not statistically significantly associated with reported medication errors. Medication-related errors occur frequently in home care. Regular training and adequate quality management measures increase patient safety. Nursing managers and other responsible individuals of home care institutions have to make sure that nursing staff take part in regular medication training and apply the DCP when they give out medication in home care.

Pressure ulcer prevention-Results of a multicentre cross-sectional survey on hospital infrastructures and processes in acute hospitals and accident and emergency departments.

AIMS AND OBJECTIVES: Pressure ulcers (PUs) are a serious health problem. They can be considered as an indicator of the quality of health care and are associated with considerable cost increases for the health care system. The prevention of PUs is a major concern in hospital care. The aim of the study was to reveal the current PU prevention-related processes and structures with a specific focus on the Accident and Emergency (A&E) Department. METHOD: In late 2018/early 2019, all German hospitals were invited to participate in a nationwide cross-sectional survey. One standardized questionnaire was assigned to a representative of each hospital. The representative was asked to state what PU-related structures and processes are implemented in their hospital, in general and specific to the A&E department. Besides mostly descriptive analysis, PU-related processes were analysed on PU incidence in a multivariate linear regression model. RESULTS: Two hundred seventy-six hospitals participated in the survey. 63.4% (n = 175) of the participating hospitals had at least one PU manager. Skin inspection was the most frequently performed procedure. Although not recommended, 1.3% (2.1%) of the facilities still use sheepskins quite often (very often). In the regression model on PU incidence, only the process 'mobilization in bed' was statistically significantly associated. Although the risk of developing a PU in the emergency department is high, more than half of the facilities had no PU guidelines. CONCLUSION: Even if recommended procedures (skin inspection, 30° positioning) have been used frequently, regular training could help to bring new scientific findings such as the use of local skin protection dressings into clinical practice. Prevention guidelines should be established in all areas of care even for A&E as well as when patients are transferred inside or out of the hospital, where the risk of PU development was considered low.

Smart@home - supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: a cross-sectional survey.

BACKGROUND: The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems. METHODS: The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (> 65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n = 37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n = 64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment. RESULTS: Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level). CONCLUSIONS: Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids.

Underweight in Nursing Homes: Differences between Men and Women.

OBJECTIVE: In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. MATERIAL AND METHODS: A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in "R." RESULTS: Average prevalence of underweight in nursing home residents was 13.7% (13.2-14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0-16.2) and the prevalence of underweight among men was 7.5% (6.7-8.2). The CRT-based modeling indicated that "loss of appetite" as the most important indicator for low BMI. If "loss of appetite" was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were "very large institutions" and the "resident/nurse ratio." The random forest analysis confirmed the importance of the CRT approach. DISCUSSION/CONCLUSION: The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.

[Prevalence and influencing factors of chronic wounds among clients of home care services in Germany]. / Prävalenz und Einflussfaktoren von chronischen Wunden bei Klienten von ambulanten Pflegediensten in Deutschland.

INTRODUCTION: Chronic or non-healing wounds are a serious problem for both the parties involved and the healthcare system. Currently, there are hardly any reliable data on the prevalence of chronic wounds in outpatient care, although this setting is becoming increasingly important. Therefore, the aim of this study was to determine the prevalence of and the factors associated with chronic wounds in clients cared for by home care services. METHOD: As part of a cross-sectional study throughout Germany in 2012, a survey was conducted among care recipients provided by home care services. The sample was drawn in a two-step procedure. First, a random sample of home care services was drawn for each federal state, followed by random selection of clients to be interviewed for each service. The aim of the study was to describe the prevalence of chronic wounds and influencing factors such as BMI, age, housing situation, activity and diabetes mellitus. Data collection through questionnaire was carried out by trained nurses. RESULTS: A total of 144 home care services with 1,296 clients had agreed to participate. With 880 care recipients from 100 home care services finally taking part in the survey, the response rate was 68 %. Of all care recipients examined, 101 had at least one chronic wound; the highest prevalence rates were observed for pressure ulcers (4.6 %) and leg ulcers (4.0 %). Care recipients with diabetes mellitus were more frequently affected by chronic wounds (16.4 %) than non-diabetic recipients (9.5 %). Community-living care recipients (14.1 % chronic wounds; 6.0 % pressure ulcers) and care recipients under the age of 65 (20 % chronic wounds; 9.5 % pressure ulcers) were affected more frequently than care recipients living alone (9.1 % chronic wounds; 3.0 % pressure ulcers) or care recipients older than 65 years (10.5 % chronic wounds; 4.0 % pressure ulcers). In the multivariate calculation, the BMI proved to be the strongest predictor. The prevalence of chronic wounds in the group of obese (BMI>35.3kg/m2) care recipients and those with activity restriction is 44.8 %. CONCLUSION: In view of the fact that one out of nine care recipients receiving assistance from home care services is affected by at least one non-healing wound, special attention should be paid to the prevention, detection and treatment of chronic wounds. Furthermore, it seems particularly necessary to identify the relevant risk groups in order to be able to initiate adequate and preventive measures at an early stage.

[Structure Parameters and Quality Outcomes of Ambulant Home-care]. / Strukturparameter und pflegerische Ergebnisqualität in der ambulanten Pflege.

INTRODUCTION: So far, there are few data available on the changes of ambulant home-care in Germany over the last decades. Therefore, the aim of this research was to provide structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany. In addition, a possible association between structure parameters and quality outcomes for pressure ulcer and malnutrition was investigated. METHODS: In 2015, a multicenter cross-sectional study was conducted in home-care services in Germany. Structure data from 99 randomly selected home-care services as well as data on pressure ulcers and malnutrition of 903 care-dependent clients were analyzed. The median (<98 clients) was used as a cut-off to differentiate between small and large home-care services. From a cut-off of 20,000 inhabitants, a region was considered urban. The average prevalence for decubitus and malnutrition (BMI<20 Kg/m2) were determined for each home-care service, and possible associations with structure parameters were analyzed using a multiple linear regression model. RESULTS: The proportion of registered nurses in non-private (private) home-care services was 60.6% (52.3%). The proportion of employees with a 200- h basic qualification in nursing was higher in private (12.5 vs. 4.7%), small home-care services (14.0 vs. 5.8%) and in urban regions (11.5 vs 5.7%). In average, registered nurses working in small home-care services spent significantly more time per client than the ones working in large services (3.8 vs. 2.9 h/week). The highest need for further training was shown on the subjects of pain, medication and cognitive impairment. No statistically significant correlation could be found between the average decubitus prevalence and structure parameters. Only the association between malnutrition prevalence and the proportion of registered nurses was statistically significant. CONCLUSION: The present representative study provides structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany that could be used as a baseline for further investigations. No statistically significant association could be found between structure and outcome quality parameters. There is a need for further training of nursing personnel on the subjects of medication, pain and cognitive impairment.

[Patient safety: The use of guidelines for dealing with multidrug resistant pathogens in outpatient care]. / Patientensicherheit ­ Einsatz von Richtlinien zum Umgang mit multiresistenten Erregern in der ambulanten Pflege.

INTRODUCTION: Due to an increasing number of care recipients with severe and multiple illnesses and their increased risk of infections, the importance of hygiene has grown steadily over the past years. In home care settings, we are increasingly faced with multidrug-resistant pathogens, resulting in new requirements for a sufficient ambulatory hygiene management. As there are only few study results relating to the prevalence and implementation of a standardized ambulatory hygiene management, our study aims to explore the extent to which both fixed MRSA decolonization measures and instructions for the handling of specific pathogens are available to care staff and whether MRSA management is documented. Finally, it was examined whether this is influenced by professional experience, qualification, working hours and hygiene trainings for care staff. METHOD: In the winter of 2016/17 a cross-sectional survey was conducted among the employees of home care services in Germany. The aim was to survey 10 employees of 10 services in each federal state. Being aware of the difficulties of this kind of study, we expected a response rate of 50 per cent. It was intended to show correlations between the existence of fixed MRSA decolonization protocols, the documentation of MRSA decolonization treatments as well as handling instructions for specific pathogens and independent variables such as professional experience in years, qualification, trainings, working hours and care patients per shift. RESULTS: A total of 107 home care services participated in the study, with 656 care workers returning completed questionnaires. The results showed statistically significant differences between hygiene trainings conducted within the last 12 months and those having taken place more than a year ago. As a general principle, there was more awareness of the existence of fixed MRSA remediation protocols, procedures for handling specific pathogens, and logging of MRSA remediation when staff hygiene training had been conducted within the past 12 months. CONCLUSION: In the light of demographic changes and the associated increase in the number of multi-morbid, chronically ill patients in need of care, adequate hygiene management should be implemented in a standardized, comprehensive manner. This includes annual trainings as well as a standardized application of hygiene procedures.

[Centrally and non-centrally designed exams in nursing: Comparisons of the final exams in 2008 to 2013 in Berlin focusing on different concepts of professional nursing education]. / Zentral und dezentral verortete Prüfungen in der Krankenpflege. Vergleich der Abschlussnoten der Jahre 2008 ­ 2013 im Land Berlin unter Berücksichtigung unterschiedlicher Ausbildungskonzepte.

INTRODUCTION: In Germany, nursing education ends with a final written, oral and practical exam. In the federal state of Berlin, Germany, all nursing students take centrally standardized written exams, while the practical and oral exams are developed by each individual nursing school or university and conducted without standardized protocols (non-central). Comparability might be seriously limited by this procedure. Since there is no official statistics available, the objective of this study is to compare the results of the final written, oral and practical exams of different nursing education institutions with an additional focus on different educational concepts. METHODS: In a secondary data analysis, the final grades (written, oral, practical) of 4,342 nursing students in all 16 educational institutions in Berlin from 2008 to 2013 were analyzed. RESULTS: The mean (SD) of all written, oral and practical exams taken was 2.9 (0.7), 2.6 (1.1) and 2.2 (1.0), respectively. In each type of exam, the trend in grades was stable over the observation period. There was a statistically significant increase in the prevalence of initially failed exams from 2008 (7.9 %) to 2013 (12.0 %). In institutions following a traditional concept of education, the difference in grades between oral/practical exams on the one hand and written exams on the other ranged from 0.1 to 0.9, while in generalist (academic) institutions it ranged between -0.1 and 0.3 (-0.1 to 0). CONCLUSION: In nursing schools with a traditional approach to education, there was a big difference in grades between written and oral/practical exams. Standardization of oral and practical exams should be initiated to ensure greater comparability between different educational institutions.