Self-Reported Questionnaire of Functional Health of Home-Dwelling Elderly People Living in Austria: Based on the Patient Questionnaire of the Standardized Assessment of Elderly People in Primary Care.

AIM: The aim was to review the construct validity and reliability of a functional health assessment questionnaire (Questionnaire on Functional Health 2 [Q-FH2]). METHODS: The Q-FH2 was used to assess 344 elderly people in a home setting. A polychoric correlation matrix was applied to conduct a principal axis factor analysis with oblique rotation. The number of factors was determined using various procedures and calculated using theta coefficients to estimate ordinal reliability. RESULTS: The exploratory factor analysis supported a 4-factor solution with an explained total variance of 82%. The internal consistency showed  coefficients ranging from 0.758 to 0.854. CONCLUSION: The Q-FH2 appears to be a useful instrument to assess the multidimensionality of functional health as defined by the International Classification of Functioning, Disability and Health to determine the resources and deficits regarding the independent living of older adults and to derive appropriate consulting measures.

[Preventive home visits : Cross-sectional study to support an independent lifestyle for elderly people]. / Präventive Hausbesuche : Querschnittstudie zur Unterstützung der selbstständigen Lebensführung älterer Menschen.

BACKGROUND: In the interest of preventing or postponing dependency on care and assistance for as long as possible, preventive home visits to people aged over 70 years living at home were conducted by registered nurses. AIM: Assessment of the functional health of people over 70 years of age and counseling or information carried out based on the identified problem areas and resources. MATERIAL AND METHODS: A multidimensional nursing assessment through self-evaluation was applied for 345 people aged over 70 years. RESULTS: The sample of people investigated showed a high level of competence in self-care; however, a large number of functional health impairments could be identified that are reflected in the high requirement for counseling and information. DISCUSSION: It became evident that recruiting of study participants was difficult and that care by family members was an important resource for people aged over 70 years. From this it was recommended that in the future sustainable advertising efforts should be conducted and special attention needs to be given to counseling and information for family members in preventive home visits.

Structural Analysis of Treatment Cycles Representing Transitions between Nursing Organizational Units Inferred from Diabetes.

In this paper, we investigate treatment cycles inferred from diabetes data by means of graph theory. We define the term treatment cycles graph-theoretically and perform a descriptive as well as quantitative analysis thereof. Also, we interpret our findings in terms of nursing and clinical management.

Network nursing: connections between nursing and complex network science.

PURPOSE: Nursing processes are complex and include quite a few nonlinear interrelationships that are difficult to discover. Moreover, the formal description, visualization, and analysis of these processes are nontrivial challenges. The purpose of this paper is to establish the term network nursing as synonym for using quantitative graph theory in nursing science and to discuss how network nursing can be used for tackling such complex challenges in nursing science. METHODS: In particular, methods from quantitative graph theory, divided into two major classes, comparative network analysis and network characterization, are employed to solve challenging problems in nursing. FINDINGS: We demonstrate by way of example that this mathematical apparatus is feasible to tackle research questions when modeling and analyzing nursing processes. Here we use a "NANDA-I" showcase to illustrate how nursing networks can be derived from nursing data and how these networks can be used to compare different patients regarding their nursing diagnoses. CONCLUSIONS: Nursing networks can be used to characterize patients from a nursing perspective. Especially, they allow a process-based view and are able to map relationships or dependencies. One major advantage of a networking approach is that it can be applied independently from the underlying nursing classifications or terminologies. IMPLICATIONS FOR NURSING PRACTICE: Network nursing makes it possible to formally investigate the nursing process and thus opens up a so far little-known cosmos of possibilities and methods to expand nursing knowledge.

Being a Nursing Home Resident: A Challenge to One's Identity.

Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future.

[Being a nursing home resident--a challenge for one's identity]. / Heimbewohner sein-- eine Herausforderung für die Identität.

When entering the nursing home, elderly people are afraid of losing their independence and identity. That is why the entry into a nursing home turns out be a critical experience for the people affected. A systematic literature research on this topic illustrates that the impacts of a nursing home entry on the identity of these people have only scarcely been investigated so far. In the present study, 20 problem-centred interviews with residents of three different nursing homes were conducted and analysed according to the summarizing content analysis developed by Mayring (2007). The result shows that moving into a nursing home is accompanied by a strong emotional burden as these people have to leave behind their friends, families, pets, long-time neighbours and property. Moreover, other residents of the nursing home create fear through their need of care. The test persons participating in the present study do not want to have their decisions and actions imposed from outside because of their need of nursing care. They protest against it. They draw enough strength from the social network they maintain, from conversations and from their faith in order to fight for their independence. They develop a new identity close to their former identity by maintaining autonomy and mobility, and they stay future-oriented.

In discourse: Bourdieu's theory of practice and habitus in the context of a communication-oriented nursing interaction model.

AIMS: This paper presents a discussion on the potential of the theories of practice and habitus as espoused by the sociologist Bourdieu. BACKGROUND: The interaction between nurses and patients is a constitutive element in the nursing process and a central aspect in the theories developed by Paterson and Zderad, and Orlando. Bourdieu's theory of habitus and practices assists in understanding and explaining differentiated results concerning nurse-patient interaction. DATA SOURCES: In a study on interactions with paraplegic patients, distinguished levels of interactions, which show considerable diversity among one another, could be identified. The data were collected over a period of 20 months in 2004-2006. The results present the central topics of interaction and show that understanding-oriented interaction is rare. DISCUSSION: Communicative acting in nursing always takes place in a social context. In the interaction with patients, nurses assign a higher distinctive value to the standardized concepts of care facilities than to the actually perceived need of care. An understanding-oriented interaction assumes that the nurses with their own contributions, themes and authorities, prove themselves in the eyes of the patient. It is expected from nurses that they habitualize their own concepts so that they can be represented in a convincing manner. CONCLUSION: If an understanding-oriented interaction is to extend into the practice of nursing, it is of crucial importance that both interaction partners assure each other how and with what capital their interaction is to be realized. Nurses need professional habitus to become agents in the social field of health.

The use of massage therapy for reducing pain, anxiety, and depression in oncological palliative care patients: a narrative review of the literature.

A considerable number of cancer patients use complementary medicine therapies in order to alleviate different symptoms such as pain, anxiety, and depression, occurring in connection with cancer. This paper explores the question to what extent massage therapies are able to reduce the amount of pain, anxiety, and depression. For this purpose, a systematic literature analysis was carried out in the electronic databases and specialist journals. There is already evidence that massage therapies can influence the symptoms of pain, anxiety, and depression in a positive way.

Measurement and quantification of generalized tonic-clonic seizures in epilepsy patients by means of accelerometry--an explorative study.

Epilepsy is one of the most common neurological diseases, which has a cumulative lifetime incidence of 3%. Two to threefold increased morbidity and mortality rates are reported, especially if generalized tonic-clonic seizures (GTCS) occur. A wireless small and user-friendly detection system would be helpful in early identification of seizures. This could minimize the risk of seizure-related injuries and further allow complete seizure frequency documentation, especially in a non-clinical private setting. The aim of our study was to develop a design and to conduct an exploratory validation of an accelerometry (ACM)-based detection system for GTCS detection in real-time. Patients were recruited via the Epilepsy Monitoring Unit at the Department of Neurology, Medical University Innsbruck. In three out of 20 patients, four GTCS could be recorded. The ACM sensors recorded increased activities at the stated seizure time, which clearly differed from everyday movements. The temporary sensitivity (100%), specificity (≥88%) and the positive predictive value (≥75%) of the detection suggests a promising alarm/false alarm ratio. The validity of the detection device has to be evaluated with more data in order to be able to significantly confirm the positive results and to further develop a cut-off algorithm for automatic seizure detection.

[About the turning point in a nurse's life when giving up the profession. A qualitative-empirical study on the willingness to continue to work and on the conditions for continuing to work in the post-professional phase of life]. / Von der Zäsur der Berufsaufgabe be Krankenschwestern. Eine qualitativ-empirische Untersuchung zur Bereitschaft und zu den Bedingungen von Weiterarbeit in der nachberuflichen Lebensphase.

Due to the increasing life expectancy and population ageing, the post-professional phase of life is becoming more and more important to the individual and to society as a whole. The perception of the potentials of elderly people and, hence, the call for self-directed and independent activities in the post-professional phase are becoming more intense. The relation between retirement and work in nurses has not been of scientific importance so far. This is primarily due to the assumption that nurses cannot or do not stay in their profession until retirement. However, nurses do manage to pursue their profession continuously and permanently until they reach the age of retirement. The aim of this qualitative research study is to investigate the post-professional phase of life of former nurses within the context of the profession pursued. The guiding research questions in this regard were: How do former nurses spend their retirement period? How do nurses use their nursing-related abilities and experiences in their postprofessional phase of life? What do nurses associate with their former profession in the post-professional phase of life? In one-to-one interviews, these questions were posed to eight retired nurses who had pursued their profession for many years. The assessment instruments used were a socio-demographic questionnaire, a guideline and a record from memory. All data were summarized and evaluated analytically with regard to their content according to Mayring (2008). The present article shows the partial results of the study on retirement and work in the post-professional life of nurses. The results indicate that the transition to retirement is often accompanied by problems, that retired nurses do not fundamentally refuse to continue to work and that the willingness to continue to work is subject to certain conditions. Reasons and conditions for and against profession-based post-professional activities were revealed. Consequentially, concepts for the systematic identification of potentials of nurses in their post-professional phase of life should be developed.

[Interventions and their effects on informal caregivers of people with dementia: a systematic literature review]. / Interventionen und deren Effekte auf pflegende Angehörige von Menschen mit Demenz--Eine systematische Literaturübersicht.

In home-care situations, the caring family members of people suffering from dementia are exposed to a great number of physical, mental and social burdens, and restrictions, putting themselves at risk of falling ill. Caring family members need adequate forms of relief in order to be able to care for the family member at home for as long as possible, and with the best possible physical and psychological status. In the present paper, interventions of relief and promotion and their effects on family members caring for dementia patients have been investigated and described on the basis of a systematic literature review. The presentation of the results shows that psycho-educational, relieving, supportive, psychotherapeutic and multimodal offers as well as counselling and case/care management among caring family members have significant effects on parameters such as burdens, level of depression, subjective well-being, skills/knowledge as well as symptoms and institutionalisation of the person in need of care. None of the interventions investigated, however, covers the entire range of parameters. In order to be able to ensure the individual support of caring family members, a superordinate organisational concept (case/care management, family health nursing) which meets the needs of the caring family members, combines and interlinks tailor-made offers for caring family members is required. Registered nurses could play a central role as care managers or family health nurses in ensuring home-based care for people with dementia. Further investigations on multimodal offers and case/care management are needed. In this context, it is essential to take well-considered decisions on study design, sample size, and result parameters (assessment instruments) in order to gain significant results and homogeneous data.

[How do users experience the handling of the Observed Emotional Rating Scale?]. / Wie erleben Erfasserinnen den Umgang mit der Observed Emotional Rating Scale?

As barely any empirical data on the application of the Observed Emotion Rating Scale (OERS) on sufferers of dementia is available for German-speaking Europe, the pilot project titled "Agitation" aimed to see how those persons entering the data get along with the OERS instrument. For this purpose, 12 test persons were persuaded to carry out observations with the OERS instrument in three care centres located in the Swiss Canton of Zurich. The test persons were predominantly holders of nursing qualifications and/or experienced in caring for patients suffering from dementia. Data collection was undertaken on the basis of three focus group interviews which were evaluated via qualitative content analysis. The preliminary results gained in the focus group interviews were validated by the same people using a questionnaire. The categories were titled "Missing Clearness", "Missing Possibility to Encode", "Level of Dementia", "Estimation of Emotions", "Influencing Factors" and "User Training". These indicated that know-ledge of dementia is just as important as skilled use of OERS.

Development and alarm threshold evaluation of a side rail integrated sensor technology for the prevention of falls.

OBJECTIVE: Patient falls constitute a serious problem both for the persons fallen and for the institutions involved. Bed-exit alarm systems are used to reduce patient falls. Existing bed-exit alarm systems have several disadvantages depending on the technology used. As in "Evaluation of Bed-Exit Alarms" stated, restless, light weighted, uncooperative, incontinent and confused patients require different systems. The aim of this work is to present the research and development process of the integrated, universally applicable BUCINATOR bed-exit-alarm system. METHODS: The use-case technique was applied to capture the functional requirements for the development of the new integrated bed-exit alarm system. An experimental study was carried out to collect data regarding preliminary sensitivity and specificity for alarm set-off. RESULTS: Major identified requirements for an optimized bed-exit alarm system were usability, wide range usage, low costs, hygiene factors, integration into nursing beds and nurse call systems and an adequate alarm/false alarm ratio with early alarm trigger functionality. On the basis of the criteria mentioned above, a sensor system was developed, comprising tubes with an air-filled passageway attached on the top of side rails. These tubes are coupled via lines to transducers which trigger an alarm when a predetermined level of pressure is reached. Both the preliminary sensitivity (96.0%) and the specificity (>or=95.5%) of the trigger level indicate a satisfactory alarm/false alarm ratio which is now to be evaluated in a clinical trial. CONCLUSIONS: After experimental testing, BUCINATOR shows great potential to be a reliable bed-exit alarm system. In general, bed-exit alarm systems with extended features could play a major role in ambient assisted living technologies. LIMITATIONS: Besides the theoretical evaluation, it will be imperative to perform more tests and to gather more data about the effect on fall rates and resulting injuries.

[Informal caregivers of elderly people in South Tyrol. A qualitative assessment of home care situation]. / Pflegende Angehörige betagter Pflegebedürftiger in Südtirol. Ein qualitatives Assessment zur häuslichen Pflegesituation.

Within the framework of a pilot project in the sanitary district of Bruneck (sanitary establishment of South Tyrol), the concept of care management is being investigated both practically and scientifically for informal caregivers of elderly people in need of care since 2009 the results of the qualitative assessment of the homecare situation. The assessment before the intervention will form the basis for further design and implementation of individual stress-reducing and supportive offers for the informal caregivers. Using a semi structured interview guideline twelve problem-centered interviews with informal caregivers were conducted and analysed according to Mayring's content analysis technique (2007). Informal caregivers are exposed to burdens in social, physical and mental areas. Own resources, family ties and support reduce stress and burdens caused by the homecare situation. The need of individual and continuous support of families and implications for further measures of care management can be deduced from the results. There is a need of support in the areas coping strategies, empowerment and direct stress reduction with regard to the homecare situation through education, training, counselling and the interconnection of social and health services.

[Development and test-theoretical analysis of an instrument for data collection on patients' preferences and experiences concerning participation in nursing care decisions in acute hospitals]. / Entwicklung und testtheoretische Analyse eines Erhebungsinstruments zu Präferenzen und Erleben von Patienten in Bezug auf die Beteiligung an pflegerischen Entscheidungen im Akutspital.

Patient orientation and patient participation are important aspects of modern health care and should be taken into consideration in the context of nursing care decision-making. The concept of evidence-based nursing also includes patient preferences in participation on decision-making, an area, however, which has not been adequately investigated so far. The aim of the present study was the development and testing of an instrument in German language for collecting data on patients' preferences and the experience of patients regarding their participation in nursing care decision-making in acute hospitals. The generation of items was based on available literature and in collaboration with specialists, using the theoretical model of Charles, Gafni and Whelan (1999). For testing the instrument, data was collected on 967 adult patients in surgical and medical wards of five hospitals in Vienna from October 2007 to March 2008. Test theoretical analyses included checking internal consistency, construct validity and criterion validity. The reliability of the scale preference and experience were confirmed by Cronbach's alpha (> or = 0.84) and the results of item analysis. The construct validity was supported by representing the decision model in the data. The criterion validity (concordant and discriminant validity) was tested with the two external criterions of subjective satisfaction with the information provided and decision making, and was supported by the results both at the level of total scores and at the level of item scores. In summary, the developed instrument represents an adequately reliable and valid test-theoretic, and also model-theoretic instrument for research in the field of evidence-based nursing. Therefore it is capable of gathering new knowledge on patients' preferences on participation in nursing care decision making.

[Patients' preferences and experience regarding participation in nursing care decisions in acute hospitals--an analysis of conformity of preferences and experience, and factors influencing different types of decision making]. / Präferenzen und Erleben von Patienten zur Beteiligung an pflegerischen Entscheidungen im Akutspital - Eine Analyse der Ubereinstimmung von Präferenz und Erleben sowie der Einflussfaktoren bezogen auf verschiedene Entscheidungstypen.

Patients' preferences regarding their participation in nursing care decisions represent a key aspect of the concept of evidence-based nursing; nonetheless, very little quantitative research has been carried out in this area. The aim of the present study was to describe the patients' preferences and experience concerning their participation in nursing care decision-making processes in acute hospitals. A total of 967 patients in five hospitals in Vienna participated in this study by completing questionnaires. The results revealed that 38.5 % of patients preferred the paternalistic style of decision-making, 42.1 % wanted to make decisions together with the nursing staff and 5.7 % expressed a wish to make their own decisions. During their hospital stay, however, patients experienced paternalistic decision-making to a higher degree than they wished for. Age, sex, form of treatment and subjectively experienced health condition represented person-related characteristics that influenced preferences regarding the form of decision-making. The results of this study underline the importance of collecting data on patients' preferences in decision-making processes in order to meet the social, legal, and professional demands of patient-oriented nursing care based on the most recent scientific knowledge.

[Stay in, dropout of and re-entry into the nursing profession of nurses under the aspect of specific types of nursing professionals in Austria]. / Berufsverbleib, -wiedereinstieg und -ausstieg diplomierter Pflegender in Osterreich unter Berücksichtigung spezifischer Berufsgruppen.

BACKGROUND: In Austria, a short to very short employment period of registered nurses has been recognised. On closer inspection, however, one can see that there is hardly any scientific data available on this topic. AIM: The aim of the study was to gather data on the duration of the employment period andto investigate the reasons for the stay in, dropout of, and re-entry into the profession by registered nurses in Austria. Another objective was to find out whether there are correlations between specific individual types of registered nurses and their professional careers. METHOD: Registered nurses, who obtained their nursing degree in Austria between 1965 and 2003, were surveyed through a questionnaire that had been elaborated within the framework of a focus group. RESULTS: The analysis revealed a considerably longer stay than reported in German-speaking literature. Furthermore, we were able to identify five different types of individuals with regard to the stay in, dropout of and re-entry into the nursing profession.

[The burden of parents caring for their children and adolescents with severe disabilities in South Tyrol]. / Die Belastungen pflegender Eltern von Kindern und Jugendlichen mit schweren Behinderungen in Südtirol.

As part of their Master's degree course in Nursing Science at the Private University for Health Sciences, Medical Informatics and Technology (UMIT), the authors carried out a quantitative (written questionnaire) and qualitative (semi-structured interviews) research on parents in South Tyrol caring for their severely handicapped young and adolescent children. The aim of the study was to assess the extent and cause of burden in care-giving parents. The extent of burden was assessed using the the "FaBel"-questionnaire (Impact on Family Scale). Semi-structured interviews were used to investigate the phenomenon of burden in these parents. By triangulation of current literature with the quantitative and qualitative data, an attempt was made to reveal the complexity of the problem. The present contribution is a report on the results of the qualitative part of the study. As shown by the category system of the investigation, families with severely handicapped children and adolescents are exposed to a variety of burden in social (everyday life and public institutions), physical, psychological (impairment of health) as well as financial and emotional (future perspectives) areas. These parents find relief with their own families (partner and children) and public institutions (school, kindergarten, care facilities). Nursing interventions such as schooling, training and empowerment programmes must be adjusted by professional care givers (family health nurse) to the special needs of the care giving parents. Federal, provincial and social institutions should implement and optimise appropriate support possibilities and offers.

[Care of the non-tunneled central venous catheter. Literature search on disinfectants, dressings and intervals between dressing changes]. / Die Versorgung des nicht-getunnelten Zentralvenenkatheters. Literaturrecherche zu Desinfektionsmittel, Verbandsmaterial und Zeitpunkt des Verbandwechsels.

Patient care in hospitals often involves insertion of a non-tunneled central venous catheter for administering drugs, intravenous solutions, or total parenteral nutrition. Every change of dressing must be carried out in an appropriate fashion in order to reduce the risk of bacterial infection. We reviewed the existent literature in order to make a listof recommended disinfectants, type of dressings and intervals between dressing changes of a central venous catheter. A comparison was drawn between the guidelines of the Centers for Disease Control and Prevention (CDC) and the Robert Koch-Institut (RKI) issued in 2002 with those more recently published. Our search showed that chlorhexidine gluconate (from 0.5 to 2 percent), povidone-iodine (from 5 to 10 percent) or alcohol (70 percent) are the recommended disinfecting agents. The recommended dressing is gauze or transparent steam-permeable polyurethane dressings. Intervals between dressing changes varied between once a day and once in seven days, depending on the nature of the dressing applied.