[Room of horrors: A low-fidelity simulation practice for patient safety-relevant hazards of hospitalization]. / Room of horrors ­ ein low-fidelity Simulationstraining für patientensicherheitsrelevante Gefährdungspotentiale im Klinikalltag.

INTRODUCTION: Even in well-developed healthcare systems, raising awareness for undesirable dangers and risks of modern healthcare services among the clinical staff is a continuous and methodical challenge. The concept of the so-called "Room of Horrors" is both an innovative and a low-fidelity simulation approach for team-based training of patient safety-relevant hazards. The purpose of this evaluation study is to report on practicability and acceptance of such a low-threshold simulation training. METHOD: A fictitious patient room including a patient manikin (lying in bed) was set up in the hospital to simulate the Room of Horrors. Additional artifacts such as a side table, medication and the medical record completed the simulation, in which 12 typical errors or latent risks related to patient safety were hidden. After a short briefing, individuals or groups (2-5 participants) should enter the room and try to find as many errors as possible. The error detection rate was evaluated immediately followed by a debriefing. The participants were then asked to answer a short structured questionnaire to provide content-related feedback about the patient safety simulation. RESULTS: Within three days, the Room of Horrors was visited by a total of 89 participants (27 teams and 6 individuals). Average error detection rate was 8.54 out of 12 hidden errors (71%), whereby the teams showed a slightly better result. All the surveyed participants found the simulation to be educational and beneficial. The importance of team discussion was particularly emphasized by a majority of participants. 91% of the participants found the wrong patient identification wristband and in spite of a documented lactose intolerance a yogurt on the side table. 88% of the participants recognized the bell which was out of the patients reach. Few participants found the missing indication of a permanent catheter (24%) and a doubled prescription of paracetamol (42%). DISCUSSION: A comparison of several international studies about so-called Rooms of Horrors shows that the present study has a relatively high average detection rate (71%), although a significant percentage of the participants are not engaged in medical or nursing services. Not surprisingly, the average detection of errors of the teams were higher than individuals. This strengthens the theory that a discursive discussion and exchange of dialogue among the clinical staff in a patient's room increases patient safety or at least strengthens situational awareness for clinical risks. The consistently positive feedback coincides with the evaluation results of other clinics and thus demonstrates the acceptance of simulation-based on-site training. The organizational and financial effort to execute the simulation training remained very low (apart from the resulting costs incurred due to the participants missing from their regular hospital duties). Hence, the evaluation study proves practicability and acceptance of this simulation method. CONCLUSION: The study provides no information about the extent to which the simulation actually influences the behavior and situational awareness of the participants. At least the awareness of the participants for real risks, hazards and errors of modern patient care was raised temporarily. The Room of Horrors can be easily adapted to different learning goals and settings. It is a flexible and practical learning arrangement. In comparison to the organizational and financial efforts involved, the implementation can be recommended without exception.

A apropriação propícia: pensar e amar como acontecimento em Heidegger / Propitious appropriation: thinking and loving as Ereignis in Heidegger

A radicalização da problemática fenomenológica da intencionalidade atinge o seu clímax no conceito de Ereignis, que não tivera lugar em Ser e Tempo, mas constitui o cerne da meditação dos Beiträge. Nele, está pensado o tempo cairológico do mútuo apropriar-se do ser e do aí em que toma forma: o erigir-se dos humanos em ser-o-aí (do ser) no instante propício do mais próprio dar-se do ser. O acontecimento dessa apropriação recíproca manifesta-se de muitas maneiras: em palavra, gesto, ato, obra. Mas, no último Heidegger, tem a sua máxima expressão naquilo a que chama «pensar¼: o «pensar-propício¼ (Ereignis-Denken), aquele que não é calculador nem metafísico, que é «outro¼ relativamente ao já sido, filosoficamente desenrolado, e que, em última instância, é um gostar (mögen) de ser (do ser), que torna possível (möglich) e grato (dankend) o novo, que só assim pode propiciar-se. O mesmo acontece no amor, enquanto apropriação que expropria e enquanto é apropriado para a diferença. O presente trabalho explora esse vínculo entre pensar e amar como âmbito propício ao acontecimento do novo e defende a sua irredutibilidade à concepção inicial de qualquer objeto intencional.

Heidegger's radicalization of the phenomenological problematic of intentionality reaches its climax in the concept of Ereignis, in the context of the Beiträge. Ereignis means the mutual appropriation of being and its "there" place in human world, which has a cairological propitious moment. The event of this reciprocal appropriation manifests itself in many ways: in word, gesture, act, work. But in the last Heidegger, it reaches its highest expression in what he calls "thinking": the "propitious thinking" (Ereignis-Denken), which is neither calculating nor metaphysical, which is "other" in relation to what has already been (philosophically). About that "other thinking" Heidegger says that it is a way of liking (mögen) being, and so it makes the new possible (möglich) and grateful (dankend) to be propitiusly propriated. The same happens in love, as a "propriation" that "expropriates", being the appropriate soil to welkome difference. The present essay explores this link between thinking and loving as a propitious scope for the happening of the "new" and defends its irreducibility to the initial conception of any intentional object.

La gravedad del duelo como acontecimiento / A gravidade do luto como acontecimento / The gravity of mourning as an event / La gravité de l'événement de deuil

El trabajo se propone elucidar la experiencia de duelo en su condición de acontecimiento. Respecto al cual se emprenden posiciones de renuencia o de desmentida. Del mismo modo se busca esclarecer los efectos de lo que concebimos como doble duelo mediante el procedimiento de interpretación de los discursos en un drama fílmico y en un testimonio de caso clínico. Se concluye advirtiendo el sentido de castración que posee el duelo en tanto acontecimiento.

O trabalho tem como objetivo elucidar a experiência de luto em sua condição de acontecimento, a respeito da qual se empreendem posições de relutância ou desmentido. Por outro lado, pretendem-se esclarecer os efeitos do que se concebe como um duplo luto, utilizando-se o processo de interpretação dos discursos em um filme do gênero drama e por meio do testemunho de um caso clínico. Conclui-se indicando o sentido da castração que se relaciona ao luto como um acontecimento.

This paper intends to clarify the experience of mourning as an event, based on which reluctance and denial are a possibility. On the other hand, we intend to explain the effects resulting from what can be considered double mourning, based on interpretation of the script of a dramatic film, as well as on testimony from a clinical case. We conclude by highlighting the feeling of castration that relates to mourning as an event.

Cet article vise à élucider l'expérience du deuil en tant qu'évènement. Face à celui-ci, le sujet assume des positions soit de réticence, soit de déni. On examine d'ailleurs les effets de ce qui est conçu comme double deuil en utilisant un processus d'interprétation de discours d'un film dramatique, ainsi que par moyen d'un témoignage d'un cas clinique. Notre conclusion porte sur le sens de la castration par rapport au deuil comme évènement.

Dieser Artikel analysiert die Erfahrung der Trauer als Ereignis, welche im Subjekt Widerwille oder Verneinung auslöst und versucht außerdem, die Auswirkungen der sogenannten 'doppelten Trauer' zu erklären. Zu diesem Zweck interpretieren wir die Diskurse eines dramatischen Filmes, sowie die Aussagen eines klinischen Falles. Abschließend zeigen wir auf, dass der Sinn der Kastration sich in der Form eines Ereignisses zur Trauer bezieht.

[Frequency and Type of Traumatic Events in Children and Adolescents with a Posttraumatic Stress Disorder]. / Häufigkeit und Art traumatischer Ereignisse bei Kindern und Jugendlichen mit Posttraumatischer Belastungsstörung.

The risk for children and adolescents to be exposed to a potentially traumatic event (PTE) is high. The present study examines the frequency of PTEs in children and adolescents with Posttraumatic Stress Disorder (PTSD), the type of index trauma, and its relation to PTSD symptom severity and gender. A clinical sample of 159 children and adolescents between 7-16 years was assessed using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). All reported PTEs from the checklist were analyzed according to frequency. The index events were categorized according to the following categories: cause (random vs. intentional), relation to offender (intrafamilial vs. extrafamilial), patient's role (victim, witness or vicarious traumatization), and type of PTE (physical or sexual violence). Relation between categories and PTSD symptom severity and sex were analyzed with inferential statistics. On average participants reported five PTEs, most frequently physical violence without weapons (57.9%), loss of loved person through death (45.9%), and sexual abuse/assaults (44%). The most frequent index traumata were intentional (76.7%). Regarding trauma type, there was a significant difference concerning higher symptom severity in children and adolescents who experienced sexual abuse/assault compared to physical violence (t=-1.913(109), p=0.05). A significantly higher symptom severity was found for girls compared to boys for the trauma categories extrafamilial offender (z=-2,27, p=0.02), victim (z=-2,11, p=0,04), and sexual abuse/assault (z=-2,43, p=0,01). Clinical and diagnostic implications are discussed in relation to the amendments of PTSD diagnostic criteria in DSM-5.

[Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care]. / Auswirkungen von strukturellen Interventionen auf wiederholte kritische Ereignisse in der stationären Kinder- und Jugendpsychiatrie.

Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

Denkerfahrung und Erfahrungsdenken Eine Begegnung zwischen Heidegger und Nishida / The experience of thinking and thinking about experience: An encounter between Heidegger and Nishida / A experiência do pensmento e o pensamento da experiência: um encontro entre Heidegger e Nishida

Ähnlich wie Heideggers Denken für die deutsche und europäische Philosophie, so erwies sich auch Nishidas Denken für die japanisch-ostasiatische Philosophie im 20. Jahrhundert als wegweisend. Anhand beider philosophischer Ansätze möchte ich eine Begegnung bzwe. ein Zwiegespräch zwischen "Denkerfahrung" und "Erfahrungsdenken" vorschlagen, worin einerseits Entsprechungen, andererseits auch Unterschiede zwischen westlicher und ostasiatischer Philosophie zum Vorschein kommen. Hierzu werde ich im ersten Abschnitt die jeweilige "Erfahrungsgrundierung des Denkens" von beiden zum Thema machen, wobei sich dies auf deren frühe Ansätze bezieht. Mit dem "Ereignisdenken" Heideggers und Nishidas "Ortlogik" möchte ich sodann im zweiten Abschnitt das Spezifische der "Kehre" bei Heidegger sowie das Besondere der "Wende" bei Nishida etwas näher herausarbeiten, um daran auch den überaus produktiven Einfluss beider für den west-östlichen Dialog aufzuzeigen.

Nishida is as much a reference for the Japanese-oriental philosophy of the twentieth century as Heidegger is a reference for the German-European philosophy. Based on these two philosophical perspectives, we suggest an encounter or a dialogue between the "experience of thinking" and "thinking about experience" to highlight, on one hand, the similarities and, on the other hand, the differences between Western and Eastern philosophy. We therefore first address the "basis of the experience of thinking" in both authors. Later, we take a deeper look at Heidegger's "thinking the event" and Nishida's "logic of the place" which are respectively called the "turn" and the "change" and then show the productive influence of both authors on the dialogue between Western and Eastern thought.

Nishida é uma referência para a filosofia japonesa-oriental do século XX, assim como Heidegger para a filosofia alemã-europeia. Tomando como base essas duas perspectivas filosóficas, gostaria de propor um encontro, ou seja, um diálogo entre "experiência do pensar” e "pensar da experiência”, no qual veem à tona, por um lado, proximidades e, por outros, diferenças entre a filosofia ocidental e oriental. Para isso pretendo tratar, em primeiro momento, da "fundamentação da experiência do pensamento” nos dois autores. Posteriormente, proponho-me a analisar com mais proximidade o "pensar do acontecimento” de Heidegger e a "lógica do lugar” de Nishida que, respectivamente, são denominados de a "virada” e a "mudança”, e daí mostrar a produtiva influência dos dois para o diálogo entre o pensamento ocidental e oriental.

Denkerfahrung und Erfahrungsdenken Eine Begegnung zwischen Heidegger und Nishida / A experiência do pensmento e o pensamento da experiência: um encontro entre Heidegger e Nishida / The experience of thinking and thinking about experience: An encounter between Heidegger and Nishida

Ãhnlich wie Heideggers Denken für die deutsche und europãische Philosophie, so erwies sich auch Nishidas Denken für die japanisch-ostasiatische Philosophie im 20. Jahrhundert als wegweisend. Anhand beider philosophischer Ansãtze mõchte ich eine Begegnung bzwe. ein Zwiegesprãch zwischen "Denkerfahrung" und "Erfahrungsdenken" vorschlagen, worin einerseits Entsprechungen, andererseits auch Unterschiede zwischen westlicher und ostasiatischer Philosophie zum Vorschein kommen. Hierzu werde ich im ersten Abschnitt die jeweilige "Erfahrungsgrundierung des Denkens" von beiden zum Thema machen, wobei sich dies auf deren frühe Ansãtze bezieht. Mit dem "Ereignisdenken" Heideggers und Nishidas "Ortlogik" mõchte ich sodann im zweiten Abschnitt das Spezifische der "Kehre" bei Heidegger sowie das Besondere der "Wende" bei Nishida etwas nãher herausarbeiten, um daran auch den überaus produktiven Einfluss beider für den west-õstlichen Dialog aufzuzeigen.(AU)

Nishida is as much a reference for the Japanese-oriental philosophy of the twentieth century as Heidegger is a reference for the German-European philosophy. Based on these two philosophical perspectives, we suggest an encounter or a dialogue between the "experience of thinking" and "thinking about experience" to highlight, on one hand, the similarities and, on the other hand, the differences between Western and Eastern philosophy. We therefore first address the "basis of the experience of thinking" in both authors. Later, we take a deeper look at Heidegger's "thinking the event" and Nishida's "logic of the place" which are respectively called the "turn" and the "change" and then show the productive influence of both authors on the dialogue between Western and Eastern thought.(AU)

Nishida é uma referência para a filosofia japonesa-oriental do século XX, assim como Heidegger para a filosofia alemã-europeia. Tomando como base essas duas perspectivas filosóficas, gostaria de propor um encontro, ou seja, um diálogo entre "experiência do pensar” e "pensar da experiência”, no qual veem à tona, por um lado, proximidades e, por outros, diferenças entre a filosofia ocidental e oriental. Para isso pretendo tratar, em primeiro momento, da "fundamentação da experiência do pensamento” nos dois autores. Posteriormente, proponho-me a analisar com mais proximidade o "pensar do acontecimento” de Heidegger e a "lógica do lugar” de Nishida que, respectivamente, são denominados de a "virada” e a "mudança”, e daí mostrar a produtiva influência dos dois para o diálogo entre o pensamento ocidental e oriental.(AU)