Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals : study protocol

With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs.Mit diesem Studienprotokoll wird ein Forschungsprogramm eingeführt. Dessen Ziel ist das Vorbereiten der Instrumente und das Durchführen des ersten Monitorings von Pflegekontextfaktoren an drei Universitäts- und zwei Kantonsspitälern in der Schweiz noch vor Einführung der DRG-basierten Finanzierung, sowie darauf aufbauend das Weiterentwickeln des theoretischen Modells und der dazu gehörenden Methodologie für zukünftige Monitorings nach Einführung der DRGs

Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. Aim The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. Methods The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. Results The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's alpha 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. Conclusion This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium

Die Analyse unerwünschter Ereignisse als Beitrag zur Sicherheitskultur im Kontext der Praxisentwicklung

Hintergrund: Die Analyse unerwünschter Ereignisse ist eine wirksame Patientensicherheitsmassnahme. Ziel: Wir zeigen, wie Pflegeexpertinnen zur Analyse unerwünschter Ereignisse mit dem „Learning from Defects-Tool“ (LFD-Tool) befähigt wurden. Methode: Für die Implementierung des Tools wählten wir eine umfassende Strategie, die sowohl am Sicherheitswissen der Pflegexpertinnen als auch an ihrer Einstellung zum Thema „Patientensicherheit“ ansetzte. Dabei wurde die Kultur der Praxisentwicklung berücksichtigt. Die Implementierungsstrategie und das LFD-Tool werden beschrieben. Ergebnisse: Pflegeexpertinnen berichten durch die Anwendung des LFD-Tools einen Kompetenzaufbau zum Thema „Patientensicherheit“. Die Anwendung des Tools unterstützte die gemeinsame Reflexion von unerwünschten Ereignissen in den Pflegeteams. Schlussfolgerungen: Die Analyse unerwünschter Ereignisse fördert das gemeinsame, arbeitsplatznahe Lernen. Pflegende können durch die Nutzung des LFD-Tools einen wichtigen Beitrag zur aktiven Gestaltung der Sicherheitskultur in einem Spital leisten

Zwischen Anspruch und Wirklichkeit - Perspektive von fallverantwortlichen Pflegefachpersonen zur Rationierung in der spitalexternen Pflege

Die Nachfrage nach Leistungen der spitalexternen Hilfe und Pflege zu Hause in der Schweiz (Spitex) steigt jährlich um 8 %. Die Pflegesituationen werden komplexer und mit Fehlen von zeitlichen und fachlichen Ressourcen steigt das Risiko für die Rationierung von notwendigen pflegerischen Leistungen. Zielsetzung: Die Studie exploriert, welche Erfahrungen fallverantwortliche Pflegefachpersonen mit Rationierung pflegerischer Leistungen machen und wie sie im Arbeitsalltag damit umgehen. Methoden: Wir wählten einen qualitativen Ansatz mit einer interpretierenden Beschreibung. Wir führten zwischen September und Dezember 2018 leitfadengestützte Interviews mit 12 fallverantwortlichen Pflegefachpersonen aus sieben Deutschschweizer Spitexorganisationen durch. Die Daten wurden anhand der thematischen Analyse von Braun und Clarke bearbeitet. Ergebnisse: Die fallverantwortlichen Pflegefachpersonen berichten über mangelnde zeitliche Ressourcen für die Steuerung des Pflegeprozesses. Sie zeigen hohes Engagement für eine gute Pflegequalität, befinden sich jedoch auf einer Gratwanderung zwischen diesem Anspruch und der Wirklichkeit der Rahmenbedingungen. Sie stehen unter Druck, notwendige Leistungen gegenüber Krankenkassen zu vertreten. Schlussfolgerungen: Das Erleben von Rationierung gehört zum Alltag der fallverantwortlichen Pflegefachpersonen. Sie federn deren Konsequenz für die Klient_innen mit hohem Einsatz ab. Enge Rahmenbedingungen begünstigen die Rationierung und sowohl auf der Ebene der Politik wie der Spitexorganisationen sind zielführende Maßnahmen erforderlich. [English abstract] Between demand and reality - Perspectives of case-leading nurses on rationing in home care; Abstract.; Background:; The demand for home care services in Switzerland (Spitex) is growing at an annual rate of 8 %. With increasingly complex client situations, lack of time and professional resources, the risk of rationing care is rising.; Objective:; This study explores how case-leading nurses (CLNs) experience rationing of care and how they deal with this in their daily practice.; Methods:; We chose a qualitative approach with an interpretative description. Between September and December 2018, we conducted semi-structured interviews with 12 CLNs from seven Spitex organisations in the German-speaking part of Switzerland. The data were analysed according to the thematic analysis of Brown and Clarke.; Results:; CLNs often experience not having enough time to fully oversee a client's care plan from the assessment to the evaluation of care needed. They show a high level of commitment to providing good quality of care, but have to walk a tightrope between demand and reality. Additionally, they are under pressure to defend the financing of needed services from health insurance companies.; Conclusions:; Rationing is an everyday experience of CLNs' practice and they invest a lot of effort in reducing its effects for their clients. CLNs work under pressure, thus targeted measures are necessary both at the political and Spitex organizational level, to reduce rationing of care

Erfahrungen von Advanced Practice Nurses mit einem klinischen Weiterbildungsstudiengang im Kontext ihrer beruflichen Entwicklung

Das an der Universität Basel seit 2012 angebotene Diploma of Advanced Studies in Advanced Nursing Practice (DAS ANP-plus) ist ein klinischer Weiterbildungsstudiengang für die noch wenig etablierte Berufsgruppe der Advanced Practice Nurse (APN). In der Berufsbiografie und für die Tätigkeit der APN in der Patientenversorgung spielt der Erwerb klinischer Kompetenzen eine zentrale Rolle. Ziel: Mit der qualitativen Studie wurde exploriert, welche Erfahrungen APNs während und nach einer klinisch ausgerichteten postgradualen Weiterbildung in der Schweiz machten und welche bedeutenden Veränderungen sie dadurch in ihrer Berufsausübung erlebten. Methode: Reflexive thematische Analyse mit konstruktivistischer Orientierung. 14 Absolvent_innen wurden leitfadengestützt unter Einbezug der Berufsbiografie interviewt. Ergebnisse: „Die Vision verfolgen besser pflegen zu wollen“ ist das konstituierende Thema. Die Absolvent_innen scheinen von einer starken Vision getragen zu werden: vom Streben mehr wissen zu wollen, hin zur Umsetzung der Vorstellung ihrer Rolle bis zu innovativen Veränderungen in der Gesundheitsversorgung. Die Vision zu verfolgen ist durch drei Themen geprägt: „Die Herausforderungen als APN Fuß zu fassen“, vor dem Studiengang, „Sicherheit erlangen durch die Stärkung klinischer Kompetenzen“ während dem Studiengang und längerfristig „mit Verbündeten neue Wege in Versorgungssystemen gehen“. Schlussfolgerungen: Durch das DAS ANP-plus werden die klinischen Kompetenzen von APNs gestärkt, dabei nimmt die Supervision in klinischen Alltag eine bedeutende Stellung ein

Family members experiences of caring for persons with dementia and outreach counseling - an interpretative phenomenological study

Almost two-thirds of the 110,000 people living with dementia in Switzerland receive home care from family members. Outreach counselling can reduce the burden for family caregivers and delay nursing home placement. However, little is known of how this works and how caregivers experience the counselling. The Canton of Aargau Alzheimer's Association has been conducting a pilot project to demonstrate the necessity, effectiveness and practicability of outreach counselling in (their canton).; As a part of the evaluation of the project this study explored how family members experience the process of caring for a relative with dementia and outreach counselling.; Interpretive phenomenology–a qualitative approach–was used to analyse data from interviews with twelve family caregivers.; Most family members felt supported in caregiving by outreach counselling. Three aspects of the counselling were especially important to the participants: being understood and taken seriously by the counsellor; receiving answers to their most pressing questions concerning the illness and being supported when difficult decision had to be taken; regaining personal time and learning how to better interact with the person with dementia. Two participants would have wished for more help by the counsellor.; To meet the needs of the family members, consultants should have sufficient experience in dementia patient care and should be strongly networked across the local health and welfare system. This study shows that family members can experience outreach counselling as a great support in their caregiving roles

Erfahrungen von Advanced Practice Nurses mit einem klinischen Weiterbildungsstudiengang im Kontext ihrer beruflichen Entwicklung

Experiences of Advanced Practice Nurses with a clinical postgraduate education program in the context of their professional development Abstract. Background: The Diploma of Advanced Studies in Advanced Nursing Practice (DAS ANP-plus), which has been offered at the University of Basel since 2012, is a clinically oriented postgraduate education program for the still poorly established professional group of the Advanced Practice Nurse (APN). The acquisition of clinical skills plays a central role in the professional biography and for the APN's work in patient healthcare. Aim: The qualitative study aims to explore the experiences of APNs during and after a clinically oriented postgraduate education program in Switzerland and what significant changes they experienced in their professional practice. Methods: Reflexive thematic analysis with a constructivist orientation was used. With fourteen APNs, guided interviews were conducted and analyzed considering the professional biography. Results: "Pursuing the vision for a better care" is the constitutive theme. The graduates all seem to be driven by a strong vision: from striving to know more, to implementing the concept of Advanced Nursing Practice, to initiating changes in the healthcare system. The vision is shaped by three themes: "the challenges of gaining a foothold as an APN" before the program, "gaining security by strengthening clinical skills" during the program and on longer terms "breaking new ground in the healthcare system with allies". Conclusions: The DAS ANP-plus increases the clinical skills of APNs within clinical supervision plays an important role

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis

Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care.; The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management.; Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form.; The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care.; Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members