Sicherheit in der häuslichen Intensivpflege - eine qualitative Studie zur Perspektive von häuslich beatmeten Menschen und ihren pflegenden Angehörigen

Background: The discourse about patient safety focuses traditionally on inpatient settings and objectively measurable outcomes, specifically the avoidance of any adverse events. The aim of this thesis is to explore safety in advanced home care and, in the spirit of person-centred care, to pay special attention to the experiences and perspectives of severely ill and technology-dependent people and their relatives. Methods: Problem-centred interviews with (non)-invasive mechanically ventilated people (n = 21) and family caregivers (n = 15) have been conducted as part of a larger multiphase qualitative health services research project. The iterative research process was based on the grounded theory methodology. In addition, a qualitative secondary analysis was carried out to explore the interpersonal trust in this context further. Results: Particularly, trusting interpersonal relationships with their nurses enhance safety for people receiving home mechanical ventilation (HMV). They feel safe when nurses are familiar with their needs and situation, and when they can rely on, inter alia, their professional abilities. Additionally, the possibility of communicating their needs and being noticed by nurses is important for them. Other themes are the continuity and feeling the presence of trustful nurses or relatives. Critical situations occur when the nurse-patient communication and interaction are strained or when patient- or technology-related monitoring tasks are neglected. Further problems occur when co-ordination and co-operation are lacking and if the negotiation process, education and supervision is neglected. Family caregivers make a decisive contribution to patient safety by fostering mutual information sharing, co-ordinating informal health care and undertaking compensation for nurses’ qualification deficits and organisational shortcomings. Discussion: From the perspective of people receiving HMV, safety is far more than the absence of adverse events. The main finding is that those receiving HMV have a relational approach to safety. In addition, it could be shown that nurses can make an essential contribution to safety when they build a trustful and needs-oriented nurse-patient relationship (NPR). If this is not successful, critical situations might occur. Family caregivers’ substantial contribution to safety deserves to be acknowledged but also constitutes potential risks. Needs-based, professional support and education should be offered which focus on joint decision-making and targeted promotion of their expertise. Conclusion: Trustful NPRs are of central importance for the feeling of safety of people receiving HMV. Developing a trustful NPR is, therefore, an essential component of nursing practice in advanced home care. Patient safety should remain the responsibility of the nurses and requires appropriate preconditions and framework conditions.Hintergrund: Der Diskurs zum Thema Patientensicherheit ist vorwiegend auf stationäre Einrichtungen und objektiv messbare Parameter ausgerichtet, wobei der Fokus auf der Vermeidung sog. „unerwünschter Ereignisse“ liegt. Ziel dieser Arbeit ist es daher, Patientensicherheit in der häuslichen Intensivpflege ins Blickfeld zu rücken. Dabei wird im Sinne einer personenzentrierten Versorgung besonderes Augenmerk auf die Erfahrungen und Sichtweisen von schwerstkranken und technikabhängigen Menschen und ihren Angehörigen gelegt. Methodik: Im Rahmen eines mehrphasigen, qualitativen Versorgungsforschungsprojekts wurden problemzentrierte Interviews mit (non-)invasiv beatmeten Menschen (n = 21) und deren Angehörigen (n = 15) durchgeführt. Der iterativ angelegte Forschungsprozess orientierte sich an den Prinzipien der Grounded Theory. Zudem wurde im Rahmen einer qualitativen Sekundärdatenanalyse eine zusammenfassende Inhaltsanalyse durch-geführt, um das Phänomen des interpersonalen Vertrauens in gegebenem Kontext näher zu untersuchen. Ergebnisse: Aus der Sicht der häuslich beatmeten Menschen werden v. a. vertrauens-volle zwischenmenschliche Beziehungen zu den Pflegefachpersonen als sicherheits-relevant angesehen. Sie fühlen sich sicher, wenn personelle Kontinuität gegeben ist, die Pflegefachpersonen mit ihren Bedürfnissen und ihrer Situation vertraut sind und sie ihnen u.a. bezogen auf Ihre Kompetenzen vertrauen können. Bedeutsam sind ferner ihre Möglichkeiten sich mitteilen zu können, das Gefühl mit ihren Bedürfnissen von den Pflegefachpersonen wahrgenommen zu werden sowie die Gewissheit, dass vertrauenswürdige Pflegefachpersonen oder Angehörige anwesend sind. Gestaltet sich die Kommunikation und Interaktion als schwierig oder werden patienten- oder technikbezogene Überwachungsaufgaben vernachlässigt, können risikobehaftete Situationen entstehen. Wenn Kooperations- und Abstimmungserfordernisse unterschätzt sowie Aushandlungs-, Edukations- und Supervisionsaufgaben vernachlässigt werden, leisten Angehörige einen entscheidenden Beitrag zur Sicherheit der beatmeten Personen, indem sie z. B. sicherheitsrelevante Informationen mit den professionellen Akteuren teilen, die Versorgung koordinieren und qualifikatorische und organisatorische Defizite kompensieren. Diskussion: Aus Sicht beatmeter Menschen ist Sicherheit in der häuslichen Intensiv-pflege weitaus mehr als lediglich die Abwesenheit „unerwünschter Ereignisse“. Die zentrale Erkenntnis ist, dass beatmete Menschen einem relationalen, subjektiven Sicherheitsverständnis folgen. Zudem konnte gezeigt werden, dass Pflegefachpersonen einen wesentlichen Beitrag zum subjektiven Sicherheitsgefühl leisten können, wenn sie die Pflegebeziehung vertrauensvoll und bedürfnisorientiert gestalten. Gelingt dies nicht, können Risikosituationen entstehen. Der wesentliche Beitrag involvierter Angehöriger verdient Anerkennung, birgt jedoch auch Sicherheitsrisiken. Es bedarf an dieser Stelle daher einer bedarfsgerechten, professionellen Unterstützung, die auf partnerschaftlichen Einbezug und gezielte Förderung ihrer Expertise setzt. Fazit: Vertrauensvolle Pflegebeziehungen sind für das subjektive Sicherheitsgefühl häuslich beatmeter Menschen von zentraler Bedeutung. Sie verantwortlich zu gestalten stellt eine pflegerische Kernaufgabe in der häuslichen Intensivpflege dar. Die Gewährleistung von Patientensicherheit liegt im pflegerischen Verantwortungsbereich. Entsprechende Voraussetzungen und Rahmenbedingungen bedürfen gezielter Entwicklung

The Journey Home- Guiding Intangible Knowledge Production in the Analysis of Ancestral Remains (Final Report)

This study, co-developed by David Schaepe, Director, Stó:lo Research and Resource Management Centreand Susan Rowley, Associate Professor, Department of Anthropology, University of British Columbia, stems from the Journey Home Project, a repatriation of ancestral remains from the UBC Lab of Archaeology (LOA) to the Stó:lo Nation of southwestern B.C.    For the Stó:lo, knowing as much as possible about these ancestors informs their process. How can scientific research address Stó:lo questions and aid this repatriation? Opportunity recently arose for scientific study, stimulating a Stó:lo-LOA dialogue touching on multiple issues of scientific process, knowledge production and intellectual property. What types of anthropological research and scientific analyses can be applied to answer community-based questions? What are the details and cultural implications of analyses — both destructive and non-destructive? Who decides which questions to ask and which means of research to implement? Who interprets the results? Who owns those data? How do ‘scientific’ and ‘cultural’ ways of knowing relate? Who is allowed to share in and benefit from this knowledge? These questions are central to the Stó:lo ’s relationship with both their ancestors and LOA.   This study aims to provide guidelines for generating knowledge within a mutually acceptable framework of authority, control, and use. These critical issues are at the forefront of our conversations as we work together to complete The Journey Home

Relations of Water-quality Constituent Concentrations to Surrogate Measurements in the Lower Platte River Corridor, Nebraska, 2007 through 2011

The lower Platte River, Nebraska, provides drinking water, irrigation water, and in-stream flows for recreation, wildlife habitat, and vital habitats for several threatened and endangered species. The United States Geological Survey (USGS), in cooperation with the Lower Platte River Corridor Alliance (LPRCA) developed site-specific regression models for water-quality constituents at four sites (Shell Creek near Columbus, Nebraska [USGS site 06795500]; Elkhorn River at Waterloo, Nebraska [USGS site 06800500]; Salt Creek near Ashland, Nebraska [USGS site 06805000]; and Platte River at Louisville, Nebraska [USGS site 06805500]) in the lower Platte River corridor. The models were developed by relating continuously monitored water-quality properties (surrogate measurements) to discrete water-quality samples. These models enable existing web-based software to provide near-real-time estimates of stream-specific constituent concentrations to support natural resources management decisions.Since 2007, USGS, in cooperation with the LPRCA, has continuously monitored four water-quality properties seasonally within the lower Platte River corridor: specific conductance, water temperature, dissolved oxygen, and turbidity. During 2007 through 2011, the USGS and the Nebraska Department of Environmental Quality collected and analyzed discrete water-quality samples for nutrients, major ions, pesticides, suspended sediment, and bacteria. These datasets were used to develop the regression models. This report documents the collection of these various water-quality datasets and the development of the site-specific regression models.Regression models were developed for all four monitored sites. Constituent models for Shell Creek included nitrate plus nitrite, total phosphorus, orthophosphate, atrazine, acetochlor, suspended sediment, and Escherichia coli (E. coli) bacteria. Regression models that were developed for the Elkhorn River included nitrate plus nitrite, total Kjeldahl nitrogen, total phosphorus, orthophosphate, chloride, atrazine, acetochlor, suspended sediment, and E. coli. Models developed for Salt Creek included nitrate plus nitrite, total Kjeldahl nitrogen, suspended sediment, and E. coli. Lastly, models developed for the Platte River site included total Kjeldahl nitrogen, total phosphorus, sodium, metolachlor, atrazine, acetochlor, suspended sediment, and E. coli

The Developmental Onset of Pair Bond Formation in Prairie Voles

Prairie voles (Microtus ochrogaster) have been studied to a great extent for their propensity to form monogamous pair bonds. Their unique bonding has allowed research to uncover the neural mechanisms behind pair bonding. The overwhelming majority of research has primarily focused on adult voles, leaving a limited understanding of the developmental onset of these behaviors. This research investigated when, in development, prairie voles can demonstrate a pair bond. Males and females were tested at three developmental stages: juveniles (postnatal day [PND] 20-25), periadolescence (PND 45-53), and adults (PND 60-65). Recordings of the first hour of interaction captured prairie voles' first behaviors between subjects and partners. After 48 hours of cohabitation, a partner preference test (PPT) was employed. Our findings indicate a partner preference emerged within periadolescent females. In contrast, males generally huddled less and only demonstrated a partner preference once they were adults. These results suggest that females become capable of forming pair bonds within periadolescence, emphasizing the potential significance of this developmental period for the onset of the neural pathways that allow for pair bonding. Further, our data suggests that male prairie voles may need a prolonged developmental period to mature the neural processes requisite for pair bonding. The data presented has broadened our understanding of how pair bonds develop across sexes, giving us a jumping-off point for further research to investigate how the social brain matures to allow for pair bonding.&nbsp;&nbsp; &nbsp;</p

The Journey Home- Guiding Intangible Knowledge Production in the Analysis of Ancestral Remains (Final Report)

This study, co-developed by David Schaepe, Director,&nbsp;Stó:lo Research and Resource Management Centreand Susan Rowley, Associate Professor, Department of Anthropology, University of British Columbia, stems from the Journey Home Project, a repatriation of ancestral remains from the UBC Lab of Archaeology (LOA) to the&nbsp;Stó:lo Nation&nbsp;of southwestern B.C.&nbsp; &nbsp; For the Stó:lo, knowing as much as possible about these ancestors informs their process.&nbsp;How can scientific research address Stó:lo questions and aid this repatriation?&nbsp;Opportunity recently arose for scientific study, stimulating a Stó:lo-LOA dialogue touching on multiple issues of scientific process, knowledge production and intellectual property.&nbsp;What types of anthropological research and scientific analyses can be applied to answer community-based questions? What are the details and cultural implications of analyses — both destructive and non-destructive? Who decides which questions to ask and which means of research to implement? Who interprets the results? Who owns those data? How do ‘scientific’ and ‘cultural’ ways of knowing relate? Who is allowed to share in and benefit from this knowledge? These questions are central to the Stó:lo ’s relationship with both their ancestors and LOA. &nbsp; This study aims to provide guidelines for generating knowledge within a mutually acceptable framework of authority, control, and use. These critical issues are at the forefront of our conversations as we work together to complete The Journey Home

"What's (the) Matter?", A Show on Elementary Particle Physics with 28 Demonstration Experiments

We present the screenplay of a physics show on particle physics, by the Physikshow of Bonn University. The show is addressed at non-physicists aged 14+ and communicates basic concepts of elementary particle physics including the discovery of the Higgs boson in an entertaining fashion. It is also demonstrates a successful outreach activity heavily relying on the university physics students. This paper is addressed at anybody interested in particle physics and/or show physics. This paper is also addressed at fellow physicists working in outreach, maybe the experiments and our choice of simple explanations will be helpful. Furthermore, we are very interested in related activities elsewhere, in particular also demonstration experiments relevant to particle physics, as often little of this work is published. Our show involves 28 live demonstration experiments. These are presented in an extensive appendix, including photos and technical details. The show is set up as a quest, where 2 students from Bonn with the aid of a caretaker travel back in time to understand the fundamental nature of matter. They visit Rutherford and Geiger in Manchester around 1911, who recount their famous experiment on the nucleus and show how particle detectors work. They travel forward in time to meet Lawrence at Berkeley around 1950, teaching them about the how and why of accelerators. Next, they visit Wu at DESY, Hamburg, around 1980, who explains the strong force. They end up in the LHC tunnel at CERN, Geneva, Switzerland in 2012. Two experimentalists tell them about colliders and our heroes watch live as the Higgs boson is produced and decays. The show was presented in English at Oxford University and University College London, as well as Padua University and ICTP Trieste. It was 1st performed in German at the Deutsche Museum, Bonn (5/'14). The show has eleven speaking parts and involves in total 20 people.Comment: 113 pages, 88 figures. An up to date version of the paper with high resolution pictures can be found at http://www.th.physik.uni-bonn.de/People/dreiner/Downloads/. In v2 the acknowledgements and a citation are correcte

Versorgungszentren in ländlichen Provinzen Nordschwedens (Vårdcentraler)

Ewers M, Schaepe C, Hämel K, Schaeffer D. Versorgungszentren in ländlichen Provinzen Nordschwedens (Vårdcentraler). PORT - Patientenorientierte Zentren zur Primär- und Langzeitversorgung. Stuttgart: Robert Bosch Stiftung; 2018