Gesundheit (MDH)
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Der Artikel, behandelt das Projekt PATIENCE, welches die Implementierung von Advanced Practice Nurses (APN) in der alterstraumatologischen Versorgung eines deutschen Universitätsklinikums zum Ziel hat. Der Hintergrund des Projekts liegt in der steigenden Anzahl alterstraumatologischer Patient*innen und deren komplexen Versorgungsbedarfen. Diese Patient*innen haben häufig multiple Erkrankungen und erfordern eine Kombination aus akutmedizinischer und rehabilitativer Versorgung.
Das Projekt PATIENCE strebt eine bedarfsorientierte Entwicklung und Implementierung von APN an, die auf die spezifischen Bedürfnisse dieser Patient*innen eingehen. Dazu werden internationale Literaturstudien durchgeführt und qualitative Interviews mit Patient*innen, Angehörigen und dem multiprofessionellen Team durchgeführt. Ziel ist es, ein Rollen- und Aufgabenprofil für APN zu entwickeln und dieses über auf einer Modellstation zu pilotieren.
Die Einführung von APN wird als eine mögliche Lösung angesehen, um den wachsenden Anforderungen in der Pflege gerecht zu werden. APN sollen durch ihre spezialisierte Ausbildung und Qualifikation die Versorgung koordinieren, eigenverantwortlich agieren und die interprofessionelle Zusammenarbeit fördern.
Freiwilligkeit hat im Kontext von Lernbegleitung eine hohe Relevanz. Als ein wesentliches Merkmal gilt es, dieses bei der Gestaltung und Reflexion zu berücksichtigen und genau zu beleuchten (Pätzold & Ulm, 2015). Die Evaluationsergebnisse des Praxisprojektes ILKA zeigen, dass Teilnehmende einer verpflichtenden Lernbegleitung zustimmen, wenn die
Nachhaltigkeit und Effekte des Angebotes als positiv eingeschätzt werden.
In der 11. Version der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (ICD-11) findet sich erstmals die Kategorie der Körperbezogenen repetitiven Verhaltensstörungen (engl. „body-focused repetitive behavior disorders“, BFRBDs), die u. a. die Trichotillomanie (TTM) sowie die Skin-Picking-Störung (SPS) enthält und dem Zwangsspektrum zugeordnet ist. Diese Neuerung umfasst sowohl die Neukategorisierung der TTM, die in der ICD-10 noch bei den „abnormen Gewohnheiten und Störungen der Impulskontrolle“ verortet war, als auch die erstmalige Einführung einer eigenständigen Diagnose für die SPS. Trotz beachtlicher Prävalenzen (TTM: 1–2 %; SPS: 1,4–3,1 %) wurden die TTM und die SPS bislang in Fachkreisen wenig beachtet, was sich neben einem hohen Forschungsbedarf – auch in Bezug auf die nosologische Verortung – insbesondere in mangelhaften Versorgungsangeboten widerspiegelt. Bezüglich der Einordnung im Zwangsspektrum ist kritisch anzumerken, dass die Störungsbilder zwar Ähnlichkeiten mit der Zwangsstörung zeigen, aber dennoch fundamentale Unterschiede in Symptomatik, Ätiologie und Behandlung zu beachten sind. In diesem Kontext sollte davon abgesehen werden, TTM und SPS pauschal als Zwangsstörungen zu bezeichnen. Vielmehr sollten die individuellen Besonderheiten der BFRBD, die sich bei Betroffenen durch eine impulshafte, zwanghafte oder auch suchtartige Phänomenologie äußern können, individuell und differenziert analysiert und behandelt werden, um die bestmögliche Versorgung zu gewährleisten. Insgesamt bietet die Einführung der BFRBD-Kategorie mit einer eigenständigen Diagnose für die SPS in der ICD-11 wichtige Chancen zur Verbesserung der Forschungs- und Versorgungslage.
Exkursion und Studienprojekt
(2024)
Partizipatives Design (PD) ermöglicht den Einbezug von Nutzer:innen in den Entwicklungsprozess digitaler Technologien im Gesundheitswesen. Der Einsatz von PD birgt jedoch Hürden, da theoretische und methodische Entscheidungen zu treffen sind. Oftmals werden diese in Forschungsarbeiten in der Versorgungsforschung nicht hinreichend dargestellt oder begründet. Dies kann zu einer eingeschränkten Bewertbarkeit und Nachvollziehbarkeit der Ergebnisse führen. Der vorliegende Beitrag thematisiert drei Schwerpunkte: Erstens wird ein Überblick über die wesentlichen theoretischen und methodischen Entscheidungen gegeben, die im Rahmen des PD aus Perspektive der Versorgungsforschung getroffen werden müssen. Zweitens werden die damit einhergehenden Herausforderungen aufgezeigt und drittens Erfordernisse für die zukünftige Anwendung und (Weiter-)Entwicklung des PD in der Versorgungsforschung beschrieben.
Fallbesprechung auf der Grundlage des Total-Pain-Konzeptes in palliativen Versorgungsstrukturen
(2017)
Lernen im geschützten Raum
(2015)
Zum Nutzen einer EDV-Dokumentation für die Bereiche Schmerz und Demenz in der stationären Altenhilfe
(2013)
Rehabilitations- und Teilhabeforschung thematisieren mit unterschiedlichen inhaltlichen und methodischen Schwerpunkten vergleichbare Untersuchungsfelder. Mit der Einführung der International Classification of Functioning, Disability, and Health (ICF) der WHO liegt ein gemeinsamer konzeptueller Anknüpfungspunkt vor. Für neue internationale Reha-Definitionen ist dabei das Konzept der Funktionsfähigkeit zentral, das auch die Komponente der Teilhabe umfasst. Während Rehabilitation auf die Unterstützung und Versorgung von individuellen Personen mit Funktionseinschränkungen zielt, setzt Teilhabeforschung in der Regel auf der gesellschaftlichen Ebene an. Aktuelle Ergebnisse der Teilhabeforschung, z.B. in Form des Teilhabeberichts der Bundesregierung bzw. des Teilhabesurveys, ermöglichen dabei wichtige Hintergrundinformationen zur Bedeutung von Umweltfaktoren bzw. Lebenslagen für die Teilhabe(chancen) von Menschen mit Behinderung, insbesondere für die Bedarfsforschung. Entsprechende Studienergebnisse werden bislang nur unzureichend in den Rehabilitationswissenschaften zur Kenntnis genommen.
Betreuung schwerstkranker und sterbender Menschen im hohen Lebensalter in Pflegeeinrichtungen.
(2012)
Anzeichen erkennen.
(2008)
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care
(2022)
The skills, knowledge and resources to search for, find, understand, evaluate and apply health information is defined as health literacy (HL). If individuals want to use health information from the Internet, they need Digital Health Literacy (eHL), which in addition to HL also includes, for example, media literacy. If information cannot be found or understood by patients due to low (e)HL, patients will not have the opportunity to make informed decisions. In addition, many health apps for self-management or prevention also require (e)HL. Thus, it follows that active participation in healthcare, in terms of Person-Centered Care (PCC) is only possible through (e)HL. Currently, there is a great need to strengthen these competencies in society to achieve increased empowerment of patients and their health. However, at the same time, there is a need to train and improve competencies in the field of healthcare professionals so that they can counsel and guide patients. This article provides an overview with a focus on HL and eHL in healthcare, shows the opportunities to adapt services and describes the possible handling of patients with low (e)HL. In addition, the opportunities for patients and healthcare professionals to improve (e)HL are highlighted.
Abstract The methodological challenges of evaluating digital interventions (DI) for health services research are omnipresent. The Digital Health Working Group of the German Network for Health Services Research (DNVF) presented and discussed these challenges in a two-part discussion paper. The first part addressed challenges in definition, development and evaluation of DI. In this paper, which represents the second part, the definition of outcomes, reporting of results, synthesis of evidence, and implementation are addressed as methodological challenges of DI. Potential solutions are presented and the need to address these challenges in future research are discussed.
Learning digital competencies can be successful if the information is also tried out immediately using interactive elements. However, interactive teaching poses a particular challenge, especially in large group formats. Various strategies are used to promote interaction, but there is little known about the results. This article shows different strategies and evaluates their influence on the interaction rate in a large group course over two terms that teaches digital medicine. Log files and participation in surveys as well as participation in chat were quantitatively evaluated. In addition, the chat messages themselves were evaluated qualitatively. For the evaluation, relation to the total number of participants was particularly relevant in order to be able to determine an interaction rate in the individual course sessions. A maximum average interaction rate of 90.97% could be determined over the entire term while the participants wrote an average of 3.96 comments during a session in the chat. In summary, this research could show that interactive elements should be well planned and used at regular intervals in order to reap the benefits.
BACKGROUND Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. OBJECTIVE In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. METHODS In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. RESULTS The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. CONCLUSIONS The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.
BACKGROUND Despite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers. OBJECTIVE The main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home. METHODS In this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis. RESULTS The newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018. CONCLUSIONS This study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11630
Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review
(2023)
Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. This review provides insights into the diversity of health care professionals’ involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.
This survey study investigates surgical patients’ use and perception of digital health technologies in Germany in the pre–COVID-19 era. The objective of this study was to relate surgical patients’ characteristics to the use and perception of several digital health technologies. In this single-center, cross-sectional survey study in the outpatient department of a university hospital in Germany, 406 patients completed a questionnaire with the following three domains: general information and use of the internet, smartphones, and general digital health aspects. Analyses were stratified by age group and highest education level achieved. We found significant age-based differences in most of the evaluated aspects. Younger patients were more open to using new technologies in private and medical settings but had more security concerns. Although searching for information on illnesses on the web was common, the overall acceptance of and trust in web-based consultations were rather low, with <50% of patients in each age group reporting acceptance and trust. More people with academic qualifications than without academic qualifications searched for information on the web before visiting physicians (73/121, 60.3% and 100/240, 41.7%, respectively). Patients with academic degrees were also more engaged in health-related information and communication technology use. These results support the need for eHealth literacy, health literacy, and available digital devices and internet access to support the active, meaningful use of information and communication technologies in health care. Uncertainties and a lack of knowledge exist, especially regarding telemedicine and the use of medical and health apps. This is especially pronounced among older patients and patients with a low education status.
Steigerung der Versorgungsqualität in der Palliativversorgung durch elektronische Gesundheitsakten
(2021)
Mundtrockenheit lindern
(2023)
ie Einbindung akademisch qualifizierter Pflegefachkräfte in die Pflegepraxis stellt eine Herausforderung dar. Um eine Übersicht über die derzeit umgesetzten Praxiskonzepte zu generieren, wird eine Literaturstudie durchgeführt. Die übergeordnete
Fragestellung lautet: Welche Konzepte zur Einbindung von Bachelorabsolvent*innen in der Pflege werden in Pflege- und Gesundheitseinrichtungen entwickelt, eingesetzt und evaluiert? Die einbezogenen Veröffentlichungen unterschiedlicher Reichweite zeigen diverse Möglichkeiten für Aufgaben- und Verantwortungsbereiche. Vereinzelte Evaluationsergebnisse sind bisher
wenig aussagekräftig. Für eine erfolgreiche Einbindung erscheint die Klärung erweiterter Aufgabenprofile und der Zielstellung
sinnvoll, um Praxiskonzepte vorteilhaft einzusetzen.
Fürther Gespräche: Expertenforum für den Rettungsdienst mit Forderungen an Politik und Gesellschaft
(2023)
Die rettungsdienstliche Versorgung, die Rettungsfachkräfteausbildung und die rechtlichen Vorraussetzungen in Deutschland bieten aktuell keine guten Rahmenbedingungen für die Zukunft. Ein Expertenforum mit deutschlandweiten Akteuren aus Wissenschaft, Bildung und Rettungsdienst diskutierten im Rahmen der Fürther Gespräche die Herausforderungen der Professionalisierung und der Kompetenzentwicklung des Rettungsdienstes und der präklinischen Versorgung in Deutschland. Die zentralen Ergebnisse und Schwerpunktthemen wurden in 7 Thesen zusammengefasst und konkrete Lösungsansätze entwickelt. Das Spannungsfeld umfasst hierbei die Anforderungen und Versorgungsbedarfe, die Prävention und erweiterte Versorgungskomponenten, die Digitalisierungsstrategie, integrierte Leitstellen und vernetzte Gesundheitsdienstleistungen, Personalentwicklung und -bindung sowie Qualifikationsniveaus und Notarztqualifikation.
Pflege trifft Design
(2022)
Trichotillomanie (TTM) ist durch repetitives Haareausreißen charakterisiert, was zu signifikantem Haarverlust, einem hohen Leidensdruck und Beeinträchtigungen in wesentlichen Lebensbereichen führt. Schätzungsweise ein bis zwei Prozent der Allgemeinbevölkerung leiden unter TTM. Gemeinsam mit anderen pathologischen körperbezogenen repetitiven Verhaltensweisen ist TTM in DSM-5 und ICD-11 dem Zwangsspektrum zugeordnet. In der Ätiologie stehen lerntheoretische Modelle im Vordergrund. Zur Behandlung wird die Kognitive Verhaltenstherapie empfohlen, wobei insbesondere Nachweise zur Effektivität des Habit-Reversal-Trainings vorliegen. Derzeit liegt keine evidenzbasierte Empfehlung für eine spezifische pharmakologische Behandlung vor. TTM ist bis heute ein wenig erforschtes und in der Praxis unzureichend bekanntes Störungsbild. Der vorliegende Beitrag liefert einen Überblick über den aktuellen Forschungsstand und allgemeine Handlungsempfehlungen für die Praxis.
Spielerisch Pflege lernen.
(2019)
Warum soll ich das Lernen? Lerngründe und Lernwiderstände in der theoretischen Pflegeausbildung
(2022)
Lernwiderstände sind Folge von unangemessener Lernanforderungen, die Lehrende an Schüler_innen richten. Vor allem Leistungsüberprüfungen und Leistungsdruck können Widerstände beim Lernen hervorrufen. Das kann zu negativen Emotionen wie Frustration und Hilflosigkeit beim Lernen führen. Außerdem erleben die Auszubildenden das Lernen als Zwang. Um diesen Problemen beizukommen ist es wichtig, sich die Relevanz von Lernbegründungen bewusst zu machen, damit Lernen als etwas positives wahrgenommen wird.