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Objective:
We examined whether autonomic flexibility to experimentally presented stressors is reduced in somatic symptom disorder (SSD) as this would point to reduced vagal control as a proposed indicator of emotion regulation deficits.
Method:
In this experimental study, the influence of health-related and social stressors on subjective and physiological reactivity was investigated in 29 subjects with SSD without any medical condition SSD(mc−), 33 subjects with SSD with medical condition SSD(mc+) and 32 healthy controls at the age from 18 to 70 years. Self-report and physiological variables were measured before and after/during stressor exposure, using state ratings of symptom intensity, disability, tension and mood, heart rate (HR), and heart rate variability (HRV).
Results:
Overall, the tension increased and the mood worsened after exposure to stressors compared to pre-exposure. Compared to HC, the two SSD groups showed higher symptom intensity, disability, tension and worse mood. The SSD(mc−) group revealed higher HR than HC (p = .012, d = −0.77). Compared to pre-exposure, symptom impairment increased after social stressor exposure in SSD(mc−) (p < .001, d = 1.36). HRV-root mean square of successive differences (RMSSD) only decreased in HC during exposure (p = .003, d = −1.09), not in the SSD groups. The two SSD groups did not differ in their reactivity to stressors.
Conclusion:
HRV in SSD, seems to respond less flexibly to stressors, potentially reflecting overall physiological disturbance through reduced parasympathetic influence on HR. Stress reactivity in SSD(mc−) and SSD(mc+) do not seem to differ.
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.
Exkursion und Studienprojekt
(2024)
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.
Pathological Skin Picking (PSP) is an excessive behavior which characterizes Skin Picking Disorder. Individuals repeatedly pick their skin and cause skin lesions, but are unable to control the behavior, which can cause severe distress. Visible self-inflicted skin lesions can additionally affect individuals with PSP due to emerging appearance-related concerns. However, these concerns and their role in PSP have hardly been studied, especially not in comparison with individuals with dermatological conditions and skin-healthy controls.
The present cross-sectional study (n=453, 83.9% female, 15.9% male, 0.2% diverse) aimed at analyzing appearance-related concerns and mental health outcomes between four groups: Individuals with PSP and dermatological conditions (SP/DC; n=83), PSP without dermatological conditions (SP; n=56), dermatological conditions without PSP (DC; n=176) and skin-healthy controls (SH, n=138). We compared questionnaire data on dysmorphic concerns, appearance-based rejection sensitivity, and body dysmorphic symptoms, as well as PSP-symptoms and mental health outcomes (depression, anxiety, and self-esteem) between groups.
The analyses showed a significant multivariate group effect in the appearance-related variables, F(6, 896)=19.92, Wilks’ Λ=0.78, p<.001, and mental health outcomes, F(6, 896)=16.24, Wilks’ Λ=0.81, p<.001. The SP/DC group had the strongest appearance-related concerns and mental health impairments, followed by the SP group, the DC group and the SH group. The SP/DC group and SP group only differed significantly with regard to dysmorphic concerns, but not in other variables. The DC group was less affected but still showed higher dysmorphic concerns and mental health impairments than skin-healthy controls. In contrast to the PSP groups, the other two groups did not exceed clinically relevant cut-off scores.
The present study shows that individuals with PSP exhibit strong appearance-related concerns, regardless of the presence or absence of underlying or comorbid dermatological conditions. These findings shed new light on the importance of appearance-related concerns in skin picking disorder and the role of PSP as a potentially overlooked risk factor in dermatological patients. Therefore, appearance-related concerns should be explicitly addressed in dermatological and psychotherapeutic settings. Future studies should also include longitudinal and experimental analyses to more clearly classify the role of appearance-related concerns in the etiology of PSP and skin picking disorder.
Background and objectives: Virtual reality simulation (VRS) can be used to complement experiential learning, as it enables nursing students to further learn and refine nursing skills outside of the clinical setting. However, gathering evidence for its effectiveness as a teaching method in achieving learning outcomes is still ongoing, and thus there is a lack of systematic synthesis. The objective of this systematic literature review is to analyze VRS scenarios with a high level of immersion and their impact on learning outcomes in nursing education.
Methods: A literature search was performed in the MEDLINE, CINAHL, and ERIC databases in November 2022. As a result, fifteen studies were included and analyzed using deductive content analysis.
Results: The studies reported twelve different scenarios for virtual reality simulations with high levels of immersion, the focus of which was on acute critical care, broader nursing processes, neonatal and pediatric care, single nursing interventions, and observation of patients’ symptoms. The associated learning objectives were mainly achieved in the domains of cognition and psychomotor skills.
Conclusions: There are several VRS scenarios that show potential for use in nursing education. The VRS scenarios are effective in improving learning outcomes, particularly those related to knowledge and skills. Overall, the supportive body of evidence gained through this review may help nurse educators in integrating virtual simulations in their curricula. In the future, nursing and adult learning theories should be given greater consideration, and the aspect of affective learning could be included in design and implementation. Moreover, future research could benefit from exploring the long-term effects of learning after using VRS with a high level of immersion to provide valuable evidence for developing VRS teaching methods in nursing.
Habits are highly automated behaviors that have received renewed attention in addiction research. The Self-Report Habit Index (SRHI) is a widely used measure of habits. Two cross-sectional online studies aimed at validating a German version of the SRHI to assess two everyday health-risk behaviors: caffeine consumption and smartphone/tablet use. In both studies (N = 1310), the SRHI scales (one adapted for caffeine consumption, one for smartphone/tablet use), as well as corresponding addiction scales and health outcomes (study 1), or established validity measures (study 2), were assessed. Both SRHI scales showed satisfying item characteristics, high internal consistencies (αs > .90), adequate construct validity, and a three-factorial solution with a satisfying model fit (CFI/TLIs > .95, SRMRs ≤ 0.05). Highest correlations emerged between SRHI and addiction scales. The studies show that the German SRHI can be used to validly assess health-risk behaviors. The observed strong correlations of the SRHI scales with addiction scales suggest that (self-reported) habit is indeed an important aspect to consider in addiction research.
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.
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.
Mundtrockenheit lindern
(2023)
Visually induced motion sickness (VIMS) is a common side-effect of exposure to virtual reality (VR). Its unpleasant symptoms may limit the acceptance of VR technologies for training or clinical purposes. Mechanical stimulation of the mastoid and diverting attention to pleasant stimuli-like odors or music have been found to ameliorate VIMS. Chewing gum combines both in an easy-to-administer fashion and should thus be an effective countermeasure against VIMS. Our study investigated whether gustatory-motor stimulation by chewing gum leads to a reduction of VIMS symptoms. 77 subjects were assigned to three experimental groups (control, peppermint gum, and ginger gum) and completed a 15-min virtual helicopter flight, using a VR head-mounted display. Before and after VR exposure, we assessed VIMS with the Simulator Sickness Questionnaire (SSQ), and during the virtual flight once every minute with the Fast Motion Sickness Scale (FMS). Chewing gum (peppermint gum: M = 2.44, SD = 2.67; ginger gum: M = 2.57, SD = 3.30) reduced the peak FMS scores by 2.05 (SE = 0.76) points as compared with the control group (M = 4.56, SD = 3.52), p < 0.01, d = 0.65. Additionally, taste ratings correlated slightly negatively with both the SSQ and the peak FMS scores, suggesting that pleasant taste of the chewing gum is associated with less VIMS. Thus, chewing gum may be useful as an affordable, accepted, and easy-to-access way to mitigate VIMS in numerous applications like education or training. Possible mechanisms behind the effect are discussed.
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.
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.
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.
Abstract The development and application of digital interventions in health-related topics are gaining momentum in health service research. Digital interventions are often complex and need to be evaluated and implemented in complex settings. Due to their characteristics, this poses methodological challenges for health services research that have to be identified and addressed. Hence, the Working Group on Digital Health of the German Network for Health Services Research (DNVF) has prepared a discussion paper. This paper discusses methodological, practical and theoretical challenges associated with the development and evaluation of digital interventions from the perspective of health services research. Possible solutions are suggested and future research needs to address these methodological challenges are identified.
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
Editorial
(2021)
KI in der Pflege
(2021)
Body shaming (BS) is a popular term for a type of negative social interaction, which frequently occurs in social media. However, there is a lack of a clear scientific definition of BS and data on its relation to other concepts in social aggression research. The present study therefore aimed at providing a definition and classification of BS. In an exploratory online-study, 25 participants (60%) provided personal definitions of BS and rated the fit of a suggested definition. In addition, they reported similarities with and differences to related concepts (appearance teasing, cyberbullying, trolling). We conducted qualitative analyses of the verbal definitions guided by the Grounded Theory approach and quantified the fit to existing concepts in the field of social aggression. The results show that BS is perceived as an unrepeated act in which a person expresses unsolicited, mostly negative opinions/comments about a target’s body, without necessarily intending to harm him/her. Still, the target perceives the comments as negative. BS can range from well-meant advice to malevolent insults and it can occur online and offline. Participants saw similarities between BS and appearance teasing. BS can be a tool for trolling and can evolve to cyberbullying with repetition over time. Altogether, BS is a form of social aggression that has a negative impact on individuals. The definition and classification help to investigate BS and its effects on body image and mental health in future research.
Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.
Background
During shortages of filtering face pieces (FFP) in a pandemic, it is necessary to implement a method for safe reuse or extended use. Our aim was to develop a simple, inexpensive and ecological method for decontamination of disposable FFPs that preserves filtration efficiency and material integrity.
Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects
(2021)
Background: Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary: The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message: EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
Einfach.Klar.Verständlich.
(2020)
„Leichte Sprache“ in der Ambulanten Pflege Menschen mit kognitiver Einschränkung oder schlechten Deutschkenntnissen haben häufig Schwierigkeiten, Texte zu lesen und zu verstehen. Aber auch sie brauchen Informationen. Bei der Betreuung dementiell erkrankter Pflegebedürftiger oder auch von Migranten muss die Sprache deshalb deren Fähigkeiten angepasst werden.
Implementation and Analysis of Two Knowledge Base Approaches for the Treatment of Chronic Wounds
(2020)
In der Corona-Krise 2020 waren und sind die Gesundheitssysteme und damit einhergehend die Pflegeberufe sehr gefordert – auch in psychiatrischen Handlungsfeldern. Die Deutsche Fachgesellschaft Psychiatrische Pflege e. V. (DFPP) hat in einer Stellungnahme Forderungen beschrieben, um eine gute psychiatrisch-pflegerische Versorgung in Zeiten einer Pandemie zu gewährleisten. Dieser Artikel ist eine verkürzte und leicht geänderte Version der Stellungnahme. Er beschreibt, welche Auswirkungen die Corona-Krise auf die psychiatrische Pflegepraxis hat und begründet damit die Forderungen der DFPP. Die ausführliche Stellungnahme findet sich auf der Homepage (www.dfpp.de).
Der Beitrag diskutiert anhand des Forschungsprojektes Game Based Learning in Nursing – Spielerisch Lernen in authentischen, digitalen Pflegesimulationen (GaBaLEARN)
die Einbindung von Learning Analytics in digitale Fallsimulationen eines Serious Games. Es werden pflege- und mediendidaktische Impulse zur Entwicklung und Integration von Learning Analytics für die Darstellung von situativen, komplexen Kompetenzen im Bereich personenbezogener Dienstleistungsberufe, wie der Pflege, dargestellt.
Das Streben nach Gleichberechtigung und Chancengleichheit zeigt sich in unserer Gesellschaft besonders durch die kognitiv unterschiedliche Entwicklung der Menschen (Schönenberg, 2020). Diese Unterschiedlichkeit führt allerdings häufig zu einer Ausgrenzung und erschwert Betroffenen den Zugang zu Hilfsangeboten (Schönenberg, 2020). Aber menschliche Ausgrenzung erfolgt nicht nur ausschließlich aufgrund von körperlichen Einschränkungen, sondern auch durch sprachliche Probleme (Romanowski, 2015). Insbesondere sprachliche Barrieren gilt es in Deutschland, einem der best alphabetisierten Länder der Welt, zu durchbrechen (Buddeberg, Dutz, Grotlüschen, Heilmann und Stammer, 2019). Sowohl Leichte-, als auch Einfache Sprache kann hier helfen.