Development of items for the assessment of paediatric incontinence-associated dermatitis in German: Delphi study Paediatric incontinence-associated dermatitis (PIAD) is a common problem in premature infants, neonates, infants and young children. Standardized instruments for the assessment of PIAD can support clinical decision-making, but no standardized instrument is yet available for German-speaking countries. Selection, development and agreement of appropriate items for the assessment of PIAD in newborns, infants and young children in German (). Using a Delphi technique, international items were formulated in German by a steering committee, the items were assessed by panellists using an online survey, and a consensus (I-CVI > = 75%, comments) was formed by the steering committee and panellists. 54 experts from four German-speaking countries were recruited. 44 (1st round) and 33 (2nd round) completed the questionnaire in full. Twelve items for the assessment of PIAD were rated as relevant, comprehensive and comprehensibility: erythema, skin change without and with damage to the skin surface, exudation, bleeding, oedema, overheating, signs of mycotic/bacterial superinfection, pain, itching, localization/extension and duration. The items for the assessment of PIAD in German should be tested for their measurement properties prior to clinical use and the construction of an instrument.

Long-term care facilities have been confronted with various workforce challenges, including a poor image within the nursing profession, a shortage of staff, and a growing demand for long-term care. Furthermore, these facilities have been significantly impacted by the pandemic and the respective measures with detrimental effects on residents, staff, and their family members. This study explored issues in working in residential long-term care from the perspective of nurses and their perception on amplifying and additional effects of Covid-19. It applied a qualitative design focusing on experiences and views of 25 LTC nurses working in Austrian long term care facilities during the pandemic. Data were collected by conducting in-depth interviews either virtually or in presence. The data analysis was conducted by applying a thematic analysis. The four identified themes are: (1) Work motivation, (2) Dealing with vulnerability, (3) Human Resource Planning and (4) External view on long-term care. For each theme it was delineated which aspects have been present in the pre-Covid-19 situation and which became more visible or arose additionally. Nurturing connection between LTC nurses and with residents and relatives as well as signaling the positive aspects of LTC such as relationships, challenge and responsibility may allow to tackle Human Resource Planning issues.

The physical and mental health of home care recipients: A quantitative secondary data analysis Although more and more people are being supported by home care services, there is a lack of information regarding the health limitations and needs of this group. The objective of this study was to examine the health status of people with home care needs in Switzerland. A secondary data analysis based on the HomeCareData database, which contains routine data on people with home care requirements in Switzerland, was conducted. All cases with a fully completed Resident Assessment Instrument (RAI-HC) were included. Data on various items of the RAI-HC and other standardized scale scores with reference to physical or mental health were analyzed using descriptive statistics. In total, 74,674 data records were evaluated. Physical limitations most frequently manifested in the form of fatigue (40.6%), pain (29.7%) or within the scope of impaired hearing (21.9%). Around a third of individuals sampled had experienced a fall in the last 90 days. With regard to mental health, the most frequent signs were fear of falling (33.5%), loneliness (13.9%), depression (12.8%) and anxiety (4%). Approximately one third showed signs of impaired cognition and polypharmacy was detected in almost 68% of those evaluated. Considering the comparatively high prevalence of mental health problems among people with home care requirements, there is a need to develop appropriate skills of employees in home care services and for adequate care planning.

Primary nursing (Process Responsible Nursing; PRN) is a nursing organization model, practiced in intensive care units (ICUs), but implementation is challenging. This paper focuses on the qualitative process analysis of the development and implementation of PRN in an ICU at a German university hospital. Aim was to record the perception of changes in nursing practice due to the introduction of PRN and obtain information on implementation and further optimization perceived by nurses. A qualitative process analysis was done. Data collection took place at three defined times (immediately before implementation and 6 and 12 months after) and each included a focus group interview (FG) and a 5-day ICU ward process analysis (WA) in the form of participant observation. The analysis of FG and WA was carried out according to Kuckartz's content-structuring qualitative content analysis. The main categories communication, care planning and integration of patients and relatives in care and 13 subcategories with a cross-sectional category could be identified. Positive effects of PRN were found, particularly concerning relatives. The optimization potential included handover, visit appointments, the documentation system and adjustments to the visiting times. The qualitative analysis was able to show changes during the introduction of PRN, e.g. in communication and care planning, but also challenges like visit appointments or the documentation system in nursing practice.

Nurses' health during the COVID-19 pandemic in Switzerland: A longitudinal study with mixed methods design The COVID19 pandemic has had a significant impact on healthcare systems worldwide. Nurses have played a crucial role in responding to the crisis, often at the expense of their own health and wellbeing. The aim of the study was to investigate the physical and mental health status as well as the resources of certified nurses during the pandemic, in German-speaking Switzerland. In a longitudinal study with a mixed methods design, data were collected among nurses from acute hospitals between 2021 and 2022 using a questionnaire survey and focus group interviews. The data were analysed using multiple regression analysis, knowledge mapping and the Neuman system model. The results show improvements in health, quality of life and job satisfaction, and a decrease in stress; whereby influencing extrapersonal factors are, among others, reorganisations within hospitals with the active involvement of nurses. On the interpersonal level, support from managers or colleagues proved helpful. At the intrapersonal level, the recognition of the nurses' competencies was deemed particularly important, to help them to remain healthy during the pandemic. Increased recognition, participation, training and career opportunities as well as flexible working models need to be implemented in the long term to ensure a sustainable improvement of the health and well-being of nurses.

Psychosocial stress and working conditions of nursing home staff in Covid-19 pandemic: A cross-sectional study With the onset of the Covid-19 pandemic in March 2020 there were numerous changes in the daily professional lives of healthcare professionals. Since the focus has been mainly on hospital staff so far, it is also important to watch the care situation in old people's and nursing homes. This study aimed to investigate the impact of the Covid-19 pandemic on the daily professional life, the psychosocial situation and the interpersonal relationships of nursing staff in old people's and nursing homes in Brandenburg. Cross-sectional survey of nursing staff from old people's and nursing homes in Brandenburg in the period from August to December 2020. The questionnaires were analysed using descriptive statistics and qualitative thematic analysis. On the one hand, the increased workload with more difficult working conditions due to Covid-19 hygiene measures or increased working hours led to physical and psychosocial stress. In private life, increased social isolation was evident and changes in interpersonal relationships were stressful. On the other hand, the participants reported recognition and increased professional political interest. The Covid 19 pandemic highlighted pre-existing pressures on caregivers. In the future, it is important to improve the known workloads for nursing staff in old people's and nursing homes and to work out measures to counteract an increase of stress in situations like the pandemic.

Advance care planning in the acute hospital: A qualitative analysis of terms and conditions Advance Care Planning (ACP) is an internationally established concept aimed to facilitate anticipatory care planning in the event of future inability to consent. In Germany, ACP is currently not regularly offered to patients in acute care hospitals. We aimed to identify preconditions for implementation of ACP in acute care hospitals in Germany through review of the international literature and expert interviews. Methods: A systematic literature search was carried out in the databases MEDLINE and CINAHL for internationally used strategies for implementing ACP in acute care hospitals. Consecutively, a guide for interviews with experts to evaluate the strategies was developed. Interviews were analyzed by qualitative content analysis according to Mayring. Out of 13 included publications, 17 preconditions were identified and assigned to 16 categories after evaluation by experts. In international ACP programs, it was described how to proceed and organize the ACP conversation. German experts emphasized that appropriate preconditions, such as sufficient time resources and training, must be granted, whereas the literature search revealed the conversation process and organization as important determinants. The implementation of ACP programs is conceivable, but requires specific conditions as legal regulation and defining and structuring of the processes.

Collaboration between care teams and care experts in home care nursing: A qualitative case study As a result of demographic change and the associated ageing population, the number of people affected by multimorbidity is increasing, and with it the complexity of home care nursing. In a home care nursing service (Spitex), care teams work with employees of different levels of competence. For support in complex situations, they can seek help from nursing experts (PEX). The aim was to investigate the collaboration between the care teams and the PEX of a regional Spitex organization and to work out measures for optimization. The research question was: "How do the care teams of a regional Spitex organization experience the collaboration with the nursing experts?" A qualitative case study design with four sub-cases was used to describe in detail how collaboration with PEX is experienced. Four Focus group interviews were evaluated using content analysis and cross-case analysis. The Cross-Case analysis reveals the categories for optimal collaboration: present, professionally versatile, relieving in coordination tasks, supportive in complex situations. The following categories are categorized as disruptive factors in collaboration: varying levels of commitment, collaboration low priority and confusing. The PEX are to be made better known through targeted information dissemination. Implications for practice include the importance of presence and mutual understanding of roles so that collaboration is experienced as added value.

Demands, resources, and work engagement of lower and middle level nurse managers: a cross-sectional study Given their responsibilities, lower- and middle-level nurse managers hold a key role in the health care system. Their performance and health are affected by their work engagement, which according to the Job-Demands-Resources-Model depends on job-related demands and resources. To date, there is a lack of studies on the demands, resources, and work engagement of nurse managers in Germany. First, the study aimed to describe the job demands and resources as well as the work engagement of lower and mid-level nurse managers in hospitals and geriatric care facilities in Germany. Second, the aim was to explore potential differences in these areas between different groups, particularly regarding gender, age, and management level. The study used a cross-sectional design. Data were collected by an online survey. N = 408 cases could be evaluated. Work overload is the most prominent demand, followed by emotional demands. In terms of resources, nurse managers can primarily draw on positive social relationships. The available professional resources are rated critically. Work engagement is moderate. The study indicates a clear need for action regarding an improvement in work engagement. In particular, work overload and professional resources need to be addressed by appropriate systemwide and organization-related measures.

Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples' life after proximal femoral fracture. We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.

Community Nursing for people with a migration biography: a qualitative study People with a migration background or with special socio-cultural needs have difficult access to health services or are affected by overuse, underuse or misuse. Community Nursing (CN), which was implemented in March 2022 in a district in Austria, can strengthen health literacy and promote individual well-being. The aim was to obtain information about perception and use of CN services by people with a migration biography and to identify adequate measures to promote increased use. In March 2023, two focus group interviews with stakeholders and people with a migration biography regarding the use of the CN service were conducted, analyzed and validated in workshops in a municipality in Vorarlberg. Diverse barriers (lack of language skills, lack of knowledge about own insurance coverage, lack of information, emotional inhibiting factors such as fear, shame and reservations about care services) were identified. The jointly developed solutions for a low-threshold offer range from the use of key persons, and health counseling in meeting cafés, to a targeted information strategy. A successful CN service requires a comprehensive implementation strategy and needs-based measures. The identified barriers, fears, and reservations should be considered to facilitate access to CN for people with a migration background.

Development and piloting of nurse-led mHealth care for heart failure patients: A feasibility study Chronic heart failure (cHI) is the most common reason for hospitalization. Telemonitoring (TM) and Heart Failure Nurses (HFN) can detect decompensations and prevent hospitalizations. The aim was to develop and examine the feasibility of a digitally supported care-guided care model for cHI patients and to evaluate it in terms of adherence, technology usability, satisfaction, self-care and health literacy, disease knowledge, quality of life and health status. The study was conducted in a user-centered manner using mixed. The 6-month pilot was carried out in the patients' domestics using qualitative (e.g. focus groups) and quantitative methods (validated questionnaires). A total of n = 30 cHI patients (age: M 66, SD 14 years; ♀ n = 10 [31%], ♂ n = 22 [69%]) completed the clinical testing. The intervention consisted of: Training, the TM application, nursing/medical advice and support and a digital library. Adherence to TM was over 80% (relative adherence: M 87, SD 16%; absolute adherence: M 82, SD 19%). Health literacy, disease knowledge and quality of life increased. The state of health improved and those affected felt more confident in dealing with the disease. No changes were recorded for self-care skills. Hybrid care is very well received and demonstrates the potential to promote self-care for those affected.

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study Families with children in need of care are exposed to great stress. This results in risks that often lead to a poor living and care situation for families. To support them, an innovative regionally anchored support service is being developed by so-called Family Health Partners (FGP) as part of the NEST research project. The primary endpoint of the study is the quality of life of the families. Secondary outcomes are resilience factors and associated measures as well as access to care services. The effectiveness of the FGP will be tested in a controlled study with four measurement times (baseline, after 6, 12 and 18 months) between January 2022 and April 2024. A total of 204 families with children in need of care were recruited for an intervention and control group. Multilevel models are used to analyze the longitudinal data. Between T0 and T1 there are statistically significant improvements in the intervention group, especially in daily and social stress in the family, in mental health and resilience. In addition, knowledge about general benefit rights as well as specific support and relief offers for caring parents has increased. The results of the first two measurement times indicate that a positive change in quality of life, resilience and health literacy can be achieved through the FGP.

Integrated regulations for medical and nursing care in long-term care: qualitative results of the process evaluation: Innovative form of care in long-term care Long-term care patients, most of whom suffer from multimorbidity, are dependent on appropriate medical and nursing care. Inadequate interdisciplinary cooperation structures and processes pose a challenge for nursing care when residents' conditions deteriorate and can lead to hospital admissions that could potentially be avoided. Structures and processes of interdisciplinary cooperation were developed and implemented as part of the SaarPHIR innovation fund project "Saarländische PflegeHeim Versorgung Integriert Regelhaft". The aims of the qualitative part of the process evaluation were the subjective assessment of the structural and process level of the complex intervention across all project phases from the perspective of the participants as well as an analysis of the context factors. Qualitative interviews were conducted with all participating facilities and the medical care communities formed as part of the project in order to record the subjective experiences gained in the implementation and impact of the complex intervention. The data analysis was carried out using qualitative content analysis. Both professional groups perceive a structural organizational change that has a positive effect on interdisciplinary cooperation. The benefits in terms of care are rated as high. Various measures (e.g. pre-weekend ward rounds, extended on-call duty) at the structural and process level should be retained when transferring to standard care.

Care-related Case Management and the experienced burden of informal caregivers: empirical study Informal caregivers are responsible for the majority of home care in Germany. Their experience of stress is becoming more and more relevant given the tense staffing situation in outpatient professional care in rural areas. Case management as an innovative approach to caring in peripheral areas also focuses on the burden experienced by informal caregivers. The question arises as to whether care-related case management can have a positive influence on the burden experienced by informal caregivers. In a mixed-method approach, the influence of case management on the experience of stress is analyzed quantitatively (N = 251) and qualitatively (N = 40) using a pre-post design with a control group. Group difference tests based on the HPS-scale and content analysis of the interviews are conducted. The analyses suggest that case management can have a positive influence on the experience of burden. From a quantitative perspective, there was a stabilizing influence on the experience of burden in the intervention group, while burden increased in the control group. Qualitatively, there was an influence on subjective burden. In particular, the role of the case manager as a central contact person in matters regarding the care situation is relevant. By providing new resources and coping strategies, case management can effectively alleviate the burden experienced by informal caregivers.