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ABSTRACT: BACKGROUND: Studies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission. METHOD: Eleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains "Physical Mobility", "Energy", "Pain", "Social Isolation", "Emotional Reaction" and "Sleep". Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL. RESULTS: 120 residents were included in total. HRQOL was mostly reduced in the domains "Physical Mobility" and "Energy" (mean scores >43.0), while impairment differences in the domains "Pain", "Social Isolation", "Emotional Reaction" and "Sleep" were only moderate (<=25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain "Pain" than men (mean score women: 29.5 +/- 31.5; males: 14.9 +/- 17.2; p = 0.011). Care dependency had an influence on the domain "Sleep" (Ss = -0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain "Sleep" than residents with a high care dependency (mean score 15.3; SD +/- 19.0 versus mean score 32.8 SD +/- 33.2; p < 0.02). CONCLUSION: The level of care dependency has no influence on the HRQOL from the nursing home residents' perspective apart from the domain "Sleep". High care dependency residents have a lower HRQOL in the domain "Sleep" compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain "Pain".
Health and Quality of Life Outcomes 03/2013; 11(1):41. · 2.11 Impact Factor
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ABSTRACT: BACKGROUND: Patient and visitor violence (PVV) is the most dangerous occupational hazard that health professionals must contend with. Staff training is recommended to prevent and manage PVV. There is minimal research focusing on risk factors associated with PVV in general hospital settings. Therefore, staff training is mostly based upon expert knowledge and knowledge from psychiatric and emergency settings. OBJECTIVES: This study investigates health professionals' experiences with PVV in order to describe risk factors related to PVV that occur in general hospital settings. DESIGN: A retrospective cross-sectional survey was conducted in 2007. SETTING: A university general hospital in Switzerland. PARTICIPANTS: 2495 out of 4845 health professionals participated (58.0% nurses & midwives, 19.2% medical doctors, 3.6% physical therapists, occupational therapists & nutritionists, 6.1% ward secretaries, medical & radiology assistants, 6.3% nursing assistants or less qualified nursing staff and 5.1% other staff). All had direct patient contact and 82% were female. METHODS: Data were collected via questionnaires using the Survey of Violence Experienced by Staff German-Version-Revised, the German version of the shortened Perception of Aggression Scale and the Perception of Importance of Intervention Skills Scale. Descriptive statistics and multiple logistic regression analyses were used. RESULTS: Risk factors associated with PVV depend upon the form of violence. Those trained in aggression management and/or those who work predominantly with patients over 65years of age experience twice as much PVV as others. Health professionals working in emergency rooms, outpatient units, intensive care units, recovery rooms, anesthesia, intermediate care and step-down units also experience PVV more often. When health professionals are older in age, are from the medical profession, are students, or when they have an attitude rating preventive measures as being less important and aggression as emotionally letting off steam, they experience less PVV. CONCLUSION: Training could change the perception and the recognition of PVV, and could therefore increase the risk of experiencing PVV. The health professionals' specific occupation along with attitude and age, the patients' age, the communication and the workplace are all relevant risk factors. Further studies should investigate the impact of aggression management training and other measures that would reduce PVV.
International journal of nursing studies 10/2012; · 1.91 Impact Factor
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ABSTRACT: Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes.
A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study.
Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied.
The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04).
Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed.
The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.
Journal of Nursing Scholarship 07/2012; 44(3):249-57. · 1.49 Impact Factor
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ABSTRACT: Pressure ulcers and falls are frequent adverse events with negative impacts for hospital patients. Guidelines recommend risk
assessment as the first step in prevention. Care dependency correlates with falls and pressure ulcers and the Care Dependency
Scale showed a diagnostic validity comparable to that of specific risk assessment tools. The aim of this study was to establish
a simple and valid screening index for the risk of falls and pressure ulcers in hospitals by using the Care Dependency Scale
and to evaluate this index within two validation samples from different countries. Quantitative, cross-sectional data from
two German surveys and one Dutch survey were analysed. A total of 305 Dutch and German hospitals with 21,880 patients took
part. The diagnostic validity of the Care Dependency Scale was evaluated by computing receiver operator characteristics curves,
the areas under the curves, sensitivity, specificity and positive and negative predictive values.The Scale demonstrated a
good diagnostic validity for pressure ulcer risk screening in Dutch and German hospitals. The diagnostic validity regarding
the risk for falls was satisfying in Germany and moderate in the Netherlands. Using the Care Dependency Scale for risk screening
could reduce the necessity of further assessment by more than a half.
KeywordsAccidental Falls-Hospitals-Nursing Home-Pressure Ulcer-Risk Assessment
Central European Journal of Medicine 04/2012; 5(5):577-587. · 0.31 Impact Factor
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ABSTRACT: Palliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for
the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer
journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986,
the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular
approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire
measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials
with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the
psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of
terminally ill cancer patients receiving palliative care in different settings. The questionnaire was well accepted in the
present patient population. Scale reliability was good (pre-treatment 0.80) especially for the functional scale. The results
support the reliability and validity of the QLQ-C30 (version 3.0) as a measure of the health-related quality of life in German
cancer patients receiving palliative care treatment.
Central European Journal of Medicine 04/2012; 4(3):348-357. · 0.31 Impact Factor
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ABSTRACT: PURPOSE: This study aimed at gaining insight into supportive care needs and cancer treatment-related symptoms, and to determine factors associated with supportive care needs. Breast cancer and its treatment cause emotional trauma and health complaints. These lead to supportive care needs in some patients, while others are more able to cope with these consequences themselves. To be able to address these needs, it is important to identify patients' needs at the time they arise. METHODS: Women (n = 175) with newly-diagnosed breast cancer, under treatment in two Swiss breast cancer clinics, participated in a cross-sectional survey. Standardized instruments were used: Supportive Care Needs Survey, Cancer- and Cancer Treatment-related Symptom Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, and Interpersonal Relationship Inventory. RESULTS: The patients' most needed help with psychological issues. Many had treatment-related symptoms like fatigue (87.7%), hot flashes (71.5%), and a changed body appearance (55.8%). The majority suffered from distress (56.2%), fewer from anxiety (24.1%) and depression (12.1%). Physical and social impairment, impaired body image, distress, anxiety and depression, a lack of social support and conflicts in their personal relationships were associated with supportive care needs. CONCLUSIONS: The findings can help to identify more vulnerable patients with unmet needs and a higher demand for support. Assessment of patients enables health care professionals to provide support and counselling. In these assessments, the patients' relationship to close relatives should also be addressed.
European journal of oncology nursing: the official journal of European Oncology Nursing Society 03/2012; · 1.13 Impact Factor
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ABSTRACT: BACKGROUND: The promotion of self-care in patients with heart failure (HF) is a promising strategy for maintaining health and preventing exacerbation of HF and a continuous need for healthcare services. To assess patient self-care, valid and reliable instruments are needed, but there is no psychometrically tested instrument for use in a German HF population. AIM: The aim of this study was to determine the validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale (G9-EHFScBS). Construct validity including factor analysis and discriminant validity, concurrent validity, test-retest reliability and internal consistency were analysed. METHODS AND RESULTS: The G9-EHFScBS was translated into German, and its validity and reliability were tested with 109 patients. The item-total correlation ranged from 0.09 to 0.63. Internal consistency was fair, with a Cronbach's alpha of 0.71 (95%CI: 0.63 to 0.77). Test-retest reliability using an intra-class correlation coefficient showed substantial agreement for the entire scale (ICC: 0.69; 95%CI: 0.56 to 0.79). The G9-EHFScBS was able to distinguish patients with and without extra HF education at a statistically significant level (t = 2.105; p = 0.04). A factor analysis did not show the theoretical assumed dimensions of the scale. CONCLUSION: The G9-EHFScBS is deemed a valid and reliable instrument to assess HF-specific self-care in a German HF population.
European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 03/2012;
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ABSTRACT: The Nottingham Health Profile (NHP) assesses perceived emotional, social, and physical health problems and the extent to which such problems affect daily activities. The objective of our study was to determine the feasibility of the NHP for nursing home residents.
A prospective multicenter observational study was conducted in 11 nursing homes from April 2008 to December 2009 in which 286 newly admitted residents were included. Cognitive status was evaluated using the Mini-Mental State Examination (MMSE). The feasibility of the NHP was determined by administration rate, time and type of administration, and missing items. A cut-off point stating the MMSE score up to which the NHP can be applied was determined with receiver operating characteristics curves (ROC). Internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation; ICC) were evaluated.
Administration rate was 44.4% (n = 127) ranging from 76.1% for normal residents to 5.9% for residents with a severe cognitive impairment. An average of 12.6 (SD + 6.0) minutes was required for data collection and 92.1% (n = 117) of the questionnaires were completed during an interview. Frequently missing items were in the domain "Pain" (47.2). MMSE scores were significantly higher in the group with a completed NHP (P < 0.001) and analyses of ROC curves indicated a cut-off point of >16 on the MMSE score. Cronbach's α was >0.7 in four domains and >0.6 in two domains, while the ICC in all domains was >0.7.
The NHP is a feasible questionnaire for residents with normal cognitive function and moderate cognitive impairment, and can be administered in nursing homes.
International Psychogeriatrics 03/2012; 24(3):416-24. · 2.24 Impact Factor
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ABSTRACT: hahn s., hantikainen v., needham i., kok g., dassen t. & halfens r.j.g. (2012) Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey. Journal of Advanced Nursing 00(0), 000-000. ABSTRACT: Aim. This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated. Background. There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved. Design. A cross-sectional survey. Method. The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. Findings. Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. Conclusion. To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.
Journal of Advanced Nursing 03/2012; · 1.48 Impact Factor
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ABSTRACT: The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals.
Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints.
A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used.
The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model.
Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints.
Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.
Journal of Clinical Nursing 12/2011; 21(7-8):1033-40. · 1.12 Impact Factor
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ABSTRACT: Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition.
To report the prevalence of problems that potentially led to decreased nutritional intake. To investigate the association between these problems and body mass index (BMI). To investigate the association between increased care dependency and BMI. To document nutrition-related interventions.
Cross-sectional multicentre study.
A total of 15 hospitals (H) and 76 nursing homes (NH) in Germany were included.
A total of 2930 hospital patients and 5521 nursing home residents were included in the study. The mean age was 66.6 ± 16.7 years (in H) and 84.9 ± 9.8 years (in NH); 14.7% (in H) and 50.4% (in NH) were almost or completely care dependent. A BMI ≤ 20kg/m² was found in 8.5% (in H) and 16.7% (in NH).
Most hospital patients were eating and drinking independently (72.2%), whereas 58.4% of the nursing home residents needed assistance. Major problems in hospitals were polypharmacy (18.6%), loss of appetite (14.6%) and pain (7.8%); in nursing home common problems were functional problems of the upper extremities (17%), loss of appetite (15.5%) and polypharmacy (15.5%). Patients with a high level of care dependency had higher rates of BMI ≤ 20kg/m². In both settings (H and NH), BMI ≤ 20kg/m² was significantly associated with loss of appetite (odds ratio (OR) 2.6, 95%CI 1.9-3.5 and OR 7.0, 95%CI 5.9-8.3), nausea (OR 2.1, 95%CI 1.3-3.3 and OR 2.8, 95%CI 1.9-4.1), chewing problems (OR 2.1, 95%CI 1.2-3.4 and OR 2.5, 95%CI 2.1-3.1) and swallowing problems (OR 2.3, 95%CI 1.4-3.6 and OR 2.3, 95%CI 1.9-2.8). Nutrition-related nursing interventions were employed more frequently in nursing homes than in hospitals.
A high care dependency in general and in terms of eating and drinking should be addressed in daily care to ensure sufficient nutritional intake. Additional problems, such as loss of appetite, should also be addressed with suitable interventions to prevent malnutrition. Nutrition-related interventions need to be increased in German health care facilities.
International journal of nursing studies 10/2011; 49(4):378-85. · 1.91 Impact Factor
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ABSTRACT: Despite similar health problems, older persons show different care seeking behaviours for a variety of reasons. The aim of this study was to identify motives underlying the attitudes of older persons to seek nursing care and to develop a theoretical rationale which allows viewing their mutual interaction. Theory development according to Walker and Avant was used as a method to derive a model from the reviewed literature. Six categories were identified that may influence seeking of nursing care: perceived threat, disposition, external options & barriers, current coping abilities, influence of significant others, and outcome value. Findings do not allow determination of factors that may predict care seeking attitude but provide a loosely structured conceptual model for culture specific investigations. Qualitative studies guided by the model should be conducted in order to develop testable theories of care seeking for different cultures and settings.
Nursing Inquiry 09/2011; 18(3):216-25. · 0.64 Impact Factor
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ABSTRACT: Around 10% of Western Europe's population suffer from a disability which can entail a decrease of independency and quality of life. However, the lives of these people can be improved by rehabilitative treatment and care. Changing the degree of dependency from dependent to independent is essential in rehabilitation, as is the assessment of these changes. To perform such kind of measurements, assessment instruments have to be responsive. In spite of this concern, responsiveness of assessment instruments is studied to a small extent only. This also applies to the Care Dependency Scale for Rehabilitation (CDS-R), a short assessment instrument measuring the care dependency of patients regarding physical and psychosocial aspects. In this longitudinal-study, the responsiveness of the CDS-R, in general and related to different disease-groups, should be determined. Therefore, a convenience sample of 1564 patients was assessed in an Austrian rehabilitation centre with the scale after admission and before discharge. Responsiveness was determined by descriptive analysis, calculation of effect-sizes and significance tests. Differences between admission and discharge occurred on a statistically significant level for patients who changed. Kazis' effect-sizes can be considered as of small/medium effect for patients who changed (0.24/0.49), and as of large effect according to Liang (0.86/1.46). Eta squared was 0.10/0.19 which can be interpreted as of moderate/large effect for patients who changed. Responsiveness-analyses related to different disease-groups showed constantly large effect-sizes for patients with musculoskeletal-disorders. These results indicate that the CDS-R can detect patient-changes over time and discriminate between patients who change under rehabilitation or not. These aspects argue for the responsiveness of the scale, wherefore the CDS-R seems to be appropriate for the assessment of treatment/health-care effectiveness and the evaluation of individual patient-changes. Nevertheless further research is recommended to confirm the level of responsiveness of the scale in general and for different disease-groups.
Scandinavian Journal of Caring Sciences 08/2011; 26(1):194-202. · 0.89 Impact Factor
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ABSTRACT: To investigate the feasibility of a survey measuring patient and visitor violence after translation and modification, namely the Survey of Violence Experienced by Staff (German version revised) and to validate the shortened Perception of Aggression Scale (POAS-S) and the Perception of Importance of Intervention Skills Scale (POIS) after adaptation for use in a general hospital setting.
The use of different approaches and research instruments for investigating patient and visitor violence negatively influences the comparability of studies. Typically, general hospitals use self-administered surveys. However, support for these instruments' validity is insufficient.
Between November 2006-January 2007, 291 nurses working in general hospitals in the German-speaking region of Switzerland completed the SOVES-G-R, the POAS-S and the POIS (response rate=71%). Results. The participants' responses demonstrated a need for modifications to enhance the feasibility of the SOVES-G-R in two categories, namely experiences with patient and visitor violence in 'the past 12 months' and in 'the past working week'. The POAS-S revealed the same factor solution as in earlier studies, with two factors explaining 38·0% of variance. In the POIS, two factors were distinguished: (1) structured interventions and evaluation and (2) the importance of preventive measures.
The SOVES-G-R, the POAS-S and the POIS are adequate for investigating factors influencing the occurrence of patient and visitor violence in general hospitals. Given the changes in the SOVES-G-R and the moderate size of our sample, further testing with a larger sample is recommended.
The instruments help determine which clinical settings have a greater risk of patient and visitor violence and the specific factors that influence this risk. This can facilitate the implementation of situation-specific preventive measures against patient and visitor violence in general hospitals.
Journal of Clinical Nursing 07/2011; 20(17-18):2519-30. · 1.12 Impact Factor
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ABSTRACT: The study assessed and compared the psychosocial needs of patients with breast cancer and of their relatives, the patients' and relatives' burden of illness, anxiety, depression and distress and assessed the patients' cancer treatment-related symptoms and identified relevant factors influencing patients' and relatives' needs.
Seventy-two patients (n=72) participated with a relative in a cross-sectional mail-survey, 1-22 months after cancer treatment.
The patients reported needing help with psychological and sexual issues. They suffered from treatment-related symptoms. More treatment-related symptoms and depression were related to the patients' needs for supportive care. Their relatives' needs primarily concerned access to information and communication with health care professionals. Relatives had higher levels of anxiety (25.0% vs. 22.2%), depression (12.5% vs. 8.3%) and distress (40% vs. 34%) than patients. Higher levels of depression, younger age and having a disease themselves were associated with relatives' need for help.
Patients' and relatives' substantial needs and psychological problems require professional support even after completion of the patients' treatment. Continued assessment of the patients' and their relatives' needs and of the patients' symptoms provide the basis for purposeful counselling and education. Rehabilitation programs for patients and their relatives should be developed and implemented in clinical practice.
European journal of oncology nursing: the official journal of European Oncology Nursing Society 07/2011; 15(3):260-6. · 1.13 Impact Factor
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ABSTRACT: This study explored caregivers' perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression.
Working in a nursing home is associated with a high risk to experience aggression from residents or patients. Despite existing recommendations for dealing with aggression there is a lack of information about caregivers' ways of dealing with it in practice.
A qualitative study with focus group method was conducted.
Five focus group interviews, with a total of 30 participants, from nursing homes in Switzerland were undertaken employing a semi-structured interview guideline. For analysing the data, qualitative content analysis was employed.
Analysis of the data produced three themes with additional sub-themes. One main theme concerns the explanations of the caregivers in regard to the occurrence of aggressive behaviour. This theme is subdivided into two areas, the contributory resident related factors and the caregiver related factors. The measures for handling aggressive behaviour are illustrated in the second theme 'dealing with residents'. The third theme refers to the strategies of the caregivers when confronted with aggressive behaviour -'self-protection' and 'coping with the situation'.
Caregivers use a broad spectrum of interventions for reducing aggression, some of which are recommended by guidelines but often ignore the link between aggressive behaviour and physiological issues like pain or elimination. The caregivers only very rarely linked their practical knowledge about aggressive behaviour with theoretical knowledge.
The results give insight into the caregivers' perspectives on factors leading to aggression and their coping strategies. Caregivers are informed about relevant reasons for aggressive behaviour and its management, but do not apply a systematic approach. Furthermore, the anxiety of caregivers involved in aggression incidents is an under examined area.
Journal of Clinical Nursing 06/2011; 20(17-18):2469-78. · 1.12 Impact Factor
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Journal of Clinical Nursing 06/2011; 20(17-18):2584-6. · 1.12 Impact Factor
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ABSTRACT: BACKGROUND: Pressure ulcer risk assessment using an age-appropriate, valid and reliable tool is recommended for clinical paediatric practice. OBJECTIVES: (1) What PU risk scales for children currently exist? (2) What is the diagnostic accuracy of their scores? (3) Are the scores reliable and what is the degree of agreement? (4) What is the clinical impact of risk scale scores in paediatric practice? DESIGN: Systematic review. DATA SOURCES: MEDLINE (1950 to December 2010), EMBASE (1989 to December 2010), CINAHL (1982 to December 2010), reference lists. REVIEW METHODS: Two reviewers independently screened databases, selected and evaluated articles and studies. Diagnostic accuracy, reliability/agreement, and experimental studies investigating the performance and clinical impact of PU risk scale scores in the paediatric population (0-18 years) were included. PU development was used as reference standard for diagnostic accuracy studies. Methodological quality of the validity and reliability studies was assessed based on the QUADAS and QAREL checklists. RESULTS: The search yielded 1141 hints. Finally, 15 publications describing or applying 12 paediatric pressure ulcer risk scales were included. Three of these scales (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Braden Q Scale, Burn Pressure Skin Risk Assessment Scale) were investigated in prospective validation studies. Empirical evidence about interrater reliability and agreement is available for four instruments (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Starkid Skin Scale, Glamorgan Scale, Burn Pressure Ulcer Risk Assessment Scale). No studies were identified investigating the clinical impact. CONCLUSIONS: Sound empirical evidence about the performance of paediatric pressure ulcer risk assessment scales is lacking. Based on the few results of this review no instrument can be regarded as superior to the others. Whether the application of pressure ulcer risk assessment scales reduces the pressure ulcer incidence in paediatric practice is unknown. Maybe clinical judgement is more efficient in evaluating pressure ulcer risk than the application of risk scale scores.
International journal of nursing studies 06/2011; · 1.91 Impact Factor
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ABSTRACT: The objective of the study was to evaluate the effect of being treated in intensive care units in comparison with general hospital wards regarding pressure ulcer occurrence when controlled for various risk factors.
Pressure ulcer occurrence is commonly used as an indicator for the quality of care. Large-scale incidence studies are costly and difficult to perform.
Secondary analysis of patient data (n = 32,400) collected during 2002-2009 as part of eight multicentre pressure ulcer surveys in 256 German hospitals.
Ward-acquired pressure ulcer rate was used for the calculation of effect sizes as a surrogate parameter for pressure ulcer incidence. The SRISAG (surface, repositioning, immobility, shear forces, age, gender) logistic regression model was used to control for differences in case mix.
Pressure ulcer prevention and intrinsic and extrinsic risk factors differ for patients from hospital wards compared with those from intensive care wards. The ward-acquired pressure ulcer rate in general hospital wards was 3·9% (1·5% excluding grade 1). In intensive care, the rate was 14·9% (8·5% excluding grade 1), which corresponds with an unadjusted odds ratio of 4·3 (95%CI 3·8-4·9). After the SRISAG model was applied, the odds ratio was reduced to 1·5 (CI 1·2-1·7).
When surface, repositioning, immobility, shear forces, age and gender are controlled for the institutional factor intensive care unit vs. general hospital wards is no longer a high-risk factor for the development of pressure ulcer. The SRISAG model is simple and can be used to compare the occurrence of pressure ulcer between different medical specialties.
Application of this model allows more valuable comparison of the occurrence of pressure ulcer in different specialities and enables clinical practitioners and health care planners to use this outcome as an indicator for the quality of care to avoid confounding.
Journal of Clinical Nursing 03/2011; 21(3-4):354-61. · 1.12 Impact Factor
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ABSTRACT: The aim of this study is to compare the responsiveness of the Care Dependency Scale for Rehabilitation (CDS-R) and the Barthel Index in rehabilitation.
A longitudinal study was performed over six months (2007-8) where patients were assessed using the scales after admission and before discharge.
A convenience sample of 1,542 patients was recruited in an Austrian rehabilitation centre.
The CDS-R and the Barthel Index.
Responsiveness was determined by descriptive analysis, significance tests and calculation of effect sizes.
For the 1,542 patients, the calculation according to Kazis yielded values of 0.10 for both instruments. For the group of patients who showed clinically relevant changes, values of 0.50 were obtained for the CDS-R and 1.06 for the Barthel Index. For the group 1,542 patients, the calculation according to Liang yielded values of 0.42 for the CDS-R and 0.34 for the Barthel Index. For the group of patients who showed clinically relevant changes, values of 1.47 were obtained for the CDS-R and 1.92 for the Barthel Index.
The Barthel Index seems to be slightly more responsive than the CDS-R, and both instruments seem to be appropriate for the assessment of patients' changes over time. Nevertheless, the exact level of responsiveness could not be clearly identified for both instruments. To confirm the level of responsiveness, further research is recommended.
Clinical Rehabilitation 03/2011; 25(8):760-7. · 2.12 Impact Factor
