Rebecca Spirig

University Hospital Zurich & University of Basel · Department of Nursing and Allied Health Care Professions

Zusammenfassung: Hintergrund: Für Pflegefachpersonen ist zentral, auf Basis ihrer Caring Haltung eine qualitativ hochstehende Pflege zu erbringen. Versäumte Pflege kann bei ihnen Schuldgefühle und Unzufriedenheit hervorrufen. Publikationen zu ihrem Erleben im Übergang zwischen vollständig durchgeführter und versäumter Pflege fehlen. Solche können z...

Objectives To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process bet...

Zusammenfassung. Hintergrund: Zeitlich angemessenes Durchführen von Pflegemaßnahmen ist grundlegend für eine professionelle Pflege. Obwohl Strategien zum Umgang mit Zeitressourcen vorliegen, werden Pflegemaßnahmen wiederholt zu früh, zu spät oder nicht durchgeführt. Dies kann negative Auswirkungen auf Pflegequalität und Sicherheit haben. Es gibt je...

A systematic screening of patients with a need for post-acute care is a helpful support for interprofessional discharge planning teams. We aimed to test self-care abilities, measured by the self-care index (SPI) as predictors of post-acute care transfer and to update the existing SPI prediction model. We analysed data from a prospective, observatio...

Objective Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants’ experiences with pain management and st...

Zusammenfassung. Hintergrund: Es ist bekannt, dass notwendige Pflege wiederholt weggelassen respektive nur teilweise oder zu einem Zeitpunkt durchgeführt wird, der nicht angemessen ist. In der Literatur steht dafür der Begriff „versäumte Pflege“. Im deutschsprachigen Raum gibt es bisher keine, mit qualitativen Methoden kritisch reflektierte Definit...

Aim Explore learning processes associated with a psychoeducational pain selfmanagement intervention. Background Self-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilit...

Commitment to change in middle-level nurse managers A qualitative study Middle-level nurse managers have an important role to play as "change agents" in times of organizational transition. Therefore, a high level of commitment to change is essential for their part. How leadership and commitment to change are interrelated, is scarcely researched in...

Zusammenfassung. Hintergrund: Krebserkrankte Menschen können psychosozial so belastet sein, dass sie Unterstützung benötigen. Seit 2012 sollen Pflegefachpersonen (PFP) im Universitätsspital Zürich alle eintretende Krebspatienten mit Hilfe des Belastungsthermometers (BT) screenen, um den Unterstützungsbedarf zu erkennen. Nach fünf Jahren war die Scr...

Background: Delays in patient discharge cannot only lead to deterioration especially among geriatric patients, but also incorporates unnecessary resources at the hospital level. Many of these delays and their negative impact may be preventable by early focused screening to identify patients at risk for transfer to a post-acute care facility. Early...

Objectives To determine the concordance of Zurich Observation Pain Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU patients. Design Prospective observational study [BASEC-Nr. PB_2016-02324]. Setting A total of 49 ICU patients from cardiovascular, visceral a...

Objectives: To determine the concordance of Zurich Observation Pain Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU patients. Design: Prospective observational study [BASEC-Nr. PB_2016-02324]. Setting: A total of 49 ICU patients from cardiovascular, visceral...

Zusammenfassung. Hintergrund: Die Zunahme von chronischen Krankheiten und Multimorbidität sowie anspruchsvollere Behandlungsmethoden führten in Akutspitälern zu erhöhter Akuität und Komplexität von Pflegesituationen. Ziel: Diese Untersuchung verfolgte das Ziel, Kategorien unterschiedlich ausgeprägter, patientenbezogener Komplexität der Pflege zu ex...

Aim To have at hand a reliable and valid questionnaire to assess performed and missed nursing care in a Swiss acute care context. Background Regular monitoring of performed and missed nursing care is crucial for nurse leaders to make evidence‐based decisions. As foundation, we developed a conceptual definition. Based on this, we decided to transla...

Rational The interest in complexity of nursing care has grown in science and practice in recent years because of changed patient profiles and higher average levels of patient acuity in acute care hospitals. Aim The aim of this study was to redefine the concept of patient‐related ‘complexity of nursing care’ in acute care hospitals. Design The hyb...

Purpose: Addressing psychosocial distress is an essential part of cancer care. Therefore, nurses at the University Hospital Zurich have been screening all cancer inpatients with the Distress Thermometer (DT) since 2012. Screening is ineffective without any form of psychosocial intervention. We aimed to identify adherence to the screening protocol...

Background: In the first year following renal transplantation, preventing weight gain to minimize overweight or obesity is particularly important. The aim of this study is to test the effect of an 8-month behavioral intervention BMI and physical activity. Methods: This randomized controlled study included 123 adult kidney or kidney-pancreas reci...

Aims: This study aimed to psychometrically test the instrument "Complexity of Nursing Care" and to broaden the understanding of the instrument's psychometrics and applicability. Design: Embedded mixed-methods design. Methods: We performed a cross-sectional study assessing all stationary patients of five Swiss hospitals daily for up to 5 days w...

When and how do intensive care nurses consider pain in the treatment process of ICU patients? A qualitative study Abstract. Background: Pain management is important in the therapeutic spectrum of the intensive care unit. However, guideline recommendations are not consistently implemented. Strategies in clinical reasoning and decision-making regardi...

Talente zu erkennen, systematisch zu fördern, ihnen Zukunftsperspektiven zu bieten und sie im Unternehmen zu halten, gilt aufgrund des Fachpersonenmangels als zukunftswichtige Aufgabe in der Pflege. Diese qualitative Studie beschreibt die Identifikation, Förderung und Retention von Talenten im Rahmen eines Laufbahnmodells. In drei Fokusgruppeninter...

Purpose Identifying and assessing psychosocial distress with an appropriate screening instrument is essential when caring for cancer patients. Since 2012, the distress thermometer (DT) has been used by nurses for all cancer inpatients at the Comprehensive Cancer Center Zurich. We wanted to identify nurses’ adherence to the screening protocol, diffe...

The relevance of interprofessional collaboration (IPC) is widely acknowledged. Given the lack of a fully validated instrument in the German language for measuring the level of IPC, we built upon the current, albeit psychometrically weak, German-language version of the instrument to devise a new version with improved wording and for subsequent psych...

Aim To undertake a theoretical systematic review to develop a conceptual model of illness‐related emotional distress in the context of symptom management in chronic respiratory disease. Design We performed a systematic search to identify conceptual models. Data sources Electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO were searched and pa...

Die Schmerzerfassung bei Patient(inn)en mit Bewusstseins-und kognitiven Einschränkungen auf der Inten-sivstation stellt Intensivpflegende und Ärztinnen/Ärzte aufgrund fehlender Selbstauskunft vor Herausforde-rungen. An Fremderfassungsinstrumente ergeht der Anspruch, mit ihren Items Schmerz bei einem breiten Pati-entenspektrum anzuzeigen und bei Pfl...

Background Pain is one of cancer patients’ most frequent and distressing symptoms; however, analgesics’ side effects often increase symptom burden. Further, with the home rapidly becoming the primary cancer care setting, family caregivers (FCs) commonly play central roles in patients’ pain self-management, but with little or no preparation. One US-...

The aim of the current study was to report findings about delirium detection when ward nurses screened for delirium in patients with cognitive impairment using the Delirium Observation Screening Scale (DOSS) in comparison to the Confusion Assessment Method (CAM). A secondary analysis was performed of research data collected in 2010 at a Swiss terti...

Abstract Background Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk...

Background: Reflexivity can be helpful in developing the methodological rigour necessary to attaining trustworthy qualitative study results. Objectives: To evaluate strategies of critical reflexive thinking during a qualitative enquiry rooted in a mixed-methods study. Methods: Guided by the questions of Rolfe and colleagues from 2001 ('what,'...

Background: Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. Aim: We investigated the phenomenon of patient-related compl...

Pflegefachpersonen von Anfang an als Mitgestalterinnen der Mobility-Entwicklung einbeziehen, maximale Nutzerfreundlichkeit sicherstellen und hohen Rückhalt durch Führungspersonen gewährleisten – diese drei Faktoren haben sich bei der Mobility-Entwicklung in der Pflege am Universitätsspital Zürich bewährt. Im Zentrum standen zwei Fragen: Welche Mobi...

BACKGROUND Patients suffering from oncological diseases experience physical, mental, social, and spiritual distress. 20 to 40 % show increased stress and need professional support. Therefore, we implemented the distress thermometer (DT) as a screening instrument on an inpatient oncological ward. METHOD We chose an action research approach („look“-...

Aim Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German‐speaking contexts. Hence, t...

Background: Patient-related complexity of nursing care in acute care hospitals has increased in recent years, in part due to shorter hospital stays and the increase in multimorbid patients. However, little research has been conducted on how nurses experience complex nursing care situations. Aims: The aim of this study was to gain a better unders...

BACKGROUND Interprofessional collaboration between nurses and physicians is a recurrent challenge in daily clinical practice. To ameliorate the situation, quantitative or qualitative studies are conducted. However, the results of these studies have often been limited by the methods chosen. AIM To describe the synthesis of interprofessional collabo...

Kognitiv und bewusstseinsbeeinträchtigte Patient(inn)en können nicht über Schmerz Auskunft geben. Eine bedarfsgerechte Schmerztherapie ist herausfordernd. 2002 begann die Entwicklung des Zurich Observation Pain Assessments (ZOPA©) zur Schmerzfremdeinschätzung bei dieser Patientengruppe. Der Beitrag zeigt den Entwicklungsprozess des ZOPA© und beleuc...

Background: In the neonatal care units of the University Hospitals of Zurich and Bern, the nurse´s role in ethical decision-making is well established. However, nurses often reported uncertainty with regard to introducing the premature infant’s situation from the nursing perspective in ethics rounds. Aims: To empower neonatal nurses in fulfilling t...

BACKGROUND Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. AIM The aim of...

Aim: To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. Background: The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is...

Patientenprozesse im Akutspital werden durch interprofessionelle Zusammenarbeit massgeblich geprägt. Deren Qualität ist entscheidend für positive Patientenergebnisse und hohe Arbeitszufriedenheit. Wir übersetzten die Collaborative Practice Scales (CPS) und befragten 128 Pflegende und 104 ÄrztInnen in einem Deutschschweizer Universitätsspital. Von i...

Context: Self-management in chronic illness involves complex medical, role-related, and emotional tasks. Still, while self-management support of patients and their families has become a cornerstone of chronic illness care, information is limited as to how liver transplant (LTx) patients and close caregivers perceive self-management before and afte...

Non-adherence in patients with chronic liver disease is a problem resulting in various consequences ranging from disease deterioration to death. Insufficient medication adherence leads to enormous health care costs. Family caregivers can essentially contribute to improving adherence. The aim of this project was to develop a work instruction specifi...

Zusammenfassung. Hintergrund: Es ist bekannt, dass das SwissDRG-Tarifsystem den Pflegeaufwand nicht ausreichend berücksichtigt, weil seine Grouperkriterien die Variabilität des Pflegeaufwands innerhalb der DRG-Fallgruppen zu wenig erklären. Um eine angemessene Vergütung und Ressourcen-Allokation zu erreichen, muss der Pflegeaufwand eindeutig quanti...

Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. To determ...

Hintergrund: In der Literatur wird kritisch über die Folgen nach Einführung von Fallkostenpauschalen debattiert, die die Bedingungen für professionelles Pflegen erschwerten. Deshalb untersuchten wir die Ausprägung von Pflegekontextfaktoren (Arbeitsumgebungsbedingungen) in fünf Akutspitälern vor Einführung des neuen Vergütungssystems in der Schweiz....

Aim: This study focuses on nursing practice for patients with chronic heart failure (CHF). The aim is to reflect on a practice development project to improve patient care in a person-centred way and to implement evidence into practice. The project consists of two phases with individual aims and evaluation processes. Part one describes the developme...

Background: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be im...

The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an...

International studies show that the majority of patients undergoing treatment in ICUs report moderate to strong levels of pain. It has been established that undetected or insufficiently treated pain can cause severe physical and emotional distress. Therefore, early and effective pain assessment is a primary treatment goal of intensive care, which i...

Background: Leadership programmes have been used to support nurse leaders in developing their skills and equiping them as transformative change agents in healthcare organisations around the world. For this purpose, the Royal College of Nursing’s Clinical Leadership Programme has been adapted, implemented, and evaluated in Switzerland. Although a sh...

AimThe aim of this pilot study was to develop an instrument for measuring complexity of nursing care in hospitalised acute care patients as well as to examine its comprehensibility, its feasibility, the effort required for data collection, and its inter-rater reliability as well as its face validity.Methods This pilot study was designed as a descri...

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The a...

Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to furt...

Context: Patients' perspectives of posttransplant self-management tasks have not been explored.OBJECTIVE-To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant. Design: Mixed-method study using semistructured interviews and a structured questionnaire.Setting-Outpatient Div...

Die Betreuung von Patienten mit chronischer Herzinsuffizienz (CHF-Pat) bedeutet eine Herausforderung. Sie setzt das Bewusstsein für die Lebenswelt der CHF-Pat und ihre Problemstellungen im Alltag voraus. Ziel dieses narrativen Literaturreviews ist, die Perspektive der CHF-Pat von der Diagnose und den Umgang mit der CHF aufzuzeigen. Die Literatur wu...

Der Schwerpunkt der Bezugspflege am UniversitätsSpital Zürich (USZ) liegt auf der Verantwortung einer Pflegefachperson für den Pflegeprozess der von ihr betreuten Patient(inn)en. Dieser wird im Rahmen einer professionellen Beziehung mit der damit verbundenen Verantwortlichkeit für pflegerische Entscheidungen und Handlungen sowie gestützt auf forsch...

Epilepsy is a common and chronic disease which affects persons at every age. Even though medication can prevent seizures, epilepsy has implications for daily living. Sorrows, increased depression rates and restrictions in everyday life were documented among family caregivers of adult persons with epilpesy. To date, no study investigated how parents...

In the first year after kidney transplantation patients are challenged with incorporating new behaviour patterns into their daily lives. Due to the higher risk of cardiovascular disease amongst kidney transplant recipients, behaviours such as preventing undesired weight gain, exercising, avoiding smoking, and managing medications take on crucial im...

The vulvar intraepithelial neoplasia (VIN) is a rare chronic skin condition that may progress to an invasive carcinoma of the vulva. Major issues affecting women's health were occurring symptoms, negative influences on sexuality, uncertainty concerning the illness progression and changes in the body image. Despite this, there is little known about...

People affected by Crohn's disease or ulcerative colitis experience a high level of suffering. A new generation of anti-tumour necrosis factor-α agents can alleviate the burden of symptoms considerably. In order to develop a need-centred care programme for this patient group, we conducted problem-centred interviews with nine patients about their ex...

Background: Managing symptoms in daily life is a challenging problem for people living with HIV. As traditional parameters used to identify symptoms needing management do not integrate aspects of daily living with symptoms, we introduced 'perceived symptom manageability' to fill this gap. Aim: The aim of this study was to quantitatively explore...

OBJECTIVE: The aim of the study was to describe the (a) symptom experience of women with vulvar intraepithelial neoplasia and vulvar cancer (vulvar neoplasia) during the first week after hospital discharge, and (b) associations between age, type of disease, stage of disease, the extent of surgical treatment and symptom experience. METHODS: This cro...

In the first year after kidney transplantation patients are challenged with incorporating new behaviour patterns into their daily lives. Due to the higher risk of cardiovascular disease amongst kidney transplant recipients, behaviours such as preventing undesired weight gain, exercising, avoiding smoking, and managing medications take on crucial im...

This article discusses concerns about women with vulvar neoplasia (vulvar intraepithelial neoplasia and vulvar cancer) and the available surgical treatment options. Given the gaps in the evidence base in terms of women with vulvar neoplasia and surgical treatment the women with vulvar Neoplasia-Patient Reported Outcome (WOMAN-PRO) research project...

Purpose/Objectives: To (a) develop the Women With Vulvar Neoplasia—Patient-Reported Outcome (WOMAN-PRO) instrument as a measure of women's post-vulvar surgery symptom experience and informational needs, (b) examine its content validity, (c) describe modifications based on pilot testing, and (d) examine the content validity of the revised instrument...

Since there is no data available about the needs of people living with Multiple Sclerosis and significant others in Switzerland a questionnaire based cross sectional study was conducted with 878 patients and 615 family caregivers. This Swiss study used the addresses from the Swiss Multiple Sclerosis Society. The response rate was 35.2 % for patient...

Das UniversitätsSpital Zürich hat vor knapp eineinhalb Jahren das Pilotptojekt „Delir-Path“ genehmigt. Die Aufgabe: Entwicklung und Implementierung einer Delirmanagement-Richtlinie zur Prävention, Früherfassung und Behandlung von Delirien mit dem Ziel, das Delirmanagement zu verbessern und das Vorkommen von Delirien bei Patienten zu verringern.

Aim: To report the synthesis of the concept of perceived symptom manageability. Background: Common symptom assessment parameters fail to address concerns about the impact of symptoms on everyday life, overall functioning, or threats to individuals living with the human immunodeficiency virus. We claim that the concept of 'perceived symptom manag...

For persons living with HIV, effective symptom management is crucial for good health outcomes and usually involves close support persons. The collaboration of persons living with HIV and their close support persons in the process of symptom management, including symptom experience reports, was investigated using an exploratory mixed methods design....