Symbiosis of Technology and Ethics: Preliminary Results of an Inquiry into the Moral Dimensions in the Use of Robotic Systems in Patient Care

The present study aims to describe ethical and social requirements for technical and robotic systems for caregiving from the perspective of users. Users are interviewed in the ReduSys project during the development phase (prospective viewpoint) and after technology testing in the clinical setting (retrospective viewpoint). The preliminary results presented here refer to the prospective viewpoint.

Missing nurses cause missed care: is that it? Non-trivial configurations of reasons associated with missed care in Austrian hospitals - a qualitative comparative analysis

BACKGROUND

Errors of omissions affect the quality of nursing care in hospitals. The Missed Nursing Care Model explains that the reasons for missed care are linked with 1) demand for patient care, 2) labor resource allocation, 3) material resource allocation, and 4) relationship and communication factors. Scientific evidence points to a lack of adequate nursing staffing as the most important factor triggering missed care. However, it remains unclear how the different theoretical reasons for missed care are interlinked with reports on missed care from the perspective of nurses in acute care settings. The aim of this study was to explore non-trivial configurations of reasons for missed care that are associated with missed care interventions from the perspective of nurses working in general units in Austrian hospitals.

METHODS

A cross-sectional study was conducted. Data collection was performed using the revised MISSCARE-Austria questionnaire. Our sample consisted of 401 nurses who provided complete data. Data were analyzed using qualitative comparative analysis. Configurational models of contextual factors, reasons for missed care, and missed nursing interventions were analyzed.

RESULTS

In our study contextual factors were not consistent precursors of the reasons for missed care. Missed care was consistently present when the demand for patient care was high. A lack of labor resources, in combination with the other known reasons for missed care, was consistently observed when missed care occurred. Different configurations of reasons were found to be non-trivially associated with different types and frequencies of missed care.

CONCLUSIONS

To understand the complexity of the causal mechanisms of missed care, complexity theory may be necessary. Accordingly, a theoretical framework that acknowledges that complex systems, such as missed care, are composed of multiple interacting causal components must be further developed to guide new methodical approaches to enlighten its causal mechanisms.

Effects of robotic-assisted early mobilization versus conventional mobilization in intensive care unit patients: prospective interventional cohort study with retrospective control group analysis

BACKGROUND

Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients' outcomes was investigated.

METHODS

We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months.

RESULTS

During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG.

CONCLUSION

In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts.

TRIAL REGISTRATION

This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.

Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use

BACKGROUND

Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units.

OBJECTIVE

Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice.

SETTING

Two intensive care units guided by anesthesiology at a German university hospital.

PARTICIPANTS

Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h.

METHODS

Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively.

RESULTS

Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6).

CONCLUSIONS

Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time.

REGISTRATION

clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248.

TWEETABLE ABSTRACT

Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.

External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling

PROBLEM

Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors.

AIMS

This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC.

DESIGN

A quantitative cross-sectional study.

METHODS

The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases.

RESULTS

The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model.

CONCLUSION

In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

[Using the TRAPD method to translate the revised MISSCARE Survey from English into German: Revised MISSCARE-Austria]

Using the TRAPD method to translate the revised MISSCARE Survey from English into German: Revised MISSCARE-Austria Abstract. Background: Questionnaire translations in German-speaking nursing science rely on methods using first- and back-translation techniques despite increasing criticism. In contrast, the TRAPD method is recognized as best practice in intercultural social research. However, experience with the application of this method in German-speaking nursing science is lacking. Aim: To describe the utilization of the TRAPD method using the example of the translation of the revised MISSCARE Survey from English into German and to discuss necessary adaptations, advantages, and limitations of this approach. Methods: An adapted version of the team-based translation method TRAPD was implemented through the steps: preparation, translation, review, adjudication, pretest, and documentation, based on the GESIS guidelines for intercultural questionnaire translation. Results: The new revised MISSCARE Austria instrument consists of 85 items. For the majority of the items, equivalent terms or phrases were found that allowed for a straightforward translation. For some items an adaptation was necessary due to cultural, measurement- and construct-related aspects. Translation equivalence regarding challenging items was examined with the first author and promoted by multiple cognitive pretesting with nurses. Conclusions: Our study strengthens the argument that the TRAPD method is appropriate for translating measurement instruments in German-speaking nursing science. However, this example shows that further experience with this method is necessary for its further development for our discipline.

Assistive robotic systems in nursing care: a scoping review

BACKGROUND

The use of assistive robotic systems in care is intended to relieve nursing staff. Differentiated and literature-based findings on current application possibilities, technological developments and empirical findings are necessary to enable a goal-oriented and participatory development of assistive robotic systems of care. The aim of this review was to identify assistive robotic systems and their areas of application in nursing settings. Furthermore, an overview of existing social and nursing science findings from the research field of assistive robotic systems will be described.

METHODS

A systematic literature search was performed based on the JBI scoping review methodology. During the period from May to August 2020, the databases MEDLINE via PubMed, CINAHL, Cochrane Library, Web of Science, and IEEE Xplore Digital Library were searched. In order to reflect current developments and evidence in the present literature work, a supplementary search with these same requirements was conducted in January 2022.

RESULTS

The 47 included publications are divided into 15 studies, 23 technical articles and nine opinion-based articles (text-opinion). A total of 39 different assistive robotic systems were identified. There were 55% in the testing phase and 29% of the systems in the development phase. Assistive robotic systems can be divided into six fields of application: Information and patient data processing, assistance with activities of daily living, fetch and bring activities, telepresence and communication, monitoring, safety and navigation, and complex assistance systems. The description of the study findings is divided into "integration of technology and impact on practice" and "attitude and acceptance of elderly people towards assistive robotic systems".

CONCLUSION

The results of the research show that the use of assistive robotic systems in care mainly take place in the context of development and testing phases. In addition to usability and acceptance issues, implementation factors must be integrated into theory-driven research projects.

Barriers and facilitators in the implementation of mobilization robots in hospitals from the perspective of clinical experts and developers

BACKGROUND

Early mobilization can help reduce severe side effects such as muscle atrophy that occur during hospitalization. However, due to time and staff shortages in intensive and critical care as well as safety risks for patients, it is often difficult to adhere to the recommended therapy time of twenty minutes twice a day. New robotic technologies might be one approach to achieve early mobilization effectively for patients and also relieve users from physical effort. Nevertheless, currently there is a lack of knowledge regarding the factors that are important for integrating of these technologies into complex treatment settings like intensive care units or rehabilitation units.

METHODS

European experts from science, technical development and end-users of robotic systems (n = 13) were interviewed using a semi-structured interview guideline to identify barriers and facilitating factors for the integration of robotic systems into daily clinical practice. They were asked about structural, personnel and environmental factors that had an impact on integration and how they had solved challenges. A latent content analysis was performed regarding the COREQ criteria.

RESULTS

We found relevant factors regarding the development, introduction, and routine of the robotic system. In this context, costs, process adjustments, a lack of exemptions, and a lack of support from the manufacturers/developers were identified as challenges. Easy handling, joint decision making between the end-users and the decision makers in the hospital, an accurate process design and the joint development of the robotic system of end-users and technical experts were found to be facilitating factors.

CONCLUSION

The integration and preparation for the integration of robotic assistance systems into the inpatient setting is a complex intervention that involves many parties. This study provides evidence for hospitals or manufacturers to simplify the planning of integrations for permanent use.

TRIAL REGISTRATION

DRKS-ID: DRKS00023848; registered 10/12/2020.

Study protocol for the implementation and evaluation of a digital-robotic-based intervention for nurses and patients in a hospital: a quantitative and qualitative triangulation based on the Medical Research Council (MRC) framework for developing and evaluating complex interventions

BACKGROUND

Nurses spend part of their working time on non-nursing tasks. Unnecessary walking distances and the assumption of service activities and other non-care-related tasks take up a lot of space, which reduces the time for direct patient care and demonstrably increases the dissatisfaction of the persons involved. The REsPonSe project aims to relieve nursing staff by using a smartphone app for communication in combination with an autonomous service robot to reduce walking distances and service activities. The technical systems are tested on a nuclear medicine ward and are intended to reduce the radiation exposure of the staff. The aim of this study is to test and evaluate the use and intervention of the technical systems, the acceptance of the users and the change in the utilisation of the nursing service. In addition to findings on usability and manageability, effects on nursing practice, as well as facilitating and inhibiting contextual factors for implementation, will be identified.

METHODS

The Medical Research Council (MRC) Framework for Developing and Evaluating for Complex Interventions was chosen as the theoretical basis. The data collection in the Feasibility and Evaluation phase is a triangulation of quantitative and qualitative methods. Standardised observations are planned to collect data on non-care activities and walking distances, and a survey of utilisation by use of a questionnaire based on the NASA TLX. Qualitative individual interviews with patients and group discussions with nursing staff will be conducted. Statements on the subjective experiences, as well as the evaluation of the use of the digital-robotic system in the clinical setting, will be collected. The descriptive evaluation of the usage and retrieval data will provide information on duration, time, requests, and reduced contact times, as well as error and fault messages.

DISCUSSION

The evaluation study will make it possible to represent a variety of perspectives from different interest groups. The results should contribute to the definition of implementation and evaluation criteria and facilitate the integration of digital-robotic assistance systems in nursing acute inpatient settings.

TRIAL REGISTRATION

The trial was registered with the German Clinical Trials Register (DRKS) on 16.02.2022: DRKS00028127.

Robot-assisted early mobilization of intensive care patients: a feasibility study protocol

Background

Early mobilization positively influences the outcome of critically ill patients, yet in clinical practice, the implementation is sometimes challenging. In this study, an adaptive robotic assistance system will be used for early mobilization in intensive care units. The study aims to evaluate the experience of the mobilizing professionals and the general feasibility of implementing robotic assistance for mobilization in intensive care as well as the effects on patient outcomes as a secondary outcome.

Methods

The study is single-centric, prospective, and interventional and follows a longitudinal study design. To evaluate the feasibility of robotic-assisted early mobilization, the number of patients included, the number of performed VEM (very early mobilization) sessions, and the number and type of adverse events will be collected. The behavior and experience of mobilizing professionals will be evaluated using standardized observations (n > 90) and episodic interviews (n > 36) before implementation, shortly after, and in routine. Patient outcomes such as duration of mechanical ventilation, loss of muscle mass, and physical activity will be measured and compared with a historical patient population. Approximately 30 patients will be included.

Discussion

The study will provide information about patient outcomes, feasibility, and the experience of mobilizing professionals. It will show whether robotic systems can increase the early mobilization frequency of critically ill patients. Within ICU structures, early mobilization as therapy could become more of a focus. Effects on the mobilizing professionals such as increased motivation, physical relief, or stress will be evaluated. In addition, this study will focus on whether current structures allow following the recommendation of mobilizing patients twice a day for at least 20 min.

Trial registration

ClinicalTrials.gov, NCT05071248. Date: 2021/10/21

[Early mobilization in the intensive care unit-Are robot-assisted systems the future?]

BACKGROUND

Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devices are increasingly being studied in mobilization.

OBJECTIVE

This qualitative review synthesizes the evidence of early mobilization in the ICU and focuses on the advantages of robotic assistance devices.

RESULTS

Active mobilization should begin early during critical care. Interventions commencing 72 h after admission to the ICU are considered early. Mobilization interventions during critical care have been shown to be safe and reduce the time on mechanical ventilation in the ICU and the length of delirious episodes. Protocolized early mobilization interventions led to more active mobilization and increased functional independence and mobility at hospital discharge. In rehabilitation after stroke, robot-assisted training increases the chance of regaining independent walking ability, especially in more severely impaired patients, seems to be safe and increases muscle strength and quality of life in small trials.

CONCLUSION

Early mobilization improves the outcome of the critically ill. Robotic devices support the gait training after stroke and are the subject of ongoing studies on early mobilization and verticalization in the intensive care setting.

Update: Entwicklungen der Gesundheitsversorgung

Neben dem Mangel an Gesundheitsfachpersonal sind vor allem Veränderungen in der Struktur der Krankenhäuser, der stationären Altenhilfe und der ambulanten Versorgung deutlich spürbar. Aktuell sind unterschiedliche Ansätze zur Neuordnung, wie die Ausgliederung der Finanzierung der Pflege aus dem G-DRG System der Krankenhäuser oder das neue Krankenpflegegesetz mit erstmalig vorbehaltlichen Aufgaben, zu verzeichnen. Grundsätzlich stellt sich bei diesen Ansätzen zur Neuordnung die Frage, welche Perspektive in der Gesundheitsversorgung künftig prioritär verfolgt werden soll: die der Versorgungsanbieter*innen in den jeweiligen Settings, die der Gesundheitsfachpersonen oder vielleicht auch endlich einmal die der Menschen mit medizinischem und/oder pflegerischen Unterstützungsbedarfen?

Der Einsatz von robotischen und technischen Systemen zur Frühmobilisation von Intensivpatient_innen

Zusammenfassung. Hintergrund: Intensivpatient_innen sind oft einer langen Immobilität ausgesetzt. Wenn sie aber frühzeitig mobilisiert werden, lassen sich positive Effekte auf ihr Outcome, wie z.B. eine Verbesserung der körperlichen Funktion, nachweisen. Einer der Gründe für die späte Mobilisation ist, dass zu wenig Hilfsmittel zur Verfügung stehen. Fragestellungen/Ziel: Dieser Beitrag gibt einen Überblick über den Einsatz von robotischen oder technischen Systemen als Hilfsmittel für die Frühmobilisation. Welche robotischen und technischen Hilfsmittel werden in Studien zur Frühmobilisation von erwachsenen Intensivpatient_innen durch Pflegefachpersonen oder Physiotherapeut_innen untersucht? Über welche Effekte von Frühmobilisation mittels robotischem und technischem System auf die Patientenoutcomes wird in den Studien berichtet? Methoden: Die Datenbanken Medline, Web of Science, CINAHL, Cochrane Library, Embase, IEEE Xplore, Scopus und WTI wurden zwischen Mai und Juli 2020 und im Januar 2022 systematisch durchsucht. Zusätzlich wurde im ersten Suchlauf eine Randsuche über GoogleScolar und ResearchGate durchgeführt. Ergebnisse: Es wurden 27 Veröffentlichungen eingeschlossen (9 RCTs, 7 Expertenmeinungen, 3 quantitative Querschnittstudien, 2 Fall-Kontroll-Studien, 2 Literaturreviews, 2 klinische Einzelfallstudien, 2 Interventionsstudien im Prä-Post-Design). Hier zeigte sich, dass als Hilfsmittel vor allem elektronische Bettfahrräder und Kipptische eingesetzt werden. Es war eine uneinheitliche Datenlage in Bezug auf verschiedene Patientenoutcomes nachweisbar. Schlussfolgerungen: Weitere Forschung zum Einsatz von technischen und robotischen Systemen zur Frühmobilisation ist vor allem in Bezug auf unterschiedliche Studienpopulationen notwendig. Frühmobilisationsrobotik ist noch nicht Teil der Regelversorgung.

Potential Uses of Assistive Robotic Systems in Acute Inpatient Care

Potential uses of assistive robotic systems in acute inpatient care were defined based on the Framework for Complex Interventions developed by the Medical Research Council (MRC). This process of definition requires the consideration of personal-related and contextual factors.

Very Early Robot-Assisted Mobilization of Intensive Care Patients - A Scoping Review

This scoping review gives an overview of current research activities in the field of very early mobilization with robotic devices of intensive care patients. It presents the effect of very early, robot-assisted mobilization on intensive care patients based on their outcomes.

Service Robotics in Nursing Care. The Preliminary Results of a Scoping Review

A scoping review was prepared in the first study phase of the REsPonSe project. The objective was to gain an overview of existing literature and available evidence on the subject of service robotics in nursing care. The systematic literature search took place using the following databases: PubMed, CINAHL, Cochrane, Web of Science and IEEE Xplore. The titles and abstracts of 2.761 references were screened based on the inclusion criteria. A total of 31 articles were identified as relevant for the study.

Is there a need to widely prescribe antibiotics in patients hospitalized with COVID-19?

BACKGROUND

Debate continues regarding the usefulness and benefits of wide prescription of antibiotics in patients hospitalized with coronavirus disease 2019 (COVID-19).

METHODS

All patients hospitalized in the Infectious Diseases Department, Dijon University Hospital, Dijon, France between 27 February and 30 April 2020 with confirmed COVID-19 were included in this study. Clinical, biological and radiological data were collected, as well as treatment and outcome data. An unfavourable outcome was defined as death or transfer to the intensive care unit. Patient characteristics and outcomes were compared between patients who did and did not receive antibiotic therapy using propensity score matching.

FINDINGS

Among the 222 patients included, 174 (78%) received antibiotic therapy. The univariate analysis showed that patients who received antibiotic therapy were significantly older, frailer and had more severe presentation at admission compared with patients who did not receive antibiotic therapy. Unfavourable outcomes were more common in patients who received antibiotic therapy [hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.07-8.11; P = 0.04]. Multi-variate analysis and propensity score matching indicated that antibiotic therapy was not significantly associated with outcome (HR 1.612, 95% CI 0.562-4.629; P = 0.37).

CONCLUSION

Antibiotics were frequently prescribed in this study and this was associated with more severe presentation at admission. However, antibiotic therapy was not associated with outcome, even after adjustment. In line with recent publications, such data support the need to streamline antibiotic therapy in patients with COVID-19.

COVID-19 ou non COVID-19 ? Comparaison des caractéristiques des patients hospitalisés pour une suspicion de COVID-19

Introduction

Matériels et méthodes

Résultats

Conclusion

Automated Mapping of LEP Nursing Data to Nursing Minimum Data Sets

Nursing Minimum Data Sets (NMDS) intend to systematically describe nursing care. Until now NMDS have been populated with nursing data by manual data ascertainment which is inefficient. The objective of this work was to evaluate an automated mapping pipeline for transforming nursing data into an NMDS. We used LEP Nursing 3 data as source data and the Austrian and German NMDS as target formats. Based on a human expert mapping between LEP and NMDS, an automated data mapping algorithm was developed and implemented in an automatic mapping pipeline. The results show that most LEP nursing interventions can be matched to the NMDS-AT and G-NMDS and that a fully automated mapping process from LEP Nursing 3 data to NMDS-AT performs effectively and very efficiently. The shown approach can also be used to map different nursing classifications and to automatically transform point-of-care nursing data into nursing minimum data sets.

[Nursing, patient safety and the acquisition of nursing-sensitive outcomes in German hospitals]

As the largest occupational group in healthcare, nurses continuously work in very close contact to patients and nursing home residents. No other professionals in the healthcare sector are involved in or responsible for so many different processes. They play a key role in, on the one hand, identifying and potentially avoiding errors and, on the other hand, in causing them. Traditionally, error handling in Germany is still strongly influenced by pointing a finger to and tabooing problematic behaviour. Structured systems for detecting errors and error reports can help to improve risk management in nursing. There is a need to develop fundamental structures like national indicators of nursing quality for systematic and valid error measurements and the structured collection of nursing-sensitive outcomes at a national level.

[The WHO pilot study on Family Health Nursing in Germany: perspectives of families in need of care--a qualitative study]

In the present study families were asked about their experiences with the first Family Health Nurses (FHN) educated in Germany according to WHO's concept. This education enables nurses and midwives to provide families and individuals a low threshold access to health care services. The study's aim was to gather information on how families perceive FHN's help and whether the curriculum meets their needs. Using a qualitative approach, eight families, for different reasons all caring for a next of kin at home, were interviewed. Data analysis followed Philip Burnard's method. Families describe FHN's assistance as "care and health related activities"or "managing everyday life". Furthermore they mention "Case Management" as part of FHN's activities. FHN's support contributes to stabilise family's situation. In addition, this analysis shows that Family Health Nurses correspond to the curriculum's contents in their daily work. Altogether, families with different care related, health related, and social related needs can benefit from FHN's support. This type of professional help relieves their personal situations. Families are empowered to handle their daily living and to develop new strategies to cope with challenges in their respective life situations.

Die Übertragung des Belgischen Nursing Minimum Data Set II (B-NMDS II) auf bundesdeutsche Krankenhäuser. Ergebnisse der ersten Untersuchungsphase zum Übersetzungs- und Adaptionsprozess des Instruments

Spätestens die Einführung der G-DRGs in Deutschland hat gezeigt, dass in den Akutkliniken ein valides und reliables Instrument benötigt wird, das vergleichbare Daten zum Pflegeaufwand, den Kosten, dem Personalbedarf und der erbrachten Qualität liefern kann. Die Daten sollen von der Pflegepraxis bis hin zur nationalen Gesundheitsberichterstattung verwendbar sein und damit fundierte Aussagen für verschiedenste Akteure im Gesundheitswesen bieten. Das NMDS scheint internationalen Publikationen zufolge ein Instrument zu sein, das die geforderten komplexen Daten liefern kann. Seit 2006 wird eine Forschungsarbeit zur Übertragung des B-NMDS II auf bundesdeutsche Krankenhäuser durchgeführt. Die Forschungsarbeit gliedert sich in zwei Untersuchungsphasen. Die erste Phase umfasst den Übersetzungs- und Adaptionsprozess des B-NMDS II. In der zweiten Phase erfolgten die Datenerhebung in den Kliniken und die Datenanalyse. In diesem Artikel wird vorrangig das methodische Vorgehen der ersten Untersuchungsphase vorgestellt. Der Übersetzungs- und Adaptionsprozess des B-NMDS II erfolgt in einem mehrstufigen Vorgehen.

Familiengesundheitspflege in Deutschland: Konsensfindung als Grundlage

Die «Projektdesign- und Konsensphase zur Implementierung der Family Health Nurse in Deutschland» wurde vom Institut für Pflegewissenschaft der Universität Witten/Herdecke im Auftrag des DBfK-Bundesverbands durchgeführt. In dieser Studie sollte vor dem Beginn des «Pilotprojekts zur Machbarkeit der Family Health Nurse in Deutschland» zur Stärkung der Prävention und Gesundheitsförderung, entsprechend dem Strategiekonzept «Gesundheit 21» der WHO, in einer Konsensfindung von elf als Experten benannten Vertretern zehn entscheidungstragender Einrichtungen, Verbände und Organisationen der deutschen Versorgungsstruktur der generelle Bedarf und Umfang der neuen Rolle für Pflegende und Hebammen ermittelt werden. Ziel war es zudem, die Machbarkeit der Family Health Nurse im deutschen Gesundheitssystem vorab virtuell abzubilden. Für das methodische Vorgehen wurde ein mehrstufiges Verfahren gewählt. Die Expertenaussagen wurden in leitfadengestützten Interviews ermittelt, qualitativen Inhaltsanalysen unterzogen, deren zentrale Aussagen identifiziert und hieraus einzelfallbezogene Einstiegsszenarien zu möglichen Aufgabenfeldern der Family Health Nurse in Deutschland entwickelt. Aus den Resultaten der anschließend zu diesen Szenarien geführten Gruppendiskussionen entstanden letztendlich fünf, von den Experten konsentierte Ergebnisszenarien. Diese wurden weiter fallübergreifend generalisiert, nach den Variablen Zielgruppen, Anlass, Bedarf, Zugang, Handlungskompetenz, Ansiedlung und Finanzierung strukturiert und so die zielgruppenspezifischen Merkmale des neuen Handlungsfeldes definiert. Auf der Basis der Resultate dieser Vorstudie wurde abschließend von den Experten der Konsens zur Durchführung des Pilotprojekts ausgesprochen. Für den Begriff «Family Health Nurse» wurden für Deutschland vorläufig die Bezeichnungen Familiengesundheitspflegerin und Familiengesundheitshebamme festgelegt. Das Projekt wurde zwischenzeitlich im Frühjahr 2005 gestartet und wird entsprechend den Forderungen der WHO wissenschaftlich begleitet und evaluiert.

Die Erfassung des Pflegeaufwands bei Patienten mit der medizinischen Diagnose Myokardinfarkt. Eine deskriptive Studie

In Deutschland fehlen gut fundierte Daten zum Pflegeaufwand bei Patienten mit spezifischen medizinischen Diagnosen, um die geforderte Berücksichtigung pflegerischer Kriterien in einer G-DRG belegen zu können. Die Pilotstudie «Die Erfassung des Pflegeaufwands bei Patienten mit der medizinischen Diagnose Myokardinfarkt», die Teil eines studentischen Forschungsprojekts am Institut für Pflegewissenschaft der Universität Witten/Herdecke war, soll hierzu einen Beitrag leisten. In der deskriptiven Querschnittstudie wurde in einer Gelegenheitsstichprobe der Pflegeaufwand von 26 Patienten während ihres gesamten Aufenthalts an einer Universitätsklinik in München erfasst. Die Messungen erfolgten mit eigens für das Projekt entwickelten, standardisierten Erhebungsbogen. Alle darin aufgeführten Pflegetätigkeiten sind für die Auswertung mit den Normzeiten des LEP® hinterlegt. Die mittlere Verweildauer der Patienten liegt bei 9,5 Tagen. 73% der Patienten sind davon 2,4 Tage auf Intensivstation. Der mittlere Pflegeaufwand beträgt 32,2 Normstunden pro Fall bzw. 3,4 pro Tag und Fall. Aus Art und Höhe des Pflegeaufwands lassen sich typische Tätigkeiten sowie ein Verlaufsmuster ableiten. Die erheblichen Variationen im Pflegeaufwand und bei den Verweildauern weisen auf die Inhomogenität der Patientengruppe hin. Bei älteren Patienten und Patienten mit Nebendiagnosen zeigt sich ein deutlicher Anstieg der Pflegezeiten und der Aufenthaltstage. Bei den Hochaltrigen nimmt insbesondere im Bereich «Bewegung und Lagerung» der Pflegebedarf drastisch zu. Die Resultate dieser Pilotstudie bestärken insgesamt die Annahme, dass die medizinische Diagnose Myokardinfarkt alleine den Pflegeaufwand nicht angemessen vorhersagen und abbilden kann. Auf der Grundlage dieser Untersuchung sollten deshalb weiterführende Studien mit einer hohen Probandenzahl und über einen längeren Zeitraum erfolgen.