Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

Nursing science as an academic discipline in Germany is still developing and has not yet been sufficiently integrated into acute hospital care. The aim of this paper is to analyze the key challenges of nursing research in acute hospital care and to develop strategic solutions to strengthen the development of nursing science in Germany. The results of a two-day scoping workshop with national and international experts indicate that the lack of structural integration of nursing science into clinical care, the low number of academically qualified nursing professionals, and insufficient research funding are major obstacles to further development. Based on a SWOT analysis, six priority action areas were identified: (1) development and implementation of qualification and career programs, (2) promotion of clinician scientists, (3) strengthening visibility and communication, (4) effective political participation, (5) increase of research funding, and (6) improvement of networks and collaborations. The implementation of these strategies will contribute to establishing nursing science as an independent discipline, increasing its societal relevance, and promoting evidence-based nursing practice in inpatient acute care. Close collaboration among academia, policymakers, and practitioners is essential for achieving these goal.

Using real-world data (RWD) for comparative effectiveness research has gained increasing attention. Real-world data is usually not collected with the primary aim of answering questions about the comparative effectiveness of medical interventions. Therefore, data collection is often not optimally designed for this purpose. For this reason, using it can be associated with several data-related or analysis-related problems. This article has two aims: First of all, we will outline the basic requirements for comparative non-randomized studies based on RWD. In addition, the advantages and disadvantages of potentially eligible RWD in Germany will be considered. In particular, the use of registry data will be discussed, as these currently appear to be the most suitable for comparing the effectiveness of interventions. There are now various databases in Germany that contain RWD and can potentially be used for comparative effectiveness research. If they contain all the necessary information and if the data are of sufficient quality, they could offer a timely and efficient way of determining the effectiveness of medical interventions. However, our analysis shows that the use of this data is sometimes associated with considerable limitations. RWD is often highly aggregated and thus may not be sufficiently detailed to select the subjects precisely or to emulate the intervention or control interventions satisfactorily. In addition, many data sources only encompass a limited set of variables and limited time horizons (e.g., only hospitalization) according to their intended purpose (e.g., billing). Therefore, it is often questionable whether this includes all endpoints on benefit and harm that are important for the assessment and whether sufficiently long observation horizons/follow-up periods are given. Similarly, it is often questionable whether all necessary data to avoid bias are included. Furthermore, it is often difficult to assess suitability in advance due to the lack of available information.

Introduction: The new Nursing Professions Act has been in force in Germany since 2020. Since then, general nursing training has been implemented. The reform of nursing training was the subject of controversial debate beforehand. Concerns were raised about inadequate preparation for different care sectors and settings. As a result, it is possible to choose specialized vocational qualifications in addition to the general nurse training. The article addresses how trainees are currently trained to meet the requirements in nursing and whether specialized vocational qualifications are chosen.

Methods: The article presents the results of an accompanying scientific research project (2021-2024). In this mixed methods study, a convergent parallel design was applied. The article is based on 80 guideline-based interviews with vocational trainers. Additionally, trainees were surveyed online in a longitudinal cohort study with three survey waves.

Results: Few of the institutions represented in the sample offer the specialized vocational qualifications. Where an offer exists, trainees make little use of it. Trainees feel that the nursing training does not prepare them equally well for the different care areas.

Discussion: The qualitative and quantitative findings demonstrate that general nursing training and the general vocational qualification are the preferred choice. Many vocational trainers consider general nursing training to be appropriate in order to meet the complex care requirements.

Conclusion: In particular, the practical part of the general nursing training must provide a more appropriate representation of care-oriented pediatric care settings. In order to cope with the fundamental transformation associated with generalistics, further training programs need to be established that adequately qualify future nurses.

Introduction: Digital transformation in healthcare is both a unique opportunity to improve care services and a significant challenge for legislation, stakeholders and all citizens. eHealth literacy (eHL) describes an important set of competencies when dealing with digital health information. Therefore, health insurance funds in Germany received the mandate to promote eHL among their policy holders. However, to date little is known about eHL in the German population and its potential determinants. Therefore, the aim of this study was to assess eHL in a sample of patients after their hospital stay and to explore potential sociodemographic determinants.

Methods: A cross-sectional, self-report, online survey study was conducted with a subgroup of a nationally representative sample in Germany using the revised eHealth Literacy Scale (GR-eHEALS). Market research providers were commissioned with the recruitment and data collection of 1,000 participants. Descriptive and bivariate analyses were computed.

Results: Overall, comparatively high scores were reported for eHealth literacy. Significant differences in eHL were found regarding age, sex, and educational background. Participants aged between 38 and 67 years had significantly higher scores than the under 27-year-olds. Female participants reported higher levels of eHL than male participants. Further, a higher level of educational attainment was related to a higher level of eHL. The native language (German) and the actual employment status were unrelated to eHL.

Discussion: Previous studies showed inconsistent results regarding the potential determinants of eHL. Our results provide further data on eHL in the German population and underscore the importance of age, sex, and education for eHL. Stakeholders such as health insurance funds should therefore pay particular attention to these determinants in order to fulfil their legal mandate to promote eHealth literacy.

Conclusions: Our results provide an assessment of the status quo of eHealth literacy among a subgroup of the general population in Germany, which can inform both legislators and health insurers about important determinants affecting the development and design of technical health products.

Background: Multimorbidity is a common health problem among patients treated in GP practices and often associated with an increased risk of hospitalization. The aim of this review was to identify GP-based interventions to reduce hospitalization in patients with multimorbidity who were evaluated in randomized controlled trials.

Methods: For the rapid review, the databases Medline and CENTRAL were systematically searched for randomized controlled trials evaluating an effect of GP-based interventions on the duration or frequency of hospitalization in adult patients with multimorbidity living at home. The interventions and their effects were described narratively.

Results: From 2,260 hits in the database searches, 15 studies could be included. The interventions identified included, amongst others, interdisciplinary cooperation, training of GPs and other practice staff, and increased patient centeredness. Hospital admissions were reported in 13 studies, and the number of days spent in hospital was reported in six studies. Two studies found a significant reduction in hospitalization.

Conclusions: While most interventions were not effective, there were also two GP-based interventions for patients with multimorbidity which focused on the patients' individual situation and contributed to avoiding hospitalization. However, more studies are needed to make reliable statements on the effectiveness of various measures.

Background: Stepped-care approaches can improve the support for the bereaved. This requires the selection of interventions according to individual support needs. Grief counsellors are in a position to identify bereaved persons possibly suffering from a psychological disorder and to refer them to psychotherapeutic or medical treatment. However, it remains unclear what knowledge regarding psychological disorders and which skills grief counsellors need for this task.

Method: We conducted an online Delphi consensus study with 17 experts of grief counselling in three consecutive survey rounds. The first round qualitatively identified the required knowledge regarding psychological disorders and the respective skills. In the subsequent rounds, the experts rated the topics concerning their relevance, whether they should be part of a training curriculum and whether they are adequately considered in current curricula. Descriptive analyses were applied. Consensus was reached if at least 50 % of the experts rated a topic as rather relevant, and 80 % endorsed the topic for a training curriculum. Expert comments were used to generate recommendations that were evaluated for consensus.

Results: The qualitative analysis identified 39 topics, and 26 reached a consensus. Of these, six referred to "knowledge about grief", five to "knowledge about psychological disorders", and 15 to professional, interpersonal, and relationship and communication skills. Experts' opinions on whether sufficient consideration is given to these topics in current curricula varied greatly between the topics.

Discussion: The experts reached a consensus regarding the areas of knowledge about psychological disorders and the specific skills to be taught. At the same time, there appears to be a high degree of heterogeneity between the various training and continuing education programmes with regard to imparting knowledge to identify the need for therapeutic support.

Conclusion: The present recommendations can be used to inform and optimise the content of training curricula for grief counsellors with regard to the identification of bereaved persons with increased therapeutic support needs.

Introduction: Patient involvement is essential for relevant, feasible, and transparent research. In recent years, generic patient advisory boards (PAB) have been increasingly established in Germany to involve patients across different projects in primary care research. One of those PABs is localized at Witten/Herdecke University as part of the North-Rhine Westphalian General Practice Research Network (NRW-GPRN). This manuscript evaluates the impact of involving the NRW-GPRN PAB into research projects, the patients' experiences with involvement activities, and conditions required for the work of the PAB.

Methods: The concept for the NRW-GPRN PAB was developed on the basis of the literature and expert discussions. PAB members were, inter alia, approached via local notices and directly by general practitioners. Since 2021 the PAB meetings have taken place twice a year and are evaluated using a short, written questionnaire. In addition, there is an oral feedback round and debriefings by the scientific coordinators. The scientists contributing their projects subsequently report on the changes that have been made due to the PABs' contributions. The findings from the written and oral evaluations are discussed together after analysis in order to draw implications for possible adjustments to PAB activities.

Results: The NRW-GPRN PAB comprises eleven persons; seven of them are female and most are 50 years or older. So far, six meetings have taken place with an average of six participants, where the contents of eight different projects have been discussed. During all sessions, patients were at least involved as advisors. The contributions of the PAB led to changes in all projects. Based on 38 written evaluations, the majority of the PAB members (n = 29) thoroughly enjoyed the meetings. The research topics, the diverse perspectives and the appreciative interaction were highlighted as particularly positive aspects.

Discussion: The involvement activities are experienced positively by both PAB members and scientists. By reflecting on the meetings together, it was possible to adapt the structure of the PAB meetings to accommodate the members' needs. This joint process may also have had a positive effect on their respectful cooperation.

Conclusion: Involving a generic PAB across projects is feasible. In the future, the impact of involvement activities on research processes will have to be examined even more closely. Also, there is a need to develop strategies to promote more diversity among PAB members.

Introduction: Traditional role models or scandalous reports revealing poor working conditions have left their mark on the nursing profession in Germany. In order to make nursing a more attractive profession to young people and to create a sense of professional pride for members of the nursing profession, we need to focus more on its positive aspects. Children with hospital experience were invited to participate in a painting competition to counter visual stereotypes. "Nursing through a child's eyes" can provide a subjective view of the nursing profession based on individual experiences.

Methods: The pictures that children created during the painting competition were analysed qualitatively. The paintings were described and interpreted by independent peer groups in a four-step procedure.

Results: A total of 42 paintings from five university hospitals were included in the analysis. Paediatric specialties with a focus on surgery, oncology and internal medicine participated. The pictures showed typical nursing activities in the areas of communication, support, organisation, technology and basic needs. Nurses were portrayed as technically experienced and pleasantly reserved. In addition, symbols such as hearts, smileys or rainbows suggest associations with attention, emotional support or hope.

Discussion: Children with hospital experience painted a positive and modern professional image of the nursing role. In some pictures, the typical visual features allowing a clear assignment to the nursing profession are missing.

Conclusion: The stereotypes of the nursing profession should be replaced with a modern and realistic, counter-stereotypical narrative in the visual presentation. The perspective of children with hospital experience demonstrates that there are numerous, often invisible aspects that give reason to be proud of being a nurse.