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Influence of digital documentation on working hours and workflow in the intensive care unit: An observational pre-post-study Abstract: Background: The introduction of digital patient documentation systems in hospitals and intensive care units is increasing in Germany. The effects of these systems on the workflow of nurses have hardly been studied. Aim: It is analysed how high the workload is with a digital documentation system compared to paper-based documentation, how the workflow changes and how the digital documentation is evaluated in comparison to paper-based in terms of usability, time required and documentation quality. Methods: Before (to) and after the introduction of the digital patient documentation system (t1), the time for documentation and the documentation frequency was measured in a prospective pre-post observation study using an app configured specifically for this purpose, and both survey periods were statistically compared (Mann-Whitney-U-test). Furthermore, a survey of nursing staff on digital patient documentation was carried out. Results: The working time for the documentation remains the same after digitization. However, 80% of respondents state that the documentation time would have been reduced. Furthermore, the number of documentation processes decreases significantly (p = 0.03). In addition, a majority (55%) indicated an increase in documentation quality. Conclusions: Digital patient documentation does not necessarily save working time, but it defragments the process of documentation work and has the potential to positively influence the documentation workflow.

Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development Abstract. Background: Nursing handovers are considered high-risk tasks but are also an important resource for conveying pertinent insights in the patients' situation and engaging them in the care process. As part of a broader action research project, a participatory approach was used to implement bedside handovers. Aims: It seemed central to sustainable change to gain insights which underlying factors motivate nurses to change handover practices. Methods: A qualitative design was chosen, in which five exploratory interviews were conducted with nurses. Results: The biggest challenges are privacy concerns and dealing with cognitively impaired patients. The motivations for bedside handover are a less error-prone transfer of information and a more accurate impression of the patient, in addition to a patient contact which is experienced as valuable. Discussion: The change in handover structure is accompanied by changes in the ward culture. The challenges faced by the staff require high communication skills to bridge them. The main factor for the preference of the handover form is the effect on the patients. Limitations: Transferability is limited due to the high contextual relevance. Transfer: With the help of a structured implementation strategy, even rituals can be modified. The bedside handover has a beneficial influence on patient-centredness.

User-oriented needs assessment of the potential use of assistive robots in direct nursing care: A mixed methods study Abstract. Background: So far, hardly any robots have been used in nursing that take over patient-related activities and thereby reduce the physical strain on the caregivers. Using user-centered design approaches, the interdisciplinary project "PfleKoRo" was therefore developing a robotic assistance system that can be used in the direct care of bedridden patients requiring intensive or very intensive care. Aim: The aim of this study was to identify nursing activities with the greatest support potential for an assistant robot for the direct care of bedridden patients. Method: Focus groups (n = 3) with nursing professionals (n = 14) from acute and long-term care were conducted first in an explorative mixed method design and then evaluated by means of content analysis. A selection of nursing activities was then prioritized by the participants of the focus groups (n = 10) with regard to their potential for support from an assistant robot in a standardized survey. Results: The highest priority was given to turning and holding patients in a lateral position as well as holding their legs in order to perform nursing tasks. Further support was needed, among other things, for repositioning the patient to the head of the bed and for tasks such as the transfer of patients. Conclusion: Turning patients and holding them in a lateral position as well as holding the leg are seen as target activities with the greatest support potential for "PfleKoRo", presenting the starting point for further development.

Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.

Background: The Disaster Preparedness Evaluation Tool (DPET) with 47 items was developed to assess the disaster preparedness level among nurses in the USA. Aim: This study aimed (1) to adapt and validate the DPET for the nursing context in Germany and (2) to perform its psychometric evaluation. Methods: The DPET items were translated to German (DPET-GER). Adaptation was performed to identify irrelevant items and content validity was estimated using the scale-level content validity index (S-CVI) based on expert ratings. Psychometric evaluation was performed based on data from an online survey of 317 nurses. Internal consistency (Cronbach's alpha) and factor structure were assessed with an exploratory factor analysis. Results: Ten items were unanimously rated as irrelevant by four experts and removed. Based on ratings by further seven experts, the content validity of DPET-GER was low for all 37 items (S-CVI of 0.53) or moderate for 19 items rated as relevant (S-CVI of 0.74). The internal consistency of DPET-GER was high (Cronbach's alpha of 0.94) and 37 items were reduced to five factors that explain 55% of variance in all items. Conclusions: The DPET-GER has acceptable psychometric properties (internal consistency and factor structure). However, low content validity indicates that further adaptation of the DPET-GER is required before it could be used to assess disaster preparedness among nurses in Germany. More research is also needed to contextualize the construct of disaster preparedness.

The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital Abstract: Background: With a prevalence of 12-64%, delirium is a common complication in acute care, associated with negative outcomes such as increased mortality and prolonged length of stay. Many hospitals have guidelines to improve the delirium management. The Delirium Observation Screening Scale (DOS) Score is collected in the study hospital from all patients ≥ 70 years at each shift for at least 3 days. Delirium is diagnosed by a physician and coded according to ICD-10. Purpose: Evaluation of the delirium screening with the DOS according to internal guideline in terms of number of DOS assessments performed, prevalence of delirium (DOS score ≥ 3 points, CD-10 code delirium). Method: This retrospective quantitative single-centre longitudinal study used 2017 and 2018 data of 10046 cases. Statistical analysis methods were used to analyse prevalence of delirium and subgroup comparisons. Results: At least one DOS score was documented in 92% of cases aged ≥ 70-years (n = 5038). DOS implementation varied between 60% in the early, 49% in the late and 38% in the night shift. The prevalence of delirium was 12% according to DOS score ≥ 3 and 4% according to physician diagnosis of a delirium. Cases with a DOS score ≥ 3 were significantly older, more often female, had more comorbidities and were depressed. Conclusions: DOS is performed in most patients when indicated. The DOS implementation frequency varied depending on the shift.

Background: Nursing home (NH) staff, general practitioners (GPs) and specialist outpatient palliative care teams are expected to cooperate to ensure adequate palliative care for NH residents in Germany. Aim: The aim of this study was to investigate the perspective of NH executives concerning collaboration with GPs and specialist outpatient palliative care teams. Methods: We conducted semi-structured telephone interviews with executives of NHs in the federal state of Baden-Wuerttemberg, Germany. Interviews were analysed by means of structured content analyses. Results: Executives of 20 NHs participated in the study, eight NHs cooperate with specialist outpatient palliative care teams. Content analysis resulted in two main categories: 'general palliative care by primary carers' and 'collaboration with SAPV in NHs', each with three first-order subcategories. The main barriers to adequate palliative care were reported to be lack of palliative care knowledge in GPs and NH staff, refusal of some GPs to cooperate with specialist outpatient palliative care teams and staff shortage in NHs. Specialist palliative care involvement was described to result in improved palliative care. Conclusion: Solutions seem obvious, e.g., further education in palliative care or round tables to discuss collaboration. However, studies show that even comprehensive educational and management interventions to implement palliative care do not always result in long-term effects and further research is needed.

Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study Abstract. Background: Numerical assessment instruments allow foreign language patients to quantify their pain. However, for a complete assessment of the pain situation, the description of pain quality is also important. Problem: To assess pain quality completely, the treatment team lacked a tool. Objective: Foreign language-speaking patients can communicate their pain to the treatment team and are actively involved in the treatment process. The treatment team develops tools for recording the quality of pain and reflects on their experiences. Method: In a practice development project, pictograms of the Iconic Pain Assessment Tool 2 (IPAT2) where chosen to assess pain quality. The pictograms were prepared for everyday use, tested, and evaluated. Results: With the help of pictograms, quality of pain of 72 patients was documented almost 50% more frequently than before the study. The nursing team experienced IPAT2 as helpful in obtaining information and deepening the quality of the relationship. A feeling of being seen and understood emerged. Discussion: Pictograms are a valid method for nonverbal pain assessment. However, there is a risk of misunderstanding. The study only allowed an external assessment of patient's perceptions. An empirical investigation of the patient's view would be desirable. Conclusions: Further use and development of pictograms for communicating with foreign language-speaking patients are recommended.