Cornelia Heinze

Zusammenfassung. Die notwendige, intensive Entwicklungsarbeit für die Pflegeausbildungen ab 2020 stellt auch die Lehrenden und Praxisanleitenden im Land Berlin vor enorme Herausforderungen. Das Projekt CurAP der Berliner Senatsverwaltung verfolgt einen partizipativen Ansatz: Lehrende und Praxisanleitende erhalten in vielfältiger Form die Möglichkeit, gemeinsam und im Austausch die Pflegeausbildung neu zu denken.

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“.

Aims and objectives. 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.Background. 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.Design. 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.Results. 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.Conclusions. 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.Relevance to clinical practice. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

Accurate and precise diagnosis and classification of pressure ulcers is important in clinical practice and research. In the planning phase of a cohort study 14 data collectors were trained according to the classification of the European Pressure Ulcer Advisory Panel (EPUAP). Interrater reliability and agreement was measured using 20 images of the pressure ulcer classification CD (PUCLAS). Across all categories values varied between 0.36 (95 percent CI 0.32 to 0.40) and 0.54 (95 percent CI 0.49 to 0.58). Highest values of interrater reliability and agreement were measured for the categories "Pressure ulcer grade 4", "Pressure ulcer grade 2", and "Blanchable erythema". Low values were measured for the categories "Other lesion" and "Incontinence lesion". Interpretation and transferability of these results into practice is limited due to low prevalence of some categories, artificial assessment conditions and due to small sample sizes. More efforts must be made to further improve interrater reliability and agreement.