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Aim. This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs’ interventions and the consequences of violence for different professions are investigated. Background. There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses’ experiences and single interactive factors between staff and patients/visitors involved. Design. A cross-sectional survey. Method. The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. Findings. Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. Conclusion. To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

Title. Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison. Aim. This paper is a report of a study to examine the psychometric properties of the Care Dependency Scale for Paediatrics in Germany and Egypt and to compare the care dependency of school-age children in both countries. Background. Cross-cultural differences in care dependency of older adults have been documented in the literature, but little is known about the differences and similarities with regard to children’s care dependency in different cultures. Method. A convenience sample of 258 school-aged children from Germany and Egypt participated in the study in 2005. The reliability of the Care Dependency Scale for Paediatrics was assessed in terms of internal consistency and interrater reliability. Factor analysis (principal component analysis) was employed to verify the construct validity. A Visual Analogue Scale was used to investigate the criterion-related validity. Findings. Good internal consistency was detected both for the Arabic and German versions. Factor analysis revealed one factor for both versions. A Pearson’s correlation between the Care Dependency Scale for Paediatrics and Visual Analogue Scale was statistically significant for both versions indicating criterion-related validity. Statistically significant differences between the participants were detected regarding the mean sum score on the Care Dependency Scale for Paediatrics. Conclusion. The Care Dependency Scale for Paediatrics is a reliable and valid tool for assessing the care dependency of children and is recommended for assessing the care dependency of children from different ethnic origins. Differences in care dependency between German and Egyptian children were detected, which might be due to cultural differences.

Aim. This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients.Background. Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should share the same understanding of the concept. The current research about care dependency has focused on external assessment by nurses and suffers from a tendency to use the concept with different meanings. As a consequence, research on dependency may capture different phenomena.Method. Walker and Avant's method for concept analysis served as the guideline for this study. The Medline, CINAHL and Cochrane databases were searched for the period 1996-2006 using the terms dependence, dependency, care dependence and care dependency.Results. Care dependency can be defined as a subjective, secondary need for support in the domain of care to compensate a self-care deficit. Functional limitations are a necessary antecedent and unmet needs are a possible consequence of care dependency. The conceptual difference between care dependency, functional limitations and unmet needs may be meaningless for study participants. They may better understand these differences if they are asked about all three phenomena in the same investigation.Conclusion. Care givers and care recipients can agree on the suggested attributes of care dependency but may judge them in different ways. Self-assessed care dependency has the potential to challenge preconceptions of care givers about care dependency.

Journal of AdvancedNursingEffect of non-response bias in pressure ulcer prevalence studiesAim. This paper reports a study to determine the prevalence of pressure ulcers inGerman hospitals and nursing homes for national and international comparison,and analyses the influence of non-response bias.Background. Outcome rates are often used to evaluate provider performance. Theprevalence of pressure ulcers is seen as a possible parameter of outcome healthcarequality. However, the results from different pressure ulcer prevalence studies cannotbe compared, because there is no standardized methodology and terminology.Observed and published prevalence rates may reflect variations in quality of care,but differences could also relate to differences in case-mix or to random variation.Methods. A point prevalence survey was carried out for 2002 and 2003 using datafrom 21,574 patients and residents in 147 different kinds of institutions throughoutGermany. Participation rates and reasons for not participating in the study weredocumented. Non-responders were considered in different calculations to show therange of possible prevalence rate for a hypothetic 100% participation.Results. In 2002 and 2003, the calculated prevalence rate (among participating per-sonsatrisk)inhospitalswas25AE1%and24AE2%respectively,whileinnursinghomesitwas 17AE3% and 12AE5% respectively. Non-response varied from 15AE1% to 25AE1%.Themajority of non-responders in hospitals and nursing homes had not been willing toparticipateinthestudy.Basedondifferentassumptionsaboutthecharacteristicsofthenon-responders, we calculated minimum and maximum prevalence rates as if 100%participation was achieved.Conclusions. Calculating the non-response bias of prevalence rates is an incon-venient but necessary thing to do because its influence on calculated prevalence rateswas high in this study. High participation rates in clinical studies will minimize non-response bias. If non-response cannot be avoided, the formula provided will helpresearchers calculate possible minimum and maximum prevalence rates for the totalsample of both the responding and non-responding groups.Keywords: Germany, non-response bias, nursing, point prevalence survey, pressureulcers, prevalence

This paper reports an investigation of the diagnostic accuracy of the Care Dependency Scale (CDS).Assessment tools can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy can be determined by several techniques as sensitivity, specificity, receiver operating curve analysis and likelihood ratios.A cross-sectional design was used with data from 237 patients from two studies. Data were collected using a questionnaire consisting of the CDS and the Barthel Index (BI). The CDS is a relatively new instrument and should be validated by comparison against an established gold standard, in this case the BI. Measures to quantify the validity of diagnostic tests, such as sensitivity, specificity, positive and negative predictive values, prevalence and likelihood ratios were calculated. In addition, the receiver operating characteristics (ROC) curve analysis was used to report the test accuracy of the CDS and to determine an appropriate cut-off point for care dependency detection.The prevalence in the sample study was very high (84%). The area under the ROC curve for the CDS was 0.81, which indicates moderate diagnostic accuracy. Patients with a CDS sumscore/=68 (rule-out cut-off point) were classified as care dependent, all others as independent. The determination of the appropriate cut-off point was based on sensitivity (0.85) and positive predictive valued (0.90).The CDS may be used for to estimate care dependency among hospital patients with various conditions.

Aim. This paper describes a systematic review of the predominant non-somatic effects of patient assault on nurses. Background. Patient aggression towards nurses is a longstanding problem in most nursing domains. Although reports on the consequences of physical aggression are more numerous, the non-physical effects create much suffering. Method. A systematic review of literature from 1983 to May 2003 was conducted using the Medline, CINAHL, PsychINFO and PSYINDEX databases. Articles from international journals in English or German and reporting at least three non-somatic responses to patient aggression were included. Findings. The electronic search produced 6616 articles. After application of the inclusion and exclusion criteria, 25 texts from eight countries and four domains of nursing remained. Twenty-eight main effects were found, and these were categorized using a system suggested by Lanza and including bio-physiological, emotional, cognitive, and social dimensions. The predominant responses were anger, fear or anxiety, post-traumatic stress disorder symptoms, guilt, self-blame, and shame. These main effects occurred across most countries and nursing domains. Conclusion. Despite differing countries, cultures, research designs and settings, nurses’ responses to patient aggression are similar. Standardized questionnaires could help improve estimations of the real prevalence of non-somatic effects. Given the suffering caused by non-somatic effects, research should be aimed at preventing patient aggression and at developing better ways to prepare nurses to cope with this problem.

Background. The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument. Aim. The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK). Method. The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients. Results. High alpha coefficients between 0.94 and 0.97 were obtained. Subsequent test-retest and interrater reliability revealed moderate to almost perfect kappa values. Conclusion. One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.

AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated.There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved.A cross-sectional survey.The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised.Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion.To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

The present study focuses on the characterization and perception of patient aggression by nurses working in a psychiatric hospital in The Netherlands. Data have been collected by interviewing nurses working on open and closed wards. The results have been compared and related to the existing literature on aggression. An expert panel has collaborated in the assessment of part of the research findings. Nurses perceive and describe aggression in different ways. Since the descriptions of aggression varied considerably, it was not possible to formulate a general definition of aggression on the basis of the results of the study. Despite the fact that on the whole the general public have a negative view of aggression, the descriptions nurses gave were not always negative. Most of the nurses acknowledged positive as well as negative aspects of aggressive behaviour by patients. Interventions in cases of aggressive behaviour depend on different factors, e.g. the individual nurse's perception of the situation, the (mostly unwritten) rules, and the type of ward (open or closed). The same interventions are often used both to prevent aggression and to stop it. The difference lies in the moment of execution. Most interventions are aimed at stopping aggressive behaviour by acting in a non-restrictive way, e.g. by talking to the patient, touching the patient and giving unexpected responses. Nurses express the belief that aggression is mainly caused by a combination of patient-related, situational and interactional factors. This is not in accordance with the opinion of the North American Nursing Diagnosis Association, who relate aggressive behaviour mainly to patient characteristics.

AIM: This paper is a report of a study to develop and test the psychometric properties of a scale measuring nursing students' performance in de-escalation of aggressive behaviour. BACKGROUND: Successful training should lead not merely to more knowledge and amended attitudes but also to improved performance. However, the quality of de-escalation performance is difficult to assess. METHOD: Based on a qualitative investigation, seven topics pertaining to de-escalating behaviour were identified and the wording of items tested. The properties of the items and the scale were investigated quantitatively. A total of 1748 performance evaluations by students (rater group 1) from a skills laboratory were used to check distribution and conduct a factor analysis. Likewise, 456 completed evaluations by de-escalation experts (rater group 2) of videotaped performances at pre- and posttest were used to investigate internal consistency, interrater reliability, test-retest reliability, effect size and factor structure. Data were collected in 2007-2008 in German. FINDINGS: Factor analysis showed a unidimensional 7-item scale with factor loadings ranging from 0.55 to 0.81 (rater group 1) and 0.48 to 0.88 (rater group 2). Cronbach's alphas of 0.87 and 0.88 indicated good internal consistency irrespective of rater group. A Pearson's r of 0.80 confirmed acceptable test-retest reliability, and interrater reliability Intraclass Correlation 3 ranging from 0.77 to 0.93 also showed acceptable results. The effect size r of 0.53 plus Cohen's d of 1.25 indicates the capacity of the scale to detect changes in performance. CONCLUSION: Further research is needed to test the English version of the scale and its validity. Language: en

Aim. This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case-control studies. Background. People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies. Data sources. The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007. Review methods. A systematic review was conducted. Cohort or case-control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality. Results. Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density. Conclusion. There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed. Language: en

Aims. The aim of this paper is to report a psychometric evaluation of the Hendrich Fall Risk Model. Background. Thoroughly developed and tested instruments for assessment of fall risk are needed to identify patients at risk of falling, to enable the implementation of preventative measures. Method. Data from 1977 patients/residents in 45 nursing homes and 7197 patients from 47 hospitals were evaluated in a cross-sectional survey. The internal consistency of the Hendrich Fall Risk Model was examined using the Kuder–Richardson Test. The dimensions of the model were revealed by exploratory factor analysis and the Care Dependency Scale was used to investigate construct validity. Using Spearman Rho the sum of weighted items was correlated with the sum of unweighted items to obtain information about the practicability of a weighted total score. The study was carried out in 2003. Results. The internal consistency of the model was not high (α = 0·54). Additionally, factor analysis showed that the model had more than one dimension. The correlation between the fall risk model and Care Dependency Scale was quite high for hospital patients and the total group (Spearman Rho = −0·71 or −0·76 respectively, P

The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument.The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK).The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients.High alpha coefficients between 0.94 and 0.97 were obtained. Subsequent test-retest and interrater reliability revealed moderate to almost perfect kappa values.One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.

Most studies of the problems and information needs of patients describe these only for the period of hospitalization. In this study, however, the authors focused on the first 6 months after discharge. Eighty-two cardiac patients, admitted to a university hospital with a myocardial infarction (MI) or for coronary artery bypass surgery (CABS), were interviewed 6 months after discharge. Questions required them to describe problems they experienced in early recovery and what information they needed. All but one of the 82 patients stated they had experienced problems during the first 6 months after discharge. Most problems described concerned: emotional reactions (59%), their change in physical condition (59%), deleterious effects of treatment (56%) and convalescence (54%). Topics on which most patients needed additional or different information were: deleterious effects of the treatment (26%), physical condition (24%), risk factors (24%), convalescence (24%) and knowledge of the disease (24%).

Recently, the relationship between theory and research has received more attention. It seems that in the past 10 to 15 years more research studies have been published that are more or less conceptualized within (nursing) theories. However, it is not always clear how the theory has been used. The purpose of this study was to analyse the role of theory in nursing practice research. To this end, papers published in six nursing journals between 1986 and 1990 have been studied. It can be concluded that, in comparison with earlier analyses, the use of theories in nursing research studies has increased (from 13% to 21%), but the use of nursing theories has not become more frequent. However, the testing of nursing theories is minimal. On the other hand, research results are being cumulated progressively in regard to theory or to other research.

This article presents the results of a national survey among intensive-care nurses, establishing whether male nurses and female nurses can be distinguished with respect to issues such as professionalization, career orientation and their preference for technical departments. The study showed that there is an over-representation of men in technical wards. At IC/CC-units the percentage of male nurses is twice as large as in the hospital as a whole (IC/CCU included). The distribution of labour among male and female nurses is taking place according to traditional sex-specific role patterns. Male nurses are more oriented towards professionalization than female nurses. Male IC-nurses see their jobs more in a medical perspective and they also show a higher frequency in the performance of medically reserved activities. Male IC-nurses seem to be particularly directed at upgrading their own profession. The differences between male and female nurses can also be explained by culturally determined differences between men and women regarding their own career perspective and career development, as well as by internal staff policy.