Search

Nursing Competence as a Developmental Task of Nursing Students in Nursing Education: A Qualitative Panel Study Abstract: Background: One of the key challenges of nursing education is to foster the development of professional nursing competency. Currently, there is a lack of empirical knowledge about nursing students' subjective educational processes to be able to specifically support them in this development. Method: To reconstruct the developmental processes of nursing students, a qualitative panel study was conducted with 26 students of the three-year nursing training in Germany. Data were collected at the end of the 1 st , 2 nd , and 3 rd year of nursing students' training through episodic interviews, and analysed using reconstructive-hermeneutical analysis (Kruse, 2015). Results: 'Developing nursing competency' was identified as one of the five developmental tasks. In the perception of the students, this development task focuses on the acquisition of medical knowledge, skills to carry out nursing actions and the ability to organise processes. In doing so, they ignore the subjective perspective of the people to be cared for. Conclusion: Through a cross-training overarching analyses, it becomes clear that nursing students do not succeed in developing a patient-oriented understanding of nursing regarding nursing competency. Hence, it must be examined whether the perspectives of the nursing students have changed due the stronger process orientation in the new legal nursing requirements.

Stress experience of teachers in nursing education: A qualitative survey Abstract: Background: Teachers in nursing operate in a special area of tension. In addition to the demands of teaching, stress factors arise out of the nature of nursing. Aims: The main question is how teachers in health care and nursing describe their professional stress experience. Supportive and stressful factors as well as coping strategies of the teachers should be identified and described. Methods: This is descriptive qualitative research. Twenty-six guideline-based telephone interviews were conducted with nursing teachers in northern Germany. After transcription these were subjected to qualitative content analysis according to 21-2Mayring (2015). Results: The teachers in nursing indicate varying degrees of professional stress. Main aspects are general conditions, high workload, misconduct and problems of students and cooperation with the collegial team and school management. The proximity to the professional field of nursing has both mitigating and reinforcing factors on the experience of stress. Conclusions: Stress experience is described by the teachers in the context of a lack of support and appreciation of professional performance. In order to maintain the high level of motivation and identification with nursing and the professionalization of nursing, and to ensure high-quality education, teachers need support in the form of solid personnel, material and space resources, as well as more visible recognition of their work.

Care in times of Corona: Results of a cross-sectional study in German home care services Abstract. Background: People in need of care are particularly affected by the COVID-19 pandemic due to their age and previous illnesses. At the same time, a large number of daily contacts between nursing staff and those in need of care increase the risk of transmission of the disease., Aim: The study aims to illustrate (I) to what extent home care services and semi-residential care facilities are affected by COVID-19, (II) human and material resources, (III) the care situation of those in need of care and (IV) the organizational handling of the situation and outline support requests to politicians., Methods: More than 12,000 home-care nursing services and semi-residential care facilities were invited to participate in an online survey with quantitative and qualitative elements, 701 nursing services (response rate 7,3 %) and 96 semi-residential facilities (response rate 3,5 %) took part., Results: Almost a third (30,1 %, 189 / 627) of the nursing services surveyed are affected by confirmed or suspected cases of COVID-19 among clients. About half of the services report a reduced use of SGB V (47,6 %, 288 / 605) or SGB XI services (59,7 %, 375 / 628). Two thirds of the semi-residential facilities (65,6 %, 63 / 96) say they are currently closed due to the pandemic. Likewise, half of the nursing services (45,8 %, 253 / 552) reported that care with reduced use of services was at risk / unstable or even not ensured., Conclusions: The results show that the situation of care-dependent people served by home-care services in the present pandemic - and also with a view to a possible second wave - should receive increased attention particularly with regard to unstable / risky care arrangements.

Long-term care during the Corona pandemic - Main results from a nationwide online survey in nursing homes in Germany Abstract. Background: As a highly vulnerable group, people in need of long-term care are particularly affected by the COVID-19 pandemic. Due to their care-dependency, measures of social distancing can only be carried out to a very limited extent. In addition, the social and health consequences of reduced contacts are particularly high for nursing home residents., Aim: The study aims to describe the extent to which nursing homes are affected, the human and material resources of nursing homes, the organizational handling of the situation, and their requests for public support., Methods: More than 7,000 nursing homes were invited to participate in an online survey with quantitative and qualitative elements. Data analysis applies descriptive statistics., Results: 824 nursing homes participated in the survey. One in five nursing homes has at least one confirmed case of SARS-CoV-2 among its residents and / or employees. The initial lack of protective equipment has now decreased, but the facilities still have to cope with additional corona-related care needs with reduced staff. Nursing homes have banned contacts between residents and relative to an extent that now has to be reduced again. Nursing homes demand the provision and external financing of protective equipment as well as the systematic and regular testing of nursing staff and the provision of uniform guidelines for action throughout Germany., Conclusions: As about half of all deceased people with COVID-19 have been living in nursing homes, the support of nursing homes in their attempt to restrict the pandemic requires highest attention.

Background: Regional dementia care networks become more and more important in the care for community-dwelling persons with dementia (PwD). However, the quality of life of PwD, served by dementia care networks, has not been investigated yet. It also remains unclear if there are differences between urban and rural dementia care networks. This study therefore aims at investigating the quality of life of PwD using this care model, also regarding possible regional differences., Methods: Within the DemNet-D-Study, PwD and their primary caregivers were interviewed using typical outcome parameters (quality of life: QoL-AD, depression: GDS, challenging behaviour: CMAI, capacities of daily living: IADL, caregiver burden: BIZA-D). In addition to these parameters, regional differences were analysed using multi-level-analysis., Results: In total, 560 PwD (79.7 years; 57.0 % female) and their caregivers participated in the study. Both self- and proxy-rated quality of life is on a moderate level. The analysis shows a sufficient explanation of the quality of life. (self: p<0.001, R2=0.493; proxy: p<0.001, R2=0.406). Higher quality of life was found for PwD living together with their care givers and for those PwD with higher capacities of daily living. Regional (urban vs. rural) differences could not be found., Conclusion: The quality of life of community-dwelling PwD using regional dementia care networks is comparable to those in other studies of outpatient dementia care. Further investigation should be carried out regarding different types of dementia care networks.

Background: Public quality reports, based on new legislative regulations of 2008, were supposed to offer potential customers the possibility to make a well-informed choice of a care provider., Aim: This empirical study on marks for long-term care is based on the public quality reports of the Medical Service of the Health Insurance Companies (MDK), of 11 884 home care services and 10 310 nursing homes, which corresponds to a comprehensive survey of almost all care providers in Germany., Method: Descriptive statistical methods and discussion of the results concerning the customer benefit., Results: The analysis of transparency reports reveals a limited value for customers, which is particularly caused by very good quality results with low scattering. In addition, a high amount of missing data - especially in the area of home care providers - leads to a growing influence of service criteria on the final grade. Though deficits in nursing might be compensated by good marks in service criteria, it rarely occurs. At present, a more detailed look at risk criteria hardly improves the customer benefit., Conclusion: The marks for nursing need to be improved to increase their informative value for the customer.

Cancer-related fatigue, a subjective feeling of a distinctive physical, emotional and/or cognitive tiredness, is a common phenomenon in patients with cytotoxic chemotherapy or radiotherapy. Research on cancer-related fatigue has been intensified in the last decade. The objective of this work was to give an overview of the effectiveness of non-pharmacological interventions for cancer-related fatigue. Therefore, the databases of the Cochrane Library, PubMed, CINAHL and DAHTA were searched for systematic reviews. Two persons independently selected the reviews and assessed the methodological quality. We used the measurement tool AMSTAR to assess the methodological quality of each systematic review. The results were summarised in a qualitative synthesis. A total of 24 reviews were included in the analysis. The results show that physical activity and psycho-social support can reduce fatigue in cancer patients. Particularly, nurse-led fatigue specific interventions proved to be effective. Currently the evidence for other intervention types is weak; however there exist some promising approaches. Despite a large number of randomised clinical trials as well as systematic reviews the evidence base is still deficient in many respects. The results can be used by nurses in clinical care, counselling and education of cancer patients.

For many decades, nurses especially in Anglo-American and Scandinavian countries have operated as «School (Health) Nurses» and have supervised children and teenagers in all health-related matters. This review applies to the question which specific tasks and roles School Nurses fulfil in these countries and which of the tasks in Germany also could be carried out by adequately qualified nurses. 34 articles were found by systematic literature search which focused on general descriptions of the roles and tasks of School Nurses. Overall, eleven central fields of duties could be identified. They included the treatment of injuries, acute and chronic illnesses, emergency care, preventive and health-promoting activities, information, education and counselling, the assessment of health-related problems and needs, the development and implementation of appropriate services as well as the fields: communication, cooperation and management of supply. With a view to the positive international experiences, the implementation of School Nurses in Germany seems to be a promising approach to promote both health and educational goals. Therefore, an additional university qualification «School Nursing» based on the existing international curricula is required.

The efficiency and effectiveness of educational programmes in the occupational field of nursing are only assessable through testing and comparing achieved learning results. In search of an appropriate diagnostic instrument, a comprehensive literature research in German-speaking countries concerning the current state of competence diagnostics in the occupational field of nursing had been conducted. Additionally, a similar research of international, professional journals had been done. The investigations lead to the result that a massive gap exists concerning national and international research of systematic, theoretically and empirically well-founded development of instruments measuring nursing competence. Finally, a conclusion for the development of instruments in nursing competence diagnostics is drawn.

Background and Objective: Support surfaces are commonly used to prevent and treat pressure ulcers. Up to now little is known about their application in Germany., Patients and Methods: We conducted a cross-sectional study using claims data of the Gmuender ErsatzKasse (GEK) for the year 2004 to analyse the utilization of support surfaces for pressure ulcers in primary care. Based on age- and sex-specific treatment prevalences for individuals with at least one prescription, prevalence ratios (PR) were calculated., Results: A total of 1999 subjects with a mean age of 63.4 years (SD: 20.7) received support surfaces for pressure ulcers. With respect to the numbers of prescriptions (n = 2421) alternating pressure mattresses (31.6%), air-filled rings (13.5%) and various seat cushions (13.0%) were used frequently, whereas foam mattresses only came to 4.7%. The treatment prevalence increases continuously with age with no sex-specific differences. Using the 50-59 year olds as a reference, men aged 90+ (PR: 43.94; 95% CI: 31.46-61.37) as well as women aged 90+ (PR: 40.61; 95% CI: 30.77-53.60) received approximately 40-times more often support surfaces for pressure ulcers., Conclusion: Support surfaces for pressure ulcers are commonly used in the elderly. Our study suggests that their application does not correspond to the best available evidence. Prevention and treatment of pressure ulcers as well as the selection of support surfaces should be seen as an interdisciplinary task.

The article examines two concepts of counselling of patients by nurses that are popular in the German-speaking area with regard to their underlying scientific standpoint and ideals and their implications on counselling-process and -result. The authors determine that both concepts disregard the biographic construction processes which are so important for coping with and tackling chronic illness. The article concludes with a discussion of prospective use of biographic diagnostics in counselling of patients with chronic illness.

This article presents the results of a qualitative empirical study of interaction between teachers and students during lessons in nursing training, focussing in particular on the perspectives of nursing didactics. It examines whether the classes warrant appropriate preparation for beginners with regard to the complex demands of professional practice. The presentation focuses on a widespread educational concept named "rule-orientation". This category summarises those communication patterns of teachers which create rules for operating in typical nursing situations and which are presented as benchmarks for professional practice. Limitations associated with this concept are (1) lacking science-based justification of those operation rules, (2) the communication of standards and recipes instead of clinical judgement, and (3) the partial resolution of intrinsically contradictious demands in nursing practice. Three nursing didactical target dimensions for nursing education are being concretised as a referential framework for class-related decisions that can contribute to better qualify nursing students for professional practice.

Present reforms and dynamics of development within the health care system have led to different health care needs and new demands on nursing. It has been assumed that in the future a number of innovative potentials and new areas of responsibility will develop. Consequently, new nursing services will also come into being which are to be located at the interface of Nursing and Public Health. Adopting the Delphi technique the Institute for Applied Nursing Research at the University of Bremen carried out nation-wide study which was aimed at experts (n = 41) representing research and development, as well as political interests regarding health and nursing-related institutions of the German health care system. Four areas of responsibility were considered most relevant for the development of new nursing services: consultancy/information work, health promotion/prevention/rehabilitation, management and co-ordination/integration/co-operation. The biggest market is expected within the area of consultancy work. The development of those four areas is closely connected with the grade of professionalisation. Additionally, linking Public Health and Nursing will include a change in the way nursing sees itself. Furthermore, nursing objectives and interventions will be altered, too.

For the last few years health politicians in Germany have passed a number of health care reform plans which have the aim to increase efficiency, effectiveness, transparency and quality in the area of health care services in order to reduce the costs of health care supply. A strategy is a shift from hospital to home. Recently passed health care measures follow this paradigm. In politics and sciences the consequences of these measures are mainly discussed for the doctors. On the basis of an analysis of Anglo-Saxon literature this article discusses the effects of health political measures on home care and asks which are the chances and possible developments for home care. The results show that home care can benefit from the developments in health care. Home care can take a central function and part in the process of change in the German health care system. Home care can take on tasks in the area of coordination of home health care and cooperation of multidisciplinary teams. Home health care must develop into a modern service profession, which takes an active part in the process of reorganisation of the German health care system.

This paper is based on the project "nursing process, standardisation and quality in nursing care" which is funded by the BMBF. This venture aims to develop and constitute a structure for recordation and documentation of nursing processes in terms of a typology and to standardise patients data for an exchange. The typology results from both the outcomes of the actual analysis of 128 patients in hospitals, homes for the elderly and community health care centers and the research on nursing classifications. The contents of the typology has been developed in co-operation with nurses working in such institutions. The structure and transfer of the data set will be realised by an IT media based network. The range of the project is regional, national and international. In this project the Bremen Institute of Industrial Technology and Applied Work Science (BIBA-ATOP) was responsible for the project management and the development of the IT based structure of the typology. The contents of the typology have been developed by the Institute of Applied Nursing Research (iap).

Language is an essential part of communication. This article focusses on the development of a professional nursing language (taxonomy). It is discussed that nurses' communication with patients is determined by verbal and nonverbal interactions. In the development of a professional nursing language, nurses will primarily rely on the verbal communication with patients, by using a patient's information that is objective and embodies observable data, that can be numerically quantified and statistically processed. This "objective" information lends itself to be systematized and classified. However, there is also the domain of nonverbal communication, the "grey" area of interaction, in which the nurse has to rely on her clinical experience when interpreting a patient's body language and symbolic interaction. This "subjective" information can be complex in its meaning and requires sophisticated professional skills in the interpretation of symbols and sounds. Nurses' clinical expertise is particularly required in this nonverbal interaction domain. Whereas physicians' prime responsibility lies in the deductive reasoning of symptoms until a medical diagnosis can be determined, nurses' prime responsibility covers the inductive reasoning of a patient's reactions to disease and illness, the observation of interaction and behaviour through which a nursing diagnosis is derived. Somewhere the medical and nursing process overlap; a physician will also pay attention to a patient's reaction to illness, whereas the nurse has to rely on her knowledge and experience of disease and impairment. It is argued that the construction of a nursing taxonomy can be no more than a means toward the goal in providing comprehensive nursing care.

This study examines the distribution, understanding and objectives of nursing visits as well as the implementation and the experience with nursing visits in 87 hospitals in North Germany (Bremen, Lower Saxony, Hamburg, Schleswig-Holstein and Mecklenburg-Western Pomerania). The survey was conducted using a questionnaire. It was found that nursing visits are implemented in 31% of the departments. By means of the nursing visit the patients are involved in the nursing process. The objectives of nursing visits are patient orientation. and the improvement of the nursing quality. The nursing visit is criticised because of both the level of organisation and the time spent on nursing visits as well as the lack of training, maintaining confidentiality and questions of data protection. The study contributes to a better understanding of nursing visits and a clearer definition of the term. It is the first empirical study of this type that has been conducted in Germany.

Over the last decades the number of breast cancer patients has dramatically increased. Attention has been drawn especially in research literature in the field of psychological medicine to the patients ' severe problems of strain and coping. In comparison to that, at least German intervention research in nursing science has to make up for lost time. This essay is, above all, a report on research literature. It summarizes study findings concerning emotional and physical problems associated with the disease and treatment for breast cancer. They result in a need for nursing care and support. Some practical conclusions for the nursing profession will be drawn in order to evolve comprehensive concepts of care both at a cognitive-emotional and tactile level of perception.

German scientists assume that new problems in nursing practice can be credited to an increasing number of accident-based long-term handicaps (Robert Bosch Stiftung 1996). This hypothesis is supported by epidemiological data as elaborated in the following article. Furthermore the critical examination of the terms "apallic syndrome" and "persistent vegetative state" leads up to the question which medical assumptions in relation to the phenomenon of the apallic syndrome are transferred to nursing. According to Feuser (1995) and for noted reason the medical perspective on the apallic syndrome appears to be similar to what can be observed in the practice of psychiatric care. This inheritance of medicine offers a new challenge to the nursing discipline which consequently will have to strengthen the own science.

Since 1991 more than 40 courses of nursing science have been established in Germany. They differ mainly in two aspects: a) they have different course contents and b) they belong to different faculties. This study focuses on two questions. (i) How is the integration of scientific knowledge proceeding? (ii) Which positive aspects and problems can be identified? For this purpose we used a questionnaire to ask heads of the faculties from all courses of nursing sciences. 32 questionnaires were returned. We have come to the conclusion that there is a broad scientific basis for courses of nursing science in Germany.

This article deals with the question of how nursing, supported by its own science, can gain benefit from natural science disciplines, if it can be presupposed that such disciplines represent one of the most important bases of nursing science. In the context of this question it is necessary to ascertain the condition, which must be fulfilled by the natural sciences in order to be able to occupy the honorable position of a cognate discipline of nursing science. This position is elucidated on the background of following aspects: The fundamental relationship between nursing science and the natural science with regard to their traditional perspectives and scientific objectives is discussed and illuminated on the background of differing concepts of body and person. In a further elaboration of this theme the particular meaning of the concept of person for nursing action is taken up and on its bases an extension of nursing issues which should be further developed is devised. In conclusion some propositions are brought up for discussion.

One important strategic feature inherent to the notion of culture is its normative potential of differentiating between "selfness" and "otherness" and of behavioural security when dealing with "others" or "otherness" (or the strange, foreign or alien), in the sense of a different culture to one's own. As a consequence, everything unknown to common sense becomes "foreign" or "strange". The idea of "otherness" and "culture" as social constructions leads to another thesis: in the context of education transcultural nursing as a subject of training cannot be merely introduced into the curriculum as a new subject that includes supposedly new factual knowledge. Moreover, established subjects should be enrichened in a way that culture as the basis of all human action and behaviour is integrated and reflected upon from the beginning. Concrete examples show the possibilities of how transcultural topics can be introduced into the conventional curriculum.

The nursing care of cancer patients has increased in complexity over the past 20 years. Cancer nurses are offering highly specialized care that is frequently delivered in teamwork in hospitals as well as in the community. Cancer nursing uses the development of nursing science and research. Nurses could not be accountable for their practice if this expert knowledge was not made accessible to them. This article focuses on nursing science as a new development in clinical nursing practice in Germany, it identifies why cancer nursing is so demanding on part of the patients, their families (significant others) and professional nurses. Research studies are discussed to demonstrate how scientific knowledge can support the nursing expert in the development of cancer nursing care, a well developed domain of nursing science.

This paper critically analyses the use of the term paradigm in nursing science. The essay consists of two main sections. The "prekuhnian" meaning of the paradigm term is described in the first section. The developments in the philosophy of science are presented in conjunction with the rise of the "antipositivist turning point" and Kuhn's historical approach with its central terms (paradigm, revolution, normal science). Some central points of criticism regarding Kuhn's approach close the first section. The second section gives attention to the application of the term paradigm in nursing science, at first describing the situation in the USA and subsequently referring to Germany. The insufficient extent of discussions on questions and problems regarding the philosophy of science is elucidated in the following criticism. The examination comes to the conclusion that the application of the paradigm term to nursing science is neither possible nor is it sensible. A brief review of the prospects for nursing science concludes the essay.

Nursing has taken important steps towards becoming a scientific discipline in Germany. The systematic registration and filing of the available literature in libraries needs to be enhanced in order to consolidate scientific infrastructures which can support activities in research, theory and international integration. In the course of teaching training studies in nursing science, a project was initiated to develop a classification system for nursing science literature at the University Library in Bremen. This article describes the genesis of the project, the basic conditions which were taken into account, the background and the developmental steps of the classification.

A combination of preliminary considerations concerning a theory of action and a philosophy of science illustrates the determining influence of the scientific preconception of the subject matter, and of the approach which is presupposed by this preconception, on the normative orientation of nursing practice. The specific physical nearness involved in nursing practice ("body to body") holds problems with regard to an appropriate theoretical frame of reference and corresponding practical convictions. This background provides the context for a concluding critical examination of several representative nursing theories with regard to their implicit, normative premises.

The debate about quality and quality assurance has a long tradition in the market economy. New in the Federal Republic of Germany, however, is the debate about "quality" in the human services sector: in medical and nursing care, in hospitals and the community, in the health service. This discussion presents practising professionals, politicians and scientists with a number of unsolved problems. This is especially so in defining quality but also in developing, implementing and evaluating appropriate instruments of quality assurance. Quality is far more than what is intended by legislation-economy, productivity and competition- and often conflicts with these expectations. As a consequence, the process of discussion about defining quality turns out to be vague and contradictory rather than systematic, especially since quality cannot be seen as a static component but must be explored as a dynamic element. It is high time to start a critical debate about the concept of quality and current methods of quality assurance.

The current discussion about the moral legitimacy of euthanasia is primarily concerned with the question of to what extent passive and active forms of euthanasia (limited legalized practice in the Netherlands) can actually be distinguished from one another. From a nursing perspective this passive/active distinction appears in a completely different way: with regard to varied conditions which would have to be fulfilled to favour another "culture of dying", in which the desire to terminate life no longer appears as the drastic alternative to a principally curative or maximum therapeutic oriented care system for the afflicted. For this purpose, new orientations within the nursing professions which equally combine instrumental, psychosocial, institutional and educational aspects, are necessary. Applied to problems of euthanasia, questions of a fundamental ethical structure in nursing appear within an enlarged framework.