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P Kutschar,1 S Berger,1 A Brandauer,1 N Freywald,1 J Osterbrink,1,2 D Seidenspinner,3 I Gnass1 1Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; 2Brooks College of Health, University of North Florida, Jacksonville, FL, USA; 3Nursing Science and Practice Development, University Hospital of Munich-Großhadern (LMU), Munich, GermanyCorrespondence: P KutscharInstitute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, Salzburg 5020, AustriaTel +43 662 80 344Email patrick.kutschar@pmu.ac.atPurpose: Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016– 2018).Participants: Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included.Intervention: In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses.Methods: Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10– 30) using self-report instruments or observed (MMSE 0– 9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥ 2) on the Pain Assessment in Advanced Dementia (PAINAD).Results: Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10– 30) and logistic regression (n=222 residents, MMSE 0– 9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p< 0.01), decreased with a better quality of life (B=− 0.07, p< 0.001), and was lower when dementia diagnoses were present (B=− 1.12, p< 0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p< 0.05).Conclusion: While no significant positive intervention effect was measured, findings suggest nurses’ raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.Keywords: nursing home residents, pain management, nurse-related intervention, nursing education, cognitive impairment, dementia

Background: Studies show that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent and how drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review is to identify studies addressing drug-based pain management for people with dementia who have had a hip or pelvic fracture for which they had either an operation or conservative treatment. We will analyse to what extent and how the drug-based pain treatment for people with dementia is performed across all settings and how it is assessed in the studies. Methods: The development of this systematic review protocol was guided by the PRISMA-P requirements, which will be taken into consideration during the review procedure. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect will be searched, using keywords such as "analgesia", "dementia", "cognitive impairment", "pain treatment", "hip fracture" or "pelvic fracture". Publications published up to January 2016 will be included. The data extraction and a content analysis will be carried out systematically, followed by a critical appraisal. Discussion: This review will provide a valuable overview on the current evidence on drug-based pain management for PwD in all settings who were conservatively treated after a hip or pelvic fracture. The review may expose a need to enhance pain management for PwD. It may also provide motivation for healthcare providers and policymakers to give this topic their attention and to facilitate further research by considering aspects of care transitions in all settings. [ABSTRACT FROM AUTHOR]

To evaluate the quality of care, particularly in the case of new forms of healthcare interventions, the healthcare services to be provided are defined and documented in advance. The presented explanatory sequential mixed methods design combines quantitative and qualitative data collection and the analysis enables a deeper understanding of a new healthcare intervention. Using the example of the POET-Pain project, which investigates the effect of a perioperative transitional pain service (TPS), the methodological application of the explanatory sequential mixed methods design is demonstrated in order to present the structural and process evaluation of the new healthcare intervention (in this case TPS) and to understand its influence on the quality of care. The mixed methods design presented enables the results of the quantitative phase to be interpreted and expanded in depth using qualitative data, which leads to a comprehensive understanding of the subject matter (second pillar of health services research)., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: I. Gnass, S. Berger, N. Schürholz, U. Kaiser, A. Schäfer und A. Schnabel geben an, dass kein Interessenkonflikt besteht. E. Pogatzki-Zahn erhielt in den letzten 3 Jahren Gelder von Grünenthal für wissenschaftliche Projekte und von Grünenthal, Novartis und Medtronic für Vorträge und Advisory-Board-Aktivitäten. Sie erhält momentan bzw. erhielt in den letzten 3 Jahren wissenschaftliche Gelder für Forschungsprojekte von der Deutschen Forschungsgemeinschaft (DFG), dem Bundesministerium für Bildung und Forschung (BMBF), dem Gemeinsamen Bundesausschuss (G-BA) und dem European Union’s Horizon 2020 research and innovation programme. Alle diese Gelder gingen an die Einrichtungen, für die E. Pogatzki-Zahn arbeitet, nicht an sie persönlich. E. Pogatzki-Zahn ist „council member“ der International Association for the Study of Pain (IASP), Schatzmeister der Deutschen Schmerzgesellschaft e. V., Past Chair und Treasurer der Acute Pain Special Interest Group (SIG) der IASP, „research committee member“ der European Society of Anaesthesiology and Intensive Care (ESAIC), Chair der „research group“ der European Pain Federation (EFIC), Mitglied der ESRA-PROSPECT Group, Debuty Editor in Chief für das European Journal of Anaesthesiology (EJA) und das European Journal of Anaesthesiology and Intensive Care (EJAIC) und Section Editor für das European Journal of Pain (EJP). N. Nestler erhielt in den letzten 3 Jahren Honorare von B. Braun, Mundipharma international für Juryaktivitäten und Referate. Sie ist Schriftführerin der Deutschen Schmerzgesellschaft e. V., Mitglied der Ad-hoc-Kommission Pflegecurriculum Schmerz der Deutschen Schmerzgesellschaft e. V, Chair der „nursing group“ der European Pain Federation (EFIC) und Chair der Health Literacy Campaign der European Pain Federation (EFIC). Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Purpose: Responsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment., Methods: An open, prospective, interventional study with before-after comparisons was used to implement "Serial Trial Intervention" (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions., Results: No significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use., Conclusion: No significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lukas, Bienas, Mayer, Radbruch and Gnass.)

Tasks and roles of newly bachelor graduates of nursing in acute care settings - A scoping review Abstract. Background: Despite the need, institutions in the German-speaking health care system are still not prepared for newly qualified bachelor graduates of professional nursing programs, since task and role profiles for their use in the acute care setting are not available., Aim: The aim is to provide an international overview of tasks and roles of newly qualified bachelor graduates in the acute care setting., Methods: The search covered the period from 2010 to 2021 in the databases CINAHL and MEDLINE. Publications in German and English were included in the scoping review regardless of their study designs., Results: The eight included studies follow mostly a qualitative design (n = 5), two studies had a cross-section design and one a mixed-methods design. They were predominantly conducted in the Scandinavian (n = 3) and North American (n = 3) regions. The results show a mix of tasks and roles in which bachelor graduates are employed in basic nursing care, as educators (including lecturers) and in medication management of all age groups, as well as for advanced pediatric lifesaving, monitoring and maintenance of equipment for assessment and diagnostics plus as managers of nursing teams., Conclusions: There is a nationally need for the development of task and role profiles for specific care settings derived from existing competency attributions. Training programs based on these profiles support transition into the acute care setting and promote the assurance of quality interprofessional care.

Background: Evidence and recommendations for hygiene management in home mechanical ventilation (HMV) are rare. In Germany, few regionally limited studies show poor hygiene management or a lack of its implementation. This scoping review of international literature identified the evidence in hygiene management for ventilated patients in the home care setting which has to be implemented for infection prevention and control., Methods: A review of international literature was conducted in CINAHL, PubMed and Web of Science. The search focused on four key domains: HMV, hygiene management, home care setting, and methicillin-resistant Staphylococcus aureus (MRSA). Data of included studies were extracted using a data charting sheet. Extracted data were assigned to the categories (1) study description, (2) setting and participants, and (3) hygiene management., Results: From 1,718 reviewed articles, n = 8 studies met inclusion criteria. All included studies had a quantitative study design. The approaches were heterogeneous due to different settings, study populations and types of ventilation performed. Regarding aspects of hygiene management, most evidence was found for infectious critical activities (n = 5), quality management for hygiene (n = 4), and training and education (n = 4). This review identified research gaps concerning kitchen hygiene, relatives and visitors of HMV patients, and waste management (n = 0)., Discussion: Overall evidence was rather scarce. Consequently, this review could not answer all underlying research questions. No evidence was found for measures in hygiene management relating to ventilated patients' relatives. Evidence for kitchen hygiene, waste management and interaction with relatives is available for inpatient care settings. However, this may not be transferable to outpatient care. Binding legal requirements and audits may help regulate the implementation of HMV hygiene measures., Conclusion: Infection control programmes included qualified personnel, hygiene plans, and standards for MRSA and multidrug-resistant organisms (MDRO). The appropriateness of hygiene management measures for outpatient care is the basis for their application in practice., (© 2022. The Author(s).)

Objectives: We (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies., Design: Systematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline., Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018., Eligibility Criteria: All original empirical research published in English or German including PROs of patients aged 18-75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies., Data Extraction and Synthesis: Data extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently., Results: The search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain., Conclusions: There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision., Prospero Registration Number: CRD42017060825., Competing Interests: Competing interests: JS was executive secretary of the Academy for Trauma Surgery GmbH (AUC). The authors declare that they have no competing interests., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nursing home residents are often affected by pain. Pain assessment aims to determine pain intensity and quality. An evidence-based guideline on pain assessment in nursing homes was developed to support residents and informal caregivers in archiving an adequate pain assessment prerequisite to pain treatment., Aim: The residents' guideline presents key recommendations that is comprehensible and accessible to residents and informal carers., Design: We conducted a content analysis., Setting/subjects: Therefore, all recommendations of an evidence-based guideline for pain assessment in nursing home were evaluated on relevance for supporting residents' decision-making process., Methods: Two researchers conducted the content analysis independently and as a result, 29 recommendations could be included. In addition, representatives of a support-group organization for patients with pain validated the derived recommendations., Results: The present residents' guideline of pain assessment consists of nine thematic categories, written in laymen's terms to enable older persons to make informed choices and optimizing their own pain management process., Conclusions: The Guideline is available in print format and ready for implementation to enhance the effects on maintaining the physical and psychological well-being and optimal care of older adults in Nursing Homes., Competing Interests: Conflict of Interest None., (Copyright © 2021 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed. A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization. It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess only low levels of evidence. Therefore, research into this area needs to be systematically developed to address questions of clinical relevance to support patient care., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: People with dementia are receiving treatment in acute care hospitals at increasing rates. Most prominently, patients exhibiting behavioral and psychological symptoms of dementia (BPSD) are perceived as significant burdens for staff members. Non-detected pain is seen as one substantial reason for behavior that is seemingly unexplainable. In order to gather information about dealing with BPSD a survey was performed. The objective of this study was to enable a more cause-oriented treatment., Methods: The procedure consisted of an anonymous survey of nurses, by semi-structured interviews with open and closed questions about BPSD: type, frequency, perceived burden, therapeutic countermeasures including pain recognition., Results: A total of 46 nurses from 3 wards (internal, geriatric, surgery) were interviewed. 1. Nurses reported being heavily burdened by patients with BPSD. 2. A structured identification of possible causes as part of an established treatment process was not observed. 3. Offering to talk with the patient in order to identify possible causes for BPSD was seen as the first step in the right direction but is inhibited by the limitations of people with severe dementia. 4. Pain as one important cause for BPSD was known by the staff but was often measured by inadequate instruments. 5. Positioning and mobilization were the most commonly used attempts at treatment., Conclusion: Nurses are especially affected in their daily work by patients with BPSD. Clarifying the cause may play a crucial role in treating BPSD.

Background: People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation., Methods: By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted., Results: On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment., Conclusions: Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

Introduction: Survivors of polytrauma experience long-term and short-term burden that influences their lives. The patients' view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments' application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function)., Methods and Analysis: The systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, 'polytrauma', 'multiple trauma', 'quality of life', 'activities of daily living' or 'pain' will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed., Ethics and Dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication., Prospero Registration Number: CRD42017060825., Competing Interests: Competing interests: JS is executive secretary of the Academy for Trauma Surgery GmbH (AUC)., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross-sectional study was conducted in 13 nursing homes and examined pain (measure: Pain Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen-Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures' original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs' discrimination and instruments' discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice., (© 2017 John Wiley & Sons Ltd.)

Background: Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status., Method/design: The development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal., Results: Eight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews., Conclusion: People with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia., Trial Registration: This systematic review was registered at Prospero ( CRD42016037309 ); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).

Elderly live in nursing homes if the necessary need for care cannot be realized in the home care setting. Dementia syndrome (60 % of nursing home residents) has a prominent role. Pain is a frequent problem in nursing homes, affecting functionality and quality of life. Studies often show inadequate pain therapy. Not only is the presentation of pain often atypical, but pharmacological and invasive pain therapy is limited by multimorbidity and increased risk of side effects. Nonpharmacological pain therapy is part of nursing therapy; however, the effect on nursing home residents has been insufficiently studied. This situation necessitates interprofessional coordination of all team members, in which the nursing pain assessment and the realization of both pharmacological and nonpharmacological pain therapy are very important.

Background: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice., Objectives: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city., Methods: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011., Results: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent., Conclusions: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

A research project addressing roles of nurses in pain management is described. The role of specialized pain management nurses is discussed. Standards, communication, and multidisciplinary care, as well as roles of nurses in hospitals, nursing homes, and home care are described. Specialization is discussed including training and certification. The German National Expert Standard for Pain Management in Nursing is described.

Background: High healthcare needs are evident for pain caused by cancer. Those affected are not only looking for help in acute inpatient structures but also for a much larger part in outpatient care structures. To avoid mistreatment, undertreatment or overtreatment of pain in people with cancer, it is necessary to differentiate the tasks and roles of different providers while highlighting the specific aspects of pain management within the given network structures., Materials and Methods: Aspects, such as pain assessment and the necessary scope of action in pain treatment are illustrated from the perspective of nurses from home care services, primary physicians as well as the general or special ambulatory palliative care (AAPV or SAPV) on the basis of initial survey results and a documentation analysis., Results: Ambulatory care nurses (93 %) and primary caregivers (64 %) use pain assessment scales. The kind of scales used varies. The ability to provide adequate pain care for patients in the immediate care situation is reported as given by more than half of the nurses (56.6 %)., Conclusions: In order to ensure an adequate pain therapy targeted interprofessional coordination is required between outpatient and primary physicians with respect to aspects of pain assessment, scope of action and accessibility.

In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group "Pain and Age" of the German Pain Society ("Deutschen Schmerzgesellschaft") in conjunction with the German Centre for Neurodegenerative Diseases ("Deutschen Zentrum für Neurodegenerative Erkrankungen"), Witten, has embarked on the development of interdisciplinary S3-Guideline for "Pain Assessment in Elderly People in Nursing Homes", based on the methodology suggested by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V."), the German Agency for Quality in Medicine ("Ärztliche Zentrum für Qualität in der Medizin"), and that described in the DELBI ("Deutschen Leitlinien-Bewertungsinstrument"). Delegates of the 38 scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.

Inadequate pain care in health care facilities is still a major concern. Due to structural and organizational shortcomings the potential of modern analgesia is far from being exhausted. The project "Action Alliance Pain-free City Münster" is designed to analyze the multiprofessional pain management in health care facilities in the model City of Münster in an epidemiologic study and aims to optimize pain management in accordance with nursing standards and medical guidelines. Hospitals, nursing homes, outpatient nursing services, hospices and pain care centers will be examined. After an analysis of the current state on the basis of a pre-test, the necessary optimization measures will be developed and implemented. Subsequently, the pain management will be reevaluated in a post-test. In partly still unexplored health care areas of Germany, epidemiologic data will be generated, barriers to the implementation of standards and guidelines revealed and measures of improvements developed and tested. In addition, interface problems between the evaluated sectors will be identified. In this article the objective and the methods of the project are described.

Background: Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range between 15% and 70%. The wide variation might be explained by different definitions and diagnostic criteria, settings, and participants' characteristics. Contractures lead to additional nursing demands. In Germany, contracture risk assessment and prevention have been recently defined as a quality indicator of nursing home care that should be regularly monitored by expert raters of the statutory health insurance system. Therefore, it is necessary to have a clear definition of contracture. The goal of this literature review was to identify definitions of contractures used in controlled trials., Methods: A systematic literature search of controlled trials investigating contracture as primary, secondary, or adverse outcome was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. The search was limited to articles published after 1985 and written in English or German language. Publications were excluded, if animals, children, or congenital contracture were investigated. Two reviewers independently screened the abstracts and extracted data from full publications. Disagreement was solved by consensus involving a third reviewer., Results: Initially, 544 publications were identified; 37 controlled studies fulfilled the inclusion criteria and were included. A total of 33 studies investigated contracture as primary outcome, three as secondary outcome, and one as adverse outcome. Five studies clearly defined the term contracture. However, all these definitions are different. In 31 studies, only the diagnostic criteria were mentioned and one study mentioned neither a definition nor specific diagnostic criteria., Conclusion: The majority of clinical trials investigating contracture as outcome parameter do not provide a clear definition. However, the success of contracture prevention and treatment in clinical trials and practice can only be judged in the presence of a clear definition. Thus, it appears especially difficult to use contracture as a quality indicator for nursing homes.