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Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required.

Background In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice. Methods We performed a cluster-randomized trial from October–November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers. Results Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (P <.001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39–1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49–1.52] for the 6-step technique; P =.629). Conclusions In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique. Clinical Trials Registration ISRCTN45923734. [ABSTRACT FROM AUTHOR]

Background: Demographic and epidemiological shifts, as well as increasing quality control and greater emphasis on cost effectiveness are the challenges for today’s healthcare organisations. Against this background, institutions are undertaking reforming processes in order to adapt to this complex and unstable market. These transformations require innovative practice and highly effective leadership – leaders who are capable of conveying the need for change and creating a vision for the future. Despite its growing importance, the development process of such a vision is barely addressed in the literature. Aim: The aim of this article is to describe the process of a university hospital towards developing a shared vision for nursing practice. Methods: By means of the four phases of the evidence-based appreciative inquiry process (Discovery – Dream – Design – Destiny), a shared vision was developed. The main methods used were individual interviews, focus group interviews and SWOT analyses. The different datasets produced were synthesised and abstracted to form a vision and corresponding strategic objectives. Conclusions: Although the developmental process was rather time consuming and complex, it provided a systematic approach to change and enabled the leaders involved to commit to the strategic orientation. Implications for practice: • A vision provides direction and meaning for leaders and their teams in complex transformation processes within healthcare organisations • The approach of appreciative inquiry is well suited to facilitate the creative and innovative process of developing a vision • Before initiating the process of developing a vision, it is important to consider the time factor and to plan accordingly so that the necessary creative thinking and reflection can take place [ABSTRACT FROM AUTHOR]

Recognition of Psychiatric Symptoms in Inpatient Long-Term Care Abstract. As part of the Swiss national strategy on dementia, we investigated to which extent the needs assessment instruments RAI and BESA can early detect symptoms of depression, delirium, and behavioral and psychological symptoms of dementia (BPSD) in long-term care facilities. While we decided that the RAI sufficiently detected depressive symptoms, we suggest to add the two-questions-test and the geriatric depression scale to the BESA assessment. The BESA evaluation had more targeted focused assessments, allowing for better identification of delirium. Neither RAI or BESA cover the whole spectrum of behavioral and psychological symptoms of dementia. We consider the continuous application of these assessment instruments an important step towards interdisciplinary exchange and a better treatment of residents with psychiatric symptoms.

Background: In the day-to-day course of nursing, ethical issues are being openly articulated to a growing extent. However, nurses only rarely systematically address these issues. This subject was explored in interviews with professionals who have a particular focus on ethics., Objective: Gain input for further developing the skills of nursing staff in ethical reasoning., Method: In two focus groups and four individual interviews, we questioned 14 professionals, including nine nurses, who have a special interest in ethics., Results: Nurses find it ethically problematic when the wishes of patients are not respected or something is forced on them, creating the impression that the care being given is exacerbating rather than alleviating the patient’s suffering. These problematic aspects are often overlooked because the consequences of the action in question are not immediately apparent. Ethical issues in nursing are often addressed in informal, non-systematic discussions among nursing staff. Nurses actively and confidently engage in discussions on treatment goals, and the teamwork with doctors is usually experienced as being based on mutual respect and partnership. The inherent hierarchical role differences between nursing and medical staff nevertheless manifest in ethical issues., Conclusion: Through the practical application of ethical reasoning in day-to-day nursing, structured discussions of the ethical aspects of cases and dedicated further education, nurses should learn to better recognise ethical issues in nursing and effectively analyse them and find solutions.

In 2000, the Institute of Nursing Science in Basel started with a clinically oriented Master programme in Advanced Nursing Practice (ANP). The nursing expertise achieved with this degree includes enhanced skills and know-how in a specialised area. Together with their nurse colleagues, the clinically, scientifically, and practice-orientated Advanced Practice Nurses (APNs) support and develop nursing practice in Switzerland further, especially for chronically ill and geriatric patients. It is estimated that 25 % of older adults aged 80-years and older experience at least one hospitalisation per year. Beside the acute diagnosis, they suffer from several chronic illnesses. These highly complex and fragile patients need to be cared for by nurses with enhanced practice skills in gerontology. At the acute geriatric ward of the University Hospital Basel a practice development project is ongoing under the guidance of an APN to support person-oriented, geriatric care. The practice development project is led by the principles of action research. The circular process of "look-think-act" facilitates the critical examination of nursing practice. First results show shorter length of hospital stay for patients and improved job-satisfaction and self-efficacy for nurses. This article shortly reveals the history of ANP and highlights the development, implementation, and first results of the practice development project.