Homes In Germany Research Articles

Medication supply and polypharmacy in long-term care : An overview of possible interventions and the question of afunctioning concept

Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management. Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected? A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety. A total of six programs were identified for which evaluation results are available. Despite amostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice. There are nearly no significant changes as aresult of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.

Describing the status quo of person-centred dementia care in different types of care units in German nursing homes: A convergent mixed methods study

BackgroundThe policies and mission statements of nursing homes support the implementation of person-centred dementia care. The Dementia Policy Questionnaire assesses the content of person-centred dementia care in policies. To date, it is unknown whether these policies exist exclusively in dementia care units and whether the policies are consistent with the mission statements of nursing homes. ObjectiveWe aimed to (1) investigate nursing home care unit types regarding the existence of policies measured by the Dementia Policy Questionnaire, (2) explore whether these policies are addressed in the mission statements of the nursing homes, and (3) integrate both results. DesignThis is a convergent mixed methods study performed with a quantitative and qualitative dataset that was collected in the BeStaDem survey (2020). SettingThe BeStaDem survey included licensed nursing homes in Germany. ParticipantsA total of 134 nursing home administrators provided informed consent to participate in the BeStaDem survey. MethodsFor quantitative data, we performed Fisher's exact test to identify differences in the Dementia Policy Questionnaire item distribution of several types of care units (aim 1). To support the results of Fisher's exact test, we additionally applied logistic regression analysis. For qualitative data, we analyzed the mission statements deductively with the qualitative content analysis method (aim 2). For integration, we used a convergent triangulation approach (aim 3). ResultsThe quantitative data collected from 134 German nursing homes show significant associations among person-centred dementia care policies, such as behavior assessment, and nursing homes with dementia care units. Regarding the qualitative data, of the 60 mission statements in total, eight mission statements of nursing homes with dementia care units exclusively address aspects such as dementia-specific interventions. The convergent triangulation approach shows that the answers given by the nursing homes in the quantitative survey are not always consistent with what they address in their mission statements. ConclusionsNursing homes with dementia care units provide more person-centred dementia care policies than other care unit types do but mostly do not address these aspects in their mission statements. The implementation of person-centredness benefits from the existence of policies and mission statements if nursing homes clearly address what is meant by person-centred dementia care in their nursing home.

You Are Not Alone! Care Professionals‘ Acceptance of Telemedicine in Nursing Homes Comparing Pre- and Post-Implementation Evaluations

A lack of personnel in care institutions and high proportions of older people in need of care pose central challenges for today’s aging society, often resulting in the hospitalization of geriatric patients. In many cases, these hospitalizations are not medically necessary and cause deterioration of health. Applying telemedicine in nursing homes represents one approach aimed at a reduction of unnecessary hospitalizations of geriatric patients and supporting care personnel in medically uncertain situations. For a sustainable and successful implementation of technical innovations such as telemedical consultations, the care personnel’s perspectives and acceptance are especially essential. The Optimal@NRW project implemented telemedical consultations in 24 nursing homes in Germany, investigating medical and economic efficiency and in particular also the social acceptance of digital care in nursing homes. This paper presents quantitative results comparing the acceptance evaluations before (PRE: N = 130) and after (POST: N = 87) the implementation of the telemedical consultations in the nursing homes from the perspective of care professionals. The results showed positive evaluations of the telemedical consultations in both evaluation phases: POST evaluations especially showed a lower evaluation of perceived barriers of using telemedical consultations in nursing homes. This study’s insights enable one to derive guidelines and recommendations regarding the communication and information of telemedical applications considering the needs and wishes of care personnel as a central user group.

Dementia-Sensitive Environmental Design of Living Units in German Nursing Homes: First Results of the German Environmental Audit Tool (G-EAT).

The built environment is a key component of dementia-specific care. Little is known about the characteristics of dementia-sensitive environmental elements in living units of nursing homes in Germany. The German Environmental Audit Tool (G-EAT) is a systematic assessment tool for describing these elements in detail. To describe the extent of dementia-sensitive design principles and environmental elements in a regionally limited sample of living units in Germany. The built environment was assessed using G-EAT and analysed quantitatively and descriptively. Definitions of living units were developed based on site visits and analysed using qualitative content analysis. The 42 participating living units were heterogeneous in terms of space and composition. Dementia-sensitive design principles varied greatly in their implementation in the built environment; on average, 87.7% of the environmental elements were oriented towards a familiar environment. In contrast, visual accessibility was much less frequently enabled by the built environment (mean 37.3%). The characteristics of various dementia-sensitive environmental elements need to be further investigated against the background of the nursing home care concept and the homogeneity of the resident group to enable the initiation of tailored environmental adaptation that can be implemented by interdisciplinary teams in nursing homes. This also requires a follow-up study with a larger sample of living units to identify the factors that promote and inhibit the development of a dementia-sensitive environment.

Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018

BackgroundPain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI. ObjectiveThe aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain. MethodsInformation on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses. ResultsPain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment. ConclusionsThe study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.

Acceptance of a robotic system for nursing care: a cross-sectional survey with professional nurses, care recipients and relatives

BackgroundThe end-users’ acceptance is a core concept in the development, implementation and evaluation of new systems like robotic systems in daily nursing practice. So far, studies have shown various findings concerning the acceptance of systems that are intended to assist people with support or care needs. Not much has been reported on the acceptance of robots that provide direct physical assistance to nurses in bedside care. Therefore, this study aimed to investigate the acceptance along with ethical implications of the prototype of an assistive robotic arm aiming to support nurses in bedside care, from the perspective of nurses, care recipients and their relatives.MethodsA cross-sectional survey design was applied at an early stage in the technological development of the system. Professional nurses, care recipients and relatives were recruited from a university hospital and a nursing home in Germany. The questionnaire was handed out following either a video or a live demonstration of the lab prototype and a subsequent one-to-one follow-up discussion. Data analysis was performed descriptively.ResultsA total of 67 participants took part in the study. The rejection of specified ethical concerns across all the respondents was 77%. For items related to both perceived usefulness and intention to use, 75% of ratings across all the respondents were positive. In the follow-up discussions, the participants showed interest and openness toward the prototype, although there were varying opinions on aspects such as size, appearance, velocity, and potential impact on workload.ConclusionsRegarding the current state of development, the acceptance among the participants was high, and ethical concerns were relatively minor. Moving forward, it would be beneficial to explore the acceptance in further developmental stages of the system, particularly when the usability is tested.

A 10-step participatory program for developing, implementing, and evaluating physical activity promoting actions in nursing homes in Germany

BackgroundSince multidimensional barriers challenge nursing homes, a socio-ecological approach is needed for physical activity promotion in this setting. So far, little is known about how such an approach can be transferred into the successful development and implementation of PA-promoting actions together with stakeholders on-site. We aimed to investigate the actions and dimensions of PA-promoting actions and their sustainable implementation. To contribute to closing this gap, we present a 10-step program for co-developing and co-evaluating PA-promoting actions in nursing homes through an integrated counselling approach.MethodsWe used a multiple case study approach that built upon manifold data sources, collected in 7 nursing homes over 3 years between 2021 and 2023. We collected fieldnotes and photologs from 14 future workshops (2 per home); 7 evaluation workshops (1 per home); 36 individual counsellings (2 sessions per resident), as well as 87 implementation protocols (action type and frequency), 11 evaluation questionnaires (changes among resources, cooperations, and collaborations); 7 goal attainment scales and 18 individual activity schedules. In addition, we retrieved and documented progress information at regular intervals by phone or email.ResultsWith staff, residents, relatives, and volunteers, we co-developed 112 ideas for PA promotion; from which 54 ideas were implemented and integrated into everyday life, differentiated into “activities of daily living,” “structured activities,” and “activity-friendly environments.”; 18 residents in 4 homes participated in individual counselling to develop individual activity schedules. Eighteen actions were rated as “(much) more successful than expected”; 10 “(much) worse than expected,” and 23 “as successful as expected.” Three actions were not evaluated.DiscussionThe participatory integrated counselling approach led to home-specific actions and promoted implementation into everyday life. The number and dimensions of actions implemented largely depended on the mission and vision of the respective home. The lack of staff could partially be compensated for by involving neighbourhoods, volunteers, and community organisations, such as local clubs.ConclusionTo effectively promote PA in nursing homes, a tailored approach considering structural conditions, locations, volunteer engagement, and organisational visions is essential. Long-lasting partnerships and low-threshold opportunities prove promising. Future research should delve into structural-level change processes and outcomes in this context.

Presence as Absence: The Homely and the Unhomely in Jewish Photography under Nazism

This article traces the change in practice and the transition of meaning in the photographs taken in Jewish homes in Germany under the Nazi regime. It draws on the ontological duality of absence and presence embedded in the medium of photography to analyze examples of such photographs selected from numerous archival and private collections, discerning a move away from the practice of interior photography as a tool of social affirmation in the late Weimar Republic toward its attestation of absence and loss shortly before emigration from Germany. Employing the Freudian term uncanny in its original spatial connotation as “unhomely,” the analysis contextualizes the latent presence of the inhabitants in images of vacant interiors through a discussion of the historical change in the domestic life of Jews in the face of the increasing Nazification of the public space. Focusing on the commemorative and mnemonic function of the photos, the article concludes by addressing their constitutive role in personal narratives as a private lieu de mémoire and as the generator of future postmemories.

Nurses' perspectives and preferences on MoliCare Premium Elastic products for incontinence management

Background: With the wide range of absorbent incontinence products available, it is crucial to select the most suitable product for individuals with incontinence, ensuring that their expectations are met and their quality of life is not compromised. Aim: This study aimed to assess the key features of the newly introduced MoliCare Premium Elastic product by nurses working with residents with incontinence in nursing homes and compare the product characteristics with those of the previous design. Methods: Forty-three nurses from five nursing homes in Germany were asked to complete a questionnaire focusing on key product performance aspects to elicit their views on the use of MoliCare Premium Elastic products. Findings: All performance features of the new product design received positive ratings from most nurses: 84% considered the overall acceptance of the new design as ‘Good’, and 52% preferred the new MoliCare Premium Elastic. Conclusions: The new MoliCare SkinGuard absorbent core technology performed well on each performance characteristic, demonstrating the high quality of the product and its ability to meet the needs of people with incontinence.

Healthiness and sustainability of food service in healthcare settings in Germany

Abstract Background Current dietary patterns threaten individual and planetary health. Healthcare settings can set a positive example for dietary change, but data on the quality of food they offer is scarce. The aim of our study was to assess the environmental footprint and nutritional quality of food service in hospitals and nursing homes in Germany. Methods We collected 6-12 months of food procurement data and all available meal plans from three nursing homes and two hospitals in Germany. Procured food items were categorized into 50 food groups (e.g., potatoes, beef, apples), and the environmental footprint was calculated (i.e., land use, greenhouse gas (GHG) emissions, acidification, eutrophication, and water use) using life-cycle analysis factors based on a recent meta-analysis. Lunches from a representative week were broken down into their constituent ingredients and analyzed for adherence to the Planetary Health Diet (PHD) using an established dietary index (PHDI). Results Preliminary analysis of one nursing home and one hospital showed that animal-source foods (ASF) accounted for 70% of overall GHG emissions and land use and 76% of water use, primarily from beef, pork, milk, and cheese. Among plant-based foods, coffee disproportionately contributed to the environmental footprint. Red meat accounted for 30-45% of lunch calories consumed (13-25% of weight) and potatoes accounted for 20-24% of calories (31-35% of weight), whereas vegetables and legumes combined accounted for 11-15% of calories (33-35% of weight). Nursing home meals achieved 61 and hospital meals 71 out of 150 points on the PHDI. Conclusions Healthcare institutions in Germany have poor adherence to the PHD, with up to two-thirds of calories derived from red meat and potatoes. Unsurprisingly, ASF account for the majority of the institutions’ environmental food footprint. Policies to make healthcare foodservice more environmentally sustainable while ensuring nutritional adequacy are urgently needed. Key messages • Foodservice in German hospitals and nursing homes is neither healthy nor environmentally sustainable. • Policies are needed to improve healthcare food service for individual and planetary health.

COVID-19 risks in private equity nursing homes in Hesse, Germany – a retrospective cohort study

BackgroundPrivate-equity-owned nursing homes (PENH) represent the strongest form of profit orientation in the nursing care market. Private equity firms aim to increase the profitability of nursing care facilities, which often leads to cost-cutting measures and the use of less qualified staff. Our study aims to fill the existing knowledge gap by examining the association between private equity ownership and COVID-19 related infections and deaths among residents and staff during the COVID-19 pandemic.MethodsWe analyzed outbreak and mortality data for the period from 20/03/2020 to 05/01/2022 from 32 long-term care facilities in the Federal State of Hesse, Germany, which included 16 PENH that were propensity score matched on regional population density and number of beds with 16 non-PENH. We used logistic regression to determine the odds ratios (OR) for above-median values for the independent variables of PENH-status, number of beds, proportion of single rooms, registered nurses' ratio, and copayments.ResultsPENH had substantially fewer outbreaks in number, but longer and larger outbreaks among nursing home residents, as well as a markedly increased proportion of deceased residents. The odds of the outcome "infections & deaths" were 5.38 (p <. 05) times higher among PENH compared to non-PENH.ConclusionsThe study indicates a need for further research into the quality of care in PENH to inform evidence-based policy decisions, given the higher infection and death rates. Improved documentation and public visibility of PENH is also recommended, in line with existing practices for for-profit and non-profit nursing homes in Germany. Given our findings, regulatory bodies should closely observe PENH operational practices.

Effectiveness of an individually tailored complex intervention to improve activities and participation in nursing home residents with joint contractures (JointConEval): a multicentre pragmatic cluster-randomised controlled trial

ObjectiveThis study aims to examine the effects of the individually tailored complex intervention Participation Enabling Care in Nursing (PECAN) on activities and participation of residents with joint contractures.DesignMulticentre pragmatic cluster-randomised...

Connection Points: The Dynamics of Recruitment to Packaging-Free Shopping

Practice theorists have indicated the importance of understanding everyday life – how it changes and stays the same – in responding to current environmental problems, including the proliferation of food packaging waste. Focusing on individuals as carriers of practices who carry them out is essential for the diffusion of sustainable practices because the more carriers are recruited by less wasteful food consumption, such as packaging-free shopping, the more they are likely to spread. Thus far, however, insights regarding the dynamics of how practices recruit their carriers have been limited. Based on a focused ethnography in a recently opened packaging-free shop and its customers’ homes in Germany, this study specifies the dynamics of recruitment by introducing the concept of connection points. The presence of connection points enables a practice to recruit carriers, allowing them to maintain daily routines to a certain degree, while in the process of adopting a new practice that entails changing their everyday life. This reveals a paradoxical dynamic: continuity, in very diverse ways, seems to pave the way towards change.

Kulturelles Erbe und Arbeit im Exil: Die deutschsprachige Literatur und der internationale Film (1933–1945)

Considering the devastating impact of Fascism and National Socialism on exiles and their literary heritage through the lens of adaptation history, this essay focuses on German-language literature in international cinema from 1933–45 and, by implication, on the role of refugees in major film industries abroad. When Adolf Hitler was appointed Reich Chancellor, most notable authors and filmmakers were forced to leave their homes in Germany and soon Austria. Many of them went to Paris and quite a few eventually made it to Hollywood. Several exile filmmakers sought to claim German-language literature for that ‘other Germany’ in foreign language films, but — especially after Hitler’s troops had invaded Poland — the literary canon of Germany and Austria was considered a liability by most international film producers. In desperate need of income, many exile authors actively pursued adaptations of their own works, but only rarely did their plans materialize, even for bestselling writers; Remarque, Seghers, and Werfel were among the lucky few. Max Ophuls’ effort to preserve at least a fragment of the German literary canon and ensure the survival of German culture abroad, by filming Goethe’s Die Leiden des jungen Werthers (1774), was an exception. For the most part neither international film studios nor audiences were interested in German literary culture during the Hitler era unless an exile writers’ works provided useful and entertaining insights into current challenges and/or had established a wide-ranging readership.

Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort.

Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.

Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey

BackgroundSleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses’ knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management.MethodsA multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers.ResultsFinally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident’ health. Although, the assessment of sleep was seen as nurses’ responsibility, only 40 nurses (14.7%) stated that residents’ sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training.ConclusionsOur results indicate that nurses working at night can play an important role in residents’ sleep promotion. The findings indicate nurses’ educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents’ sleep based on adequate evidence-based non-pharmacological interventions.

Implementation, barriers, and recommendations for further development of advance care planning for the last phase of life in nursing homes in Germany (Gut-Leben): protocol for a mixed-methods study

BackgroundNursing home entry often marks the transition into the end-of-life. In 2018, Germany legally introduced reimbursement for advance care planning (ACP according to § 132 g SGB V) in nursing homes that applied for ACP approval to improve end-of-life care. The Gut-Leben project aims to evaluate the implementation and barriers of ACP in nursing homes in Germany, with a special focus on the federal state of Lower Saxony, and provide practical recommendations for further development of end-of-life care.MethodsThis mixed-methods study spreads across five work packages (WP) over a three-year period. WP 1 will explore the approval process, implementation, and barriers to ACP in nursing homes. Data will be collected through a national postal survey in a random sample of n = 600. WP 2 will explore whether documented ACP reports are applicable as a data source for research (expecting up to 500 available ACP reports). In WP 3a and 3b, data on the ACP process will be collected in n = 15 approved nursing homes in Lower Saxony over a 12-months period. For WP 3a and WP 3b, data on ACP conversations (n = 600) and on end-of-life care paths (n = 300) will be collected by facilitators and nurses of the respective nursing homes. In WP 4, residents’ characteristics upon entry and changes in these characteristics over the length of stay are analyzed, utilizing claims data from the AOK Lower Saxony (expected sample of about 100,000 people entering nursing homes over a 10-years period). WP 5 connects, interprets, and reflects on the findings from WP 1–4 through focus groups and individual interviews with facilitators, nursing staff, residents, relatives, and care providers. Within a participatory approach, a practice advisory board will be set up existing of personal of nursing homes and will be closely involved in the whole research process.DiscussionIn summary, the Gut-Leben project provides insight into the implementation and barriers of ACP in nursing homes according to German legislation for the first time, including practitioners’ and residents’ perspectives. Insights will help the further development of ACP in Germany through practical recommendations based on quantitative and qualitative data.

Challenges, strategies and consequences from the perspective of German nursing home managers during the first wave of the COVID-19 pandemic - a qualitative interview study

BackgroundThe first wave of the COVID-19 pandemic reached Germany between March and May 2020. In order to contain the spread of the virus and particularly protect vulnerable people, the government imposed a lockdown in March 2020. In addition to infection control measures, such as hygiene and social distancing requirements, a general ban on access to nursing homes for relatives and external service providers was issued.MethodsTo investigate the challenges and consequences of the enacted infection prevention measures and specific strategies for nursing homes in Germany, a multicentre cross-sectional qualitative interview study with nursing home managers and ward managers was conducted. Recorded audio data were transcribed, analysed using thematic framework analysis and reflected in peer debriefings.ResultsSeventy-eight interviews with 40 nursing home managers and 38 ward managers from 43 German nursing homes were conducted. At organisational level, the following six themes were identified: Appointing a multi-professional crisis task force, reorganizing the use of building and spatial structures, continuous adaption and implementation of hygiene plans, adapting staff deployment to dynamically changing demands, managing additional communicative demands and relying on and resorting to informal networks. To deal with the pandemic challenges also six themes can be described for the direct care level: Changed routines, taking over non-nursing tasks, increased medical responsibility, increased documentation demands, promoting social participation and increased communication demands. Also various negative consequences were identified (four themes): Psychological stress, negative emotional consequences, permanent feeling of responsibility and increased potential for conflicts. Positive emotional consequences were also reported (two themes): resources for the challenges and positive emotional consequences for home managers and staff.ConclusionsThe results of the described challenges, strategies and consequences allow recommendations as basis for possible approaches and successful adaptation processes in nursing home care in the future. In particular, there is a need for local networks to act in a coordinated way and a need for quantitative and qualitative support for nurses, such as staff support as well as advanced nursing practice, to cope with the challenges of the pandemic.

Challenges and care strategies associated with the admission to nursing homes in Germany: a scoping review

BackgroundThe admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany.MethodsWe conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model.ResultsTwelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people.ConclusionAlthough the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers.

Quality of leadership and self-rated health: the moderating role of ‘Effort–Reward Imbalance’: a longitudinal perspective

ObjectiveLongitudinal studies on the influence of leadership behavior on employees’ self-rated health are scarce. As a result, potential mechanisms describing the impact of leadership behavior on health have not been adequately investigated so far. The present study accounts for the influence of leadership behavior on self-rated health within the framework of the Effort–Reward Imbalance model.MethodsThe study was conducted on the basis of a cohort which comprised a random sample of healthcare workers from ten different hospitals and one elderly nursing home in Germany. A 2-level repeated measurement model with random intercept and slopes was modeled, since it was aimed to account for individual as well as intra-individual variation of subjective health across three time points over 36 months. Beside ‘Effort–Reward Imbalance’ and ‘Quality of Leadership’ from the Copenhagen Psychosocial Questionnaire, physical and mental health was assessed by German version of the SF12 multipurpose short-form measure of health status.Results‘Effort–Reward Imbalance’ and a lack in ‘Quality of Leadership’ negatively affect self-rated physical health. No effect was found for self-rated mental health. Effort–Reward Imbalance significantly moderates the effect of ‘Quality of Leadership’ on self-rated physical health.ConclusionThe findings, and the interaction effects in particular, suggest that leadership behavior moderated by factors such as appreciation and support, influences self-rated physical health. The study therefore provides an interpretation for leadership behavior and its influence on employees’ self-rated health within the ‘Effort–Reward Imbalance’ model.