Franziska A. Herbst

Effects of Methicillin-Resistant Staphylococcus aureus/Multiresistant Gram-Negative Bacteria Colonization or Infection and Isolation Measures in End of Life on Family Caregivers: Results of a Qualitative Study

BACKGROUNDnLittle is known about the experiences of family caregivers of hospitalized patients with confirmed methicillin-resistant Staphylococcus aureus/multiresistant gram-negative bacteria (MRSA/MRGN) diagnosis at the end of life. The study at hand is a subproject of an interdisciplinary cooperation project that aims at developing a patient-, family-, and team-centered approach in dealing with MRSA/MRGN-positive hospitalized patients in palliative and geriatric care.nnnOBJECTIVESnThe present study aimed to assess the individual effects of the patients MRSA/MRGN colonization or infection and isolation measures on family caregivers.nnnDESIGNnBetween April 2014 and September 2015, all known family caregivers associated with an MRSA/MRGN-positive patient from a palliative care unit, a hospital palliative care support team, and a geriatric ward were considered for study participation. A qualitative interview study with family caregivers and an additional focus group was conducted. Data were analyzed using the principles of Grounded Theory.nnnRESULTSnFamily caregivers (Nu2009=u200962) raised suggestions regarding the provision of information and communication on the MRSA/MRGN diagnosis and hygiene measures from staff members and the consistency of hygiene procedures. Family caregivers requested not to be stigmatized or being disadvantaged due to the MRSA/MRGN diagnosis of the patient, and they wished to receive psychosocial and emotional support.nnnCONCLUSIONSnStaff members and institutional stakeholders should be aware that family caregivers might be burdened and upset by positive MRSA/MRGN diagnosis and the required hygiene measures. The need for detailed and understandable information on MRSA/MRGN, adequate communication between staff members and family caregivers, and support for family caregivers should be of special attention in particular in end-of-life care.

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis

Background The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU). Aim The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach. Design Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available. Results 297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%). Conclusions PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.

Understanding institutional stakeholders’ perspectives on multidrug-resistant bacterial organism at the end of life: a qualitative study

Background Information lacks about institutional stakeholders’ perspectives on management approaches of multidrug-resistant bacterial organism in end-of-life situations. The term “institutional stakeholder” includes persons in leading positions with responsibility in hospitals’ multidrug-resistant bacterial organism management. They have great influence on how strategies on multidrug-resistant bacterial organism management approaches in institutions of the public health system are designed. This study targeted institutional stakeholders’ individual perspectives on multidrug-resistant bacterial organism colonization or infection and isolation measures at the end of life. Methods Between March and December 2014, institutional stakeholders of two study centers, a German palliative care unit and a geriatric ward, were queried in semistructured interviews. Interviews were audiotaped, transcribed verbatim, and analyzed qualitatively with the aid of the software MAXQDA for qualitative data analysis using principles of Grounded Theory. In addition, two external stakeholders were interviewed to enrich data. Results Key issues addressed by institutional stakeholders (N=18) were the relevance of multidrug-resistant bacterial organism in palliative and geriatric care, contradictions between hygiene principles and patients’ and family caregivers’ needs and divergence from standards, frame conditions, and reflections on standardization of multidrug-resistant bacterial organism end-of-life care procedures. Results show that institutional stakeholders face a dilemma between their responsibility in protecting third persons and ensuring patients’ quality of life. Until further empirical evidence establishes a clear multidrug-resistant bacterial organism management approach in end-of-life care, stakeholders suggest a case-based approach. Conclusion The institutional stakeholders’ perspectives and their suggestion of a case-based approach advance the development process of a patient-, family-, staff-, and institutional-centered approach of how to deal with multidrug-resistant bacterial organism-positive patients in end-of-life care. Institutional stakeholders play an important role in the implementation of recommendations following this approach.

Perspectives on multidrug-resistant organisms at the end of life

BackgroundThere is axa0lack of research into how hospital staff and institutional stakeholders (i.u202fe. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education.ObjectiveThis study explored and compared staff members’ and stakeholders’ perspectives on multidrug-resistant organisms and on provision of end-of-life care to carrier patients.MethodsIn this study four focus groups consisting of hospital staff members and institutional stakeholders were formed within axa0mixed-methods parent study in axa0palliative care unit at axa0university clinic and axa0geriatric ward of axa0Catholic and academic teaching hospital. Participants discussed results from staff and stakeholder interviews from axa0former study phase. Data were analyzed according to Grounded Theory and perspectives of staff members and institutional stakeholders were compared and contrasted.ResultsKey issues debated by staff members (Nu202f=u200919) and institutional stakeholders (Nu202f=u200910) were 1)xa0the additional workload, 2)xa0reasons for uncertainty about handling carrier patients, 3)xa0the format of continuing education, and 4)xa0the preferred management approach for dealing with multidrug-resistant organism carrier patients. Although similar barriers (e.u202fg. colleagues’ ambiguous opinions) were identified, both groups drew different conclusions concerning the management of these barriers. While institutional stakeholders recommended making decisions on hygiene measures under consideration of the specific patient situation, staff members preferred the use of standardized hygiene measures which should be applied uniformly to all patients.DiscussionStaff members and institutional stakeholders perceived similar barriers to practice caused by multidrug-resistant organisms and similar needs for continuing education. The staff members’ preferred management approach might originate from an uncertainty about the multidrug-resistant organism infection risk. Experiences and visions of both groups should be included in axa0specific recommendation for end-of-life care to ensure behavioral confidence.ZusammenfassungHintergrundWenig ist über den Umgang von Teammitgliedern und institutionellen Vertretern (z.u202fB. aus Gesundheitsbehörden, aus der Krankenhaushygiene und aus Abteilungen für Mikrobiologie, Palliativmedizin und Geriatrie) mit Patienten mit multiresistenten Erregern in der Versorgung am Lebensende im Krankenhaus bekannt. Erkenntnisse über deren Erfahrungen, Arbeitsaufwand und Bedürfnisse sollten bei Entscheidungen zum Umgang mit den Patienten und bei der Gestaltung von Weiterbildungen berücksichtigt werden.ZielIn der vorliegenden Studie wurden Sichtweisen von Teammitgliedern und institutionellen Vertretern auf multiresistente Erreger und Versorgungssituationen von Patienten am Lebensende untersucht und verglichen.MethodenVier Fokusgruppen mit Teammitgliedern und institutionellen Vertretern wurden innerhalb eines gemischt-methodischen Forschungsprojekts an der Abteilung für Palliativmedizin eines Universitätsklinikums und der geriatrischen Station eines katholischen und akademischen Lehrkrankenhauses durchgeführt. Interviewergebnisse aus einer vorausgehenden Studienphase mit Teammitgliedern und institutionellen Vertretern wurden diskutiert. Die Datenanalyse erfolgte in Anlehnung an die „Grounded Theory“. Perspektiven der Teammitglieder und institutionellen Vertreter wurden zueinander in Beziehung gesetzt.ErgebnisseVon Teammitgliedern (Nu202f=u200919) und institutionellen Vertretern (Nu202f=u200910) diskutierte Kernthemen sind 1.xa0der zusätzliche Arbeitsaufwand, 2.xa0Gründe für Unsicherheit im Umgang mit Patienten, 3.xa0das Fortbildungsformat und 4.xa0der bevorzugte Ansatz zum Umgang mit Patienten mit multiresistenten Erregern. Obwohl ähnliche Hürden beschrieben wurden (z.u202fB. auseinandergehende Auffassungen zwischen Kollegen), zogen die beiden Gruppen unterschiedliche Schlussfolgerungen für den Umgang mit diesen Barrieren. Während institutionelle Vertreter zu einem Ansatz rieten, bei dem im Einzelfall anhand der Situation des Patienten über Hygienemaßnahmen entschieden wird, bevorzugten Teammitglieder standardisierte Vorgehensweisen, die für jeden Patienten gleichermaßen angewandt werden.DiskussionTeammitglieder und institutionelle Vertreter nahmen bezogen auf multiresistente Erreger in der Praxis ähnliche Barrieren und Fortbildungsbedarfe wahr. Unsicherheit über das Risiko, das von multiresistenten Erregern ausgeht, könnte dem bevorzugten Ansatz der Teammitglieder zugrunde liegen. Für mehr Handlungssicherheit, sollten Erfahrungen beider Gruppen in einer spezifischen Empfehlung für die Versorgung am Lebensende berücksichtigt werden.

Multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care: development of recommendations for hospitalized patients using a mixed-methods approach.

PurposePalliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. Aim: provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care.MethodsRecommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts’ comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations. Findings of 158 interviews and six focus groups (39 participants) with patients, family caregivers, staff members and institutional stakeholders contributed to the recommendations. The assessments of 17 experts were considered.ResultsIn total, 21 recommendations were approved. The recommended strategy in dealing with MDRO at the end of life allows case-based application of protection and isolation measures. MDRO diagnostics and therapy involve screening at admission. The recommendations suggest consideration of required accommodation facilities, provided material as well as staff and time resources. The recommendations further highlight the importance of providing for strategies enabling the patient’s social inclusion and provision of verbal and written information about MDRO for patients and family caregivers, transparent medical documentation, and staff member training.ConclusionThe recommendations summarize the perspectives of individuals and groups affected by MDRO at the end of life and provide practical guidance for clinical routine. Further dissemination and implementation requirements are discussed and should contain the evaluation of the knowledge, views, worries, and anxieties of the target groups.

Staff members’ ambivalence on caring for patients with multidrug-resistant bacteria at their end of life: A qualitative study

AIMS AND OBJECTIVESnTo explore healthcare professionals personal experiences, feelings and attitudes about caring for hospitalised patients with multidrug-resistant bacteria in palliative and geriatric care.nnnBACKGROUNDnWorking in end-of-life care involves at times burdening demands that affect not only healthcare professionals personally but also their actions. It is suggested that multidrug-resistant bacteria and their consequences for colonised or infected patients in hospitals are among the challenges for all professionals in end-of-life care. Little is known about the feelings and experiences of staff members during healthcare activities with regard to these bacteria.nnnDESIGNnA qualitative interview study in two German hospitals.nnnMETHODSnWe interviewed 35 staff members from a German palliative care unit and a geriatric unit about their experiences with multidrug-resistant bacteria in end-of-life care and the management of colonised or infected patients. Semistructured interviews were transcribed verbatim and analysed using grounded theory.nnnRESULTSnInterviewees represented two interdisciplinary teams with 40% nurses, 26% physicians and 34% other professionals. Salient themes that were identified included impact of multidrug-resistant bacteria on staff members personal actions, feelings and attitudes towards the bacteria and the required isolation measures. Besides higher workload and consequences for working routines, the patients palliative care needs were recognised, as well as the necessary protection measures to avoid contaminations in hospital. Healthcare professionals reported a dilemma that they experienced when facing these diverse demands.nnnCONCLUSIONSnFindings point to emotional and behavioural ambivalence in end-of-life care among staff members because necessary isolation measures and particular situation in end-of-life care create unsolvable conflicts for healthcare professionals. Possible strategies to cope with ambivalence are discussed.nnnRELEVANCE TO CLINICAL PRACTICEnHealthcare professionals in palliative and geriatric care have to deal with multidrug-resistant bacteria and have to face contradictory feelings while trying to fulfil patients needs as well as isolation requirements.

Exploring end-of-life interaction in dyads of parents and adult children: a protocol for a mixed-methods study

BackgroundA considerable number of terminally-ill adult children are outlived by at least one parent and receive palliative care prior to their death. At the same time, adult children continue to be confronted with their parents’ terminal illnesses and end-of-life situations. The current study explores the specifics of dyadic interaction at the end of life between a) adult children suffering from a life-threatening disease and their parents, and b) terminally ill parents and their adult children.MethodsThis prospective observational study aims at filling the existing gap on adult child-parent interaction specifics at the end of life using an exploratory mixed-methods framework. The mixed-methods framework combines a qualitative face-to face interview and quantitative self-report questionnaires to study the topic at hand. The qualitative interview will focus on experiences, expectations, and wishes with regard to dyadic communication, information about illness and prognosis, expressed and perceived burden and support as well as caregiving role at the end of life. The questionnaires will cover socio-demographics, loneliness, attachment style, social support, and emotional closeness.DiscussionThe research group is currently adjusting a semi-structured interview guide and questionnaire instructions based on the results of a multiprofessional scientific advisory board meeting (Jan. 2018). In a next step, and prior to qualitative and quantitative data collection, the questionnaires will be piloted on patients and their family members in a palliative care setting. The main expected results are i) a description of the specifics of the interaction within and between both dyads, ii) the development of hypotheses and a theoretical framework on the specifics, similarities, and differences for both study groups, and iii) clinical conclusions on specific psychosocial care needs of both groups.Trial registrationThe study was registered prospectively in the Health Services Research Germany register (Versorgungsforschung Deutschland – Datenbank) (Registration N° VfD_Dy@EoL_17_003897; date of registration: November 22, 2017) and in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00013206; date of registration: October 27, 2017). The study is visible in the International Clinical Trials Registry Platform Search Portal of the World Health Organization under the German Clinical Trials Register number.

Kompetent vernetzt – optimal versorgt!@@@Well connected – optimally cared for!: Förderliche Faktoren der Zusammenarbeit in hospizlich-palliativen Versorgungsnetzwerken in Bayern@@@Beneficial factors of collaboration in hospice and palliative care networks in Bavaria

ZusammenfassungHintergrundDas Bayerische Staatsministerium für Gesundheit und Pflege (StMGP) fördert den Aufbau regionaler Hospiz- und Palliativversorgungsnetze. Bisher ist nur wenig bekannt über bewährte Strukturen und förderliche Faktoren der Zusammenarbeit in solchen Netzwerken.Ziel der ArbeitDas vorliegende Projekt erforscht, unter welchen Rahmenbedingungen und mit welchen Arbeits-, Organisations- und Kommunikationsformen Netzwerke der Hospiz- und Palliativversorgung in Bayern erfolgreich funktionieren.MethodenEine Bestandserhebung von März bis Juni 2015 wurde mit zehn Koordinatoren und Vorsitzenden aus zehn bayerischen Hospiz- und Palliativnetzwerken in halbstrukturierten Interviews durchgeführt. In einer anschließenden Diagnosewerkstatt im November 2015 wurden Ergebnisse zu Aspekten von Netzwerkmodellen und förderlichen Faktoren der Netzwerkarbeit aus der Bestandserhebung mit acht Vertretern aus fünf Netzwerken diskutiert. Die Einzelinterviews und Diskussion der Diagnosewerkstatt wurden auf Tonband aufgenommen und wortwörtlich transkribiert. Die Daten wurden mithilfe der qualitativen Datenanalysesoftware MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin) analysiert und in Anlehnung an die Grounded Theory datenbasiert Hypothesen gebildet.ErgebnisseDie von den Netzwerkkoordinatoren und -moderatoren beschriebenen förderlichen und vielfältigen Faktoren können den Themenbereichen Netzwerkorganisation und -koordination, Kommunikationsstrukturen und Informationswege sowie Sichtbarkeit und Sichtbarmachen in der Öffentlichkeit zugeordnet werden.DiskussionBewährte und etablierte Arbeitsweisen der Netzwerkarbeit sind in den erforschten Hospiz- und Palliativnetzwerken vorhanden. Die Erfahrungen und Visionen der Netzwerke können zur Erstellung einer Handreichung für den Aufbau und die Gestaltung neuer Netzwerke sowie die Ausgestaltung bestehender Netzwerke beitragen.AbstractBackgroundThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.ObjectivesThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.MethodsData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.ResultsNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.ConclusionsWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.BACKGROUNDnThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.nnnOBJECTIVESnThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.nnnMETHODSnData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989-2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.nnnRESULTSnNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.nnnCONCLUSIONSnWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.

[Well connected - optimally cared for! : Beneficial factors of collaboration in hospice and palliative care networks in Bavaria].

ZusammenfassungHintergrundDas Bayerische Staatsministerium für Gesundheit und Pflege (StMGP) fördert den Aufbau regionaler Hospiz- und Palliativversorgungsnetze. Bisher ist nur wenig bekannt über bewährte Strukturen und förderliche Faktoren der Zusammenarbeit in solchen Netzwerken.Ziel der ArbeitDas vorliegende Projekt erforscht, unter welchen Rahmenbedingungen und mit welchen Arbeits-, Organisations- und Kommunikationsformen Netzwerke der Hospiz- und Palliativversorgung in Bayern erfolgreich funktionieren.MethodenEine Bestandserhebung von März bis Juni 2015 wurde mit zehn Koordinatoren und Vorsitzenden aus zehn bayerischen Hospiz- und Palliativnetzwerken in halbstrukturierten Interviews durchgeführt. In einer anschließenden Diagnosewerkstatt im November 2015 wurden Ergebnisse zu Aspekten von Netzwerkmodellen und förderlichen Faktoren der Netzwerkarbeit aus der Bestandserhebung mit acht Vertretern aus fünf Netzwerken diskutiert. Die Einzelinterviews und Diskussion der Diagnosewerkstatt wurden auf Tonband aufgenommen und wortwörtlich transkribiert. Die Daten wurden mithilfe der qualitativen Datenanalysesoftware MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin) analysiert und in Anlehnung an die Grounded Theory datenbasiert Hypothesen gebildet.ErgebnisseDie von den Netzwerkkoordinatoren und -moderatoren beschriebenen förderlichen und vielfältigen Faktoren können den Themenbereichen Netzwerkorganisation und -koordination, Kommunikationsstrukturen und Informationswege sowie Sichtbarkeit und Sichtbarmachen in der Öffentlichkeit zugeordnet werden.DiskussionBewährte und etablierte Arbeitsweisen der Netzwerkarbeit sind in den erforschten Hospiz- und Palliativnetzwerken vorhanden. Die Erfahrungen und Visionen der Netzwerke können zur Erstellung einer Handreichung für den Aufbau und die Gestaltung neuer Netzwerke sowie die Ausgestaltung bestehender Netzwerke beitragen.AbstractBackgroundThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.ObjectivesThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.MethodsData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.ResultsNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.ConclusionsWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.BACKGROUNDnThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.nnnOBJECTIVESnThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.nnnMETHODSnData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989-2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.nnnRESULTSnNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.nnnCONCLUSIONSnWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.

Kompetent vernetzt – optimal versorgt!

ZusammenfassungHintergrundDas Bayerische Staatsministerium für Gesundheit und Pflege (StMGP) fördert den Aufbau regionaler Hospiz- und Palliativversorgungsnetze. Bisher ist nur wenig bekannt über bewährte Strukturen und förderliche Faktoren der Zusammenarbeit in solchen Netzwerken.Ziel der ArbeitDas vorliegende Projekt erforscht, unter welchen Rahmenbedingungen und mit welchen Arbeits-, Organisations- und Kommunikationsformen Netzwerke der Hospiz- und Palliativversorgung in Bayern erfolgreich funktionieren.MethodenEine Bestandserhebung von März bis Juni 2015 wurde mit zehn Koordinatoren und Vorsitzenden aus zehn bayerischen Hospiz- und Palliativnetzwerken in halbstrukturierten Interviews durchgeführt. In einer anschließenden Diagnosewerkstatt im November 2015 wurden Ergebnisse zu Aspekten von Netzwerkmodellen und förderlichen Faktoren der Netzwerkarbeit aus der Bestandserhebung mit acht Vertretern aus fünf Netzwerken diskutiert. Die Einzelinterviews und Diskussion der Diagnosewerkstatt wurden auf Tonband aufgenommen und wortwörtlich transkribiert. Die Daten wurden mithilfe der qualitativen Datenanalysesoftware MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin) analysiert und in Anlehnung an die Grounded Theory datenbasiert Hypothesen gebildet.ErgebnisseDie von den Netzwerkkoordinatoren und -moderatoren beschriebenen förderlichen und vielfältigen Faktoren können den Themenbereichen Netzwerkorganisation und -koordination, Kommunikationsstrukturen und Informationswege sowie Sichtbarkeit und Sichtbarmachen in der Öffentlichkeit zugeordnet werden.DiskussionBewährte und etablierte Arbeitsweisen der Netzwerkarbeit sind in den erforschten Hospiz- und Palliativnetzwerken vorhanden. Die Erfahrungen und Visionen der Netzwerke können zur Erstellung einer Handreichung für den Aufbau und die Gestaltung neuer Netzwerke sowie die Ausgestaltung bestehender Netzwerke beitragen.AbstractBackgroundThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.ObjectivesThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.MethodsData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989–2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.ResultsNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.ConclusionsWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.BACKGROUNDnThe Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks.nnnOBJECTIVESnThe present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication.nnnMETHODSnData were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in axa0subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989-2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory.nnnRESULTSnNetworking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility.nnnCONCLUSIONSnWell-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of axa0best practice recommendation for the establishment of new and the enhancement of existing networks.