Gudrun Theile

Interprofessional collaboration and communication in nursing homes: a qualitative exploration of problems in medical care for nursing home residents – study protocol

AIMnThis study explores the current state of collaboration and communication between nurses and general practitioners in nursing homes, as well as needs and expectations of nursing home residents and their families. Finally, we aim to develop a new model of collaboration and communication.nnnBACKGROUNDnRising numbers of residents in nursing homes present a challenge for general practice and nursing in most Western countries. In Germany, general practitioners visit their patients in nursing homes, where nurses work in shifts. This leads to a big variety of contacts with regard to persons involved and ways of communication.nnnDESIGNnQualitative multicentre study.nnnMETHODSnStudy part 1 explores needs and problems in interprofessional collaboration in interviews with nursing home residents and their relatives, general practitioners and nurses. Simultaneously, general practitioners visits in nursing homes are observed directly. In study part 2, general practitioners and nurses will discuss findings from study part 1 in focus groups, aiming to develop strategies for the improvement of shortcomings in a participatory way. Based on the results, experts will contribute to the emerging model of collaboration and communication in a multi-professional workshop. Finally, this model will be tested in a small feasibility study. The German Federal Ministry of Education and Research approved funding in March 2011.nnnDISCUSSIONnThe study is expected to uncover deficits and opportunities in interprofessional collaboration in nursing homes. It provides deeper understanding of the concepts of all involved person groups and adds important clues for the interaction between professionals and older people in this setting.

Reaching the elderly: understanding of health and preventive experiences for a tailored approach – results of a qualitative study

BackgroundOften preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German “Reaching the Elderly” study (2008–2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs.MethodsFour focus groups (Nu2009=u200942 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65–75 years andu2009≥u200976xa0years). Participants from two districts of a major German city were selected from a stratified random sample (Nu2009=u2009200) based on routine data from a local health insurance fund. The study focused on the participants’ knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.ResultsA gender-specific approach profile was observed. Men were more likely to favor competitive and exercise-oriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The “older seniors” (76+) were ambivalent towards certain wordings referring to aging.ConclusionsOur results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of the potential participants.

Holistic Care and Palliation

Adults with congenital heart disease have been the recipients of heroic surgical and medical care over the years. Although a lot of effort is made to improve survival and to find novel treatment concepts for these patients, we have to accept that for many patients, no viable treatment options will be available and many will be at high risk of dying as young and middle-aged adults. Although our ability to ‘cure’ these patients may be limited, our ability to support our patients with non-strictly ‘medical’ measures is substantial and may have an important impact on patients’ quality of life and a self-determined and dignified end of life. Hence in this chapter, we will focus on measures of patient support, advance care planning and end-of-life care—summarized as comprehensive care. The concept of comprehensive care combines cardiac care, supportive care and measures of palliative care adjusted and matched to the individual patient’s stage of disease and circumstances of living.

mHealth Technologies for Palliative Care Patients at the Interface of In-Patient to Outpatient Care: Protocol of Feasibility Study Aiming to Early Predict Deterioration of Patient’s Health Status

Background Palliative care patients are a particularly vulnerable population and one of the critical phases in patients’ trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable readmissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring. In the last years, different mHealth technology applications have been evaluated in many different patient groups. Objective The aim of our study is to test feasibility of a remote physical and social tracking system in palliative care patients. Methods A feasibility study with explorative, descriptive study design, comprised of 3 work packages. From the wards of the Clinic of Radiation-Oncology at the University Hospital Zurich, including the specialized palliative care ward, 30 patients will be recruited and will receive a mobile phone and a tracking bracelet before discharge. The aim of work package A is to evaluate if severely ill patients accept to be equipped with a tracking bracelet and a mobile phone (by semiquantitative questionnaires and guideline interviews). Work package B evaluates the technical feasibility and quality of the acquired electronic health data. Work package C will demonstrate whether physical activity parameters, such as step count, sleep duration, social activity patterns like making calls, and vital signs (eg, heart rate) do correlate with subjective health data and can serve as indicator to early detect and predict changes in patients’ health status. Activity parameters will be extracted from the mobile phone’s and wristband’s sensor data using signal processing methods. Subjective health data is captured via electronic version of visual analog scale and Distress Thermometer as well as the European Organization for Research and Treatment of Cancer – Quality of Life Questionnaire C30 in paper version. Results Enrollment began in February 2017. First study results will be reported in the middle of 2018. Conclusions Our project will deliver relevant data on patients’ acceptance of activity and social tracking and test the correlation between subjective symptom assessment and objective activity in the vulnerable population of palliative care patients. The proposed study is meant to be preparatory work for an intervention study to test the effect of wireless monitoring of palliative care patients on symptom control and quality of life.

Monitoring Patients in Ambulatory Palliative Care: A Design for an Observational Study

We present the setup of an observational study that aims to examine the application of wearables in ambulatory palliative care to monitor the patients’ health status – especially during the transition phase from hospital to home since this phase is critical and often patients are re-hospitalised. Following an user-centred design approach, we performed interviews with patients recruited at the Clinic of Radiation Oncology of the University Hospital Zurich, Switzerland. The patient group was perceived as very vulnerable and varied largely in physiological burden and mental aspects. Special needs concern primarily obtrusiveness of the system and sensitivity in the work with this vulnerable patient group.