Hartmut Remmers

Stress and nursing care needs of women with breast cancer during primary treatment: A qualitative study

PURPOSE The primary surgical therapy for breast cancer represents a special phase in the course of the disease. The aim of this study was to find out the specific strains influencing the women affected during this time, and the needs and expectations they had of the nurses. METHOD In a semistructured interview, 42 women at an early stage of breast cancer were asked about their strains and care needs. RESULTS The results show that the women interviewed suffer more from psychological strains than physical ones, and express the wish for, above all, emotional support. Analysis of the interviews provides 4 categories of strains: immediate strains regarding the surgery, fear through uncertainty, change of self-perception and the strains caused by the social environment. Care needs can be divided into 3 main areas: wishes for (a) the relationship to the nurses, (b) professional competence and (c) the external conditions of care. CONCLUSIONS Nurses can support the women well by listening to them, accepting their emotions and informing them in detail. Therewith, they can convey a sense of security to the women and help them to maintain hope and the ability to deal with reality.

The Lower Saxony research network design of environments for ageing: towards interdisciplinary research on information and communication technologies in ageing societies

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the ‘Lower Saxony Research Network Design of Environments for Ageing’ (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GALs high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.

Environments for ageing, assistive technology and self-determination: ethical perspectives

The development of information and communication technologies for design of environments for ageing is of great importance considering demographic trends in the future. There is a realistic hope for the preservation of self-determination and independence in the long term. However, some risks like a gradual lost of privacy should not be underestimated. The article discusses some ethical problems within this context. At the same time, the article demonstrates that the development and implementation of these technologies might be discussed for instance under some ethical assumptions of personal self-responsibility as well as social responsibility for the widest independence in advanced age.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies – outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL)

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human–machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific “GAL technology”, providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL’s highly inter- and multidisciplinary aspects, with respect to research into GAL’s application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study.

Background: Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. Objectives: We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. Methods: Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. Results: The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. Discussion and conclusions: Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

Self-Perception and Self-Determination in Surveillance Conditions

The current demographic trends require rethinking health care and home care solutions. Rapid development of information and communication technologies that can be applied to technically equip priva...

Bedürfnisse von Brustkrebspatientinnen nach pflegerischer Unterstützung während der stationären Erstbehandlung

Das Ziel dieser Studie ist die Erkundung von speziell an Pflegende adressierten, subjektiven Betreuungsbedurfnissen von Frauen mit Brustkrebs wahrend der chirurgischen Primartherapie. Untersuchunge...

Belastungen und Bewältigungsstrategien von Frauen mit Brustkrebs in der Phase der chirurgischen Primärtherapie – die Sicht der Pflegenden

Die hier dargestellten Ergebnisse stellen einen Ausschnitt eines groseren von der Deutschen Krebshilfe e.V. finanzierten Forschungsprojektes dar, das zum Ziel hat, die Belastungen, Copingstrategien und Bedurfnisse von Frauen mit Brustkrebs wahrend der chirurgischen Primartherapie zu untersuchen. Brustkrebs fuhrt fur die betroffenen Frauen und ihre Familien zu zahlreichen Belastungen. Dabei setzen Frauen verschiedene Strategien ein, um die Krankheit zu bewaltigen. Fremd- und Selbsteinschatzungen von Belastungen und Bewaltigungsstrategien fuhren gelegentlich zu unterschiedlichen Ergebnissen, indem Experten zum Beispiel die Angst oder Depression ihrer Patientinnen uberschatzen, oder Copingstrategien aufdecken, die fur die Betroffenen nicht sichtbar sind. Es wurden qualitative Interviews mit zwolf Krankenschwestern aus drei norddeutschen Krankenhausern durchgefuhrt. Die inhaltsanalytische Auswertung der Interviews erfolgte in Anlehnung an Mayring. Vor allem Ungewissheit und Angst sind fur die betroffenen Frau...

Working with a domestic assessment system to estimate the need of support and care of elderly and disabled persons: results from field studies

This article describes the results of field studies performed over a period between five months and 24 months. The objectives of these studies were to collect long-term real-life data to evaluate how these data can be mapped to items on standardized assessment tests and which presentation method is most suitable to inform caregivers about critical situations and changes in health or care needs. A Home-monitoring system which uses modern sensor technologies was developed for and used in these field studies. It was installed in living environments of seven people (three who were not in need of care, two in need of care, and two with mental disabilities). The data were generated by sensor data acquisition and questionnaire reporting. Four types of data analysis and representation were evaluated to support caregivers. Results show that sensor data can be used to determine information directly or indirectly, which can be mapped to relevant assessment items and presented with different degrees of granularity. It is also feasible to determine and present additional information of potential interest which cannot be directly mapped to any assessment item. Sensor data can also be displayed in a live view. This live data representation led to a decrease in the caregivers’ workload when assessed according to the German version of the Perceived Stress Questionnaire.

A novel approach for discovering human behavior patterns using unsupervised methods

BackgroundAs is well known, elderly people gradually lose the ability of self-care. The decline can be reflected in changes in their daily life behavior. A solution to assess their health status is to design sensor-enhanced living environments to observe their behavior, in which unobtrusive sensors are usually used. With respect to information extraction from the dataset collected by means of these kinds of sensors, unsupervised methods have to be relied on for practical application. Under the assumption that human lifestyle is associated with health status, this study intends to propose a novel approach to discover behavior patterns using unsupervised methods.MethodsTo evaluate the feasibility of this approach it was applied to datasets collected in the GAL-NATARS study. The study is part of the Lower Saxony research network Design of Environments for Aging (GAL) and conducted in subjects’ home environments. The subjects recruited in GAL-NATARS study are older people (age ≥ 70 years), who are discharged from hospital to live alone again at their homes after treatment of a femoral fracture.ResultsThe change of lifestyle regularity is measured. By analyzing the correlation between the extracted information and medical assessment results of four subjects, two of them exhibited impressive association and the other two showed less association.ConclusionsThe approach may provide complementary information for health assessment; however, the dominant relationship between the change of behavior patterns and the health status has to be shown and datasets from more subjects must be collected in future studies.LimitationsMerely environmental data were used and no wearable sensor for activity detection or vital parameter measurement is taken into account. Therefore, this cannot comprehensively reflect reality.ZusammenfassungHintergrundDass ältere Menschen allmählich Selbstsorgekompetenzen verlieren, ist weithin bekannt. Der allmähliche Verlust kann sich in Veränderungen des Verhaltens im Alltagsleben widerspiegeln. Eine Möglichkeit zur Überprüfung ihres gesundheitlichen Zustands ist die Entwicklung sensorgestützter Lebensumfelder, um ihr Verhalten zu beobachten. Dabei werden in der Regel unauffällige Sensoren verwendet. Im Hinblick auf die Extrahierung von Informationen aus den so gesammelten Datensätzen verlässt man sich für die praktische Anwendung auf nichtsupervidierte Methoden. Ausgehend von der Annahme, dass Lifestyle und Gesundheitszustand miteinander zusammenhängen, zielt diese Studie auf einen innovativen Ansatz, Verhaltensmuster mit nichtsupervidierten Methoden zu detektieren.MethodenUm die Machbarkeit dieses Ansatzes zu evaluieren wurde er auf die in der GAL-NATARS-Studie generierten Datensätze angewendet; vom niedersächsischen Forschungsnetzwerk Design of Environments for Aging (GAL) wird diese Studie im Wohnumfeld der Probanden durchgeführt. Die allein lebenden Probanden der GAL-NATARS-Studie waren ≥ 70 Jahre alt und nach stationärer Behandlung einer Femurfraktur wieder in ihr häusliches Umfeld entlassen worden.ErgebnisseGemessen wurden die Veränderungen in der Regelmäßigkeit des Lebensstils. Bei 4 Probanden wurden die extrahierten Informationen und die Ergebnissen des medizinischen Assessments miteinander korreliert: Bei 2 von ihnen zeigte sich ein eindrucksvoller Zusammenhang, bei den anderen beiden fand sich weniger Assoziation.SchlussfolgerungenZwar kann der untersuchte Ansatz zusätzliche Informationen für das medizinische Assessment liefern, doch die dominante Beziehung zwischen den Änderungen in Verhaltensmustern und dem Gesundheitszustand ist noch darzustellen. In künftigen Studien müssen noch mehr Patientendatensätze gesammelt werden.EinschränkungenVerwendet werden lediglich Umweltdaten, keine Daten von tragbaren Sensoren zur Registrierung von Aktivität bzw. Vitalparametern. Daher können die Ergebnisse die Wirklichkeit nicht umfassend wiedergeben.