Marianne Müller

The prevalence of pressure ulcers in four paediatric institutions

AIM AND OBJECTIVE Pressure ulcers are a common nursing care issue in hospitals. They are associated with psychological and physical suffering, an increased morbidity and mortality rate and higher overall health care costs. The aim of the current study is to describe the frequency of pressure ulcers in a paediatric care setting and to identify the population at risk, as well as to assess the factors predisposing to the development of pressure ulcers. DESIGN A point prevalence study. METHODS The study was conducted in four paediatric hospitals in the German-speaking part of Switzerland and included children from the age of 0-18 years. The method of data collection was a direct systematic inspection and assessment of the skin, taking into account the clinical condition of the patient for risk assessment. A valid risk assessment and data collection instrument was used and, each patient was assessed by a previously instructed rater pair. RESULTS Of all possible patients, 81% (n = 155) were included. An overall pressure ulcer prevalence of 27.7% (including grade 1) was registered. Thirty-six patients (84%) had grade 1 ulcers, including many caused by external medical devices. Sixty-five per cent (n = 100) of all patients were considered at risk (Braden score < or = 20) of developing a pressure ulcer. Thirty-five per cent of patients in the risk group were afflicted with one or more pressure ulcers. CONCLUSIONS The prevalence of pressure ulcers in paediatric patients is greater then previously appreciated and the problem requires further exploration. The high percentage of grade 1 pressure ulcers caused by medical devices requires nursing interventions to prevent lesions for these patients. RELEVANCE TO CLINICAL PRACTICE The high prevalence rate in paediatric patients is disconcerting and requires further exploration in terms of interventions needed to improve outcomes for this patient group.

Moral distress in nurses at an acute care hospital in Switzerland: Results of a pilot study

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.

Nursing competence: psychometric evaluation using Rasch modelling.

AIM To test the psychometric properties and evaluate the German version of the Nurse Competence Scale. BACKGROUND Nursing competence is an important factor for high-quality healthcare. However, there are only few instruments available, which try to assess nurse competence and there is limited knowledge about the psychometric quality of any of these instruments. DESIGN A cross-sectional survey of 679 nurses was used. METHOD Analysis of the psychometric properties of the 73-item Nurse Competence Scale was undertaken using confirmatory factor analyses and Rasch modelling with data generated in a study in 2007. RESULTS The 7-factor model of the Nurse Competence Scale could not be confirmed. However, six scales consisting of 54 items demonstrated adequate fit to the Rasch model. The six subscales could also be combined into an overall competence scale. CONCLUSIONS There are concerns about the psychometric properties of the Nurse Competence Scale. The reduced set of items removes redundancy among items, is free from item bias and constitutes six unidimensional scales.

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.

Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. Background: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. Methods/Design: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings. Conclusion: The research program will produce baseline data on nursing service context factors in Swiss acute care hospitals prior to DRG introduction as well as a theoretical model and a methodology to support nursing managers and hospital executive boards in distributing resources effectively. The study was approved by the ethics committees of Basel, Bern, Solothurn and Zürich.

Risikofaktoren für Stürze und sturzbedingte Verletzungen im Akutspital – Eine retrospektive Fall-Kontroll-Studie

Falls in patient are a major problem in acute care institutions because of direct and indirect consequences. The objectives of the present retrospective case control study were to explore predictors of falls and fall-related injuries in hospitalised patients in a department of internal medicine at a Swiss acute care hospital. The sample included 228 hospitalised patients with a fall and 228 patients without a fall as control subjects, matched by age, gender and medical diagnosis. The cases were further analysed, whereby injured patients were compared with uninjured ones. Data were obtained from patient records and the hospital information system (HIS). Patients with a previous fall, mobility disorders, altered cognition, altered urinary and fecal excretions, intake of sedativa or other psychotropic drugs, a higher amount of comorbidities and case mix, as well as a prolonged length of stay were significantly more frequent in the cases than in the controls. Patients with falls and controls showed no differences in terms of impaired vision, intake of five and more medications, or diuretica. Analysis by logistic regression revealed mobility disorder (OR 5,2; 95 % VI 2.39-11.44) and altered excretions (OR 1,8; 95 % VI 1.02-3.31) as significant main effects and there also were significant interactions between previous falls, intake of sedativa or other psychopharmaca and altered cognition. No difference could be seen in any variable between patients with a fall-related injury and no injury. Therefore a predictive profile could be found for patients at risk to fall which might be helpful for further prevention strategies. However, no predictive marker for fall-related injuries could be defined in the present study.

Advancement of the German version of the moral distress scale for acute care nurses-A mixed methods study

Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German‐speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German‐language version of the Moral Distress Scale.