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The ongoing demographic changes in Germany pose increasing challenges for the healthcare system. As society ages, the number of people in need of care rises rapidly, and in the wake of multimorbid illnesses, the quality of care required is constantly changing. But fewer and fewer skilled nursing staff are available in the labor market to cope with this growing need for care. The continuing shortage of skilled workers means that the increasing demands on nursing staff have to be met by fewer and fewer staff. As a result, the workload is increasing enormously, and the health of nursing staff is suffering, causing additional absences due to staff illness and further exacerbating the staff shortage. The incapacity numbers in nursing professions are now at a record high, raising concerns regarding the security of patients. Many nurses now experience mental health problems such as burnout. Previous models to explain the development of burnout in the work context point to the great importance of demands and resources; however, they are too unspecific to make predictions for the nursing context. This thesis therefore, develops a specific model to explain the development of burnout in health care professions (e.g., nursing), with a particular focus on the role of intraindividual resources. For this purpose, a multimethod approach was used in the context of three studies. In the first study, qualitative interviews were conducted in long-term care settings: group interviews in workshops with employees and individual interviews with leaders. Based on these findings, longitudinal surveys in long-term care and hospitals were conducted in the second and third studies to test the hypotheses derived in Study 1. Chapter 4 uses two qualitative interview studies to describe the perspectives of employees and leaders in long-term care regarding perceived challenges in the work context and potential opportunities for change. The results show that self-endangering behaviors promote the development of burnout among caregivers. The study suggests that self-endangering is a harmful coping strategy promoted by high altruistic job motivation, high identification with the team, and low self-esteem. Chapter 5 elaborates on the findings presented in Chapter 4 and tests them using a quantitative longitudinal survey over two measurement time points. The results confirm that high altruistic job motivation leads to more self-endangering behavioral tendencies and cognitions in nurses. Self-endangering cognitions mediate the effect of altruistic job motivation on the experience of exhaustion. Further evidence was found for the effect of low self-esteem on the promotion of self-endangering cognitions. Chapter 6 examines in a longitudinal survey the effect of altruistic job motivation and under what conditions it has a detrimental effect on health and leads to self-endangering tendencies in nurses. Workload, as well as leadership behavior, are examined as moderators. The results show that altruism promotes self-endangering cognitions when qualitative workload is high. In addition, leaders who allow their employees few opportunities to recover from work promote their employees’ self-endangering cognitions. In summary, self-endangering is a harmful coping strategy in caring professions; it promotes burnout and is particularly promoted by high altruistic job motivation and low selfesteem. Both changes in working conditions and behavioral interventions are needed to reduce self-endangering in caregiving and thus maintain caregivers' mental health. Intraindividual resources could be strengthened in interventions, working conditions could be changed, and leaders could be sensitized.:Abstract (English) Zusammenfassung (Deutsch) List of Figures List of Tables Self-Endangering in Nursing Theoretical Background Overview of the Research Program Psychological Mechanisms Underlying Nurses’ Burnout Self-Endangering and Nurses’ Job Motives Self-Endangering and Effects of Workload and Leadership Behavior Overall Discussion References Appendix / Der fortschreitende demographische Wandel in Deutschland stellt das Gesundheitssystem vor wachsende Herausforderungen. Mit zunehmender Alterung der Gesellschaft steigt die Zahl pflegebedürftiger Menschen rapide an und im Zuge von multimorbiden Erkrankungen verändert sich auch die Qualität der Pflegebedürftigkeit stetig. Zur Bewältigung dieses wachsenden Pflegebedarfes stehen immer weniger Fachkräfte in der Pflege dem Arbeitsmarkt zur Verfügung. Der fortschreitende Fachkräftemangel führt insbesondere in der Pflege dazu, dass die immer größere werdenden Arbeitsanforderungen von zunehmend weniger Personal bewältigt werden muss. In Folge dessen steigt die Arbeitsbelastung enorm und die Gesundheit des Pflegepersonals leidet, was zusätzliche Ausfälle durch Erkrankungen des Personals verursacht und die Personalknappheit weiter verschärft. Die Arbeitsunfähigkeitszahlen in pflegenden Berufen sind dadurch inzwischen auf einem Rekordhoch und besorgniserregend für die Versorgungssicherheit der Patienten*innen. Viele Pflegende leiden dabei insbesondere unter psychischen Erkrankungen, wie Burnout. Die bisherigen Modelle zur Erklärung der Entstehung von Burnout im Arbeitskontext weisen auf die große Bedeutung von Anforderungen und Ressourcen hin, sind dabei aber zu allgemein, um spezifische Vorhersagen für den Pflegekontext treffen zu können. Diese Thesis entwickelt daher ein spezifisches Modell zur Erklärung der Entstehung von Burnout in pflegenden Berufen, mit dem besonderen Fokus auf die Rolle von intraindividuellen Ressourcen. Hierzu wurde ein Multimethoden-Verfahren im Rahmen von drei Studien eingesetzt. In der ersten Studie wurden in der stationären Langzeitpflege qualitative Interviews im Rahmen von Gruppeninterviews in Workshops mit Mitarbeitenden und Einzelinterviews mit Führungskräften durchgeführt. Auf Basis der hieraus gewonnenen Erkenntnisse wurden in der zweiten und dritten Studie Längsschnittbefragungen in der Langzeitpflege und im Krankenhaus zur Prüfung, der in Studie 1 abgeleiteten Hypothesen, durchgeführt. Kapitel 4 beschreibt im Rahmen von zwei qualitativen Interviewstudien die Perspektive von Mitarbeitenden und Führungskräften aus der stationären Langzeitpflege hinsichtlich der wahrgenommenen Herausforderungen im Arbeitskontext und möglicher Veränderungsmöglichkeiten. Die Ergebnisse zeigen, dass selbstaufopfernde Verhaltensweisen die Entstehung von Burnout bei Pflegenden begünstigen. Die Studie legt nahe, dass Selbstaufopferung eine gesundheitsschädliche Bewältigungsstrategie ist, die durch eine hohe altruistische Berufsmotivation, hohe Identifikation mit dem Team und geringen Selbstwert gefördert wird. Kapitel 5 vertieft die in Kapitel 4 dargestellten Ergebnisse und prüft diese anhand einer quantitativen Längsschnittbefragung über zwei Messzeitpunkte. Die Ergebnisse bestätigen, dass eine hohe altruistische Berufsmotivation zu mehr selbstaufopfernde Verhaltenstendenzen und Kognitionen bei Pflegenden führt. Selbstaufopfernde Kognitionen mediieren dabei den Effekt von einer altruistischen Berufsmotivation auf das Erschöpfungserleben. Weitere Hinweise zeigten sich für die Wirkung von geringem Selbstwert auf die Förderung von selbstaufopfernden Kognitionen. Kapitel 6 untersucht die Wirkung einer altruistischen Berufsmotivation in Pflegeberufen und unter welchen Bedingungen diese gesundheitsschädlich wirkt und zu Selbstaufopferungstendenzen von Pflegenden führt. Als Moderatoren werden die Arbeitsbelastung, sowie das Führungsverhalten untersucht. Die Ergebnisse zeigen, dass Altruismus dann selbstaufopfernde Kognitionen fördert, wenn die qualitative Arbeitsbelastung hoch ist. Darüber hinaus konnte gezeigt werden, dass Führungskräfte, die ihren Mitarbeitenden wenig Möglichkeiten zur Erholung von der Arbeit ermöglichen, die selbstaufopfernden Kognitionen ihrer Mitarbeitenden fördern. Zusammenfassend lässt sich sagen, dass Selbstaufopferung eine gesundheitsschädliche Coping Strategie in pflegenden Berufen darstellt, die Burnout fördert und insbesondere durch eine hohe altruistische Berufsmotivation und ein geringen Selbstwert gefördert wird. Es sind sowohl verhältnis- als auch verhaltensorientierte Maßnahmen notwendig, um Selbstaufopferung in der Pflege zu verringern und damit die psychische Gesundheit des Pflegepersonals zu erhalten. So könnten die intraindividuellen Ressourcen in Interventionen gestärkt, die Arbeitsbedingungen verändert, sowie die Führungskräfte sensibilisiert werden.:Abstract (English) Zusammenfassung (Deutsch) List of Figures List of Tables Self-Endangering in Nursing Theoretical Background Overview of the Research Program Psychological Mechanisms Underlying Nurses’ Burnout Self-Endangering and Nurses’ Job Motives Self-Endangering and Effects of Workload and Leadership Behavior Overall Discussion References Appendix

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<p>Oppgaven ser på et område som det i dag er implementert lite støtte for i eksisterende EPJ-systemer (Elektronisk Pasientjournal), knytting av emner til ustrukturert sykepleiedokumentasjon ved hjelp av tradisjonelle søketeknikker og rammeverk. Søking og navigering er dårlig utviklet i mange EPJ-systemer, spesielt for ustrukturert dokumentasjon. Knytning av emner til denne typen dokumentasjon kan derfor lette sykepleiernes hverdag, og metoden som presenteres i denne oppgaven kan være et verktøy i denne sammenhengen. Automatisk klassifisering er knyttet til mange usikkerhetsfaktorer. Disse usikkerhetsfaktorene forsøkes belyst ved vise til sykepleiedokumentasjonens natur og sprikende struktur, noe som vanskeliggjør en regelbasert tilnærming. Oppgaven argumenterer for at man kan tolerere feilkilder så lenge man er klar over at disse eksisterer, og at nytteverdien av å søke på emner fremfor enkelttermer er større enn problemene disse usikkerhetsfaktorene gir. Bruk av eksisterende rammeverk fremfor egendefinerte klassifiseringssystemer er en naturlig innfallsvinkel til en slik problemstilling. Oppgaven forsøker å vise ett prinsipp, mer enn en favorisering av ett spesielt rammeverk. Likevel vil ett rammeverk, Sabaklass versjon 2.0N, bli mer omtalt enn andre på grunn av at det har vært benyttet i implementasjonen av en prototyp i forbindelse med oppgaven. Oppgaven viser hvordan slik emnetilknytning kan foregå ved hjelp av en prototyp som er blitt utviklet for formålet. Prototypen benytter vektorrommodellen (VSM) sammen med en ordliste knyttet til rammeverket for å klassifisere ustrukturert sykepleiedokumentasjon. Valget av vektormodellen fremfor andre, tradisjonelle tekstgjenfinningsteknikker, er gjort ut ifra modellens egenskaper til å rangere delvise treff. De konkrete resultatene av prototypingen kan være diffuse. Dette er i stor grad knyttet til konstruksjonen av ordlisten, og vanskeligheter knyttet til å skaffe en god testsamling. Likevel peker de foreløpige resultatene i favør for en slik søkemetodikk, fordi den kan benyttes sammen med eksisterende søkemetodikker, og den representerer en fordel ved ukjent dokumentasjon.</p>

Oppgaven ser på et område som det i dag er implementert lite støtte for i eksisterende EPJ-systemer (Elektronisk Pasientjournal), knytting av emner til ustrukturert sykepleiedokumentasjon ved hjelp av tradisjonelle søketeknikker og rammeverk. Søking og navigering er dårlig utviklet i mange EPJ-systemer, spesielt for ustrukturert dokumentasjon. Knytning av emner til denne typen dokumentasjon kan derfor lette sykepleiernes hverdag, og metoden som presenteres i denne oppgaven kan være et verktøy i denne sammenhengen. Automatisk klassifisering er knyttet til mange usikkerhetsfaktorer. Disse usikkerhetsfaktorene forsøkes belyst ved vise til sykepleiedokumentasjonens natur og sprikende struktur, noe som vanskeliggjør en regelbasert tilnærming. Oppgaven argumenterer for at man kan tolerere feilkilder så lenge man er klar over at disse eksisterer, og at nytteverdien av å søke på emner fremfor enkelttermer er større enn problemene disse usikkerhetsfaktorene gir. Bruk av eksisterende rammeverk fremfor egendefinerte klassifiseringssystemer er en naturlig innfallsvinkel til en slik problemstilling. Oppgaven forsøker å vise ett prinsipp, mer enn en favorisering av ett spesielt rammeverk. Likevel vil ett rammeverk, Sabaklass versjon 2.0N, bli mer omtalt enn andre på grunn av at det har vært benyttet i implementasjonen av en prototyp i forbindelse med oppgaven. Oppgaven viser hvordan slik emnetilknytning kan foregå ved hjelp av en prototyp som er blitt utviklet for formålet. Prototypen benytter vektorrommodellen (VSM) sammen med en ordliste knyttet til rammeverket for å klassifisere ustrukturert sykepleiedokumentasjon. Valget av vektormodellen fremfor andre, tradisjonelle tekstgjenfinningsteknikker, er gjort ut ifra modellens egenskaper til å rangere delvise treff. De konkrete resultatene av prototypingen kan være diffuse. Dette er i stor grad knyttet til konstruksjonen av ordlisten, og vanskeligheter knyttet til å skaffe en god testsamling. Likevel peker de foreløpige resultatene i favør for en slik søkemetodikk, fordi den kan benyttes sammen med eksisterende søkemetodikker, og den representerer en fordel ved ukjent dokumentasjon.

Text in English / In this study an attempt has been made to reflect upon T.G. Mashaba's transcultural themes. For the purpose of this study, the researcher had to differentiate between traditional and professional cultural themes. All of these were mirrored in some of Mashaba's works through the employment of descriptive devices in a manner that enables one to picture her philosophy of transcultural nursing care, her ideas and ideals, conceptions, opinions and beliefs. The chief aim of this study was to survey the significance and contribution of Mashaba transcultural themes to nursing. In identifying the two systems, Mashaba was attempting not only to help nurses to become aware of these systems, but to consider ways to make reciprocal interfaces with the two systems. Marked caring differences among health care systems exist as well as similar features. Efforts were made - by Mashaba - to explicate these caring aspects in order to provide a sound rationale and therapeutic nursing care. The design used in this study was purely descriptive, investigative, interpretive and analytic with the specific aim of elucidating Mashaba's ideas, ideals and thoughts. This approach helped in bringing to light the value of the themes while at the same time focusing attention on their transcultural nature. Leininger's Cultural Theoretical Model was applied - as a conceptual Model - for the analysis of transcultural themes. This research study gives us a picture of a gifted and hardworking woman. She was ambitious and had set definite goals for herself. Her sense of cultural observation and imaginativeness elevate her as- a spokesperson for the underprivileged, not only of her race, but of any nationality. In her efforts, she was a moderate who believed that engagement in a dialogue would bring better and more lasting solutions than war. This gives her work the universal relevance and appeal. / Health Studies / D.Litt. et Phil. (Advanced Nursing Sciences)

Text in English / In this study an attempt has been made to reflect upon T.G. Mashaba's transcultural themes. For the purpose of this study, the researcher had to differentiate between traditional and professional cultural themes. All of these were mirrored in some of Mashaba's works through the employment of descriptive devices in a manner that enables one to picture her philosophy of transcultural nursing care, her ideas and ideals, conceptions, opinions and beliefs. The chief aim of this study was to survey the significance and contribution of Mashaba transcultural themes to nursing. In identifying the two systems, Mashaba was attempting not only to help nurses to become aware of these systems, but to consider ways to make reciprocal interfaces with the two systems. Marked caring differences among health care systems exist as well as similar features. Efforts were made - by Mashaba - to explicate these caring aspects in order to provide a sound rationale and therapeutic nursing care. The design used in this study was purely descriptive, investigative, interpretive and analytic with the specific aim of elucidating Mashaba's ideas, ideals and thoughts. This approach helped in bringing to light the value of the themes while at the same time focusing attention on their transcultural nature. Leininger's Cultural Theoretical Model was applied - as a conceptual Model - for the analysis of transcultural themes. This research study gives us a picture of a gifted and hardworking woman. She was ambitious and had set definite goals for herself. Her sense of cultural observation and imaginativeness elevate her as- a spokesperson for the underprivileged, not only of her race, but of any nationality. In her efforts, she was a moderate who believed that engagement in a dialogue would bring better and more lasting solutions than war. This gives her work the universal relevance and appeal. / Health Studies / D.Litt. et Phil. (Advanced Nursing Sciences)

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La majorité des personnes âgées atteintes de démence présente des symptômes comportementaux et psychologiques. Plusieurs instruments de mesure sont disponibles afin d’évaluer les troubles de comportement des personnes résidant en centre d’hébergement mais peu d’entre eux ont été traduits et validés en français. Ce mémoire a pour objectif principal de déterminer la structure factorielle de la version française du Nursing Home Behavior Problem Scale (NHBPS) auprès de personnes atteintes de démence et résidant en centre d’hébergement. Un objectif secondaire est de documenter les variables associées aux dimensions sous-jacentes de cet instrument. Les participants (N=155) ont un diagnostic de démence et sont usagers de trois centres d’hébergement et d’une unité de soins de longue durée d’un hôpital. Une infirmière a évalué les troubles du comportement des participants à l’aide du NHBPS ainsi que leurs caractéristiques personnelles. Une analyse factorielle confirmatoire montre un manque d’adéquation des données à deux solutions factorielles de la version anglaise du NHBPS. Une analyse en composantes principales révèle cinq dimensions expliquant 58 % de la variance. Plusieurs variables, notamment la consommation d’antipsychotiques, la présence d’un delirium, la douleur et la dépression, sont associées au score total du NHBPS et à ses différentes dimensions sous-jacentes. Bien que la solution factorielle de la version française du NHBPS soit similaire à celle de la version originale anglaise, nos résultats montrent également des différences qui peuvent dépendre de facteurs méthodologiques et culturels.

L'estimation des coûts est un incontournable pour une meilleure planification et allocation des ressources dans les différentes unités d'un établissement de santé, et ce, particulièrement aux unités de soins intensifs (USI), qui figurent parmi les plus coûteuses à l'hôpital. Le but de cette étude était d'offrir une contribution à l'estimation des coûts aux USI. Comme le personnel infirmier représente une proportion importante des dépenses des USI et que ce sont les infirmières qui prodiguent la majorité des soins directs aux patients, ce projet avait pour objectif d'évaluer la faisabilité d'utiliser la méthode développée par Miranda & Jegers (2012) pour d'estimer les coûts-patient à partir de la mesure de l'intensité des soins infirmiers. L'outil utilisé pour mesurer l'intensité des soins infirmiers aux USI est le Nursing activities score (NAS). Cette étude s'appuie sur la vision de la performance des soins infirmiers de Dubois (Dubois & al., 2013) combinée au cadre de référence du Triple Aim de l'Institute for Healthcare Improvement (Berwick et al., 2008) qui souligne la place fondamentale qu'occupent les coûts dans l'optimisation des systèmes de santé. Les analyses de coûts ont été conduites dans quatre USI et une unité intermédiaire des centres hospitaliers universitaires de Québec. Le coût des soins infirmiers par patient variaient de 730 $ à 1 227$ et le coût total d'hospitalisation de 1 999$ à 2 524$. Nos résultats ont démontré que l'utilisation du temps infirmier consacré aux soins directs permet d'individualiser les coûts, en renforçant la contribution possible du NAS à l'estimation des coûts aux USI. Des études futures incluant une plus longue période de collecte de données du NAS, l'optimisation des informations concernant les coûts-patient indirects et la comparaison avec d'autres méthodes d'estimation de coûts sont encore nécessaires. Bien que tous les membres de l'équipe interdisciplinaire à l'USI y occupent une place importante, l'infirmière demeure le pilier central de la prestation constante des soins directs aux patients, d'où la prépondérance de la contribution de ces professionnelles aux coûts de l'USI. L'utilisation du NAS en continu dans ces unités pourra contribuer à une estimation des coûts plus précise tout en offrant une réponse directe aux exigences les plus récentes du Ministère de la santé et des services sociaux du Québec (MSSS) en matière de financement des établissements de santé, qui s'oriente vers le financement axé sur les patients (FAP). Ce type de financement considère l'estimation du coût des services et soins prodigués à un patient pendant un épisode de soins (coût par parcours de soins et de services - CPSS). La méthode utilisée dans la présente étude peut apporter une contribution unique à l'estimation du CPSS. / Estimating costs is essential for better planning and allocation of resources in health care facilities. This is especially important in intensive care units (ICU), which are among the most expensive in the hospital. The purpose of this study was to provide a contribution to the estimation of ICU costs. As nurses account for a significant proportion of ICU expenditure and nurses provide most of the direct patient care, the objective of this study was to assess the feasibility of using the method proposed by Miranda & Jegers (2012) to estimate patient costs through the measurement of nursing care intensity. The instrument Nursing Activities Score (NAS) was used to assess the intensity of nursing care. This study is based on Dubois's view of nursing performance (Dubois & al., 2013) combined with the Institute for healthcare improvement's Triple Aim framework (Berwick et al., 2008), which emphasizes the fundamental role of costs in optimizing healthcare systems. Cost analyses were conducted in four ICUs and one intermediate unit of the University Hospital Centres of Quebec City. The cost of nursing care ranged from $730 to $1,227 and total hospitalization cost ranged from $1,999 to $2,524. Our results showed that the use of the nursing time related to direct care allows for cost individualization, reinforcing the possible contribution of the NAS to a more individualized ICU cost estimation. Future studies including a longer period of NAS data collection, optimization of indirect patient costs information and comparison with other costs estimation methods are still needed. Although all members of the interdisciplinary team in the ICU play an important role, the nurse remains central in the ongoing provision of direct patient care, hence the preponderance of the contribution of these professionals to ICU costs. The continuous NAS data collection in these units may contribute to a more accurate costs estimate while providing a direct response to the most recent requirements of the Ministère de la santé et des services sociaux du Québec (MSSS) regarding the financing of healthcare institutions which is patient-oriented financing. This type of financing considers the estimation of the costs of services and care provided to a patient during an episode of care (costs of the care pathway and services - CPSS). The method used in this study can make a unique contribution to the estimation of the CPSS.