No description available.

Sammanfattning Titel: Patienters erfarenheter av kontakten med äldresköterskan i primärvården. Bakgrund: Andelen äldre människor i Sverige ökar eftersom vi lever längre. Med stigande ålder ökar mottagligheten för sjukdom. Både sjukdom och åldersförändringar kan ge funktionsnedsättningar men trots detta bor många äldre med hälso- och sjukvårdsbehov hemma utan inskrivning i den kommunala hemsjukvården. Syfte: Att belysa patienters erfarenheter av kontakten med äldresköterska inom primärvården. Metod: Studien utgår från en kvalitativ design med induktiv ansats. Fem patienter deltog enskilt i en semistrukturerad intervju. Dataanalysen genomfördes med kvalitativ manifest innehållsanalys. Resultat: De intervjuade upplevde att samtalet är den viktigaste erfarenheten av kontakten med äldresköterskan. Patienterna upplever att kontakten ger dem stöd och minskad oro i vardagen. Deras trygghet ökar genom den kontinuitet och tillgänglighet som äldresköterskan erbjuder. Slutsats: Det arbete som äldresköterskan utför bör lyftas fram och tillåtas utvecklas eftersom antalet äldre med vård- och omsorgsbehov ökar. / Abstract Titel: Patients' experiences of contact with elder nurses in primary health care. Background: The proportion of elderly people in Sweden will increase due to longer life span. With age susceptibility to disease increases. Both disease- and agerelated changes can cause impairments even though many elderly people with health needs live at home, without enrollment in the municipal home care. Objective: The aim was to illuminate patients´experiences of contact with the elder nurse in primary health care. Method: The study uses a qualitative design with inductive approach. Five patients participated individually in a semi-structured interview. Data analysis was performed by qualitative manifest content analysis. Results: The interviewees felt that the conversation is the most important experience of contact with the nurseproviding elder care. Patients feel that the contact give them support and reduced anxiety in daily life. Their safety is enhanced by the continuity and availability provided by the elder nurse. Conclusion: The work that elder nurse perform should be emphasized and allowed to evolve as the number om elderly people with health and care needs increase.

The thesis deals with specific nursing care for children with facial cleft anomalies. Facial clefts belong to frequent congenital anomalies with incidence of 1 : 500 in lively born children, which is why adequate care has to be provided to these children to honour the founder of Czech plastic surgery Prof. František Burian. Two goals were set in this thesis. The first goal was to elaborate a proposal of a nursing procedure for children with facial cleft. The other goal was to elaborate an educational programme for nurses and parents of children with facial cleft anomalies. Both the goals have been achieved. Two hypotheses were set in this thesis: Hypothesis No. 1 ?Nurses working at a specialized department are sufficiently informed on the care about children with facial cleft anomalies?. Hypothesis No. 2 ?Nurses working at maternity wards are sufficiently informed on the care about children with facial cleft anomalies?. Two research questions were also set before the research itself: Research question No. 1: How do nurses provide specific nursing care to children with facial cleft anomalies? Research question No. 2: What principles do nurses consider important for the care about children with facial cleft anomalies? The questionnaire, interview and observation methods were used for data collection. The questionnaire was based on information obtained from literature and was designed for ward nurses. The interview was prepared upon own experience from observation of nurses in the Královské Vinohrady University Hospital in the Centre for Cleft Anomalies Treatment and upon information from literature. 60 questionnaires were distributed in the České Budějovice Hospital in March 2011. There were 47 completed questionnaires suitable for processing. 11 questionnaires were distributed in the Královské Vinohrady University Hospital in March 2011. 9 completed questionnaires were used for processing. The research sample for the interview consisted of 11 nurses working in the Královské Vinohrady University Hospital, the Centre for Cleft Anomalies Treatment, the Paediatric ICU and the Paediatric ward. The results show that the nurses working at maternity wards are sufficiently informed. The results also show how nurses provide specific nursing care and what principles they consider important. We have elaborated educational programmes for parents and nurses within the set goals and upon the interviews with nurses, which may help improve the nursing care and particularly teach parents to care about their children with facial cleft properly.

The thesis is focused on a research and the evaluation of the nurse role during the invasive methods in chronic pain treatment and on a research the patient satisfaction and expectation with the nurses approach during the invasive methods in chronic pain treatment. The basis for the thesis processing is qualitative ? quantitative research carried out in the departments of pain treatment in four hospitals, in University Hospital Motol, University Hospital Brno, Hospital České Budějovice a.s., University Hospital PlzeňAlejSvobody. Qualitative research focuses on nurses working in the department of pain treatment using a method of questioning with the technique of non-standardized interview. Within qualitative research, we was looking for the answer to the research question: What is the nurse role during the invasive technique in chronic pain treatment? It was found, from the results of the interviews and their analysis, that nurses have within the invasive performance wide field of action and their role is changing in various stages of the entire performance. In all phases of the invasive performance, it´s essential the communication between the nurse and the patient. In the phase before the invasive performance and afterwards is the most dominated the educational role, except for the nursing role. Quantitative research using the questionnaire was intended for patients in the departments of pain treatment. The following predetermined hypothesis were verified using quantitative research: H1: Patients are satisfied with the nurses approach during the invasive techniques in pain treatment. H2: Patients with chronic pain during the invasive methods are expecting especially the empathetic approach from nurses. Evaluation of the questionnaires, which were voluntarily completed by patients, can be ended that both given hypothesis H1 and H2 have been confirmed and that the targets of qualitative researches have been met. The space for improvement can be found in the patient education before the invasive performance. Therefore We created educational material for patients. This educational material is not intended to replace the education conducted by nurses, it rather serves as a basis for the questions preparation that the patient will want to clarify before the invasive performance.

Increasing the education of nursing staff is a society-wide issue, influenced by continuous development of medicine and medical technologies. The provision of nursing care is rightly demanding. The only way to keep up with new trends is lifelong nursing education. Nursing education in a particular workplace primarily aims at addressing current problems of the department and nurses? needs. The theoretical part deals with the influence of education on the quality of nursing care. We present a structure of education of paramedical professions. We define and clarify terms such as pedagogy, didactics, education and learning. We deal with the specifics of education, didactic principles and principles of adult education. In addition, we specify instructional strategies for nursing staff. For the purposes of this thesis, four objectives were set. In the first one we wanted to find out what the system and process of nursing education in the department looks like. The research showed that educational events are held in all departments. The organizing departments mostly report irregular or monthly frequency. The aim of the second objective was to obtain an opinion on the effectiveness of education in the department. We found disparity between the views of ordinary nurses and head nurses. The third objective was to answer the question of whether the organized educational events are initiated by the nurses? requests. Based on the answers of head nurses and ordinary nurses, we found out that this is not always the case. The last objective was to determine whether nurses implement the knowledge and skills gained to routine nursing care. The questionnaires showed that ordinary nurses try to incorporate the knowledge and skills to routine nursing care. For the purposes of this thesis, the combination of qualitative and quantitative research was selected. In order to carry out the qualitative part of the research, the method of questioning, using the technique of semi-structured interview with open questions was chosen. For the issue of quantitative research, the method of questioning, using the questionnaire technique with closed and semi-closed questions was used. For qualitative research, we set two research questions. In the first research question we wanted to find out what impetus the management uses when planning education in the hospital and the department. We found out that most often it is initiated by head nurses and ward nurses. In the second research question, we examined what obstacles the management sees to the effectiveness of education and implementation of the knowledge and skills gained into practice. Head nurses identify a problem in the actual participation in education in the department. For quantitative research, we set five hypotheses. Hypothesis 1 was: Nursing education in the workplace is an activity organized by the management regardless of the ordinary nurses? requests. The hypothesis was not confirmed. Hypothesis 2 was: Management, unlike ordinary nurses, sees the effectiveness of education in the workplace positively. The hypothesis was not confirmed either. The third hypothesis was: Education is seen as a necessary, routine activity, not as motivating factor for improving the quality of nursing care. The hypothesis was not confirmed. The last hypothesis was: Implementation of the knowledge gained from the educational events into nursing care is monitored by the management. The hypothesis was not confirmed, the implementation of knowledge is monitored, but not to the extent we expected. When evaluating the results we came across other very interesting facts, which we believe deserve more attention. Finally, it is surprising that the organization of educational events does not reflect nurses? shifts. One of the reasons for this might be the fact that some head nurses do not prepare the plan and time schedule for nursing education. We tried to propose the time schedule of nurses education in deparments.

The aim of the thesis is to find out the conception of human dignity at medical staff. At nurses, in addition, with a hidden observation to verify to what extent they meet their statements in practice, whether for nurses a patient does not become only an object of relevant therapeutic and nursing acts. The empirical part of this thesis was processed in form of a qualitative research. The data collection technique was a non-standardised interview with nurses at standard in-patient departments, students of the nursery Master study programme, students of a higher nursing school and patients at a standard department. At nurses it was verified, using the technique of hidden observation, to what extent their actual behaviour in practice corresponds to the information mentioned in interviews. Therefore in their interviews we differentiated the mentioned and non-mentioned elements. The interviews were anonymous. They were recorded in writing because only in one case the respondent agreed for us to use a dictaphone. Collection of empirical data proceeded from June to August 2008. Unlike our expectations the research showed that respondents have no conception of human honour and have no complex conception of its keeping in practice. We categorised the rather poor information into five basic categories that covered 92% (intimacy, communication, individuality, empathy and equality of approach). Statements that we did not manage to categorise here create other 5 categories (worthy dying, consider seriously, pain calming, lege artis process and faith). Most often the respondents mentioned the following categories: intimacy (80.4 %), communication (76.8 %), individuality (60.7 %), empathy (39.3 %) and equality of approach (33.9 %). The hidden observation showed that most nurses (13 out of 16, i.e. 81 %) adhered to their fundamentals of keeping human dignity when working with ill people in a satisfactory way. The other 3 nurses made mistakes in all categories except keeping intimacy; here only one of them did wrong. Results of the thesis should contribute to improvement of quality of care and help to better respect for human dignity.

Die Sicherung und Weiterentwicklung der Versorgungs- und Pflegequalität sind wesentliche Bestandteile der Patientenversorgung im Krankenhaus (vgl. Boucsein, 2004: 1). Sowohl die Pflegewissenschaft als Disziplin als auch der Gesetzgeber haben ein hohes Niveau an die Qualität der Versorgung definiert. Dies und die zunehmende Komplexität der Behandlungsfälle erfordern die Nutzung geeigneter Instrumente (vgl. Kußmaul, 2011: 270). Neben Patientenbefragungen, Pflegestandards und normierten Prozessen, ist die Pflegevisite ein wichtiges Instrument der internen Qualitätssicherung der Pflege. Die Mehrzahl der deutschsprachigen Fachliteratur zur Pflegevisite ist aus den neunziger Jahren bis in die Anfänge der 2000er Jahre. Es finden sich überwiegend Praxisberichte, die in der Analyse heterogene Definitionen und Inhalte aufzeigen. Daher wurde für die vorliegende Dissertation eine umfassende Literaturanalyse vorgenommen. Es erfolgte eine Darstellung der theoretischen Grundlagen, wobei unter anderem die Abgrenzung von anderen Begriffen und Instrumenten beschrieben wurde, um Pflegevisite eindeutig zu definieren. Die Autorin orientiert sich in ihrer Arbeit an der Definition der Verfahrensanweisung Pflegevisite des Universitätsklinikums Carl Gustav Carus Dresden: „Die Pflegevisite ist ein Instrument zur ganzheitlichen Gestaltung und Evaluation des Pflegeprozesses, mit dem Ziel der Qualitätssicherung und -entwicklung. Es erfolgt im Rahmen der Pflegevisite ein Gespräch mit dem Patienten / der Patientin und / oder den Angehörigen. Die Pflegevisite ist ebenso ein Führungsinstrument, sofern Pflegevisiten durch leitende Pflegekräfte gemeinsam mit den Pflegenden durchgeführt werden. Die Pflegevisite ist dabei kein Kontrollinstrument (vgl. Bieg, 1995: 208; Koch, 2006:48).“ Das Universitätsklinikum Dresden (UKD) führte am 01.01.2011, verpflichtend für alle stationären Bereiche, das Instrument Pflegevisite ein. Die vorliegende Arbeit beschäftigt sich mit der Evaluation von Inanspruchnahme, Akzeptanz und Nutzen der Pflegevisite am Beispiel dieser Einrichtung. Dazu führte die Autorin vom 01.06.2013 bis zum 30.11.2015 eine dreiteilige Forschungsstudie, bestehend aus einer Befragung, Experteninterviews innerhalb des UKD und einer Datenauswertung der Pflegevisiten des UKD von 2011-2014, durch. An der deutschlandweiten Befragung nahmen insgesamt 53 Einrichtungen teil. 58,5 % der Teilnehmenden gaben an, Pflegevisiten durchzuführen. Die 41,5% der Einrichtungen, die keine Pflegevisiten durchführten, gaben als häufigste Gründe der fehlenden Umsetzung an, dass die Prioritäten in anderen Themengebieten lägen sowie fehlende zeitliche und personelle Ressourcen. Es zeigte sich keine flächendeckende Nutzung. Somit wurde die These eines in Deutschland etablierten Instrumentes der Pflegevisite nicht bestätigt. Pflegevisitendurchführende Einrichtungen gaben die Qualitätssicherung und -weiterentwicklung, die Steigerung der Patientenzufriedenheit und das Aufdecken von Defiziten als Gründe für die Etablierung an. Dabei werden inhaltliche Schwerpunkte wie Pflegequalität, Patientenzufriedenheit, Pflegedokumentation, Umgebung, Organisation, Fachkompetenz der Mitarbeitenden und die Umsetzung von Vorgaben geprüft. 71,4 % der Teilnehmenden orientieren sich bei der Durchführung von Pflegevisiten an einer internen Verfahrensanweisung. Die Umsetzung dieser hausinternen Vorgaben (Anzahl der Pflegevisiten, Verfahrensanweisung) wird jedoch von nur 42,9 % erfüllt. Die Auswirkungen und Veränderungen aufgrund der durchgeführten Pflegevisiten auf die Einrichtung im Allgemeinen, die Mitarbeitenden und die Patienten / Patientinnen wurden durch die Teilnehmenden als sehr stark und wichtig eingeschätzt. Damit konnte die vorliegende Hypothese einer hohen Wirkung des gewünschten Nutzens bestätigt werden. An den Experteninterviews „Pflegevisite“ im UKD nahmen 42 Experten / Expertinnen, bestehend aus Pflegekräften, Stations- und Pflegedienstleitungen teil. Sie waren in den verschiedenen Fachgebieten für stationäre Einheiten tätig und hatten persönliche Erfahrungen, durch Teilnahme oder Verantwortlichkeit, in der Umsetzung mit Pflegevisiten. Dem überwiegenden Teil der Teilnehmenden waren die Vorgaben und Instrumente zum Verfahren bekannt, welche jedoch von 57% als nicht durchführbar eingeschätzt wurden. Am häufigsten wurde dafür der Grund des Zeit- und Personalmangels angegeben. 62 % der Teilnehmenden ergänzten, dass aufgrund der hohen Arbeitsbelastung oder veränderten Rahmenbedingungen, Instrumente wie Pflegevisite und andere Themen der Pflegequalität in den Hintergrund geraten. Dies konnte als vorher bestehende Hypothese bestätigt werden. Hingegen gaben alle Teilnehmenden an, in der Durchführung der Pflegevisiten für Patienten / Patientinnen, Mitarbeitenden und Leitungen einen großen Nutzen und positive Resultate zu spüren. Die Einschätzung des Instruments Pflegevisite hinsichtlich seiner Wirkung und Wichtigkeit in Bezug auf die Einrichtung im Allgemeinen, die Patienten / Patientinnen und Mitarbeitenden erfolgte durch die Teilnehmenden analog der deutschlandweiten Befragung als sehr stark und wichtig. Die These, dass das vorliegende Verfahren und Instrument der Pflegevisite zu umfangreich ist, konnte nicht bestätigt werden. Die Datenauswertung der durchgeführten Pflegevisiten des UKDs der Jahre 2011-2014, musste nach Abschluss der Datenbereinigung und Erstellung der Datenbasis für die Datenanalyse leider als insgesamt für ungeeignet bewertet werden. Dennoch wurde sich für die Durchführung der Datenanalyse entschieden, um Tendenzen der Durchführung der Pflegevisiten zu erkennen. Dabei zeigte sich eine sehr heterogene Umsetzung. Maßnahmen für eine bessere Gestaltung eines zukünftigen Dokumentes und Reports konnten abgeleitet werden und sind in der Arbeit dargestellt. Es zeigte sich, dass das elektronisch etablierte Instrument für eine bessere Auswertbarkeit überarbeitet und neugestaltet werden sollte. Vielen Befragten fehlte eine Auswertung für die gesamte Einrichtung, um für die itarbeitenden den Nutzen sichtbar zu machen. Insgesamt war zu erkennen, dass die Teilnehmenden der Befragung und der Experteninterviews die Pflegevisite als ein sehr sinnvolles Instrument zur Evaluation des Pflegeprozesses ansehen und auch in der Durchführung eine positive Wirkung sehen. Die Umsetzung der Pflegevisiten bereitete jedoch bereits 2013-2015 den Teilnehmenden aufgrund von fehlenden Personal- und Zeitressourcen große Probleme. Daher ist bei Neugestaltung oder Überarbeitung bestehender Pflegevisiteninstrumente und der dazugehörigen Verfahren eine Optimierung notwendig, welche fünf Kernelemente als Erfolgsfaktoren beinhaltet. Auch der nachgewiesene Nutzen der Pflegevisite, welcher noch nicht erbracht wurde, wird durch die Teilnehmenden gewünscht. In Zeiten der evidenzbasierten Medizin und Pflege ist der Nachweis, dass Pflegevisite die Pflegequalität des Bereiches langfristig verbessert bzw. den gewünschten Nutzen erbringt, unbedingt notwendig und stellt einen weiteren Forschungsbedarf dar. Denn medizinische und pflegerische Interventionen sollten nur angewendet werden, wenn sie nachweislich wirksam sind und für die Patienten / Patientinnen einen gesundheitlichen Nutzen erbringen (vgl. Herkner & Müller, 2011: 3). Die Mitarbeitenden haben ein hohes Interesse am Patientenwohl und der Erbringung einer hochwertigen Versorgungsqualität innerhalb der Behandlungs- und Pflegeprozesse. Die Rahmenbedingungen verhindern dies jedoch zunehmend und ein Erreichen dieser Ziele wird erschwert. Daher ist es nicht ausreichend gute Instrumente wie die Pflegevisite für die Patientenversorgung und den Pflegeprozess zu entwickeln und zu etablieren, auch die Arbeits- und Rahmenbedingungen im Gesundheitswesen müssen national weiterentwickelt werden (vgl. Bräutigam, 2014: 8). Die Monographie besteht aus 170 Seiten mit 105 Abbildungen, 55 Tabellen und 12 Anlagen.:Zusammenfassung I Abstract V Inhaltsverzeichnis IX Abkürzungsverzeichnis XI Abbildungsverzeichnis XII Tabellenverzeichnis XV Vorwort und Danksagung 1 1 Einleitung 3 2 Theoretische Grundlagen der Pflegevisite 6 2.1 Entwicklung der Pflegevisite 6 2.2 Rechtliche Grundlagen 7 2.3 Definition Pflegevisite 9 2.4 Abgrenzung von anderen Begriffen und Interventionen 13 2.4.1 Pflegevisite vs. Fallbesprechung 13 2.4.2 Pflegevisite vs. Pflegefachgespräch 14 2.4.3 Pflegevisite vs. Übergabe am Patientenbett 14 2.4.4 Ist der Begriff Visite korrekt gewählt? 15 2.5 Ziele und Vorteile der Pflegevisite 16 2.5.1 Ziele und Vorteile für Patienten / Patientinnen 16 2.5.2 Ziele und Vorteile für Pflegekräfte 17 2.5.3 Ziele für und Vorteile für leitende Pflegekräfte 18 2.5.4 Qualitätsziele für das Unternehmen 19 2.5.5 kritische Faktoren der Pflegevisite 20 2.6 Formen der Pflegevisite 20 2.6.1 Unterteilung nach Teilnehmenden 21 2.6.2 Unterteilungen nach Inhalten 22 2.7 Rahmenbedingungen und Voraussetzungen 23 2.7.1 Teilnehmende 24 2.7.2 Pflegeprozess und Pflegedokumentation 25 2.7.3 Organisation 26 2.8 Ablauf der Pflegevisite 26 2.9 Möglichkeiten der Evaluation 29 3 Pflegevisite im Universitätsklinikum Dresden 30 3.1 Projekt „Pflegevisite“ 2008 bis 2010 30 3.2 Formen der Pflegevisite im Universitätsklinikum Dresden 32 3.3 Erfahrungen aus der Umsetzung 33 3.4 Pflegevisite UKD Status Quo Mai 2023 34 4 Forschungsstudie „Pflegevisite“ 35 4.1 Hintergrund und Ziele der Studie 35 4.2 Forschungsdesign 36 4.3 Befragung zur Thematik Pflegevisite in Deutschland 37 4.3.1 Forschungsfrage und Hypothesen 37 4.3.2 Methodik 38 4.3.3 zentrale Ergebnisse der Befragung 41 4.3.3.1 Baustein 1: Basisdaten - Krankenhaus und Person 42 4.3.3.2 Baustein 2: Wissen und Umsetzung zur Pflegevisite 49 4.3.3.3 Baustein 3: Nutzen und Wirkung zur Pflegevisite 66 4.3.3.4 Baustein 4: Qualitätssicherung und Anregungen 76 4.3.3.5 Zusammenfassung der Ergebnisse 80 4.3.4 Methodenkritik und Einordnung der Ergebnisse 82 4.4 Experteninterview „Pflegevisite“ Universitätsklinikum Dresden 86 4.4.1 Forschungsfrage und Hypothesen 86 4.4.2 Methodik 87 4.4.3 zentrale Ergebnisse der Experteninterviews 90 4.4.3.1 Baustein 1: Person / Werdegang 90 4.4.3.2 Baustein 2: Wissen und Umsetzung zur Pflegevisite 97 4.4.3.3 Baustein 3: Nutzen und Wirkung der Pflegevisite 104 4.4.3.4 Baustein 4: Feedback zum Verfahren und Instrument Pflegevisite 116 4.4.3.5 Baustein 5: Arbeitsorganisation / -inhalte 120 4.4.3.6 Zusammenfassung der Ergebnisse 124 4.4.4 Methodenkritik und Einordnung der Ergebnisse 127 4.5 Datenauswertung Pflegevisiten Universitätsklinikum Dresden 130 4.5.1 Forschungsfragen und Hypothesen 130 4.5.2 Methodik 130 4.5.3 zentrale Ergebnisse 133 4.5.3.1 Baustein 1: Basisdaten 133 4.5.3.2 Baustein 2: Pflegedokumentation 140 4.5.3.3 Baustein 3: Hinweise, Lob, Kritik, Notenvergabe 142 4.5.3.4 Baustein 4: Modul Maßnahmenkatalog anhand Mängel 143 4.5.3.5 Baustein 5: sonstige verbale Einschätzungen 145 4.5.3.6 Vollständigkeitsanalyse 145 4.5.3.7 Zusammenfassung und Begrenzung der Ergebnisse 146 4.5.4 Methodenkritik und Einordung der Ergebnisse 148 5 Diskussion 150 5.1 zentrale Ergebnisse der gesamten Studie 150 5.2 Stärken und Limitationen der Forschungsstudie 156 5.3 Weitere Forschungs- und Praxisentwicklungsbedarfe 159 5.3.1 Entwicklungsvorschläge für die Praxis 159 5.3.1.1 Pflegeprozess 159 5.3.1.2 Qualitätsanspruch 160 5.3.1.3 Verfahren zur Umsetzung der Pflegevisite in den Einrichtungen 161 5.3.1.4 Inhaltlich-pflegefachliche Gestaltung der Pflegevisite 163 5.3.1.5 Protokoll Pflegevisite 165 5.3.1.6 Pflegevisite auf nationaler Ebene 166 5.3.2 weitere Forschungsbedarfe 167 5.4 Fazit und Ausblick 168 Erklärung zur Eröffnung des Promotionsverfahrens - 1 - Erklärung über die Einhaltung der aktuellen gesetzlichen Vorgaben im Rahmen der Dissertation - 2 - Literaturverzeichnis - 3 - Anlagenverzeichnis - 7 - Anlagen - 8 - / The securing and further development of supply and care quality are essential components of patient care in hospital (cf. Boucsein, 2004: 1). Both the nursing science as discipline as well as legislators have defined a high level for quality of supply. This and the increasing complexity of treatment cases require the use of appropriate instruments (cf. Kußmaul, 2011: 270). In addition to patient surveys, care standards and normalized processes, the nurse visit is an important instrument of internal quality assurance of nursing. Most of the german-speaking specialist literature about nurse visit is from the nineties to the beginnings of the 2000s. There are mainly practice reports that show heterogeneous definitions and contents in the analysis. For this reason, a comprehensive literature analysis has been carried out for the present dissertation. A description of the theoretical foundations took place, whereby the delimitation of other terms and instruments was described, among other things, to clearly define nurse visit. The author is oriented in her work on the definition nurse visit of the University Hospital Carl Gustav Carus Dresden: 'The nurse visit is an instrument for the holistic design and evaluation of the nursing process, with the aim of quality assurance and development. A conversation with the patient and/or his/her relatives is carried out in connection with the nurse visit. The nurse visit is also a guiding instrument, given that nurse visits performed by head of nurses are carried out together with the nurses. In doing so the nurse visit is not a control instrument (cf. Bieg, 1995: 208; Koch, 2006:48). ' The University Hospital Dresden established the instrument nurse visit on 01.01.2011, mandatory for all stationary areas. This work is concerned with the evaluation of the use, acceptance, and benefit of the nurse visit, using the example of this facility. To this end, the author ran from 01.06.13 to 30.11.15 a three-part research study, consisting of a germany-wide survey, expert interviews within the UKD and a data evaluation of the nurse visits of the UKD from 2011-2014, by. A total of 53 facilities took part on the germany-wide survey. As a result - 58.5% of the participants stated that they perform nurse visits. The remainder of the institutions not performing nurse visits stated as most frequent reasons for the lack of implementation, that the priorities were in other areas, as well as the lack of time and personnel resources. It did not show any widespread use. Thus, the thesis of an instrument of nurse visit established in Germany has not been confirmed. Nurse visit-carrying institutions gave quality assurance and enhancement, increased patient satisfaction, and the uncovering of deficits as reasons for establishing. The focus will be on topics such as care quality, patient satisfaction, nursing documentation, environment, organization, professional competence of the employees and implementation of guidelines. 71.4% of the participants are guided by an internal procedure for the implementation of nurse visits. However, the implementation of these in-house specifications (number of care visits, process instruction) is met by only 42.9%. Caused by the nurse visits performed, the effects and changes on the facility in general, the employees and the patients were assessed by the participants as very strong and important. Thus, the present hypothesis of a high effect of the desired benefit could be confirmed. The expert interviews 'nurse visit' in the UKD were participated by 42 experts, consisting of head of nurses, head of station and nurses. They were acting in the various specialist areas for stationary units and had personal experience through participation or responsibility in the implementation of nurse visits. The predominant part of the participants was aware of the requirements and instruments of the procedure, which, however, were assessed by 57% as impractical. The most common reason for this was the lack of time and staff. Furthermore, 62% of the participants added that due to the high workload or changing conditions, instruments such as nurse visits and other issues of the quality of nursing have fallen into the background. This could be confirmed as a previously existing hypothesis. On the other hand, all participants had a great benefit and positive results in the implementation of the nurse visits for patients, employees and lines management. The participants assessed the instrument nurse visit in terms of its impact and importance in relation to the facility in general, the patients and employees in analogy to the nationwide survey as very strong and important. The thesis that the present method and instrument of the nurse visit is too extensive could not be confirmed. The data evaluation of the nurse visits performed by the UKD of the years 2011-2014, after the completion of the data cleansing and the creation of the data base for the data analysis, unfortunately, had to be evaluated as unsuitable in total. Nevertheless, it was decided to run the data analysis to identify trends in the implementation of the nurse visits. A very heterogeneous application was shown here. Measures for a better design of a future document and reports could be derived and are presented here in this elaboration. It was shown that the electronically established instrument should be revised and redesigned for better evaluability. Many respondents lacked an evaluation of the entire facility to make the benefits visible to the employees. Overall, it was evident that the participants in the survey and the expert interviews looked at the nurse visits as a very useful tool for evaluating the nursing process and sensed a positive effect in the implementation. However, the implementation of the nurse visits already prepared major problems for the participants in 2013-2015 due to lack of personnel and time resources. Therefore, in the case of redesign or revision of existing nurse visit instruments, an optimization is necessary, which contains five core elements as success factors. The participants would also like to see the proven benefit of the nurse visit, which has not yet been provided. In times of evidence-based medicine and nursing the proof of nurse visit improving the nursing quality of the area in the long term, or providing the desired benefit, is necessary and represents a further need for research. Medical and nursing interventions should only be used if they are demonstrably effective and provide health benefits to patients (cf. Herkner & Müller, 2011: 3). The employees have a huge interest in the patient's well-being and the provision of a high-level supply quality within the treatment and nursing processes. However, the framework conditions are increasingly preventing this, and achieving these goals is made more difficult. Therefore, it is not sufficient to develop and establish adequate instruments such as the nurse visit for patient care and the nurse process. In addition, the working and framework conditions in health care must be developed further nationally (cf. Bräutigam, 2014: 8). The monograph consists of 170 pages with 105 illustrations / charts, 55 tables and 12 appendices.:Zusammenfassung I Abstract V Inhaltsverzeichnis IX Abkürzungsverzeichnis XI Abbildungsverzeichnis XII Tabellenverzeichnis XV Vorwort und Danksagung 1 1 Einleitung 3 2 Theoretische Grundlagen der Pflegevisite 6 2.1 Entwicklung der Pflegevisite 6 2.2 Rechtliche Grundlagen 7 2.3 Definition Pflegevisite 9 2.4 Abgrenzung von anderen Begriffen und Interventionen 13 2.4.1 Pflegevisite vs. Fallbesprechung 13 2.4.2 Pflegevisite vs. Pflegefachgespräch 14 2.4.3 Pflegevisite vs. Übergabe am Patientenbett 14 2.4.4 Ist der Begriff Visite korrekt gewählt? 15 2.5 Ziele und Vorteile der Pflegevisite 16 2.5.1 Ziele und Vorteile für Patienten / Patientinnen 16 2.5.2 Ziele und Vorteile für Pflegekräfte 17 2.5.3 Ziele für und Vorteile für leitende Pflegekräfte 18 2.5.4 Qualitätsziele für das Unternehmen 19 2.5.5 kritische Faktoren der Pflegevisite 20 2.6 Formen der Pflegevisite 20 2.6.1 Unterteilung nach Teilnehmenden 21 2.6.2 Unterteilungen nach Inhalten 22 2.7 Rahmenbedingungen und Voraussetzungen 23 2.7.1 Teilnehmende 24 2.7.2 Pflegeprozess und Pflegedokumentation 25 2.7.3 Organisation 26 2.8 Ablauf der Pflegevisite 26 2.9 Möglichkeiten der Evaluation 29 3 Pflegevisite im Universitätsklinikum Dresden 30 3.1 Projekt „Pflegevisite“ 2008 bis 2010 30 3.2 Formen der Pflegevisite im Universitätsklinikum Dresden 32 3.3 Erfahrungen aus der Umsetzung 33 3.4 Pflegevisite UKD Status Quo Mai 2023 34 4 Forschungsstudie „Pflegevisite“ 35 4.1 Hintergrund und Ziele der Studie 35 4.2 Forschungsdesign 36 4.3 Befragung zur Thematik Pflegevisite in Deutschland 37 4.3.1 Forschungsfrage und Hypothesen 37 4.3.2 Methodik 38 4.3.3 zentrale Ergebnisse der Befragung 41 4.3.3.1 Baustein 1: Basisdaten - Krankenhaus und Person 42 4.3.3.2 Baustein 2: Wissen und Umsetzung zur Pflegevisite 49 4.3.3.3 Baustein 3: Nutzen und Wirkung zur Pflegevisite 66 4.3.3.4 Baustein 4: Qualitätssicherung und Anregungen 76 4.3.3.5 Zusammenfassung der Ergebnisse 80 4.3.4 Methodenkritik und Einordnung der Ergebnisse 82 4.4 Experteninterview „Pflegevisite“ Universitätsklinikum Dresden 86 4.4.1 Forschungsfrage und Hypothesen 86 4.4.2 Methodik 87 4.4.3 zentrale Ergebnisse der Experteninterviews 90 4.4.3.1 Baustein 1: Person / Werdegang 90 4.4.3.2 Baustein 2: Wissen und Umsetzung zur Pflegevisite 97 4.4.3.3 Baustein 3: Nutzen und Wirkung der Pflegevisite 104 4.4.3.4 Baustein 4: Feedback zum Verfahren und Instrument Pflegevisite 116 4.4.3.5 Baustein 5: Arbeitsorganisation / -inhalte 120 4.4.3.6 Zusammenfassung der Ergebnisse 124 4.4.4 Methodenkritik und Einordnung der Ergebnisse 127 4.5 Datenauswertung Pflegevisiten Universitätsklinikum Dresden 130 4.5.1 Forschungsfragen und Hypothesen 130 4.5.2 Methodik 130 4.5.3 zentrale Ergebnisse 133 4.5.3.1 Baustein 1: Basisdaten 133 4.5.3.2 Baustein 2: Pflegedokumentation 140 4.5.3.3 Baustein 3: Hinweise, Lob, Kritik, Notenvergabe 142 4.5.3.4 Baustein 4: Modul Maßnahmenkatalog anhand Mängel 143 4.5.3.5 Baustein 5: sonstige verbale Einschätzungen 145 4.5.3.6 Vollständigkeitsanalyse 145 4.5.3.7 Zusammenfassung und Begrenzung der Ergebnisse 146 4.5.4 Methodenkritik und Einordung der Ergebnisse 148 5 Diskussion 150 5.1 zentrale Ergebnisse der gesamten Studie 150 5.2 Stärken und Limitationen der Forschungsstudie 156 5.3 Weitere Forschungs- und Praxisentwicklungsbedarfe 159 5.3.1 Entwicklungsvorschläge für die Praxis 159 5.3.1.1 Pflegeprozess 159 5.3.1.2 Qualitätsanspruch 160 5.3.1.3 Verfahren zur Umsetzung der Pflegevisite in den Einrichtungen 161 5.3.1.4 Inhaltlich-pflegefachliche Gestaltung der Pflegevisite 163 5.3.1.5 Protokoll Pflegevisite 165 5.3.1.6 Pflegevisite auf nationaler Ebene 166 5.3.2 weitere Forschungsbedarfe 167 5.4 Fazit und Ausblick 168 Erklärung zur Eröffnung des Promotionsverfahrens - 1 - Erklärung über die Einhaltung der aktuellen gesetzlichen Vorgaben im Rahmen der Dissertation - 2 - Literaturverzeichnis - 3 - Anlagenverzeichnis - 7 - Anlagen - 8 -

Little is known regarding registered nurse (RN) information management practice in long-term care (LTC) settings. This study identifies LTC RNs’ information management practice and needs, which are important for designing and implementing health information technology (HIT) in LTC settings. Methods: This descriptive qualitative study combines direct observations and semi-structured interviews, conducted at Alberta’s LTC facilities between May 2014 and August 2015. The constant comparative method of joint coding was used for data analysis. Results: Nine RNs from six nursing homes participated in the study. Based on the RNs’ existing information management system requirements, a graphic information flow model was constructed. Conclusion: This baseline study identified key components of LTC RNs’ information management system. The information flow model may assist HIT developers with future design and development of HIT solutions for LTCs, serve as a communication tool between RNs and developers to refine requirements and support further LTC HIT research. / Graduate

Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and research.

The concept of a missing nursing care in a nursing practice is a phenomenon that could endanger patients' safety in all cultures. This global deficit of a superior and comprehensive nursing care occurs in various departments of healthcare facilities. The theoretical part of this thesis deals with problematic aspects of the concept of a missing nursing care based on theoretical findings. Furthemore it summarises strategies used for ensuring that quality, safety and kompetence in a nursing care is met in relation to latest findings and the legislation. The research part presents outcomes of a conducted qualitative survey research focusing on nurses working in an Intensive Care Unit where a nursing care is directed towards the population of adult patients. Research Metodology: The data collection in the study is based on a semi-structured interview conducted on an actively working group of nine Intensive Care Unit nurses. Aim of the Study: The main objective of the thesis is to describe and analyse problematic aspects of the concept of a missing nursing care in an Intensive Care Unit, as well as to identify factors that affect occurrence of the given concept limited to the nursing staff in the Intensive Care Units. Research Results: The study analyses six categories in total, of which five categories...