AIM:To determine the factorial structure of the German Care Dependency Scale (CDS) for self-assessment in supported housing in Austria.BACKGROUND:The CDS is a well-established tool for the assessment of care dependency. However, several versions of the scale showed different factorial structures depending on the country and the setting where they were applied. The factorial structure of the CDS, therefore, needed clarification prior to its application in supported housing.DESIGN:Cross-sectional study.METHODS:Self-assessments of care dependency were obtained from residents in supported housing in Austria. The factorial structure of the scale was determined by exploratory factor analysis. The resulting factor models were compared by confirmatory factor analyses with a single factor model regarding the best fit. CDS total score and sum scores of the identified factors were correlated with externally assessed care levels according to the Austrian care insurance.RESULTS:48.2% of the residents in supported housing participated, but some of them were younger than 60. Exploratory factor analysis resulted in a three-factor model with two variants in the distribution of items, depending on whether people over 59 were included in the analysis or not. The second variant showed the best fit in confirmatory factor analysis. CDS total score and sum scores of the identified factors showed statistically significant correlations with externally assessed care levels.CONCLUSION:The three-factorial structure differentiates between various aspects of support and results from the particular characteristics of the setting and the care recipients. Several cross-loadings of items indicate an ambiguous understanding of support needs. It is suggested to modify the scale to adapt it to the target group and setting.IMPLICATIONS FOR THE PROFESSION:Self-assessments with a modified version of CDS in supported housing can be useful to identify the various support needs in this setting.PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Objective: This study was carried out to examine the effect of the ethical training program applied to the nurses on the nurses’ level of capability for ethical decisions. Methods: This study was carried out as a qualitative research methods of descriptive phenomenology and the research sample consisted of 13 nurses. The research was carried out in three stages. In the first stage, the first data were collected by the face to face individual interviews lasting approximately 90-120 minutes.In the second stage of the research, “Ethical Training Program” was applied. In the third stage of the research, data were collected by the depth interview method. Nvivo 11 package software and “Content Analysis” method were used in evaluation of the qualitative data. Results: In the interviews with the nurses before the ethics education, 8 themes and 33 sub-themes were determined. After the ethics education, 10 main themes and 22 sub-themes were determined. After the education, the nurses could express their opinions about ethical decision making and ethical decision process which they couldn’t express before the education. Conclusions: In conclusion, after the “Ethical Training Program”, there was a positive change in the nurses’ “Ethical Basic Knowledge” and “Level of Capability of Ethical Decision”.

Elderly population is characterized by larger need for social welfare and medical treatment than other age groups. Along with aging, there is a number of emerging health, nursing, caring, psychological and social problems. Complexity of these problems results from overlapping and advancing involutional changes, multi-illness, decreased functional efficiency and other factors. The aim of the study was the assessment of health problems in geriatric patients as well as bio-psycho-social need deficiencies in a view of selected parameters of functional efficiency. The research group consisted of the Chair and Clinic of Geriatrics, 186 women and 114 men, 300 persons in total. The research was carried out using a diagnostic poll method with the application of the Activities of Daily Living (ADL) questionnaire of assessment of daily efficiency on the basis of the Katz Scale; the Care Dependency Scale (CDS) questionnaire used to measure the level of the care dependency and human needs, Norton’s bed sores risk assessment scale, the Nursing Care Category (NCC) questionnaire applied to assess the need for nursing care. In most patients the results unveiled manifestations of three or more illnesses. Functional efficiency was at low and average level. Half of the subjects were endangered by risk of bed sores as well as showed high need fulfillment deficiency. The highest level of the deficiency was observed in patients in the eldest age group as well as suffering from multi-illness. Material status, education, place of residence or gender showed no significant influence on the level of need fulfillment. 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +48 052 585 4021; fax: +48 052 585 4921. E-mail address: muszalik@cm.umk.pl (M. Muszalik).

IntroductIon The Diffusion of Innovation theory states that innovations spread in a social system via communication, over time and in a given population. Model Smart Homes display and demonstrate assistive technology meant to support among others older people with a chronic illness. The models are meant to inform all kinds of stakeholders. Hence they help to diffuse technology and promote its use on a wider scale. Around 20 model Smart Homes exist in the Netherlands, showing assistive technologies that support ‘living longer at home’. The Smart Homes and assistive technologies on display could reduce difficulties in care that arise from functional or mental disorders. It is expected that adopting these technologies will help to reduce the burden for care-givers, enhance the quality of care, soften its financial impact and raise the patients’ quality of life. Most of the 20 model Smart Homes in the Netherlands are situated in apartments, shops, schools, hotels and other houses. In this article, we will introduce the ‘House of the Present’ and share some experiences and visitors’ views.

Dramatic changes have occurred during my 40+ years of teaching research methods to nurses and nursing students, including important transformations within the profession, an explosive growth in published research by nurses, greater inter-professional collaboration, increased funding opportunities, and stunning methodologic and technologic advances.In this talk I will describe some of the major ways in which nursing research has evolved over the past 4 decades by tracing content revisions in my textbook Nursing Research: Generating and Assessing Evidence for Nursing Practice-now in its 10th edition and still the world's #1 textbook on research methods for nurses.The earliest editions of this book had no mention of such key concepts as evidence-based practice, mixedmethods research, complex interventions, and systematic reviews; now, entire chapters are devoted to these topics.Indeed, it was not until the 3rd edition of the book (1987) that qualitative research was given serious coverage, and now many chapters of the book describe methods for conducting high-quality qualitative inquiry.My presentation will focus especially on the key revisions I introduced in the 10th edition, which was published in 2016 (2017 copyright date).In particular, I will discuss a topic about which I have become passionate-the measurement and interpretation of clinical significance (distinct from statistical significance) in nursing studies.I will also describe revisions that I am planning to make in the 11th edition, which will be published in early 2020.In all editions published thus far, I have strived to provide guidance on how to do research with rigor and integrity-that is, how to "get it right" when answering a research question.In the 11th edition I plan to devote considerably more attention to what nurse researchers can do to "get it right" in asking their research questions.In this regard, I will provide an overview of strategies for improving the relevance and applicability of nursing research.

PURPOSE:The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes.DESIGN:Instrument development.METHODS:The English version of the CDS was translated into Persian. A convenience sample of 140 (100 older people without dementia and 40 patients with dementia) Persian-speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined.FINDINGS:Exploratory factor analysis indicated that the CDS has two factors, including psychosocial and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia.CONCLUSIONS:The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes.CLINICAL RELEVANCE:The Persian version of the CDS can help clinicians and nurses to assess patients' need and the degree of care dependency among older adults in Persian-speaking areas.

Care complications are common conditions which affect residents in care homes and often arise from risks associated with their illness. They can be serious and affect the health and quality of life of residents. It is important that nurses are able to assess an individual's risk of developing complications of care, and determine appropriate prevention and treatment measures. This article discusses three common care complications for residents in care homes: pressure ulcers, malnutrition and falls. Assessment tools commonly used to identify these conditions are discussed, as well as the use of clinical reasoning to assist nurses in implementing appropriate care. Nurses have a central role in risk assessment, identifying problems, planning interventions and monitoring complications of care.

OBJECTIVE:This study investigates the influence of personal characteristics and health-related variables on the care dependency status among elderly in-patients with clinically diagnosed Alzheimer's disease in two countries.METHODS:A descriptive cross-cultural survey was administered to a convenience sample of 137 elderly in-patients. Patients were recruited from a hospital in Japan (N = 77) and from a nursing home in the Netherlands (N = 60).RESULTS:In both countries, almost all participants are assessed on the severity level of care dependency in the range of "completely care dependent" (Japan: 35.1%; the Netherlands: 20.0%), or "to a great extent care dependent" (Japan: 24.7%; the Netherlands: 45.0%), to "partially care dependent" (Japan: 22.1%; the Netherlands: 21.7%).CONCLUSION:This study demonstrates that there is no interdependence between the severity level of care dependency and personal characteristics of patients with Alzheimer's disease in both countries. Regarding the interplay of health-related variables on the severity level of care dependency, a difference was found between countries.

Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p < 0.05), age and informal care given by family members (r = -0.27 to 0.27, p < 0.01) were significantly correlated with the care dependency status for the whole samples. All HRQOL variables, hearing aid and duration of illness correlated with care dependency status (r = -0.20 to 0.50, p < 0.01). Moreover, the FACIT sum score (Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries.

objective (s): Maintaining independence and attending to the bio-psychosocial needs of elderly always have been one of the main goals of caregivers and policy-makers. This study was carried out to investigate the psychometric properties of the Persian version of Care Dependency Scale (CDS) in older people nursing home residents. Methods: This study was carried out during 2011 and 2012 among a sample of 100 older people 65 years and older residing in nursing homes in Ahvaz, Iran. First, the English version of the CDS was translated into Persian language. Then, psychometric properties of the questionnaire were assessed by several tests. To examine reliability, the Cronbach’s alpha coefficient and test-retest reliability analyses were performed. Construct validity was determined using exploratory and confirmatory factor analyses and concurrent validity was carried out using the Modified Barthel Index. Results: The Exploratory and confirmatory factor analyses indicated that CDS has 2 factors including psycho-social (65.73% of the variance) and somatic (8.71% of the variance) factors. Internal consistency as assessed by the Cronbach’s alpha coefficient was 0.95, test-retest reliability was 0.99 and it showed excellent correlation with the Modified Barthel Index (r = 0.90). Conclusion: The results study indicated that the Persian version of the CDS is reliable and valid measure for assessment of care dependency and to determine care needs among older persons.

AIM:The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands.BACKGROUND:Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals.DESIGN:Cross-sectional design.METHODS:The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings.RESULTS:For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU.CONCLUSIONS:The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited.

Purpose The main aim of our research was to evaluate general health, functioning, and performance parameters, as well as care problems of Geriatric Clinic inpatients in relation to deficits in fulfilling needs. The assessment of health-related quality of life was also performed. Patients and methods The research subjects were patients attending the Clinic of Geriatrics: 149 women and 78 men; 227 persons in total. The research was carried out using a diagnostic poll method, with the application of the Activities of Daily Living questionnaire of assessment of daily efficiency on the basis of the Katz index, the Instrumental Activities of Daily Living questionnaire, the Care Dependency Scale used to measure the level of care dependency and human needs, and the Nottingham Health Profile scale. Results The results showed that the majority of respondents achieved high and medium levels of functional capability. The main problems associated with the fulfillment of needs were difficulties with the adoption of appropriate body posture, movement restrictions, and problems related to participating in unassisted leisure activities outside the home. The general deficit in fulfilling the needs of the patients was low. The most significant problems were related to sleep disorders, restrictions in freedom of movement, loss of vital energy, and ailments resulting in the observable presence of pain. Conclusion Good daily functioning of elderly patients significantly depended on their intellectual and mental efficiency. Elderly patients require a comprehensive, holistic approach to a variety of problems that occur with aging.

This paper explores the use of design for transfer in simulations and serious games. Key in this study is the hypothesis that meaningful play can be achieved by designing for figural transfer by the use of metaphorical recontextualisation. The Game Transfer Model (GTM) is introduced as a tool for designing and thinking about serious game design, stretching the possibilities from high-fidelity simulations to metaphorical fantasy worlds. Key for in-game learning experience is the presence of conceptual continuity defined by the congruence of fidelity-elements. The GTM differentiates between realisticness and realism. Where simulations use the road of literal transfer and therefore relies on realisticness and high-fidelity, figural transfer can be a guiding principle for serious game design, using metaphorical recontextualisation to maintain conceptual continuity. Conceptual continuity aligns fidelity and enables the game to connect its serious content to the realities of life.

Background. Prevention is the most effective method of reducing the risk of pressure ulcers. Prophylaxisinvolves several actions and procedures that can decrease the risk and aid implementation of rapidtreatment if pressure ulcers develop.Aim. To evaluate the risk of pressure ulcers in elderly patients. Material and methods. The study group involved patients hospitalized at the Department and Clinic ofGeriatric Medicine in Bydgoszcz: 82 females and 34 males (116 in total). The study used a diagnostic pollmethod with the application of an ADL (Activities of Daily Living) questionnaire to assess daily efficiencyon the basis of the Katz Scale, CDS (Care Dependency Scale) questionnaire to measure the level of caredependency and human needs, and a risk scale for pressure ulcer development devised by D. Norton. Results. The risk of pressure ulcers was observed in approximately one third of the study subjects (30.2%).Almost a half of the patient group had multiple morbidities. Problems concerning the care of patientswith a high risk of pressure ulcers were usually connected with a lack of independence in changing bodyposition, movement, dressing, and sphincter dysfunction. Conclusion. There is a correlation between the level of functional capability and the risk of pressureulcers. The accumulation of problems related to the lack of independence in fulfilling the patients’ ownneeds significantly increased the risk of pressure ulcers in the study group.

dijkstra a., yönt g.h., korhan e.a., muszalik m, kędziora‐kornatowska k. & suzuki m. (2012) The Care Dependency Scale for measuring basic human needs: an international comparison. Journal of Advanced Nursing 68 (10), 2341–2348. Abstract Aim. To report a study conducted to compare the utility of the Care Dependency Scale across four countries. Background. The Care Dependency Scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson’s components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the Care Dependency Scale items. Design. The study used a cross‐cultural survey design. Method. Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch Care Dependency Scale. Psychometric properties in terms of reliability and validity of the Care Dependency Scale have been assessed using Cronbach’s alpha, Guttman’s Lambda‐2, inter‐item correlation and principal components analysis. Data were collected in 2008 and 2009. Results. High internal consistency values were demonstrated. Principal component analysis confirmed the one‐factor model reported in earlier studies. Conclusion. Outcomes confirm Henderson’s idea that human needs are fundamental appearing in every patient‐nurse relationship, independent of the patient’s age, the type of care setting and/or cultural background. The psychometric characteristics of the Care Dependency Scale make this instrument very useful for comparative research across countries.