Hintergrund Patientenstürze zählen zu den häufigsten unerwünschten Ereignissen im stationären Versorgungskontext und stellen insbesondere für ältere und multimorbide Patient*innen ein relevantes Risiko dar. Die standardisierte Dokumentation von Sturzereignissen mittels Sturzprotokollen spielt eine wichtige Rolle für die interne Qualitätssicherung und die rechtlich geforderte Behandlungsdokumentation. Trotz bestehender Empfehlungen ist bislang unklar, wie diese an deutschen und österreichischen Universitätskliniken umgesetzt werden. Methode Im Rahmen einer Dokumentenanalyse wurden 21 unausgefüllte Sturzprotokolle aus 20 Universitätskliniken analysiert. Die Analyse erfolgte anhand eines deduktiv-induktiven Vorgehens unter Verwendung eines vordefinierten strukturlogischen Prozessmodells eines Sturzereignisses mit den Bereichen Vor dem Sturz, Sturz, Unmittelbar nach dem Sturz und Nach dem Sturz. Items wurden kategorisiert und deskriptiv ausgewertet. Ergebnisse Es konnten 378 Items in 15 Kategorien und 18 Subkategorien identifiziert werden. Items, die Zeitpunkt, Ort und Umstand des Sturzes zum Inhalt hatten, wurden in allen Protokollen vollständig abgefragt. Sturzrisikofaktoren, prophylaktische Maßnahmen sowie Konsequenzen nach dem Sturz, wie die Anpassung von Präventionsmaßnahmen oder die Information von Angehörigen, wurden nur in einem Teil der Protokolle berücksichtigt. Schlussfolgerung Die an Universitätskliniken verwendeten Sturzprotokolle zeigen eine hohe inhaltliche Variabilität und bilden den Sturzprozess nur teilweise ab. Dies steht im Widerspruch zu den Empfehlungen einschlägiger Fachgesellschaften und Patientensicherheitsorganisationen Die Befunde legen nahe, dass die Entwicklung eines konsentierten, prozessorientierten Mindestdatensatzes für die Sturzdokumentation an Universitätskliniken im deutschsprachigen Raum pflegewissenschaftlich geboten ist. Ergänzend bieten strukturierte multidisziplinäre Nachbesprechungen eines Sturzes einen vielversprechenden teamorientierten Ansatz zur reflexiven Auseinandersetzung mit Sturzereignissen und zur nachhaltigen Stärkung der Patientensicherheitskultur.

BACKGROUND:Patient falls are among the most common adverse events in inpatient care settings and represent a significant risk, particularly for older and multimorbid patients. The standardized documentation of fall incidents using fall incident reports plays an important role in internal quality assurance and in legally required clinical documentation. Despite existing recommendations, it remains unclear how these recommendations are implemented at university hospitals in Germany and Austria. METHODS:As part of a document analysis, 21 blank fall incident report forms from 20 university hospitals were analyzed. The analysis followed a deductive-inductive approach using a predefined, structurally logical process model of a fall event, including the domains Before the Fall, The Fall, Immediately After the Fall, and After the Fall. Items were categorized and descriptively analyzed. RESULTS:A total of 378 items were identified across 15 categories and 18 subcategories. Items addressing the time, location, and circumstances of the fall were comprehensively included in all report forms. Fall risk factors, preventive measures, and post-fall consequences-such as adjustments to prevention strategies or informing relatives-were only addressed in some of the forms. CONCLUSION:The fall incident reports used at university hospitals show substantial variability in content and only partially reflect the overall fall process. This contrasts with recommendations issued by relevant professional societies and patient safety organizations. The findings suggest that the development of a consensus-based, process-oriented minimum dataset for fall documentation at university hospitals in German-speaking countries is warranted from a nursing science perspective. In addition, structured multidisciplinary post-fall debriefings offer a promising team-oriented approach for reflective engagement with fall events and for sustainably strengthening the culture of patient safety.

AIM OF THE STUDY:Pressure injuries pose a significant healthcare challenge, with prevention relying on nursing knowledge and attitudes. This study evaluated German nurses' knowledge of pressure injury development, prevention, and classification, as well as their attitudes, continuing education (CE) participation, and self-perceived training needs. As the first large-scale assessment in Germany, it aimed to identify knowledge gaps and associated factors in acute inpatient care. MATERIALS AND METHODS:A cross-sectional study was conducted at six German university hospitals using an online questionnaire. Participants were nurses with at least 3 years of vocational training. Knowledge was assessed using the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0), and attitudes with the Attitude towards Pressure Ulcer Prevention (APuP) instrument. Data on completed and needed CE were collected. Statistical analyses included descriptive and inferential methods, including bivariate and multiple linear regression. RESULTS:The online questionnaire was accessed 1286 times. Participants who completed the PUKAT 2.0 instrument (n = 688) scored a median of 60% (IQR: 52-68) correct answers. However, prevention knowledge was lower (median: 38%). Attitudes were positive with a median APuP-Score of 36, (IQR: 34-38; n = 714). Of the 646 participants who fully answered the questions about CE 60% had attended recent CE, and 90% reported a need for further training, especially in risk assessment and prevention. A statistically significant but clinically irrelevant association between knowledge and attitude could be observed (β = 0.007; p < 0.001). CONCLUSION:This study reveals strengths and gaps in German nurses' pressure injury knowledge. Although knowledge exceeds international results, prevention deficits remain. Targeted education could improve prevention. Future research should address contextual barriers to reduce pressure injury incidence.

Im Pflegemanagement eines Akutkrankenhauses erfordert die Versorgung von Menschen mit Demenz ein strategisches Umdenken. Angesichts steigender Prävalenzzahlen und der Nationalen Demenzstrategie zeigt dieser Beitrag auf, wie durch evidenzbasierte Strukturkonzepte, gezielte Personalqualifikation und prozessuale Anpassungen die Versorgungsqualität nachhaltig gesichert, die Patientensicherheit erhöht und das Klinikpersonal in der Maximalversorgung spürbar entlastet werden kann.

Journal clubs in nursing practice: An online survey of German university hospitals Abstract. Background: Journal clubs (JCs) are an evidence-based method for enabling nursing professionals to develop a scientifically based practice. Research results can be made available to nurses to directly influence their nursing practice. The level of implementation in German university hospitals is currently unknown. Aim: This study surveyed the current state of JCs at German university hospitals. The aim is to develop recommendations for the implementation of JCs for nursing practice. Methods: The online survey of all 27 representatives of the "Network of Nursing Science and Practice Development" of the VPU e.V. was conducted from October to November 2020. The questionnaire was developed based on literature. The data analysis was descriptive. Results: 15 of the 19 clinics surveyed currently implement, or have previously implemented, a JC (response rate 70,4%). In approximately half of the clinics, JC is an established structure that is also offered as part of advanced training and continuing education (46,6%) and is used to develop and expand methodological, scientific competencies (86,6%). Positive experiences, but also structural problems in the implementation of a JC were reported. Approximately one quarter of the clinics evaluate their JC regularly (26,7%). Conclusions: JCs at German university hospitals are currently being established. In order to establish JCs on a permanent basis, EBN knowledge must be continuously imparted in further education and training; in addition, JCs should be an essential component of academic role profiles.

Zusammenfassung. Hintergrund: Journal Club (JC) als Instrument einer evidenzbasierten Methode ermöglicht es Pflegefachpersonen, Ergebnisse der Forschung direkt für die Pflegepraxis nutzbar zu machen. Ein Umsetzungsstand an deutschen Universitätskliniken in der klinischen Pflegepraxis ist bisher unbekannt. Fragestellung/Ziel: Die Studie erfragt den Stand der Umsetzung von JCs an deutschen Universitätskliniken. Ziel ist es, Empfehlungen für die Entwicklung von JCs für die Pflegepraxis zu synthetisieren. Methoden: Die Onlinebefragung aller 27 Vertreter_innen des Netzwerks Pflegewissenschaft und Praxisentwicklung im VPU e.V. erfolgte von Oktober bis November 2020. Der Fragebogen wurde literaturbasiert entwickelt. Die Datenanalyse erfolgte deskriptiv. Ergebnisse:15 von 19 Kliniken setzen einen JC um (Rücklaufquote 70,4%). In jeder zweiten ist der JC eine etablierte Struktur, der auch als Fort- und Weiterbildung angeboten wird (46,6%) und dem Auf- und Ausbau methodisch-wissenschaftlicher Kompetenzen dient (86,6%). Es wird von positiven Erfahrungen, aber auch von strukturellen Problemen in der Umsetzung berichtet. Rund ein Viertel der Kliniken evaluieren den JC regelmäßig (26,7%). Schlussfolgerungen: JCs in der klinischen Pflegepraxis befinden sich an deutschen Universitätskliniken im Aufbau. Zur Verstetigung der JCs bedarf es einer kontinuierlichen Vermittlung von EBN-Kenntnissen in Fort- und Weiterbildungen, zudem sollten JCs Bestandteil akademischer Rollenprofile sein.

This cross-sectional study compared hospital staff who had received influenza or COVID-19 vaccination or who had refused COVID-19 vaccination in terms of attitudes towards each vaccination, uptake of influenza vaccination and reasons for refusing COVID-19 vaccination. COVID-19 vaccine refusers rated the risk of infection for themselves and in general and the effectiveness of the vaccination lowest and the vaccination risk highest compared to the other two groups. They also reported the lowest past uptake of influenza vaccination. Perceived pressure to vaccinate proved to be a relevant barrier. Future vaccination campaigns should maintain a balance between information on vaccines, the need for vaccination, and voluntary uptake.

BACKGROUND In elderly patients following surgery, postoperative delirium (POD) is the most frequent complication and is associated with negative outcomes. The 2017 European Society of Anaesthesiology guideline on POD aims to improve patient care by implementing structured delirium prevention, diagnosis and treatment. However, these recommendations, especially systematic delirium screening, are still incompletely adopted in clinical practice. The aim of this study was to evaluate the feasibility and acceptance of validated delirium screening tools and to identify barriers to their implementation on nonintensive care unit wards. METHODS Screening rates, as well as practicability, acceptance and the interprofessional handling of positive results, were assessed for each group. Screening rates were calculated as a percentage of the total potential testing episodes completed (up to 15 per patient). Patients were considered eligible when aged 65 years and above. Barriers and motivating factors were assessed in a mixed method approach by utilising questionnaires and focus group discussions. INTERVENTION In a 3-month phase, a guideline-compliant screening protocol involving screening for POD three times daily for 5 days following surgery was introduced in five wards: both the 4-item assessment test (4AT) and the nursing delirium screening scale (NuDESC) were used. Before commencing the study and again after 6 weeks, medical staff of the respective wards underwent a 45 min training session. RESULTS Of a total of 3183 potential testing episodes, 999 (31.4%) were completed, with more NuDESC observational tests (43%) than 4AT bedside tests completed (20%). The 4AT was considered more difficult to integrate into daily working routines, it took longer to administer, and nurses felt uncomfortable conducting the screening (53 vs. 13%). Screening results indicating delirium were often not discussed within the team (47%), and nurses felt that often such results were not taken seriously by physicians (54%). CONCLUSION The observational NuDESC showed a higher completion rate than the bedside 4AT, although overall testing rates were low. The necessary time needed to conduct the screening, the negative reactions by patients, insufficient team communication and a lack of initiation of any therapy were identified as major barriers in the implementation of the guideline-compliant screening protocol. For all staff, further education and awareness of the importance of POD diagnosis and treatment might improve the screening rates. The NuDesc received better results concerning acceptance, practicability and introduction into daily work routine, leading to higher screening rates compared with the 4AT. The latter instrument, which was intended to be used rather selectively or when POD is suspected, might therefore not be suitable for guideline-compliant regular and repeated screening for POD.

Demografische Veränderungen führen zu einer Zunahme von Patienten mit Demenz im Krankenhaus. Aus Deutschland liegen hierzu wenige epidemiologische Daten vor; Anhaltszahlen aus Universitätskliniken (UK) fehlen ganz. Auf der Grundlage von ICD-10-GM-Routinedaten wurden Prävalenzraten in UK und deren Verteilung analysiert.

Background A fall-related femur fracture is one of the most frequent reasons for hospital admission of patients with dementia. The aim of the study was to identify dementia-specific characteristics of patients with fall-related femur fractures and additionally an unspecified dementia in order to gain further knowledge about this particular patient group. Methods A descriptive explorative case study with a single case-embedded design based on routine hospital data from a university hospital was performed. A total number of 34 patient records from 2015 were analyzed. In the embedded unit of analysis I the data of selected items of the nursing assessment AcuteCare (ePA-AC (c)) were descriptively analyzed for the time of admission and discharge. In the embedded unit of analysis II a summarizing inductive content analysis was conducted. Results The results of the embedded unit of analysis I showed that this patient group is characterized by a high need for care, changes of cognition and behavioral symptoms. The status of cognition, behavior and reciprocity as well as the self-care index stagnated or deteriorated in many patients from admission to discharge. The embedded unit of analysis II identified observable (social)behavior, (non)compliance and orientation as central dementia-specific characteristics. Conclusion The results reflect the complexity of the care situation of patients with unspecified dementia in acute care hospitals. The results showed that a higher awareness for this particular patient group is needed to improve outcomes.

Background Demographic changes result in a higher prevalence of patients suffering from dementia in hospital. In Germany, epidemiological data of this target group are scarce and prevalence rates from university hospitals (UH) are not available. The prevalence rates and distribution were analyzed on the basis of ICD-10-GM (German modification) routine data Method A secondary analysis on ICD-10-GM main and secondary diagnoses of dementia from 2014 and 2015 from 5 UH was performed. All patients admitted to hospital for at least 24h and >= 18 years old (2014 n = 187,168; 2015 n = 189,040) were included. A descriptive analysis for the >69-year-old group was carried out (2014, n = 67,111; 2015; n = 67,824). Results The 1-year prevalence (2014/2015) for all 5 UH for patients >= 18 years old was 1.3%/1.4% and for the >69-year-old group, 3.3%/3.5%. The prevalence rates between the five UH varied: for patients >= 18 years the range was 0.44-2.16% (2014) and 0.44-2.77% (2015) and for >69-year-olds 1.16-5.52% (2014) and 1.16-7.06% (2015). Most cases were correlated with major diagnostic categories of traumatology, cardiology, gastroenterology and neurology. Conclusion Analysis of ICD-10-GM routine data can provide an indication of the prevalence of dementia in UH. Results of the >69-year-olds varied greatly between participating UH. The reasons for this might be different healthcare tasks, especially with respect to geriatric patients; however, it is also possible that assessment procedures are not standardized and unreliable and therefore the coding is invalid. A standardized procedure for the identification of people suffering from dementia is necessary.

Zusammenfassung. Akademisch qualifizierte Pflegefachkräfte in der direkten Patientenversorgung integriert und akzeptiert? Im Rahmen eines Projekts beschäftigt sich das Universitätsklinikum Hamburg-Eppendorf (UKE) mit der nachhaltigen Integration von akademisch qualifizierten Pflegefachkräfte. Hierzu wurde ein innovatives Kompetenzmodell entwickelt, das pflegerische Qualifikationen auf allen Stufen mit einbezieht.