Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the "Geriatric Delirium Pass (GeDePa)", a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023-2024). Results: Healthcare professionals confirmed the GeDePa's practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.

Experiences of nurses on sensor-based fall prevention in long-term care: Results of the mixed methods study "Sensi-Care" Abstract: Background: Falls are common in long-term care. Sensor technology offers potential for preventing and analysing falls, enhances residents' autonomy and supports nurses. Successful implementation is strongly dependent on their acceptance. Aim: The "SensiCare" project accompanies the implementation of sensor-based fall prevention in long-term care. In an initial phase of the project nurses' experiences and evaluations regarding the benefits of the technology were examined. Methods: In this mixed methods study, semi-structured expert interviews were conducted with 19 nurses from German-speaking regions and analysed using content analysis. A standardized online expert rating was applied with 49 nurses to validate and consolidate the findings. The synthesis was carried out in a joint display. Results: Nurses reported predominantly positive experiences with sensor technologies. According to that, these technologies alleviate workload by detecting fall risks and enabling quick responses after a fall. They also help analyse falls and optimize preventive measures. In use, nurses experience confidence and the benefits of the technologies. Integration into the care process and timesaving were highlighted as important factors for acceptance. Conclusion: Nurses, especially those with a high level of technical competence and experience with sensors, recognize the benefits of sensor technologies. Active involvement in the implementation of the technology promotes its safe and efficient use.

Zusammenfassung: Hintergrund: Stürze sind ein häufiges Ereignis in der Langzeitpflege. Sensortechnologien bieten Potenziale zur Prävention und Analyse von Stürzen, erhöhen die Autonomie der Bewohner_innen und unterstützen Pflegefachpersonen. Ein erfolgreicher Einsatz ist maßgeblich von deren Akzeptanz abhängig. Ziel: Das Projekt „SensiCare“ begleitet die Implementierung einer sensorbasierten Sturzprävention in der Langzeitpflege. In einer ersten Projektphase wurden Erfahrungen und Einschätzungen von Pflegefachpersonen bezüglich des Technologienutzens untersucht. Methodik: In der Mixed-Methods-Studie wurden semistrukturierte Experteninterviews mit 19 Pflegefachpersonen aus dem deutschsprachigen Raum geführt und inhaltsanalytisch ausgewertet. Zur Validierung und Vertiefung erfolgte ein standardisiertes Online-Expertenrating mit 49 Pflegefachpersonen. Die Synthese erfolgte mittels Joint Display. Ergebnisse: Die Pflegefachpersonen berichteten überwiegend positive Erfahrungen mit Sensortechnologien. Diese entlasten demnach, indem sie Sturzgefahren erkennen und schnelle Reaktionen nach Stürzen ermöglichen. Sie helfen bei der Analyse von Stürzen und optimieren Präventionsmaßnahmen. Im Gebrauch erfahren sie Sicherheit und den Nutzen der Technologien. Die Integration in den Pflegeprozess und Zeitersparnis sind wichtige Akzeptanzfaktoren. Schlussfolgerung: Pflegefachpersonen, vor allem jene mit hoher Technikkompetenzüberzeugung und Erfahrung mit Sensoren, erkennen den Nutzen von Sensortechnologien. Eine aktive Beteiligung in der Implementierung der Technologie fördert den sicheren und effizienten Einsatz.

Because of demographic changes, the need for healthcare among older people will increase significantly in the coming years. One way to confront these challenges is to rely on modern technologies, such as virtual healthcare assistants (VHAs). In the area of eHealth, this is made particularly difficult by “digital divides,” which lead to unequal technological capabilities and access to technology, and therefore, potentially unequal patterns of use of digital tools. This study analyzes opinions toward a specific VHA, a tablet-based telecare device that supports older people in private households. The sample is based on an extensive cross-national online access panel in the DACH region (Germany, Austria, and Switzerland, with the French-speaking part examined separately) that was conducted between May and June 2023, with 2,906 respondents included in the analysis. Respondents rated the VHA’s functions and appearance using standardized instruments, as well as descriptions and pictures.Our analysis builds upon an extended Unified Theory of Acceptance and Use of Technology (UTAUT) model and structural equation modeling to examine how technological affinity, subjective well-being, and relevant sociodemographic background variables shape the acceptance of the VHA. While technological readiness emerges as the most important variable, subjective well-being is significantly but weakly associated with respondents’ views toward the VHA. In addition, both variables vary across sociodemographic characteristics. The results underscore the importance of social inequality regarding technological readiness, noting that subjective well-being may be relevant when assessing the acceptance of digital tools in healthcare.

Due to demographic changes, the need for healthcare among older persons is expected to increase. Modern technologies, such as digital health applications and telecare solutions embedded into the care practice, offer potential solutions. Evidence on healthcare professionals' acceptance of digital technologies and their technological readiness is rather scarce. This study assesses the factors on technological readiness regarding a prototypical virtual healthcare assistant among nurses in Austria and Germany through an online survey (n = 289). Utilizing the extended Unified Theory of Technology Use and Acceptance model and structural equation modeling, the study shows that socioeconomic attributes influence views on technology beyond factors of technology acceptance. Technological affinity, skepticism, and views toward digitalization in healthcare are mainly relevant to explain certain attitudes toward virtual healthcare assistant solutions. The findings highlight the necessity to expand existing theoretical frameworks with social factors to better understand technological readiness in healthcare.

PURPOSE:Falls and pressure ulcers are serious complications impacting care quality in nursing homes. Sensor technologies can help prevent these adverse events through continuous monitoring and timely intervention. This scoping review, following JBI guidelines, evaluated the effects of sensor-based fall and pressure ulcer prevention in long-term care and the experiences of patients and healthcare professionals. METHODS:The review included primary studies, reviews, and protocols published from 2014 to 2023. Screening, data extraction, and quality appraisal were conducted independently by two authors using MMAT and JBI tools. RESULTS:A total of 31 studies were included: 22 on fall prevention, eight on pressure ulcer prevention, and one addressing both. User-based sensors were effective in preventing both falls and pressure ulcers. Accelerometers enhanced sensitivity for fall detection and adherence to repositioning protocols. Context-based sensors, such as Doppler, webcams, and Kinect, showed variable precision and false alarm rates, while range sensors demonstrated high precision. Context-based accelerometers were promising for pressure ulcer prevention, but pressure sensors provided inconsistent data. Additional manual assessments enhanced sensor data accuracy. Patients preferred non-obtrusive, user-friendly sensors, while healthcare professionals emphasized the need for seamless integration into care routines. Both groups valued real-time monitoring and alert capabilities, though privacy and data security remained concerns. CONCLUSIONS:Sensor technologies show potential in enhancing patient safety and care quality in long-term care, though further refinement is needed for context-based sensors in pressure ulcer prevention. Integrating these technologies with standard care can improve outcomes, but addressing privacy and ethical issues is essential for broader acceptance.

BACKGROUND:The prevention of postoperative delirium (POD) in older adults requires interprofessional collaboration among all healthcare professionals (HCP) involved in the continuum of care. OBJECTIVE:This study investigated the question of how HCPs experience the interprofessional prevention of POD in older adults within the continuum of care. Additionally, it examined the challenges and desired changes in the intersectoral communication and collaboration for prevention of POD. METHODS:This multicenter study was carried out with a qualitative research approach. To explore the experiences of HCPs a total of 21 semistructured expert interviews were conducted with general practitioners, geriatricians, anesthesiologists, surgeons and nurses across the 2 study regions Salzburg County and South Tyrol. The interviews were analyzed using content analysis. RESULTS:The results show that the interviewed HCPs already implement measures to prevent POD but these predominantly focus on identifying patients at risk in the inpatient sector. Information about risk factors is not systematically shared between disciplines or across the intersectoral continuum of care. Structures and processes for intersectoral communication and collaboration in the prevention of POD over the continuum of care are largely missing. CONCLUSION:To improve the prevention of POD in older adults efforts should be made to enhance intersectoral and interprofessional collaboration and communication between the HCPs involved. The development of a shared instrument for the systematic identification and documentation of relevant risk factors across the continuum of care could support the prevention of POD.

Due to demographic changes, the need for healthcare among older persons is expected to increase. Modern technologies, such as digital health applications and telecare solutions embedded into the care practice, offer potential solutions. Evidence on healthcare professionals' acceptance of digital technologies and their technological readiness is rather scarce. This study assesses the factors on technological readiness regarding a prototypical virtual healthcare assistant among nurses in Austria and Germany through an online survey (n = 289). Utilizing the extended Unified Theory of Technology Use and Acceptance model and structural equation modeling, the study shows that socioeconomic attributes influence views on technology beyond factors of technology acceptance. Technological affinity, skepticism, and views toward digitalization in healthcare are mainly relevant to explain certain attitudes toward virtual healthcare assistant solutions. The findings highlight the necessity to expand existing theoretical frameworks with social factors to better understand technological readiness in healthcare.

Studies indicate that patients with delirium require more nursing care. However, the extent of this additional nursing workload is unclear. Bundles of measures for delirium prevention and treatment measures to prevent and treat delirium cause a substantial and particularly high nursing workload. What is the nursing workload involved in caring for patients with delirium compared to patients without delirium, and to what extent does it differ? A systematic literature search was conducted in the PubMed, CINAHL, and Cochrane Library databases. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). Eight studies conducted in hospitals over the past 15 years were included. The mean quality of the studies was 6.1 out of a possible 9 NOS points (standard deviation 0.8). The nursing workload for patients with delirium is consistently higher when indices are applied and when workload recording tools are used. Patients with delirium require more frequently nursing interventions with two nurses and more time for observation, monitoring, and nursing care because of falls. Patients with delirium require more nursing care than patients without delirium, regardless of the hospital setting. The delirium screening and (nursing) workload recording tools used in the eight studies showed a wide variation and, thus, limit standardized quantitative statements on nursing workload. The higher nursing workload of patients with delirium should be considered prospectively in nursing staff planning. In addition to the increased nursing workload, increased workloads for other health professional groups can also be assumed.

Für die Prävention des postoperativen Delirs (POD) bei älteren Patient:innen ist die interprofessionelle Zusammenarbeit aller am Versorgungskontinuum beteiligten Healthcare Professionals (HCP) zentral. Die Studie geht der Frage nach, wie die HCP die interprofessionelle Prävention des POD bei älteren Patient:innen im Versorgungskontinuum erleben, und welche Herausforderungen und Änderungswünsche sie an die intersektorale Kommunikation und Zusammenarbeit zur Prävention des POD haben. Diese multizentrische Studie wurde mit einem qualitativen Forschungsansatz durchgeführt. Zur Exploration der Erfahrungen der HCP wurden in Salzburg und der Region Südtirol insgesamt 21 semistrukturierte Experteninterviews mit Allgemeinmediziner:innen, Geriater:innen, Anästhesist:innen, Chirurg:innen und Pflegefachpersonen geführt und inhaltsanalytisch ausgewertet. Die Ergebnissen zeigen, dass die HCP Maßnahmen zur Prävention des POD setzen, diese sich aber primär auf die Identifikation von Risikopatient:innen im intramuralen Bereich beschränken. Informationen zu den Risikofaktoren werden interdisziplinär und intersektoral nicht systematisch ausgetauscht. Strukturen und Prozesse zu Kommunikation und Zusammenarbeit in der Prävention des POD über das Versorgungskontinuum hinweg sind kaum vorhanden. Zur Prävention des POD bei älteren Patient:innen sollten vermehrt Anstrengungen unternommen werden, die intersektorale, interprofessionelle Zusammenarbeit und Kommunikation der beteiligten HPC zu verbessern. Ein gemeinsames Instrument zu systematischer Erfassung und Dokumentation der relevanten Risikofaktoren über das Versorgungskontinuum hinweg könnte dabei die Prävention des POD unterstützen.

Background: Geriatric care nurses used different strategies to cope with the various burdens they faced during the COVID-19 pandemic, affecting care interactions and reflecting their professional identity. Objective: To explore the burdens and coping strategies of German geriatric care nurses, using professional identity as a conceptual framework. Design: Cross-sectional factorial survey using vignettes (i.e., hypothetical descriptions of care situations). Setting & Participants: Stratified sampling was applied at the facility level, based on the distribution of nursing homes across German federal states. A total of 188 geriatric care nurses participated. Methods: The factorial online survey included socio-demographic variables, COVID-19-specific questions, vignettes, and feedback items. Descriptive statistics and multilevel regression analysis were conducted. Results: Participants reported higher stress during the pandemic than before. Burden characteristics described in the vignettes had no significant effect on participants' judgement behaviour. A random-intercept level 2 model showed that a higher workload and caring for residents significantly influenced participants' judgement. Closeness to family and friends, and seeking support from colleagues were effective coping strategies, while bending guidelines and harmful consumption behaviour were less effective. Conclusions: Coping strategies focused on social interaction were particularly beneficial despite contact restrictions. The type of burden appeared less important than the ability to cope with it. The subordinate role of professional identity may reflect a shift towards functional care. We have highlighted the possible need to address stress management and working conditions of geriatric care nurses, especially in the light of potential future crises. Registration: None Tweetable abstract: A factorial survey exploring relevant burden and coping strategies German geriatric care nurses experienced during the COVID-19 pandemic.

Purpose Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries. Design/methodology/approach This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries. Findings The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries. Originality/value Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

Abstract Background Discrepancies between objective and subjective measures of physical activity have been reported in healthy populations but remain unexplored in adults with obesity and psychosomatic disorders. Exercise is key for reducing these disorders, yet physiological and psychosomatic factors may complicate valid activity assessments in this population. Here, we compare self-reporting with actigraph data in a clinical setting. Methods Over two years, 27 obese patients (21 female, 6 male; 43±14 yrs; 41.3±5.7 kg·m−2) with eating disorders (EDE-Q) were recruited from an Austrian Psychosomatic Center. Total physical activity was assessed using the metabolic equivalent (MET min/w) and sitting time (min/d). Objective data were collected using the SenseWear® wristband (SWA) during weeks 3-4 of patients’ clinical stay. SWA was worn for ≥18 h/d on ≥ 4 days, including one weekend day. Patients self-administered the International Physical Activity Questionnaire (IPAQ-SF) in alignment with the ∼7 days of SWA wear. Concurrent validity - SWA as a criterion - was assessed using regression analyses, and proportional bias was examined with regression and equality line similarity analyses. Results Comparison showed an overestimation of total activity (+45%; p<.001) and underestimation of sitting time (-28%; p<.001) with IPAQ-SF vs SWA. Within-patient correlations were poor for MET (r=.92, p<.001) and impractical for sitting time (r=.27, p=.018), with a proportional bias for both outcomes (p≤.001). Converting objective to subjective measures yielded typical errors of 232 (total activity) and 90 min (sitting time). Conclusions The observed disparities emphasize the need to integrate sensor-based assessment of physical activity into clinical practice or tailored public health initiatives for adult obesity and psychosomatic disorders. However, further research is needed to evaluate the long-term impact of incorporating accurate SWA data on intervention efficacy in this vulnerable group. Key messages • There was strong evidence for meaningful differences in objective vs subjective physical activity assessments in obese patients with eating disorders. • Integrating objective measures into treatment seems crucial to improve exercise-guided interventions and address the global obesity and psychosomatic disorders pandemic.