Zusammenfassung. Hintergrund: Zahlreiche Instrumente zur Erkennung eines postoperativen Delirs sind verfügbar. Leitlinien empfehlen die Benutzung des 4 A’s Test (4AT). Allerdings gibt es kaum Evidenz zur Validität und Reliabilität des deutschsprachigen 4AT. Fragestellung/Ziel: Die Zielsetzung war, die Interrater-Reliabilität des deutschsprachigen 4AT zur Erkennung eines postoperativen Delirs bei allgemeinchirurgischen und orthopädisch-traumatologischen Patient_innen und die Übereinstimmungsvalidität mit der Delirium Observation Screening (DOS)-Skala zu überprüfen. Methoden: Die Arbeit ist Teil einer prospektiven Kohortenstudie. Die Stichprobe bestand aus 202 stationären Patient_innen (≥ 65 Jahre), die einem chirurgischen Eingriff unterzogen wurden. Die Interrater-Reliabilität des 4AT (Intraklassenkoeffizient) wurde bei 33 Patient_innen durch zwei Krankenpfleger_innen überprüft. Die Übereinstimmungsvalidität zwischen der DOS und dem 4AT wurde anhand des Korrelationskoeffizienten nach Pearson berechnet. Ergebnisse: Die Interrater-Reliabilität für den 4AT-Gesamtwert und der dichotomisierte Gesamtwert lagen bei 0,92 (95%-KI: 0,84–0,96) und 0,98 (95%-KI: 0,95–0,98). Die Korrelation zwischen DOS und 4AT betrug 0,54 (p < 0,001). Schlussfolgerungen: Der 4AT kann als Screening-Instrument zur postoperativen Delirerkennung durch das Krankenpflegepersonal bei älteren, allgemeinchirurgischen und orthopädisch-traumatologischen Patient_innen eingesetzt werden. Allerdings besteht bei positiven 4AT-Ergebnissen die Notwendigkeit eines weiterführenden Assessments durch Pflegeexpert_innen oder Ärzt_innen.

In South Tyrol we developed guidelines with two different methodological approaches: one relates to the autonomous development of a nursing guideline for oral care using GRADE, and the other relates to the adaptation process of the NICE guideline on the prevention of venous thromboembolism. Both methods do have advantages and disadvantages: by autonomously developing guidelines the guideline panel identifies more with the product but time and effort is much higher than adapting and amending existing (high quality) guidelines. On the other hand there are only few high quality nursing guidelines. Additionally, the experiences in South Tyrol show that nursing guidelines seem to be not really suitable for a 1:1 application into practice because nearly half of the nurses have not changed their practice - although they knew the content of the guideline. Therefore, in order to promote the implementation process multimodal strategies on different organisational levels were adopted. Amongst these was the involvement of management through the negotiations of objectives, training and active participation of staff in the development of user-friendly application tools.

Apart from ‘direct’ resident care, care workers in nursing homes also perform tasks that are related to organizational or management activities. ‘Indirect’ care activities, such as administrative tasks, are often considered as burdensome, as they increase overall workload and keep care workers away from caring for their residents. So far, there is little investigation on care workers’ administrative burden. The multicenter cross-sectional Swiss Nursing Homes Human Resources Project (2018) study included a convenience sample of 118 Swiss nursing homes and 2207 care workers (i.e., registered nurses and licensed practical nurses). Care workers completed questionnaires assessing the administrative burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied 2-level binomial generalized linear mixed models. Overall, 73.91% (n=1561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n=787) reporting to spend 2h or more during a "normal" day performing administrative tasks. Ratings ranged from 42.6% (n=884; ordering supplies and managing stocks) to 75.3% (n=1621; filling out the patient’s medical record). One out of four care workers (25.5%, n=561) intended to leave the profession, whereby care workers reporting higher administrative burden (OR=1.24; 95%CI: 1.02-1.50) were more likely to leave the profession. This study provides first insights on care workers’ administrative burden in nursing homes, which can inform the development of interventions to reduce the workload related to ‘indirect care activities’ and to improve care workers’ job satisfaction and retention in the profession.

Background Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than ‘direct patient care’. ‘Indirect care activities’, such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers’ outcomes. Purpose The objective of this study was to describe care workers’ administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession). Methods This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2′207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland’s German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. Results Overall, 73.9% (n = 1′561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1′621; filling out the resident’s health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02–1.50) were more likely to intend to leave the profession. Conclusion This study provides first insights on care workers’ administrative burden in nursing homes. By limiting care workers’ burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers’ workload and improve their job satisfaction and retention in the profession.