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Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.

Background: Delirium is an acute disturbance characterized by fluctuating symptoms related to attention, awareness and recognition. Especially for elderly patients, delirium is frequently associated with high hospital costs and resource consumption, worse functional deterioration and increased mortality rates. Early recognition of risk factors and delirium symptoms enables medical staff to prevent or treat negative effects. Most studies examining screening instruments for delirium were conducted in intensive care units and surgical wards, and rarely in general medical wards. The aim of the study is to validate the Nursing Delirium Screening Scale (Nu-DESC) and the Delirium Observation Screening Scale (DOS) in general medical wards in a German tertiary care hospital, considering predisposing delirium risk factors in patients aged 65 and older. Methods: The prospective observational study including 698 patients was conducted between May and August 2018 in two neurological and one cardiology ward. During their shifts, trained nurses assessed all patients aged 65 or older for delirium symptoms using the Nu-DESC and the DOS. Delirium was diagnosed according to the DSM-5 criteria by neurologists. Patient characteristics and predisposing risk factors were obtained from the digital patient management system. Descriptive and bivariate statistics were computed. Results: The study determined an overall delirium occurrence rate of 9.0%. Regarding the DOS, sensitivity was 0.94, specificity 0.86, PPV 0.40 NPV 0.99 and regarding the Nu-DESC, sensitivity was 0.98, specificity 0.87, PPV 0.43, NPV 1.00. Several predisposing risk factors increased the probability of delirium: pressure ulcer risk OR: 17.3; falls risk OR: 14.0; immobility OR: 12.7; dementia OR: 5.38.

Background Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management. Methods Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others. Results Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6–4.7) vs. post 3.0 (2.2–4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved. Conclusions Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke. Registry DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436.

Introduction:The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. Method: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. Results: In total, n = 29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n = 786 between 2015 (n = 593) and 2018 (n = 1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD = 1.66; min -max = 1.09 -6.69; Q1 -Q3 = 1.49 -4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD = 1.40; min -max = 0.47 -5.42; Q1 -Q3 = 0.87 -3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). Discussion: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

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Zusammenfassung Hintergrund Das Delir ist ein neuropsychiatrisches Syndrom, welches häufig ältere Patient_innen betrifft und schwerwiegende Folgen haben kann. Oftmals wird es vom Gesundheitspersonal nicht erkannt. Der Wissensstand über das Delir ist beim pflegerischen und ärztlichen Personal häufig unzureichend ausgeprägt. Zum aktuellen Zeitpunkt fehlt im deutschsprachigen Raum ein Fragebogen zur Erfassung des Wissensstands. Ziel Weiterentwicklung eines Fragenbogens und Bewertung der Inhaltsvalidität. Methode Im Rahmen einer Literaturrecherche wurden mehrere Fragebögen identifiziert. Ein bereits publizierter Fragebogen mit den Dimensionen Grundlagenwissen über das Delir und Risikofaktoren ist übersetzt, angepasst und um die Dimension der nichtpharmakologischen Delirprävention erweitert worden. Die Bewertung der Fragebogenitems erfolgte durch Delirexpert_innen in 2 Runden. Die Inhaltsvalidität wurde anhand des Content Validity Index (CVI) auf Item(I-CVI)- und Skalen(S-CVI)-Level angegeben, zusätzlich wurde der „modified Kappa“ (κ*) mit der Untergrenze des 95 %igen Konfidenzintervalls (KI) berechnet. Ergebnisse Der 30 Items umfassende Originalfragebogen wurde um 18 Items der Delirprävention erweitert. Nach der ersten Bewertungsrunde durch 13 Expert_innen zeigten 30 von 48 Items gute bis exzellente I‑CVI-Werte (0,78–1,0). Unter Berücksichtigung der Kommentare wurden 6 Items verworfen und 12 Items sprachlich und inhaltlich adaptiert. In der finalen Version des Fragebogens verblieben 41 Items mit exzellenten Werten (1,0). Der Gesamtskalenwert hatte sich von 0,88 in der ersten Version auf 1,0 in der finalen Version erhöht. Als Zielgruppe wurden Pflegefachpersonen identifiziert, aber potenziell auch therapeutisches und ärztliches Personal. Schlussfolgerung Der Fragebogen zur Erfassung des Wissens über das Delir ist inhaltsvalide.