Zusammenfassung. Diese Empfehlungen sollen dazu dienen, Fachpersonen das Wissen über die aktuelle Evidenz von Diagnostik und Therapie der Depression im Alter zur Verfügung zu stellen und damit zur frühzeitigen Erkennung und evidenzbasierten Behandlung beizutragen. Da für einige Behandlungsansätze nur rudimentär kontrollierte Studien vorliegen, wird auch das klinische Expertenwissen in die Beurteilung einbezogen. Im diagnostischen Vorgehen wird die besondere Symptomatik der Depression im Alter beleuchtet, auf die Suizidalität eingegangen und werden die häufig vorkommenden somatischen Komorbiditäten hervorgehoben. Auch Hypothesen zur Pathogenese, wie Neuroendokrinologie, Neurodegeneration und vaskuläre Faktoren, werden erläutert. In der Behandlung gilt heute ein integrierter biopsychosozialer Ansatz mit gezielten psychosozialen Interventionen, spezifischer Psychotherapie und einer antidepressiven Pharmakotherapie bei schweren Depressionen als sinnvoll. Daneben kommen auch chronobiologische oder Neurostimulationsverfahren zum Einsatz.

Objective: Falls and related injuries remain a considerable health risk for in-patients. Numerous studies link falls with nurse staffing levels, but the results are inconsistent. The purpose of this study was to explore the associations between fall prevalence and injurious falls on medical wards and three unit-level system factors: daily nurse staffing, patient turnover, and safety climate. Methods: Using a cross-sectional design, we conducted a secondary data analysis of data from the Patient Safety and Falls Project. Five medical units in a Swiss university hospital were included, resulting in a data set of 949 days, with daily measures of nurse staffing, patient turnover and falls. The safety climate was measured using a subscale of the Safety Attitudes Questionnaire and analyzed at the unit level including data from 154 nurses. Robust multivariate logistic regression was used to explore nurse staffing, patient turnover, and safety climate's associations with in-patient falls and fall injuries. Results: After controlling for patient age, length of stay and nursing fulltime equivalents, registered nurse experience showed a significant negative relationship with falls (OR = .83, p < .0001). Patient turnover and safety climate were not significantly associated to falls or fall injuries. Conclusions: By linking nurse staffing variables to in-patient falls and fall injuries, the current study's findings partly confirm those of previous research. Further investigation will be necessary to isolate key factors influencing the association at the unit level between safety climate and in-patient falls.

This case study examined whether the movement support based on Kinaesthetics furthers the body perception, movement abilities and functional independency of elderly nursing home residents with movement restrictions. Two elderly nursing home residents who showed a strong dependence (Barthel-Index II; 20-60 points) after a stroke and who were not previously cared based on Kinaesthetics took part in the study. A four months follow-up with pre-test, Kinaesthetics interventions, and monthly evaluations (n = 4) was carried out. The data was gathered by means of observation. Structured observation was used in order to assess the functional independence by means of Barthel-Index and unstructured observation was used for qualitative information by means of Kinaesthetics assessment from. In addition, the care personnel kept a diary over the development of the participants during the study. Both cases showed clear improvement of the information processing, body perception, and the movement abilities. However, Barthel-Index showed only a little increase in functional development in case A (from 30 to 40 points). Based on the Kinaesthetics concepts, case A however showed a higher level of functional development. The score of case B on the Barthel-Index increased cleary from 55 to 95 points. Movement support based on principles of Kinaesthetics if used consistently, continuously, and adapted to the situation of the assisted person can increase the body perception, movement abilities, and the functional independence of patients in old age. Barthel-Index is not sensitive enough to detect small development in functional status, whereas with Kinaesthetics assessment form it is possible. Besides of quantitative scales it is recommended to use qualitative measures that focus more on qualitative progress and on the way how the level of score is achieved.

Background: Skilled practice development facilitators are a key factor in practice development. Facilitators not only need technical skills, but also the ability to establish trustful relationships and an environment in which team members feel safe to explore their practice. Aims: The aim of the study was to explore how participants at the International Practice Development Collaborative’s Foundation Practice Development School in German-speaking Switzerland succeed in developing their roles as facilitators in their clinical settings, and which factors support or impede their path towards becoming experienced facilitators. The secondary aim was to identify factors that could inform future practice development foundation schools. Methods: A qualitative approach was chosen, using the structured dialogue technique in the context of group discussions. Data analysis was performed by means of knowledge mapping, following Mayring’s qualitative content analysis. Findings/results: A total of 30 participants of the foundation practice development schools held between 2015 and 2018 attended the group discussions. As novice facilitators, they were highly motivated after the school, but they needed courage to critically analyse their practice within their busy day-to-day work and to take a leading role as facilitators. The study participants are clear that time and space for reflection, support from managers and learning opportunities are preconditions for a successful journey as practice developers. Conclusions and implications for practice: A special focus is needed on the reflective skills of novice facilitators to enable them to take time for self-reflection in busy workplaces The implementation of a mentoring programme for foundation school participants in German-speaking Switzerland has to be considered The involvement of the managers of school attendees needs to be considered from the outset, hence refocusing the preparation work of participants More practical guides and basics in German should be made available

At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.