Görres, Stefan
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Görres, Stefan
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Görres, Stefan
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Item-typ:Veröffentlichung, Die Wissensvermittlung und die Angehörigenintegration bei der Betreuung von über 65 Jahre alten Hämodialysepatienten : die Sicht der Patienten und der Pflegekräfte(2015-06-16); ; ; Professional nursing care for patients on dialysis is aimed at life-sustaining measures that ensure a good quality of life whilst maintaining the highest-possible level of independence for the patient. Intensive communication with patients and the timely engagement of families in the care process form an important part of this. This study demonstrates the results of an anonymous survey in Germany that was conducted simultaneously among dialysis care teams and hemodialysis patients aged 65 and over. This report sets out to evaluate the results obtained in relation to failures in the communication of information as part of consultations and training events. Such instances related to the timing and volume of information, as well as to how well the information was adapted to suit the patient's condition, whether it was made accessible and whether it was relevant in terms of its applicability in prac-tice. Hemodialysis patients were found to have only limited knowledge of care-related issues. Delivery of normal patient care was rendered more work-intensive as a re-sult, leading to a shortfall in terms of the amount of time available for specialist care. While families accounted for the largest proportion of care provided in the home, clear deficits were noted with regard to the way this contribution was being integrat-ed as part of an overall care strategy. The reason for this was the failure of nursing and care staff to gauge the true nature of the role and behavior of family members. Similarly, hemodialysis patients underestimated the real impact of dialysis on family members. The only way to eliminate the shortcomings identified by this report is to increase the role of "narrative-based medicine" and "effective communication" in patient care. This will involve contributions not only from care staff but also from doctors, who remain the patients' preferred source of information. Part of this task will be to pro-vide both patients and their relatives with information that is relevant to the stage of the patient's kidney disease, and to ensure that this information is presented in a well-structured manner. The implementation of these steps will require these ser-vices to be eligible for reimbursement by health insurance funds (as a stimulus), subject to mandatory reporting as part of medical record keeping procedures, and to form part of a care quality strategy that includes both knowledge transfer and family engagement. In the fields of nephrology and dialysis, "narrative-based medicine" and "effective communication" still do not receive the attention or recognition they deserve - and should be valued more highly. Care staff should be given clearly defined responsibilities as part of an overall knowledge transfer and family engagement strategy. This will require a well-coordinated approach involving the close collaboration of doctors and care staff, who will need to work together as equals. A welcome consequence of this approach could be an enhanced professional status for nursing and care staff, and improved recognition for the profession as a whole.Dissertation389 291 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Zur Theorie des Pflegehandelns - eine explorative Studie zur Bedeutung des Selbst, Selbstkonzepts und Körperbilds für die Transformation des Pflegemodells von Roper, Logan&Tierney in eine pragmatistisch-interaktionistische Theorie des Pflegehandelns.(2012-06-25); ; ; The nursing model by Roper, Logan&Tierney (RLT Model), originated in the UK, forms the springboard for this study. In putting this model into practice it became clear that some implicit, yet important concepts like the self, self-concept and body image had not been sufficiently explored. A major underlying assumption of this Thesis is that the comprehension of human action requires a clear understanding of such elusive concepts as the self, self-concept and body image. Nursing is embedded in actions that profoundly affect the body as well as the self. To overcome this deficiency I first adapted insights gained from three American nursing theories which elaborate on the self, self-concept and body image. Second, I draw upon the thinking of the classical American pragmatist tradition, a philosophical-theoretical approach dealing with these three key concepts mentioned. By incorporating the work of George H. Mead and John Dewey and by synthesising its uptake by Anselm Strauss, I attempt to advance the RLT-model into a more proactive practical framework.Dissertation2004 6116 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Prophylaxe der invasiven pulmonalen Aspergillose durch dezentrale Luftreiniger mit HEPA-Filter(2010-05-20); ; ; Background: Invasive pulmonary aspergillosis (IPA) is a severe complication in the treatment of haemato-oncological patients. The major risk factor is the depth and duration of neutropenia. The airborne Aspergillus conidia are ubiquitous prevalent. They are continuously inhaled by humans and can reach the alveoli in the lung. High Efficiency Particulate Air (HEPA) filters can eliminate Aspergillus conidia from the ambient air and thus reduce the exposure to them. There has been reported a positive correlation of the exposure to Aspergillus conidia and the incidence of IPA. The results of some studies suggest that the IPA incidence can be reduced by HEPA filtration of the ambient air. It is the first time that the efficacy of mobile air cleaners with HEPA filters was evaluated in a prospective randomised controlled blind trial.Objectives: (1) Evaluation of the suitability of an air cleaner(2) Analysis of historical patient data(3) Evaluation of the efficacy of mobile air cleaners with HEPA-filters to reduce the incidence of IPA in high risk patients.Study designs: (1) Analysis of documents, series of tests with an air cleaner(2) Retrospective analysis of patient records(3) Prospective randomised controlled triple-blind trial.Methods: (1) Evaluation of technical data of the air cleaner, particle measurement, sampling of airborne germs in natural or extremely high spore load, sedimentation test, tests with air cleaners with and without HEPA filters. (2) Inclusion criteria: patients with acute leukaemia, at least 18 years of age, receiving intense chemo therapy. Exclusion criteria: aspergillosis in medical history. (3) Inclusion criteria: patients who were expecting a prolonged neutropenia, at least 18 years of age. Exclusion criteria: aspergillosis in medical history. To achieve a relative risk reduction of 60% at a significance level of 0.05 and a power of 0.80 a sample size of 34 patients per group was necessary.Interventions: (1) Contamination of a room with Aspergillus spores, operating an air cleaner under different conditions.(2) -(3) The intervention group had air cleaners with HEPA filters in their rooms, while the air cleaners of the control group contained 'sham filters'. Patients in both groups were told to keep doors and windows preferably shut and to use high-efficiency masks, when leaving or airing the room.Analysis:(1) Construction of time-effect-curves. (2) and (3) Primary endpoint: IPA incidence. Secondary endpoints: length of IPA-free interval, mortality, duration of antimycotic therapy, overall length of stay.Outcomes:(1) The air cleaner was suitable. (2) 35 patients were included in the retrospective analysis. 80% of the patients suffered from acute myeloid leukemia (AML), 20% from acute lymphoblastic leukemia (ALL), 60% were male. The mean age was 58 years, the average length of neutropenia was 26.4 days. The IPA incidence was 54.29%. On average the IPA-free intervall lasted 76.6 days. 75% of all IPA cases occurred in the first 56 days after initiation of therapy. Mortality rate was 14.3%. The average length of stay in hospital was 118.8 days. IPA patients received systemic antimycotica for treatment for 31.9 days on average. (3) The prospective randomised controlled trial included 76 patients. 70 patients received the allocated treatment. 77.63% of the patients had AML, 19.74% ALL and 2.63% had a non-Hodgkin lymphoma (NHL). 59.21% of the patients were male. The mean age was 53.61 years, the average length of neutropenia was 26.4 days. The IPA incidence was 46.15% (18 of 39) in the intervention group (IG) and 54.05% (20 of 37) in the control group (CG), p = 0.49, relative risk = 0.85. The mean IPA-free interval was 81 days in the IG and 74.38 days in the CG, p = 0.65. The log rank test of the Kaplan-Meier statistics resulted in a p value of 0.39. Mortality rate was 7.69% in the IG and 18.92% in the CG, p = 0.13. Length of stay in hospital and duration of antimycotic therapy did not differ between groups (p = 0.63 and p = 0.8 resp.).Discussion: The expected efficacy of mobile air cleaners could not be verified. The outcome is consistent with outcomes of recent systematic reviews with meta-analyses, in which only non-randomised trials achieved a statistically significant reduction of the infection rate. The problem of air quality control remains unresolved in patients with acute leukemia. Due to the severity of the problem further clinical trials or adequate observational studies are needed.Dissertation335 898