BACKGROUND: In Germany, an estimated number of 70,000 people diagnosed with long COVID or post-COVID syndrome (PCS) had received inpatient medical rehabilitation by the end of 2022. Due to the heterogeneity of the clinical picture, the variability of interventions and inconsistent endpoints, previous studies on the effectiveness of rehabilitation are of limited value. It therefore remains unclear whether and to what extent rehabilitation measures established for, e.g., pulmonary, cardiovascular, or neurological diseases are suitable for patients with PCS.
OBJECTIVE: To identify the experiences and perspectives of those affected by PCS, in relation to inpatient rehabilitation and to describe patients\' values and wishes with respect to evidence-based medicine.
METHODS: In January/February 2023, the German initiative \"Long COVID Deutschland\" conducted a retrospective online survey (39 closed items, two open answer fields) among adult PCS sufferers on their experiences with inpatient rehabilitation. Recruitment was carried out via social media and websites of patient initiatives. The open answers were analyzed using a structuring and summarizing qualitative content analysis according to Mayring, supplemented by descriptive representations of the distribution of standardized information.
RESULTS: Of 1,191 participants in the survey, 733 used open response formats to additionally explain their experiences and the effects of individual measures on their general condition. 366 (50%) reported that their state of health deteriorated, mainly because of strength or endurance training and too extensive treatment plans. The presence of a post-exertional malaise (PEM) or its insufficient consideration during rehabilitation was described as the main barrier. Recognition and acceptance of individual performance limits, flexible and coordinated individual treatment plans tailored to the patient\'s limitations, and support in coping with the disease were described as supportive factors. From the participants\' perspective, learning strategies to avoid deterioration in their state of health due to overexertion, the so-called pacing, should be the core treatment goal for patients affected by PEM.
CONCLUSIONS: The results are not statistically representative but ensure systematic insights into the subjective perspectives of those affected, the consideration of which represents one of the three principles of evidence-based medicine. The results show that for PCS patients with PEM, even minimum requirements for rehabilitation measures can lead to overexertion and aggravation.
CONCLUSIONS: Common subject-specific rehabilitation concepts appear to be only partially suitable for dealing with the symptoms and the heterogeneity of the disease. Aims and interventions should be individually adapted, and the focus should be on pacing, disease coping and management. A reliable test for PEM and rehabilitation ability before the start of rehabilitation is needed to ensure safety for those affected. To adequately classify studies on the effectiveness of rehabilitation, risks and side effects should be disclosed.

Background: Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. Objectives: We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples\' life after proximal femoral fracture. Methods: We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Results: Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. Conclusion: To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.

BACKGROUND: Permanent health impairments after a COVID-19 infection can lead to a lack of social participation and pronounced emotional stress. The aim of this study was to find out how Long COVID affects the social activities of those affected and understand the role that medical support and the immediate social environment play in this.
METHODS: Between January and May 2022, 25 participants with long COVID were interviewed about their health situation, their perception of health care in Germany, and their social and professional context. The interviews, which were mainly conducted online, were analyzed for content, and the results were assessed using lifeworld-theoretical approaches.
RESULTS: The participants reported a variety of health symptoms such as fatigue, shortness of breath, and cognitive impairments. The majority of respondents had a pessimistic attitude toward a timely recovery. Most participants perceived the medical support for long COVID as inadequate. Long waiting times for specialist appointments and the lack of acceptance of the health impairment by some doctors lead to an increase in existing uncertainties. Long COVID also had a major impact on respondents\' social life. Many participants referred to a burdensome decline in the number of meetings with family and friends. Many respondents avoided physical contact with friends and family members due to a high level of fear of infection. Some participants explained that they separated themselves from people in their environment because they did not take their precarious situation seriously. However, an important resource was the close circle of family and friends from whom the majority of the interviewees received support.
CONCLUSIONS: While other research studies particularly emphasize the comprehensive psychological and emotional consequences of long COVID, such as identity conflicts, existential angst, or depression, the present study shows that a lack of understanding from medical professionals as well as heavily delayed treatment leave the interviewees in a state of emotional void.
CONCLUSIONS: The findings show a considerable need for support among people with health impairments after a COVID-19 infection. Empathic and empirically based counseling and support by general practitioners as well as improvement of access to rehabilitative services can provide substantial support for people with long COVID.

Registered nurses\' experience of necessary performed and missed nursing care: a qualitative study Abstract: Background: Providing high quality care based on their caring attitude is essential for nurses. Missed Care can cause feelings of guilt and dissatisfaction among them. Studies on their experiential transition between fully performed and missed care are lacking. They may contribute to a more comprehensive understanding of influencing factors and the impact on nurses\' experience. Aim: The aim was to explore how nurses at a centre hospital in German-speaking Switzerland describe performance of nursing interventions in terms of the different expressions between performed and missed care. Methods: Between September 2020 and March 2021 the first author conducted eleven qualitative guide-based individual interviews with registered nurses which were analysed using Mayring\'s qualitative content analysis and knowledge maps. Results: The analysis resulted in five main categories: Optimal care, satisfaction in mediocrity, a huge lack, patients\' reactions and influencing factors. Nurses described, in addition to personal experience and expertise, different coping strategies to prevent missed care and maintain patients\' and their own satisfaction. Conclusions: In addition to interventions that can prevent missed care, nurses\' experience of performed care should be explored further. This can deepen the understanding of its relationship with professional caring attitudes as well as with patient-related and professional satisfaction.
Zusammenfassung: Hintergrund: Für Pflegefachpersonen ist zentral, auf Basis ihrer Caring Haltung eine qualitativ hochstehende Pflege zu erbringen. Versäumte Pflege kann bei ihnen Schuldgefühle und Unzufriedenheit hervorrufen. Publikationen zu ihrem Erleben im Übergang zwischen vollständig durchgeführter und versäumter Pflege fehlen. Solche können zum umfassenderen Verständnis von beeinflussenden Faktoren und den Auswirkungen auf das Erleben von Pflegefachpersonen beitragen. Ziel: Zu explorieren, wie Pflegefachpersonen an einem Deutschschweizer Zentrumsspital das Durchführen von Pflegeinterventionen in Bezug auf die Ausprägungen zwischen durchgeführter und versäumter Pflege beschreiben. Methode: Von September 2020 bis März 2021führte die Erstautorin elf qualitative, leitfadengestützte Einzelinterviews mit Pflegefachpersonen, die mit der qualitativen Inhaltsanalyse nach Mayring und Knowledge Maps ausgewertet wurden. Ergebnisse: Die Analyse ergab fünf Hauptkategorien: Optimale Pflege, Befriedigung im Mittelmaß, Mangel an allen Ecken und Enden, Reaktionen von Patient_innen und beeinflussende Faktoren. Pflegefachpersonen beschreiben verschiedene Umgangsstrategien, um versäumter Pflege vorzubeugen und die Zufriedenheit von Patient_innen und ihrer selbst zu erhalten. Schlussfolgerungen: Neben Maßnahmen zur Prävention versäumter Pflegeinterventionen sollte das Erleben zum Erbringen der Pflege weiter exploriert werden. Damit kann das Verständnis für dessen Zusammenhang mit der beruflicher Caring Haltung sowie mit der patientenbezogenen und beruflichen Zufriedenheit vertieft werden.

Objectives: Despite its high appeal, the concept of resilience remains unclear. Current definitions include a process approach, but most resilience scales remain trait-based. This study assessed implicit concepts of researchers in an interdisciplinary research group in order to develop a process-based model of resilience. Methods: Expert interviews were conducted with nine experienced researchers from the fields of theology, medicine, and philosophy and analyzed using qualitative content analysis. Results: Categories are classified as predictive, process-related or outcome-related. Central elements in the process are the articulation and acceptance of negative experiences as well as a narrativization and meaningful integration of experiences. Conclusions: Based on the categories, a working definition for a process-oriented resilience model is created.The categories show proximity to known elements and goals of psychotherapy. The reinterpretation of resilience as a process of conscious \"moving forward\" (Yahuda) instead of an unattainable \"hero ideal\" can be helpful for psychotherapy patients.
Zusammenfassung Fragestellung: Trotz hoher Attraktivität bleibt der Begriff der Resilienz unscharf. Aktuelle Definitionen beinhalten zwar einen Prozessgedanken, dennoch erfassen Resilienzskalen meist statische Personenmerkmale. Ziel dieser Arbeit ist, zur Erschließung eines prozessbezogenen Resilienzmodells implizite Konzepte der Forscher:innen einer interdisziplinären Forschungsgruppe zu Resilienz zu erfassen. Methode: Mit neun erfahrenen Forscher:innen ausTheologie,Medizin und Philosophie wurden Experteninterviews durchgeführt und mittels qualitativer Inhaltsanalyse ausgewertet. Ergebnisse: Es wird zwischen prädiktiven, prozessbezogenen und ergebnisbezogenen Resilienzkategorien unterschieden. Zentrale Elemente im erstellten Prozessmodell sind die Artikulation und Akzeptanz auch von negativen Erfahrungen sowie eine Narrativierung und sinnhafte Einordnung des Erlebten. Diskussion: Auf Basis der gefundenen Kategorien wird eine erste Arbeitsdefinition für ein prozessorientiertes Resilienzmodell erstellt. Inhaltlich findet sich viel Nähe zu bekannten Elementen und Zielen von Psychotherapie. Die Umdeutung von Resilienz als Prozess des bewussten „moving forward“ (Yahuda) anstelle eines unerreichbaren „Heldenideals“ kann für Psychotherapiepatient:innen hilfreich sein.

BACKGROUND: Tissue transplantation can improve the quality of life of patients in a very wide range of applications. In 2021, around 900 people in Germany agreed to donate organs after death - the number of tissue donors was significantly higher. Nevertheless, there is a shortage of organs and tissues in Germany. In order to counteract this, the introduction of a presumed consent legislation has been discussed time and again. However, the debates focused on possible positive effects for organ donation, whereas potential consequences for tissue donation have so far not been considered in the political discourse or in research. Using an exploratory approach, this paper aims to contribute to closing this research gap: Multidisciplinary interviews with experts were conducted to investigate whether the presumed consent legislation is a key success factor for increasing the number of tissue donors in Germany and which other approaches might be promising.
METHODS: We conducted qualitative interviews with 14 experts who worked as employees in different positions in tissue banks/networks, ophthalmologists performing corneal transplantation, medical ethicists, lawyers or scientists. These interviews were evaluated using the structuring content analysis according to Mayring. In reporting, we followed the Standards for Reporting Qualitative Research (SQRQ).
RESULTS: The majority of experts did not consider presumed consent legislation to be a key factor in increasing the donation rate in Germany. Instead, an improvement of processes and structures in tissue donation was cited as the most important optimization potential. Furthermore, communication measures were postulated to create transparency about the characteristics of tissue donation as distinct from organ donation. These should address not only the general population, but also the professional groups involved in the tissue donation process.
CONCLUSIONS: The present study indicates that the presumed consent legislation is not a success factor for increasing the number of tissue donors in Germany. It would be far more effective to improve structures and processes in order to identify the large number of potential tissue donors and to be able to conduct informed conversations with their relatives. Information measures for the general public and professionals, which clearly differentiate between tissue donation and organ donation, are also more promising than fruitless debates about the introduction of the presumed consent legislation.

The development of infant mental health (IMH) services globally is still in its early stages. This qualitative study aims to understand the challenges of setting up IMH services and explores the views and experiences of 14 multi-disciplinary stakeholders who are part of the IMH implementation group in a large Scottish health board. Six major themes were identified through thematic analysis. This paper examines the most prominent theme \"Systems\" alongside the theme \"Gaps in Current Service\". The theoretical framework of \"candidacy\" is found to be a valuable way to conceptualize the complex systemic layers of micro, meso, and macro factors that contribute to the challenges of setting up services. At the micro level, key themes included the view that services must be accessible, individualized, and involve families. At the meso level, in line with the aims of the service, multiagency integration, aspects of early intervention, and clear operating conditions were all seen as important. Finally, at the macro level, perhaps the biggest challenge perceived by stakeholders is delivering a service that is entirely infant-focused. These findings will help inform policy makers about factors considered by professionals to be vital in the establishment of IMH services in Scotland and across the globe.
El desarrollo de los servicios de salud mental infantil (IMH) globalmente está aún en sus niveles básicos. Este estudio cualitativo se propone comprender los retos de establecer los servicios IMH y explora los puntos de vista y experiencias de 14 personas interesadas de múltiples disciplinas que son parte de un grupo de implementación de IMH dentro de una extensa junta de salud escocesa. A través de análisis temáticos se identificaron seis temas de mayor importancia. Este estudio examina el tema más prominente según la mayor percepción, “Sistemas,” junto con el tema “Vacíos en la Actual Prestación de Servicio.” Se estima que el marco teorético de trabajo de “candidatura,” es una manera valiosa de conceptualizar los complejos niveles sistémicos de micro, medio y macro factores que contribuyen a los retos de establecer los servicios. Al nivel micro, los temas claves incluyen el punto de vista de que los servicios deben ser accesibles, individualizados y deben involucrar a las familias. Al nivel medio, alineados con las metas del servicio, la integración de agencias múltiples, aspectos de temprana intervención y claras condiciones operativas fueron todas estimadas como importantes. Finalmente, al nivel macro, quizás el mayor reto percibido por las personas interesadas es cumplir con el ofrecimiento de un servicio que esté enteramente enfocado en el infante. Estos resultados ayudarán a informar a quienes determinan las políticas a seguir acerca de los factores que los profesionales consideran vitales en el establecimiento de servicios IMH en Escocia y alrededor del globo.
Au niveau global, le développement de service de santé mentale du nourrisson et de la petite enfance en est encore à ses débuts. Cette étude qualitative s\'est donnée pour but de comprendre les défis que pose l\'installation de services IMH. Elle explore les vues et les perspectives de 14 parties prenantes de diverses disciplines qui font partie d\'un groupe de mise en place IMH dans un grand conseil de santé en Ecosse. Six thèmes principaux ont été identifiés au travers une analyse thématique. Cet article examine le thème ayant été perçu comme le plus grand et proéminent, Systèmes, ainsi que le thème « Brèches dans les services actuels ». La structure théorique de la ‘candidature’ a été utilisée pour trouver une manière utile de conceptualiser les couches systémiques complexes de facteurs micro, méso, et macro qui contribuent aux défis qu\'il y a dans l\'installation de services. Au niveau micro, les thèmes clés ont inclus l\'idée que les services doivent être accessibles, individualisés et engager les familles. Au niveau méso, s\'alignant avec les buts du service, l\'intégration de plusieurs agences, les aspects d\'une intervention précoce et des conditions d\'opération claires ont tous été estimé être importants. Enfin, au niveau macro, le défi étant peut-être le plus grand selon les parties prenantes est d\'offrir un service qui est entièrement focalisé sur le nourrisson. Ces résultats aideront les décideurs pour ce qui s\'agit des facteurs considérés comme étant vitaux par les professionnels pour ce qui concerne l’établissement de services IMH en Ecosse et au travers du globe.
Die Entwicklung von Leistungen für die psychische Gesundheit von Kindern (infant mental health; IMH) befindet sich weltweit noch in einem frühen Stadium. Diese qualitative Studie zielt darauf ab, die Herausforderungen bei der Einrichtung von IMH-Leistungen zu verstehen. Untersucht werden die Ansichten und Erfahrungen von 14 multidisziplinären Interessenvertretenden, die Teil der IMH-Implementierungsgruppe in einem großen schottischen Gesundheitsamt sind. Durch eine thematische Analyse wurden sechs Hauptthemen ermittelt. In diesem Beitrag wird neben dem Thema “Lücken im derzeitigen Angebot” das als am stärksten wahrgenommene Thema “Systeme” untersucht. Der theoretische Rahmen der “Candidacy” hat sich als wertvoller Weg erwiesen, um die komplexen systemischen Schichten von Mikro-, Meso- und Makrofaktoren zu konzeptualisieren, die zu den Herausforderungen bei der Leistungseinrichtung beitragen. Zu den Schlüsselthemen auf der Mikroebene gehörte die Ansicht, dass die Leistungen zugänglich und individuell gestaltet sein und die Familien einbezogen werden müssen. Auf der Mesoebene wurden im Einklang mit den Zielen der Leistung die Integration mehrerer Stellen, Aspekte der Frühintervention und klare Arbeitsbedingungen als wichtig angesehen. Auf der Makroebene schließlich sehen die Beteiligten die vielleicht größte Herausforderung in der Bereitstellung einer Leistung, die ausschließlich auf Kleinkinder ausgerichtet ist. Diese Ergebnisse werden dazu beitragen, die politischen Entscheidungstragenden über Faktoren zu informieren, die von Fachleuten als entscheidend für die Einrichtung von IMH-Leistungen angesehen werden - in Schottland und auf der ganzen Welt.
世界的な乳幼児精神保健(IMH)サービスの開発は、まだ初期段階にある。この質的研究は、IMHサービス立ち上げの際の課題を理解することを目的とし、スコットランドの大規模な保健委員会でIMH実施グループの一員である14人の多職種の関係者の見解と経験を調査するものである。6つの主要なテーマが主題分析法により特定された。本論文では、最も大きく認識され注目しているテーマ「システム」を、テーマ「現状のサービスにおけるギャップ」とともに検証する。「キャンディダシー(candidacy)」という理論フレームワークはサービス立ち上げの課題に寄与するミクロ、メゾ、マクロ因子からなる複雑なシステム層の概念化に有用であるとされている。ミクロレベルでは、サービスはアクセスしやすく、個別化され、家族を含むものでなければならないという見解が主要なテーマに含まれた。メゾレベルでは、サービスの目的に沿って、複数機関の統合、早期介入の側面、明確な運営条件がすべて重要であると考えられている。最後に、マクロレベルでは、関係者が認識しているおそらく最大の課題は、徹底して乳幼児に焦点を当てたサービスを提供することであろう。これらの結果は、専門家がスコットランドや世界のIMHサービスの確立に不可欠とみなしている要素を、政策立案者に情報提供するのに役立つであろう。.
婴儿心理健康 (IMH) 服务的全球发展仍处于早期阶段。这项定性研究旨在了解建立IMH服务的挑战, 并探讨苏格兰一家大型卫生委员会IMH实施团队中14位多学科利益相关者的观点和经验。通过专题分析确定了六大主题。本文探讨了被认为最突出的主题“系统”以及“现有服务的差距”。“候选资格”的理论框架被认为是一种有价值的方法, 可以将微观、中观和宏观因素的复杂系统层概念化, 这些因素导致了建立服务的挑战。在微观层面, 关键主题包括这样一种观点, 即服务必须是易获得的、个性化的, 并让家庭参与。在中观层面, 根据服务目标, 多机构整合、早期干预以及清晰的运行条件都被视为重要因素。最后, 在宏观层面, 利益相关者认为的最大挑战可能是提供一种完全以婴儿为中心的服务。这些发现将有助于决策者了解专业人士认为对在苏格兰和全球建立IMH服务时至关重要的因素。.
لا يزال تطوير خدمات الصحة النفسية للأطفال (IMH) على مستوى العالم في مراحله الأولى. تهدف هذه الدراسة الوصفية إلى فهم تحديات إنشاء خدمات الصحة النفسية للأطفال واستكشاف آراء وخبرات 14 من أصحاب المصلحة متعددي التخصصات الذين يشكلون جزءًا من مجموعة تنفيذ IMH في لجنة إدارة صحية على مستوى عالي في اسكتلندا. تم تحديد ستة مواضيع رئيسية من خلال التحليل المواضيعي. تبحث هذه الدراسة في أكبر موضوع بارز وهو “الأنظمة” إلى جانب موضوع “الثغرات في الخدمة الحالية”. وقد تم استخدام الإطار النظري المعروف بـ (candidacy) أو السعي لتلقي الرعاية الصحية ليكون وسيلة لوضع تصور مفاهيمي لجوانب النظام المعقدة للعوامل الجزئية والمتوسطة والكلية التي تساهم في تحديات إنشاء الخدمات. على المستوى الجزئي ، تضمنت الموضوعات الرئيسية وجهة النظر القائلة بأن الخدمات يجب أن تكون في المتناول ، وأن تكون فردية ، وأن تشمل العائلات. على المستوى المتوسط ، تمشياً مع أهداف الخدمة ، تم اعتبار التكامل وجوانب التدخل المبكر واجراءات العمل الواضحة جميعها مهمة. أخيرًا ، على المستوى الكلي ، ربما يكون التحدي الأكبر الذي يدركه أصحاب المصلحة هو تقديم خدمة تركز بالكامل على الأطفال الرضع. ستساعد هذه النتائج على إعلام صانعي السياسات بالعوامل التي يعتبرها المتخصصون حيوية في إنشاء خدمات الصحة النفسية للأطفال في اسكتلندا وفي جميع أنحاء العالم.

Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis Abstract. Background: With the progress in medical options, the need for home mechanical ventilation increases. The transition from long-term ventilation in an institution to home mechanical ventilation in an outpatient setting is a difficult phase in terms of setting up the network of care, coordination of care for those with the ventilatory insufficiency and the financing. Aim: The study describes how patients with ventilatory insufficiency and family caregivers experience the transition from an institution to an ambulatory setting with invasive or non-invasive home mechanical ventilation. Methods: A qualitative research design with a social-constructivist approach was adopted using thematic analysis according to Braun and Clarke. We included seven German-speaking patients (≥ 18 years old) with ventilatory insufficiency and home mechanical ventilation (> 6 h/day) from the German part of Switzerland, with discharge from an institution to home, and five family caregivers who care for patients with the described criteria. Results: The institution was seen as a safe place. Affected persons and their family caregivers had to create a safe environment at home. Three themes were formed inductively: To gradually build trust with each other, to become experts as family caregivers, to align their own network with the new care needs.Conclusions: The transition home succeeds in the interplay of gaining trust, building expertise, and creating sustainable networks. Professionals can use this knowledge to provide targeted support to patients with home mechanical ventilation and their family caregivers.
Zusammenfassung. Hintergrund: Mit dem Fortschritt an medizinischen Möglichkeiten erfolgt ein erhöhter Bedarf an Heimbeatmung. Der Übergang von stationärer Langzeitbeatmung in ambulante Heimbeatmung ist eine schwierige Phase in Bezug auf den Aufbau des Netzwerks zur Betreuung, die Koordination der Pflege und die Finanzierung. Ziel: Die Studie beschreibt, wie Betroffene mit ventilatorischer Insuffizienz und pflegende Angehörige den Übergang von einer Institution ins ambulante Setting mit invasiver oder nichtinvasiver Heimbeatmung erleben. Methode: Es wurde ein qualitatives Forschungsdesign mit sozialkonstruktivistischem Ansatz gewählt mit einer Auswertung nach der thematischen Analyse von Braun und Clarke. Eingeschlossen wurden sieben deutschsprachige Betroffene (≥ 18 Jahre) mit ventilatorischer Insuffizienz und Heimbeatmung (> 6 h/Tag) aus der Deutschschweiz, mit Austritt von einer Institution nach Hause, sowie fünf pflegende Angehörige, welche Betroffene mit den beschriebenen Kriterien betreuen. Ergebnisse: Die Institution wurde als sicherer Ort erlebt. Betroffene und Angehörige mussten nach dem Übergang zu Hause ein sicheres Umfeld schaffen. Drei Themen wurden induktiv gebildet: Miteinander schrittweise Vertrauen gewinnen, als Angehörige Expert_innen werden und das eigene Netzwerk auf die neuen Betreuungsbedürfnisse ausrichten. Schlussfolgerungen: Der Übergang nach Hause gelingt im Zusammenspiel von Vertrauen gewinnen, Expertise aufbauen und tragfähige Netzwerke schaffen. Fachpersonen können mit diesem Wissen Betroffene mit Heimbeatmung und ihre Angehörigen gezielt begleiten.

BACKGROUND: There is an increase in hearing and visual impairments worldwide. Those affected have a reduced ability to participate in social contacts, mobility, and access to information. Until now, there have been no recommendations for Advanced Practice Nurses (APNs) in Switzerland to support this group of people in the autonomous organization of everyday life in their own homes.
OBJECTIVE: The aim of the study was to understand how people integrate their dual hearing and visual impairments into everyday life to derive recommendations for APNs to support individuals to manage their daily lives.
METHODS: Following the constructivist approach of grounded theory, guided interviews and a questionnaire survey with hearing and visually impaired persons (n = 46) over 70 years of age on independent daily living were conducted (concurrent embedded strategy). In addition, demographic data on age, gender, living situation, and use of assistive devices were analyzed.
RESULTS: Based on the results, a communication-based dynamic resilience model (CoRes) was developed. This article represents the third phase of the three-stage-model. Integration of altered hearing depends on resources and risk factors.
CONCLUSIONS: Advanced practice nurses can use recommendations from this research to actively help individuals and their families build resilience.

BACKGROUND: In 13 European countries, laws have been passed that allow nurses to prescribe medicines, but mostly within a limited framework and with a doctor involved. Germany is not among these countries. Only the prescription of medical aids has already been included into the development of extended nursing competencies. We investigated the views of the health care professions involved (doctors, pharmacists and nurses) regarding the role of nurses in pharmaceutical care.
METHODS: We conducted 22 semi-structured interviews with 23 members of the three professional groups involved in the European research project DeMoPhaC. These data collected in Germany were analysed using qualitative content analysis. Five main categories were developed.
RESULTS: Pharmaceutical care by nurses can be described within the following main categories: 1. Knowledge and competences, 2. Patient care, 3. Communication, 4. Multi-professional team and 5. System. The communication between the professional groups involved and with patients and caregivers is of particular importance. Interaction in the multi-professional team is just as crucial. Pharmaceutical care takes place within the health system which sets the framework and often boundaries as well. The current and ideally conceived roles of nurses are seen differently in the respondents\' respective contexts. Between the professional groups there is both agreement and dissent on the topics addressed. However, the development of nursing roles requires collaborative and transparent processes in teams and organisations. Particularly in the hospital setting, the participants saw a great need for change in order to achieve cooperation at eye level.
CONCLUSIONS: The results show that nurses play their role in the complex field of pharmaceutical care under very heterogeneous circumstances. The empowerment of nurses, which was called for by some participants, cannot be achieved from within the professional group alone. Cooperation from all the players involved is needed. The development of nursing roles in the medication process with simultaneous expansion of qualifications and competences can contribute to making the nursing role more attractive. Clear role models promote the transparency of processes for all involved. If all players know what they can expect of nurses, tasks can be redistributed in the multiprofessional team.
CONCLUSIONS: The above-mentioned diversity of perspectives can be a resource for development and individual solutions. However, it can also be interpreted negatively as a sign of uncertainty and less standardised ways of working. In view of the data evaluated here, the prescription of medicines by non-medical professionals remains a distant goal for developments in the German health care system. First of all, structures and processes are required that permanently guarantee safe pharmaceutical care with equal participation of all relevant stakeholders.