People who are affected by long COVID (LC) and have limitations in their ability to work can apply for a multi-professional rehabilitation programme. This qualitative study analysed the development of occupational participation, health limitations at work and factors supporting occupational participation in LC rehabilitants. Guided telephone interviews were conducted with LC rehabilitants aged 18-65 years, who were undergoing pneumological rehabilitation, at three time points (shortly after the end of rehabilitation, and six and twelve months after rehabilitation). Data were analysed using qualitative content analysis according to Mayring. Between 04/2021 and 07/2022, a total of 30 interviews were conducted with 11 rehabilitants (N = 7 women; average age: 50 years). Three health-related stress dimensions were identified: cognitive (e. g., word-finding difficulties, concentration problems), psychosocial (e. g., anxiety, worry), and physical (e. g., physical exhaustion, shortness of breath) limitations. The reintegration prepared by social services, the general conditions at the workplace (e. g., flexible working hours, empathy in the workplace) and personality traits, such as acceptance of personal limitations, were described as conducive to occupational participation. Respondents used compensatory techniques (e. g., mnemonics) and pacing to cope with the demands of work despite existing limitations. The results of the study show that "returning to work" is not the same as "regaining the ability to work". In both rehabilitation and aftercare, the restoration of physical, psychosocial, and cognitive work ability should play an essential role in counteracting the manifestation of participation restrictions.
In Switzerland, there is no obligation to record outpatient diagnoses. PraxisGruppe Schweiz (PraxiS), a network of about 30 GP and specialist practices in predominantly rural German-speaking regions in Switzerland, assign diagnosis codes per patient and consultation using the ICD-10 classification system. We compare these diagnoses with approximate ones, the so-called Pharmaceutical Cost Groups (PCGs), based on claims data from SWICA health insurance. We suspected that the distributions of diagnoses differed significantly between the two samples. The PraxiS database was used to identify patients with at least one consultation between 2020 and 2022 who were insured with SWICA. Claims data identified patients who had at least one consultation with a PraxiS network clinician in the same period. Diagnoses (ICD-10) were analyzed, and the ten most frequent diagnoses per age group were reported. The number of consultations per patient and age group were calculated. PCG information was derived from claims data following the official Swiss risk equalization definition, based on defined daily doses in the last observation year. Differences in diagnosis distributions between the two samples were tested using a Pearson χ2 test. High cholesterol, hypertension, diabetes, and depression are amongst the most frequently recorded diagnoses in both data sources. Furthermore, acute events (e.g., infections of the upper respiratory tract) and non-specific symptoms or problems that cannot be clearly assigned to a certain diagnosis occur frequently in primary care, while thyroid diseases, asthma/COPD and glaucoma are more commonly recorded in the claims data, since they are associated with regular medication intake. For 6 of the 32 PCG diagnoses, we rejected the null hypothesis of identical distributions, i.e., the diagnosis prevalences differ significantly between the two samples. While the GPs' diagnoses reflect the most frequent reasons for consultations, claims data also include prescriptions from outside primary care. Both data sources must be used in a complementary manner. Claims data should be used to analyze morbidity and medication use in a population. To gain a deeper understanding of the care situation, the data generated by GPs should be used. Particularly in times of GP shortages, when it is necessary to think about alternative or advanced forms of primary care, a detailed analysis of the care needs and care situations of the affected patient groups is necessary. Efforts in this direction should be supported.
General practitioners (GPs) play a central role as the first point of contact for patients with post-COVID. The aim of this qualitative study was to explore challenges and needs in the care for post-COVID patients from the perspective of GPs. Between October 2023 and May 2024, one face-to-face and two online focus groups were conducted with a total of 17 GPs from Berlin and Brandenburg. A self-developed guide was used, and data were analysed using framework analysis. In October 2024, results were validated in follow-up discussions with seven of these GPs. Across all focus groups, GPs reported multiple challenges. These included diagnostic and therapeutic uncertainties, a lack of robust evidence, and gaps in service provision, such as long waiting times in specialised care facilities and feelings of helplessness in dealing with affected patients. Several care needs emerged from these challenges: low-threshold access to specialised outpatient clinics, the development of tailored rehabilitation concepts, and structured, up-to-date information for patients. In addition, GPs highlighted the need for stronger recognition and support of their role in post-COVID care. GPs provide the lion's share of care for people affected by post-COVID, and thus their perspective should be given greater consideration in order to strengthen ambulatory care. The findings uncover genuine opportunities to address gaps in care and improve patient support. GPs require support through structured care pathways and closer collaboration with specialised services. Further research is needed to develop cross-sectoral models of care that both improve patient outcomes and alleviate the burden on primary care.
The German Innovation Funds project MSnetWork introduced a complex outpatient intervention to improve treatment of patients with MS. This study analyses the perception of healthcare professionals working in neurological practices to determine their ability and willingness to implement these interventions during the MSnetWork period and beyond the end of the project. The study assumes that the motivation of these professionals to implement the intervention is crucial for its success. For this qualitative study, semi-structured interviews assessed the perception of neurological practice personnel (neurologists, assistants) of all MSnetWork practices (full sample) to determine their motivation to implement the interventions. Furthermore, challenges and opportunities of the implementation were retrieved to find out the reasons for promoting or hindering the new intervention. The interviews were transcribed and analysed using qualitative content analysis. The interviews with 26 participants from 19 neurology practices (52.8 % participation, 12 interviews with physicians and 14 interviews with assistants) were conducted from October to December 2023 and lasted about 60 minutes.. From the professionals' perspective, key motivations included improving patient care, exploring innovative approaches, and fostering collaboration. Challenges included resource limitations, unclear intervention processes, and patient engagement. The healthcare professionals also indicated that making the MSnetWork interventions an essential element of routine treatment of MS patients would require more flexibility, fair reimbursement, and specialized training. MSnetWork seems to have implementation potential, i.e., healthcare professionals perceive that the new services fill gaps in care that are usually not appropriately addressed due to a lack of adequate funding. However, the main barrier to implement the new scheme is its integration into routine care, given the tense situation in specialist care and the simultaneous shortage of staff. The ultimate goal of innovative care projects is the transition of the pilot into routine care. The results of this interview study indicate that healthcare professionals have to be involved right from the start in both design and implementation of innovative care projects. Innovative routine care is not only a medical or technological challenge, but above all a social process that requires the joint efforts of all stakeholders. The findings indicate that the project should be transferred into routine care.
Many refugees initially receive medical care in the medical outpatient clinics of initial reception centers as part of the statutory health service restrictions in Germany. The care on offer varies greatly depending on the center and the resources available. Reliable information on the health status or health needs of refugees in these contexts remains scarce. Against this backdrop, an electronic medical records (EMR) software (Refugee Care Manager [Ref.Care]) was developed at Heidelberg University Hospital with funding from the Federal Ministry of Health. The development began in 2016, and the software has since been implemented in over 40 reception facilities in three federal states. On the one hand, the software makes it possible to document medical treatments digitally in a standardized form and, on the other hand, to process the treatment data anonymously and based on indicators. Extensive research into the effects of EMRs has already been carried out. Health care provided for refugees in reception centers has rarely been included in this research. This study therefore examines 1) the contributions that EMRs can make to patient care from the perspective of the software users and 2) the potential for improvement with regard to both software and implementation strategy. In 2018, semi-structured expert interviews were conducted with 30 service providers from outpatient clinics in reception facilities in Germany. The interview guide focused on the topics of satisfaction, acceptance, and usability of the newly introduced electronic medical records. The interviews were digitally recorded, pseudonymized, transcribed verbatim, and analyzed based on content-structuring content analysis according to Kuckartz. MAXQDA 20 was used to support the analysis. The introduction of the electronic medical records software was facilitated by personal contact with the practice teams during and after the training courses. The materials provided were rarely used afterwards. In everyday care provision, the possibility to adapt the software to the treatment context was seen as particularly positive. Technical difficulties and missing features, such as lack of interoperability with other software products, sometimes made it difficult to apply Ref.Care. From the respondents' point of view, the software makes an important contribution to improving the quality of care and increasing efficiency in terms of documentation. The option to further use the data for research purposes was viewed positively as well, and adaptability to specific professional groups and user needs was identified as a potential area of improvement. The early evaluation of the introduction of the software Ref.Care shows that the advantages and disadvantages of electronic medical records in the setting of care for refugees are very similar to those in routine care, and the problem of the lack of interoperability between different software products is also reflected here. To ensure acceptance and use of digital interventions, a participatory development process and an adapted implementation strategy would be beneficial.
The primary objective of the DELIVER-CARE study was to evaluate a generic model for the delegation of clinical tasks to medical practice assistants (MPAs) in the outpatient treatment of chronic inflammatory diseases in the form of an MPA consultation. In addition to proving that the model is not inferior to standard care, permanent implementation also requires a positive evaluation by those involved and knowledge of the barriers and success factors. Therefore, the aim of this study was to investigate the perspectives of those involved from the specialist fields of rheumatology, gastroenterology, and dermatology on the delegation of medical activities to MPAs and to identify both success factors and barriers to transferring the model to standard care. The focus here will be on the experience of setting up and running an MPA consultation. Qualitative, semi-structured guided interviews were conducted with doctors, medical assistants and patients in the fields of rheumatology, gastroenterology, and dermatology (convenience sample). Qualitative content analysis of interview transcripts was used. In 2022, 61 interviews were conducted with physicians (n = 21), medical assistants (n = 18), and patients (n = 22). In addition to the general willingness expressed by the majority of participants to continue using the delegation or MPA consultation model, aspects from the following areas were identified: (1) goals and motives for participating, (2) the participants' experiences with the intervention as well as current barriers to and challenges of long-term implementation. In summary, the interviewees were mostly pleased with the model and saw advantages, such as easing the workload of doctors, appreciating the work of medical assistants, and improving patient care). However, lack of a funding concept and general staffing conditions (fluctuation, lack of specialist staff) have made it difficult to implement the model. Considering the shortage of medical resources, MPA visits can be a key element in the transformation of outpatient care. However, further research and discussion is needed to specify the delegation model before it can be permanently integrated into standard care (i. e., regarding the mandatory face-to-face encounter between doctors and patients, remuneration for services, and the competency framework for medical assistants).
The "Registry for Recurrent Stone Diseases of the Upper Urinary Tract" (RECUR) was developed as a prospective long-term study. The aim was to link clinical data from hospital information systems (HIS) with self-report data from patients. The aim was to sustainably minimize resource requirements through digital and automated processes. However, numerous formal, legal, and logistical factors led to considerable delays in the implementation of the necessary digital infrastructure. This caused a significant delay in the start of recruitment. In addition, recruitment itself fell far short of the projected figures so that the registry had to be closed, partly because further funding could no longer be guaranteed. This paper describes the obstacles, supporting measures and reasons for the inability to achieve the targets, in particular the inadequate recruitment. To evaluate the recruitment process, seven guided expert interviews were conducted in the autumn of 2024 at the Freiburg site with healthcare professionals recruiting for RECUR (doctors and a ward secretary). Interview transcripts served as the basis for the qualitative summarizing content analysis according to Mayring. This involved sorting and summarizing the data material on the basis of case- and topic-related summaries. The following reasons for insufficient recruitment of participants were identified: (1) Physicians faced increasing workloads, particularly due to administrative tasks, making even minor additional duties a low priority. (2) There was no intrinsic benefit perceived by those responsible for recruitment. (3) On the patient side, challenges included language and cognitive barriers, lack of technical affinity and equipment, as well as information overload. Opportunities for optimization include centralizing responsibilities, providing additional staffing resources, automating and digitalizing processes, and implementing incentive systems for staff. Everyday hospital life is characterized by a high level of organizational and administrative effort combined with limited personnel and time resources. Such conditions considerably limit the implementation of care research studies. In the RECUR use case, recruitment was hampered by limited cognitive, technological, and linguistic competences as well as little recognizable intrinsic benefit for both staff and patients. Future research projects should incorporate these findings to improve design and recruitment.
Informal care costs account for the largest share of the total costs of dementia. The informal care costs of dementia have been well researched in Germany, but the group of family caregivers of people with MCI ("mild cognitive impairment") has not been taken into account so far. The aim of this study is to evaluate the care time spent by family caregivers of people with cognitive impairment according to the severity of the disease and to estimate informal care costs. The data is based on the multicenter, prospective registry study "Digital Dementia Regustry Bavaria - digiDEMBayern" (German title: "Digitales Demenzregister Bayern - digiDEM Bayern"). Information on informal care time was collected using the "Resource Utilization in Dementia Lite (RUD-Lite)" instrument. Informal care costs were calculated using the opportunity cost approach. Sensitivity analyses were used to determine a high and a low cost estimate and to compare them with each other. Severity-related differences were assessed using variance analyses. The survey results of 445 people with cognitive impairment and their informal caregivers were evaluated. The average care time to support activities of daily living significantly increased with greater severity (p = 0.005). The average cost of informal caregiving was between 15,057 and 30,994 EUR for people with mild cognitive impairment, between 19,785 and 38,747 EUR for people with mild dementia, and between 23,709 and 48,451 EUR for people with moderate dementia. Several earlier studies found an increase in the costs of informal caregiving with increasing cognitive decline in Germany. However, these studies differ in the methodologies used. There are various reasons why comparatively higher costs of informal care have been calculated in the present study. It is likely that the annual costs of informal caregiving are in the range described, depending on the level of severity. The results indicate that people caring for family members with MCI bear a significant burden and that this leads to high social costs. The indirect costs of dementia increase the burden on society also from an economic perspective.
Patient-centered therapy, with shared decision making (SDM) as a fundamental principle, is recommended in clinical guidelines for the care of individuals with type 2 diabetes mellitus but is often not implemented in practice. "arriba Diabetes" was developed as a decision aid to support shared decision-making (SDM) regarding therapy intensity. The underlying linear model requires four inputs: (1) age, (2) comorbidities, (3) preference preferences regarding treatment efforts, and (4) preferences regarding the avoidance of organ damage. Based on these inputs, the program calculates an appropriate therapy intensity. This study aimed to examine how GPs perceive "arriba Diabetes". This qualitative interview study aimed to explore general practitioners' (GPs') perceptions of "arriba Diabetes", specifically (1) whether the therapy intensity suggested by the model was considered appropriate, (2) whether the tool was perceived as comprehensible, and (3) whether it was regarded as complete. Interviews were conducted at two time points-before and after the application of the tool. The interview performed before the application followed the cognitive pretest approach. Data were analyzed thematically according to Braun and Clarke. We conducted five interviews before and 18 interviews after the application of "arriba Diabetes". GPs generally perceived the recommended therapy intensity as appropriate. In some cases, it was initially regarded as not strict enough but, upon reflection, was considered comprehensible and even educational in terms of supporting de-escalation. The four input parameters (age, comorbidities, preference regarding treatment efforts, and preference regarding the avoidance of complications) were largely viewed as meaningful and complete, although the assessment of comorbidities and treatment efforts was sometimes described as challenging. Overall, GPs considered "arriba Diabetes" to be a practical and comprehensible tool for supporting SDM. "arriba Diabetes" has the potential to support shared decision-making on therapy intensity for individuals with type 2 diabetes mellitus.
Healthcare professionals have a responsibility to base their decisions on a combination of clinical experience, evidence-based research, and the inclusion of patient values and preferences to improve their clients' quality of care. However, the implementation of research findings into clinical practice is often delayed by up to 15 years. Therefore, this study explores experiences of occupational and physical therapists in Germany as recipients of knowledge transfer in order to identify influencing factors and possible ways to enhance knowledge transfer and to address the knowledge-to-practice gap. We conducted 16 semi-structured, guided individual telephone interviews with occupational and physical therapists and employed thematic qualitative content analysis. The results show a variety of strategies to access knowledge (e.g., teaching materials, educational programmes, peer exchange), which are applied with various frequency: conferences are rarely attended, while search engines are used more regularly. However, accessing knowledge usually takes place outside working hours and is rated differently in terms of effectiveness/efficiency and quality of content: despite potential inadequacies of some strategies to access knowledge (e.g., due to a disputable level of evidence), others (e.g., peer exchange) are considered useful because of their simplicity and efficiency. The access to knowledge is influenced by a number of facilitating and hindering factors related to resources, communication, and organisational and individual aspects. Thus, potential for optimisation has been identified in terms of access, supply, and content of knowledge. These research findings facilitate an enhanced understanding of knowledge transfer received by therapists. This is needed to establish targeted strategies to access, integrate, and evaluate knowledge, and it may lead to an improvement in professional development and patient outcome.
In Germany, substance use disorders (SUDs) are highly prevalent and impose a significant burden on both individuals and society, such as unemployment. Participation in working life is crucial for people with SUDs as employment can help to overcome these disorders. However, re-entry into the labour market among this population remains low, which is partly due to insufficient cross-sectoral collaboration at the interface between job centres and rehabilitation. ANDANTE is an innovative intervention for people with SUDs based on the "Individual Placement and Support" model that aims to address these challenges. This study presents the experiences of people with SUDs who participated in the ANDANTE program. We conducted n = 11 semi-structured interviews between 04/2023 and 06/2024. Participants were interviewed during the first 8 months of the intervention. We analysed the interviews using a structuring qualitative content analysis with a deductive-inductive approach according to Kuckartz and Rädiker. The majority of respondents were male (n = 10). Participants spoke predominantly positive about ANDANTE in terms of content and organisation. Some respondents made suggestions for improvement such as a greater focus on stress management or application training. Support from both ANDANTE staff or peers was described as helpful. Participants also perceived positive impacts throughout the intervention, such as an improved daily structure or living situation, as well as more control over substance use. This study provides insights into the experiences of people with SUDs with an innovative intervention for reintegration into working life. The findings may contribute to targeted adaptations of ANDANTE or the development of future programmes in a similar context in Germany.
Processing data in health services research requires informed patient consent. When this consent is withdrawn, researchers face the challenge of correctly implementing legal requirements regarding data protection. This article aims to identify and analyze the tasks research institutions must undertake when processing a withdrawal of consent for data processing. Using a withdrawal case from the RADARplus research project, we conducted a legal analysis of requirements under the General Data Protection Regulation (GDPR) and other relevant legal frameworks. Based on this analysis, we discuss implementation approaches. The analysis reveals the complexity of implementing a withdrawal of consent procedure: Data may exist in various systems (research databases, backup systems, paper records) and must be identified accordingly. Different retention requirements apply depending on the type of data and legal basis. We outline responsibilities and practical approaches to restricting data processing, such as technical access limitations and blocking notices. The practical implementation of the right to withdraw consent presents complex challenges for research institutions. Open questions remain, particularly regarding pseudonymized data, long-term data storage, and collaboration with multiple research partners. While the suggested guidance provides a structured approach for legally compliant processing of withdrawals, it does not eliminate the need for data protection assessment and proper documentation.
Healthcare research results often do not find their way into practice due to missing or under-utilized communication channels. Consequently, these results fail to impact the healthcare system. To bridge this "translation gap," solutions tailored to the needs and habits of users are required. We conceptualized and implemented an online platform to communicate the results of two completed healthcare research projects to both professionals and the public in Cologne. This was achieved using a co-design approach with end users. The platform was evaluated for user satisfaction, efficiency, effectiveness, conformity with expectations, and usage through participant observation, an online survey, and web statistics analysis. A final redesign was conducted based on the evaluation. The platform was implemented according to the co-design concept. Most online survey participants found the site easy to use and engaging in terms of content. However, criticisms included the lack of multimedia and interactive content, the large amount of text used, and the absence of specific expected information. After the redesign, the platform met part of the requirements emerging from the evaluation. Nonetheless, improvements are needed in multimedia and interactive content presentation, as identified in the evaluation. The lack of specific expected content highlights unanswered research questions of the underlying projects. The developed platform has been online since the end of the development phase and continues to be used. The study demonstrated that a co-design approach can yield usable results in the field of science.
The term "Caucasian" is still used to describe study populations in medical publications, often without explicit definition or transparent operationalization. This can limit reproducibility, comparability, and external validity. As a case example, we use the first German clinical atropine trial for myopia control in children, the Low-dose AtropIne for Myopia Control in Children (AIM) study. Commentary based on an analysis of publicly available documents related to the AIM trial (protocol/published information) and a structured literature and policy/statement review (PubMed and relevant guidance documents) on race/ethnicity reporting, the use of "Caucasian", and fair participant selection. Using the first German clinical atropine trial for myopia control in children (AIM) as a case example, we show that the target population is described as "Caucasian", while the definition and assignment procedures are not transparent in public materials. This affects interpretability and transferability, especially when cohorts are used for follow-up analyses (e.g., genetics). We discuss scientific (definition/validity), ethical (fair selection), legal (equal treatment and discrimination risks), and regulatory (target population/transferability) implications. We emphasize the need to distinguish social categories from geographic recruitment and from biological hypotheses, which require appropriate variables and explicit justification. Population descriptors such as "Caucasian" should only be used when they are defined, justified, and transparently operationalized. More precise reporting standards and alternatives are available.
The supply of pharmaceuticals is undergoing structural change due to internet mail orders, a shortage of skilled workers, and the decreasing density of community pharmacies. Since January 1, 2024, Germany also has an electronic prescription procedure, the e-prescription. This study aims to answer the question how digitalization has changed access to pharmaceuticals. Semi-structured expert interviews were conducted between September 2023 and March 2024. Relevant experts were identified and surveyed about their experience with the influence of digitalization that has so far been observed, about its practicality, and their expectations and outlook regarding the consequences for the supply of medicines. Therefore, only experts from self-governing bodies, the Gematik GmbH, payers, and patient representatives were selected. The interviews were recorded and transcribed. The transcripts were analyzed using MAXQDA. A total of 9 interviews were conducted. Regarding the effects of digitalization on patient care provided by community and mail order pharmacies, the experts overall regarded mail order pharmacies as high-performance companies that comply with the safety principles required in the pharmaceutical trade. All experts could see the mail order trade's impact on the density of community pharmacies. The shortage of skilled workers was confirmed by all experts, and digitalization can help mitigate this problem. However, an excessive expansion of mail order companies can disadvantage patients. Concerning e-prescriptions, the expert interviews revealed that e-prescriptions and the telematics infrastructure (TI) are still experiencing difficulties. Despite the costs, the experts surveyed believe that improvements in patient care and patient safety will enhance patient rights. Digitization has a beneficial effect by increasing access to pharmaceutical care. People can access medicines more easily through mail orders and e-prescriptions depending on how they are dispensed. However, some groups of people do not benefit from the new advantages, resulting in the need to further reduce this imbalance in the future. The preservation of community pharmacies for the purpose of individual advice and emergency pharmacy services is another challenge that we have to face as a result of digitalization. The e-prescription still has its shortcomings and is currently testing the patience of doctors, pharmacists, and prescription recipients. If stable, it will improve both patient care and patient safety. Future studies will need to demonstrate that the access-to-medicines gap can be filled and technical difficulties further reduced.
Germany is among the countries with the highest per capita consumption of opioid analgesics, which are mostly applied for chronic non-cancer pain (CNCP). The high-quality guideline LONTS, which is not disease-specific, gives treatment recommendations for long-term opioid therapy. Our aim was to explore physicians' knowledge of and their attitude towards this guideline, as well as their perception of the guideline's impact. A cross-sectional survey was conducted in September 2021 and a reminder sent out in January 2022. A standardized questionnaire was circulated among 1,854 physicians working in outpatient healthcare. The sample consisted of a random sample of primary care physicians, orthopedists, and neurologists from the pool of an address provider (n = 1,300), as well as the members of the Professional Association of Physicians and Psychological Psychotherapists in Pain and Palliative Medicine in Germany ("Berufsverband der Ärzte und Psychologischen Psychotherapeuten in der Schmerz- und Palliativmedizin in Deutschland", BVSD) (n = 554). The questionnaire was completed by 422 physicians. The majority of physicians was older than 50 years (79%) and male (64%). One third of the participating physicians were primary care physicians (33%), 46% were anesthetists. A majority of the participants knew the LONTS guideline (83%). Their attitude towards following the LONTS guideline recommendations varied between "rare deviation in reasonable cases" (41%) and "regular deviation in reasonable cases" (52%). Though a majority of participating physicians (78%) thought that multimodal non-pharmaceutical treatment, as recommended by the LONTS guideline, is important, only 17% regarded it as being implementable. The level of knowledge and implementation of the LONTS guideline fell within the range of other guidelines. The recommendation for multimodal non-pharmaceutical treatment accompanying long-term opioid therapy was considered important but unrealistic in current healthcare practice.
With the beginning of a vocational training, nursing students are challenged with a new professional role and required to develop a professional identity. It is not clear which challenges nursing students perceive in this process and to what extent the professional identity is developed over the course of the training. These findings are needed to support nursing students in these development processes with suitable informal and formal learning and educational opportunities. A three-year qualitative panel study with guideline-based, episodic interviews was conducted. A total of 26 nursing students from nursing training courses took part and were interviewed three times, namely at the end of each training year. The data material was analyzed using a reconstructive-hermeneutical method, and development types were formed. Finding a role in organizations and the associated development of a professional identity was identified as a major challenge for nursing students in vocational training. Most students finally succeed in finding a balance between individuation and adaptation when taking on their new professional role and develop an appropriate tolerance for ambiguity. For some nursing students, though, the ongoing tension between their own expectations and the role expectations of others leads to a pronounced intolerance of ambiguity and a persistent experience of stress. Especially at the beginning of the training, trainees' role actions are strongly guided by their own or other people's expectations, and they often find themselves in conflict situations, which also means that learning opportunities are missed. The persons responsible for nursing training are required to support trainees in recognizing their learning needs and opportunities. In addition, the development of ambiguity tolerance should be specifically promoted in order to create the appropriate conditions for achieving training success and maintaining the trainees' health. The development of a professional identity should be understood as a dimension of professional competence and supported accordingly by formal learning and educational offers. Further research is needed to determine future development needs and to accordingly review existing offers.
With the increasing availability of powerful large language models (LLMs), the use of artificial intelligence (AI) in qualitative research is gaining growing attention. This article critically examines the potential and limitations of such systems along key research steps, such as category development, coding, and interpretation. Drawing on our own experiences and recent studies, we discuss both functional benefits and methodological, ethical, and data protection-related challenges. The findings suggest that AI-based systems can be meaningfully employed as complementary tools for reflection - for example, to generate alternative perspectives or serve as a second or third opinion in individual projects. At the same time, it becomes evident that the core principles of qualitative research cannot be automated. We therefore advocate for a research-driven, critically reflective use of AI, grounded in methodological rigor, ethical responsibility, and ongoing scholarly discourse.
Morbidity and mortality conferences (M&MCs) are structured interprofessional meetings to review specific treatment courses and deaths, aiming to learn from errors to improve patient care and safety. They integrate medical education, quality improvement, and risk management. With the rising importance of safety culture in German healthcare, the relevance of standardized M&MCs is also growing. Other examples of safety culture include an open error culture and critical incident reporting systems. This study analyzed facilitating and inhibiting factors of structured M&MCs, their impact on the derivation of improvement measures, and their influence on participants' professional activities and confidence to act. A mixed-methods study involving participant observation and quantitative surveys of all M&MC participants was conducted at Dresden University Hospital. Data from participant observation was analyzed using Grounded Theory approach; correlation analyses supplemented the perceived effects of derived measures. During the study period (February 2019 to December 2020), 32 M&MCs were visited in 16 departments of Dresden University Hospital (response rate 69.3 %; 400/577 questionnaires). Structured M&MCs promoted systematic case analysis and consistent presentation quality of treatment courses. Derived improvement measures correlated with better understanding of internal departmental processes, increased clarity, and confidence to act. The study highlights the importance of moderated interprofessional and multiprofessional M&MCs. It suggests that M&MCs can promote learning processes and participants' confidence to act in patient care, thereby improving the quality of medical care.
The Committee for Anti-infective Therapy within the Federal Association of German Hospital Pharmacists (ADKA) regularly surveys the status of antimicrobial stewardship (AMS) implementation in German hospitals. Following the last survey in 2017, an updated S3 guideline on AMS was published. This current survey conducted by the ADKA in 2023 aimed to assess the status of AMS implementation, highlight developments over time and analyse pharmacists' participation in AMS activities. From 13 March to 20 April 2023, an online survey was conducted among all chief pharmacists of hospital pharmacies in Germany. The questionnaire covered structural and process characteristics of AMS, as well as questions regarding pharmacists' involvement. The data were evaluated descriptively and compared to data from the 2017 survey. Data from 226 hospitals were analysed. 85 % of the hospitals have a multidisciplinary AMS team (51 % according to the S3 guideline). However, only 9 % met the staffing level recommendations for AMS activities. Hospital pharmacists are heavily involved in AMS activities, regardless of explicit funding. The implementation rate of AMS strategies mostly correlates with AMS staffing levels. The results demonstrate a positive trend in the implementation of AMS teams and interventions. Pharmacists play a central role in conducting AMS strategies. However, staffing levels fall short of national recommendations and international standards, limiting the comprehensive implementation of AMS. Hospital pharmacists play a crucial role in AMS. There is a sufficient number of qualified pharmacists. To ensure widespread establishment of AMS programmes in German hospitals, however, investment in human resources and infrastructure is necessary.