Thomas is Adjunct Professor at IMPACCT where his work concentrates on the topic of pain and delirium. His connection with the faculty of health was established in 2016 when he was an Endeavour Research Fellow at what was then the Centre for Cardiovascular and Chronic Care.
He is currently Professor of Aged Care Nursing at Evangelische Hochschule Dresden – University of Applied Sciences (ehs) in Dresden, Germany. There, he is head of the study programmes in nursing, leads several research projects with a focus on pain and impaired cognition and is instrumental in developing the health related research portfolio at ehs.
Thomas is the chair of the German Pain Society's special interest group on pain in older persons. He is also an editor for the international journal Contemporary Nurse.
Thomas studied Nursing at Frankfurt University of Applied Sciences (Diplom-Pflegewirt (FH), equivalent to a Bachelor’s / Bachelor’s Honours degree) and Public Health at Bielefeld University (Master of Public Health). He received his PhD in Nursing Science (Dr. rerum curae) from Charité – Universitätsmedizin Berlin for his thesis on the 'Development of an Instrument to Assess Pain in Older Persons with Severe Dementia".
During his career his positions included senior consultant in research, science and innovation policy at Technopolis (Frankfurt / M., Germany), lead for the development of a unit for health services research at Charité - Universitätsmedizin Berlin (Berlin / Germany) and resonsibility for quality development and research projects at different institutions, including tertiary hospitals and residential aged care.
In 2016 I was awarded an Endeavour Research Fellowship by the Australian Federal Department for Education and Training which allowed me to join the Centre for Cardiovascular and Chronic Care (now: IMPACCT) at UTS for a research project on pain assessment in delirium.
Also in 2016 I was appointed member of the Inquiry Commission into the future of Nursing in the German State of Saxony by the Saxonian State Parliament.
I have received scholarships for my PhD from Robert-Bosch-Stiftung and for my undergraduate studies from Friedrich-Ebert-Stiftung.
- Deutscher Pflegetag (Germany's largest nursing conference) - programme committee 2016 & 2018
- Interprofessionaller Gesundheitskongress, Dresden - programme committee since 2014-2017
- German Association for Nursing Science. Council member (2012 – 2014)
- German Nurses Association, DBfK
- German Pain Society. Chairman Special Interest Group on Pain in the Elderly. Member of the Steering Committee for the Development of a Guideline for Pain Assessment in Nursing Home Patients
- International Association for the Study of Pain. Special Interest Group Pain in Older Pesons
- European Delirium Association
- Australasian Delirium Association
- German Society for Gerontology and Geriatrics.
Can supervise: YES
My main research focus is on pain management and especially on pain assessment in persons with impaired cognition. I have developed the German version of an instrument for pain assessment in patients with severe dementia, contributed to an evidence-based guideline on pain assessment in older persons and currently I am investigating pain assessment in patients with delirium.
Other areas of interest include the management of behavioural symptoms in patients with dementia and innovations in the provision of residential care, especially the development of new, non-traditional and innovative forms of residential care and small-scale living arrangements for older persons.
Current research projects
- Development of a Guideline for Pain in Assessment in Residential Care (German Pain Society, 2011 – 2017)
- PRAWIMA - Developing Master Degree university programmes for experienced professionals in the fields of nursing and early childhood education (Federal Ministry for Education and Research, “Open Universities”, 2014 – 2018)
- Double Duty Carers in Germany, joint project with HTW Dresden, funded by the Federal Ministry for Education and Research through the funding programme „Forschung an Fachhochschulen – SILQUA FH“; grant number 03FH002SA6 (2016 - 2019)
- Evaluation of the Saxonian Refugee Clinics, funded by the Saxonian Ministry for Integration (Phase I: 2015 - 2016; Phase II: 2017)
- Delirium and Pain Management, joint project with IMPACCT, Faculty of Health, University of Technology Sydney.
Completed projects (selection)
- Development of a tool box for the assessment of pain in persons with cognitive impairement (COST Action TD 1005, 2011 - 2015)
- MeDemA - Patients with Dementia in acute hospital care. Together with Dresden Technical University, Faculty for Architecture, and Diakonissen Hospital, Dresden (Robert-Bosch-Foundation, 2014 – 2016)
- Providing access to alternative living models for care-dependent persons from diverse social backgrounds. Needs assessment and concept development.National Association of Statutory Health Insurance Funds, 2015 – 2016)
de Waal, MWM, van Dalen-Kok, AH, de Vet, HCW, Gimenez-Llort, L, Konstantinovic, L, de Tommaso, M, Fischer, T, Lukas, A, Kunz, M, Lautenbacher, S, Lobbezoo, F, McGuire, BE, van der Steen, JT & Achterberg, WP 2020, 'Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition', European Journal of Pain (United Kingdom), vol. 24, no. 2, pp. 279-296.View/Download from: Publisher's site
© 2019 European Pain Federation - EFIC® Background: Recognition of pain in people with dementia is challenging. Observational scales have been developed, but there is a need to harmonize and improve the assessment process. In EU initiative COST-Action TD1005, 36 promising items were selected from existing scales to be tested further. We aimed to study the observer agreement of each item, and to analyse the factor structure of the complete set. Methods: One hundred and ninety older persons with dementia were recruited in four different countries (Italy, Serbia, Spain and The Netherlands) from different types of healthcare facilities. Patients represented a convenience sample, with no pre-selection on presence of (suspected) pain. The Pain Assessment in Impaired Cognition (PAIC, research version) item pool includes facial expressions of pain (15 items), body movements (10 items) and vocalizations (11 items). Participants were observed by health professionals in two situations, at rest and during movement. Intrarater and interrater reliability was analysed by percentage agreement. The factor structure was examined with principal component analysis with orthogonal rotation. Results: Health professionals performed observations in 40–57 patients in each country. Intrarater and interrater agreement was generally high (≥70%). However, for some facial expression items, agreement was sometimes below 70%. Factor analyses showed a six-component solution, which were named as follows: Vocal pain expression, Face anatomical descriptors, Protective body movements, Vocal defence, Tension and Lack of affect. Conclusions: Observation of PAIC items can be done reliably in healthcare settings. Observer agreement is quite promising already without extensive training. Significance: In this international project, promising items from existing observational pain scales were identified and evaluated regarding their reliability as an alternative to pain self-report in people with dementia....
Henry, J, Beruf, C & Fischer, T 2020, 'Access to Health Care for Pregnant Arabic-Speaking Refugee Women and Mothers in Germany.', Qualitative Health Research, vol. 30, no. 3, pp. 437-447.View/Download from: Publisher's site
Refugee women often encounter multiple barriers when accessing ante-, peri-, and postnatal care. The aim of this study was to investigate how premigration experiences, conceptions about pregnancy and childbirth, health literacy, and language skills influence access to health care, experiences of health care, and childbirth. A total of 12 semi-structured interviews with refugee women from Iraq, Syria, and Palestine were conducted in the city of Dresden. Content analysis was applied using Levesque's access model as a framework. Results indicate that conceptions of pregnancy and childbirth and premigration experiences influence women's behaviors and experiences of pregnancy and childbirth. They contribute to barriers in accessing health care and lead to negative health outcomes. In view of limited health literacy, poor language skills, lack of information, and missing translators, female relatives in countries of origin remain an important source of information. Improved access to services for refugee women is needed.
Sirsch, E, Lukas, A, Drebenstedt, C, Gnass, I, Laekeman, M, Kopke, K & Fischer, T 2020, 'Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline', Journal of the American Medical Directors Association, vol. 21, no. 2, pp. 149-163.View/Download from: Publisher's site
© 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed. A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization. It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess o...
Lukas, A, Hagg-Grün, U, Mayer, B, Fischer, T & Schuler, M 2019, 'Pain assessment in advanced dementia. Validity of the German PAINAD-a prospective double-blind randomised placebo-controlled trial.', Pain, vol. 160, no. 3, pp. 742-753.View/Download from: Publisher's site
Pain in combination with dementia is a common condition that makes pain recognition significantly more difficult. This results in undertreatment of pain in those suffering from dementia. The Pain Assessment in Advanced Dementia (PAINAD) scale currently represents one of the best approaches to pain detection in dementia. In a pilot study, strong inter-rater and retest reliability of the German version (PAINAD-G) was proven. However, the available data concerning the validity of this instrument were insufficient. The aim of the study was to validate the PAINAD-G scale by a double-blind randomised placebo-controlled trial in people with advanced dementia expected to be in pain. A second aim was to examine whether other observational tools (BISAD = Observation Instrument for Assessing Pain in the Elderly with Dementia) (German: Beobachtungsintrument für das Schmerzassessment bei alten Menschen mit Demenz, Checklist of Nonverbal Pain Indicators, Algoplus) were also able to demonstrate a significant difference between the study groups. Surprisingly, the study revealed no difference in "pain reduction" between those treated by oxycodone compared with those treated by placebo. Equally, none of the other 3 observational tools were able to demonstrate a significant difference between the study groups. However, correlations among the 4 observational tools were mostly moderate to high. A number of possible reasons for this observation, such as difficulties regarding sensitivity to change/responsiveness, consistence of the fundamental construct, influence of the early onset study, and efficacy of the analgesic in advanced dementia are discussed.
Fischer, T, Hosie, A, Luckett, T, Agar, M & Phillips, J 2019, 'Strategies for Pain Assessment in Adult Patients With Delirium: A Scoping Review.', Journal of pain and symptom management, vol. 58, no. 3, pp. 487-502.e11.View/Download from: Publisher's site
CONTEXT:Pain and delirium are highly prevalent in the same patient groups. Disturbances in attention, awareness, and cognition are characteristics for delirium and can compromise pain assessment. OBJECTIVES:The aim of this review was to examine and map models and understandings of pain and delirium as well as pain assessment instruments and strategies for adult patients with delirium. METHODS:A scoping review of all publications that reported on pain assessment in adult patients with delirium was conducted with no time and language constraints, searching Medline, CINAHL, Scopus, Embase, and PsycINFO and systematically assessing for inclusion. Standardized data extraction and a narrative synthesis followed. RESULTS:A total of 90 publications were included in the final analysis. Despite being recommended for practice, no evidence for the use of self-report or behavioral pain assessment instruments in patients with delirium was identified, with the exception of limited evidence for the validity of the Critical Care Pain Observation Tool and Behavioral Pain Scale in delirious intensive care patients. Proxy ratings of pain and comprehensive pain assessment hierarchies were also recommended, but not supported by evidence. Current models and/or understandings of pain and delirium were not applied in most publications. CONCLUSION:The current literature is insufficient to guide clinical practice in pain assessment in patients with delirium. Future research will be needed to address the validity of existing pain assessment instruments, apply theoretical and conceptual understandings of pain and delirium, and build on prior studies to close evidence gaps.
Luckett, T, Chenoweth, L, Phillips, J, Brooks, D, Cook, J, Mitchell, G, Pond, D, Davidson, P, Beattie, E, Luscombe, G, Goodall, S, Fischer, T & Agar, M 2017, 'A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: Perceptions of Palliative Care Planning Coordinators and other health professionals in the IDEAL Study', International Psychogeriatrics, vol. 29, pp. 1713-1722.
Hickman, LD, Neville, S, Fischer, T, Davidson, PM & Phillips, JL 2016, 'Editorial: Call to action: greater investment in the registered nurse role is required to improve care outcomes for dementia patients living in residential aged care and their families.', Contemporary nurse, vol. 52, no. 2-3, pp. 137-139.View/Download from: Publisher's site
The number of people living with dementia will triple by 2050 (World Health Organization,
2012). Dementia is a complex terminal illness and international global public health priority
(World Health Organization, 2012). Whilst enormous efforts focus on dementia treatments,
there is an equally urgent need to address workforce issues and invest in increasing the registered
nurse role and ratios in residential aged care to meet the projections. In most high-income
countries residential aged care facilities have evolved over the past two to three decades from
homes for the aged into slow-stream hospices, caring for our most vulnerable community
members (Allen, Chapman, O’Connor, & Francis, 2008). This population has complex care
needs requiring the input of a range of health professionals, such as geriatricians, general practitioners,
registered nurses and care assistants (Hickman, Rolley, & Davidson, 2010; Phillips,
Heneka, Hickman, Lam, & Shaw, 2014). Over this same time period the number of registered
or enrolled nurses working in residential aged care facilities has fallen and those that remain
have been largely relegated to managerial responsibilities. As a result the bulk of nursing care
in residential aged care is now provided by a largely unskilled and unregulated workforce.
Without the prerequisite dementia knowledge, skills or training, these staff are supervised by a
small number of registered nurses (Hullick et al., 2016). This is in contrast to emerging evidence
from long-term care and acute care setting, that nurse qualifications impact outcome. It also differs
significantly from standards in countries like Germany, where a minimum RN ratio of 50% is
mandatory (Aiken et al., 2010)
Fischer, T 2015, 'A Checklist to Article Section of Care Comment', PFLEGE, vol. 28, no. 5, pp. 309-309.
© 2015, Deutsche Schmerzgesellschaft e.V. Published by Springer-Verlag Berlin Heidelberg - all rights reserved. Old people’s experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.
Fischer, T 2014, '[Pain - the unknown continent].', Pflege Zeitschrift, vol. 67, no. 9, p. 513.
Graeske, J, Verbeek, H, Gellert, P, Fischer, T, Kuhlmey, A & Wolf-Ostermann, K 2014, 'How to measure quality of life in shared-housing arrangements? A comparison of dementia-specific instruments', QUALITY OF LIFE RESEARCH, vol. 23, no. 2, pp. 549-559.View/Download from: Publisher's site
Fischer, T 2013, '[Nurses have contributed significantly to the improvement of pain management].', Pflege Zeitschrift, vol. 66, no. 9, p. 513.
Fischer, T 2013, '[Simultaneous bachelor studies during employment "nursing science/nursing management" successfully re-accredited].', Kinderkrankenschwester : Organ der Sektion Kinderkrankenpflege / Deutsche Gesellschaft für Sozialpädiatrie und Deutsche Gesellschaft für Kinderheilkunde, vol. 32, no. 5, p. 201.
Wulff, I, Koelzsch, M, Kalinowski, S, Kopke, K, Fischer, T, Kreutz, R & Draeger, D 2013, 'Perceived enactment of autonomy of nursing home residents: A German cross-sectional study', NURSING & HEALTH SCIENCES, vol. 15, no. 2, pp. 186-193.View/Download from: Publisher's site
Fischer, T 2012, '["And I ask the patient, what do you need now"].', Pflege Zeitschrift, vol. 65, no. 3, p. 129.
Fischer, T 2012, '[Residence for the elderly with nursing care needs. "Under no circumstances into a nursing home"!].', Pflege Zeitschrift, vol. 65, no. 3, pp. 148-151.
Gräske, J, Fischer, T, Kuhlmey, A & Wolf-Ostermann, K 2012, 'Dementia-specific quality of life instruments and their appropriateness in shared-housing arrangements--a literature study.', Geriatric Nursing, vol. 33, no. 3, pp. 204-216.View/Download from: Publisher's site
Shared-housing arrangements (SHA) in Germany are a specific type of housing arrangement that belongs to the global concept of small-scale living arrangements. This caring approach comprises characteristics of both home and institutional care for persons with dementia. To evaluate the impact of SHA on the quality of life (QoL) of residents, an appropriate setting- and dementia-specific QoL instrument is needed. This article aims to identify QoL instruments that relate to the core domains of SHA. After a comprehensive literature review, existing dementia-specific QoL instruments were evaluated to determine whether any have been specifically designed for or applied in SHA. Additionally, each domain of the instruments was matched with the core domains of SHA. None of the existing instruments was identified as having been developed for SHA. Matching of the instrument domains with the SHA core domains leads to the conclusion that Quality of Life-Alzheimer's Disease, Dementia Quality of Life, Alzheimer Disease-Related Quality of Life, and QUALIDEM are adequate instruments for measuring the dementia-specific QoL of persons living in SHA. For the first time, a basis has been created for valid QoL evaluations of residents with dementia living in SHA. The 4 identified instruments are considered applicable in SHA. Conducting a performance test and evaluating further attributes according to the Scientific Advisory Committee of the Medical Outcomes Trust (e.g., reliability and validity) will further elucidation of the appropriateness of the instruments for SHA.
Gräske, J, Fischer, T, Kuhlmey, A & Wolf-Ostermann, K 2012, 'Quality of life in dementia care--differences in quality of life measurements performed by residents with dementia and by nursing staff.', Aging and Mental Health, vol. 16, no. 7, pp. 819-827.View/Download from: Publisher's site
OBJECTIVES: Quality of life (QoL) is a major outcome parameter in dementia care. Self-ratings are considered the best way to evaluate QoL, but staff-ratings also provide valid results. In particular, the discrepancies between self-ratings and staff-ratings are underrepresented. The aim was to identify characteristics of people with dementia that improve the probability of completing a self rating QoL instrument on the 'Quality of Life - Alzheimers' Disease' (QoL-AD). Additionally, a level of agreement was set between self-rated and staff-rated QoL-AD and possible influencing factors. METHOD: A cross-sectional study was conducted in 2010 in Berlin. Using the instrument QoL-AD, the self- and staff-rated QoL of people with dementia was assessed. RESULTS: 104 residents (73.1% female, mean age: 79.0 years, mean cognitive function (MMSE): 11.5) were included in this research project. 49 (47.1%) residents were able to complete the QoL-AD questionnaire. A predictor to complete the QoL-AD was the MMSE-part 'language'. Residents rated their QoL as significantly higher than the nursing staff did. If the primary nurse rated the QoL, a significantly better agreement was identified. CONCLUSION: The study generated new findings concerning a better understanding of QoL measurements. The results suggest the usefulness of performing self-ratings whenever possible. If proxy-ratings have to be used, these should be performed by primary nurses only in order to get reliable results.
Kölzsch, M, Wulff, I, Ellert, S, Fischer, T, Kopke, K, Kalinowski, S, Dräger, D & Kreutz, R 2012, 'Deficits in pain treatment in nursing homes in Germany: a cross-sectional study.', European Journal of Pain, vol. 16, no. 3, pp. 439-446.View/Download from: Publisher's site
BACKGROUND: Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor. METHODS: This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (S(PMAS) ), with a cut-off value of >67% indicating appropriate pain treatment. RESULTS: A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean S(PMAS) was 48.5 ± 1.5 (range, -33 to +100). Residents with prescribed scheduled analgesics had a significantly better S(PMAS) than patients without such treatment (S(PMAS) 58 ± 1.5 vs. 37 ± 2.5, p < 0.01). NHR without current pain had significantly better S(PMAS) than residents suffering from pain (S(PMAS) 47 ± 1.9 vs. 59 ± 4.2, p = 0.01). With an S(PMAS) of 69 ± 1.5, residents (n = 106) with scheduled pain medication plus PRN analgesics achieved the highest scores in the population. Overall, similar results were found in NHR with and in NHR without cognitive impairment. CONCLUSION: Our study points to a significant deficit in pain treatment in German NHR, including NHR with or without cognitive impairment.
Lukas, A, Schuler, M, Fischer, TW, Gibson, SJ, Savvas, SM, Nikolaus, T & Denkinger, M 2012, 'Pain and Dementia: a Diagnostic Challenge', Zeitschrift für Gerontologie und Geriatrie, vol. 45, no. 1, pp. 45-49.View/Download from: Publisher's site
The aim was to present current knowledge about pain assessment in people with dementia and to discuss special challenges and possible solutions.
A literature search in MEDLINE® was performed.
Due to the changing demographics of an aging population, an increasing number of people with dementia is expected. Many of these people will simultaneously suffer pain. Under-detection and under-treatment of pain in persons suffering from dementia is often described. As dementia progresses, the ability of the sufferer to verbally communicate his/her pain is often compromised, complicating the task of recognizing and treating pain. To improve pain recognition in dementia, many pain assessment tools have been developed. However, psychometric properties have to date been insufficiently examined.
Self-report ratings should be performed as long as justifiable. Behavioural pain assessment tools should be used in advanced dementia despite their current imperfections: in particular, the PAINAD for daily use and the PACSLAC at longer intervals. All available additional information about pain should be considered.
Sirsch, E, Schuler, M, Fischer, T, Gnass, I, Laekeman, MA, Leonhardt, C, Berkemer, E, Drebenstedt, C, Löseke, E, Schwarzmann, G, Kopke, K & Lukas, A 2012, 'Pain assessment in elderly nursing home residents (Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe)', Der Schmerz, vol. 26, no. 4, pp. 410-418.View/Download from: Publisher's site
In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group “Pain and Age” of the German Pain Society (“Deutschen Schmerzgesellschaft”) in conjunction with the German Centre for Neurodegenerative Diseases (“Deutschen Zentrum für Neurodegenerative Erkrankungen”), Witten, has embarked on the development of interdisciplinary S3-Guideline for “Pain Assessment in Elderly People in Nursing Homes”, based on the methodology suggested by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.”), the German Agency for Quality in Medicine (“Ärztliche Zentrum für Qualität in der Medizin”), and that described in the DELBI (“Deutschen Leitlinien-Bewertungsinstrument”). Delegates of the 38 scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.
Stemmer, R, Fischer, T, Recken, H, Sirsch, E & Tacke, D 2012, '[Independent nursing practice by nursing specialists].', Kinderkrankenschwester : Organ der Sektion Kinderkrankenpflege / Deutsche Gesellschaft für Sozialpädiatrie und Deutsche Gesellschaft für Kinderheilkunde, vol. 31, no. 5, p. 213.
Wolf-Ostermann, K, Worch, A, Fischer, T, Wulff, I & Gräske, J 2012, 'Health outcomes and quality of life of residents of shared-housing arrangements compared to residents of special care units - results of the Berlin DeWeGE-study.', Journal of Clinical Nursing, vol. 21, no. 21-22, pp. 3047-3060.View/Download from: Publisher's site
AIMS AND OBJECTIVES: To compare different health outcomes as well as quality of life (QoL) between people with dementia living in shared-housing arrangements (SHA) and special care units (SCU) in nursing homes. BACKGROUND: Often situated in large apartments in mostly urban settings, SHA are a specific German kind of small-scale living facilities for older care-dependent persons, predominantly suffering from dementia. SHA are completely disconnected from traditional nursing homes. DESIGN: In a longitudinal design, all new residents of SHA and SCU suffering with dementia in Berlin were surveyed for one year. They were assessed when they moved into the SHA or SCU and again 6 and 12 months later. METHODS: We surveyed physical and psychological health outcomes including ADL-functioning (Barthel), neuropsychiatric symptoms of dementia (NPI) and challenging behaviour (Cohen-Mansfield agitation inventory) as well as QoL (Qualidem). RESULTS: Fifty-six persons (43 women, 13 men) were recruited into the longitudinal study. The average age was 82·5 years at admission, participants mostly had a moderate level of cognitive impairment (mean Mini Mental State Examination = 13·3), prevalence of neuropsychiatric symptoms was high. During the one-year follow-up, analyses show a significant decrease in cognitive abilities but also of neuropsychiatric symptoms in both groups. In SHA, QoL increases on average during the one-year study period. CONCLUSIONS: Both types of facilities attract slightly different populations according to our data. Comparison of SHA residents to SCU residents documented no significant beneficial effects of settings in terms of health outcomes. RELEVANCE TO CLINICAL PRACTICE: As no clear advantage of either SHA or SCU in nursing homes can be demonstrated for residents with dementia who move in newly, it is impossible to give a clear evidence-based recommendation and the decision for one setting or the other can be made according solely to personal preference o...
Fischer, T 2011, '[The "understanding diagnosis" opens doors to the diversity of pain perception].', Pflege Zeitschrift, vol. 64, no. 10, p. 577.
Fischer, T & Bornschlegel, U 2011, '[Mute patients: how pain assessment is nonetheless successful. Assessing the individual case].', Pflege Zeitschrift, vol. 64, no. 10, pp. 594-596.
Fischer, T, Berkemer, E, Drebenstedt, C, Gnass, I, Kopke, K, Laekemann, M, Leonhardt, C, Löseke, E, Lukas, A, Schuler, M, Schwarzmann, G & Sirsch, E 2011, '[Interdisciplinary team develops S3 guideline for pain assessment in nursing home residence. Experts work on a mammoth project].', Pflege Zeitschrift, vol. 64, no. 10, pp. 582-583.
Fischer, T, Worch, A, Nordheim, J, Wulff, I, Graeske, J, Meye, S & Wolf-Ostermann, K 2011, 'Shared-housing arrangements for care-dependent older persons - Characteristics, development and drivers', PFLEGE, vol. 24, no. 2, pp. 97-109.View/Download from: Publisher's site
Gräske, J, Wulff, I, Fischer, T, Meye, S, Worch, A & Wolf-Ostermann, K 2011, '[Shared-housing arrangements for care dependent older persons. Support from family members and volunteers].', Pflege Zeitschrift, vol. 64, no. 11, pp. 666-671.
Due to growing numbers of older care dependant persons shared-housing arrangements (SHA) were developed as a new approach, especially for those elderly People suffering from dementia. The involvement of family members and volunteers is a core component of the SHA concept. Besides the active involvement in meaningful activities, relatives also often act as legal representatives. Empirical data concerning how frequently family members and volunteers are involved as well as the tasks they pursue is lacking. The aim of the study is to describe and evaluate the involvement of family members and volunteers in SHA. Special Care Units (SCU) are observed in comparison. In january 2009, all identified SHA and SCU in the city of Berlin were included in a cross-sectional survey as part of the DeWeGE-study. The DeWeGE-study was the first one on SHA in the city of Berlin. Data was collected using a written, standardised questionnaire. We collected data related to the frequency and tasks of family members and volunteer involvement as well as to the residents characteristics. 963 residents of 105 SHA and 17 SCU were included. More persons suffer from dementia in SCU than in SHA. SHA offer events to inform relatives and volunteers about their possible involvement less often than SCU. Family members are involved in meaningful activities in around 50 percent of all SHA and SCU. The proportion of family members who are present in the unit at least once per week is significantly higher in SCU than in SHA. No statistically significant difference between SHA and SCU is found regarding the involvement of volunteers. In SHA, legal representatives are more often paid professionals than in SCU. The real involvement of family members and volunteers in SHA does not reflect the conceptual propositions of this care arrangement.
Koelzsch, M, Kopke, K, Fischer, T, Hofmann, W, Kuhnert, R, Bolbrinker, J, Kuhlmey, A, Draeger, D & Kreutz, R 2011, 'Prescribing of inappropriate medication in nursing home residents in Germany according to a French consensus list: a cross-sectional cohort study', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, vol. 20, no. 1, pp. 12-19.View/Download from: Publisher's site
Kopke, K, Fischer, T, Koelzsch, M, Hofmann, W, Kuhlmey, A, Kreutz, R & Draeger, D 2011, 'Use of Health Insurance Data to Analyse Pain Management Practices in the Nursing-Home Setting', GESUNDHEITSWESEN, vol. 73, no. 7, pp. 459-460.View/Download from: Publisher's site
Holzhausen, M, Bornschlegel, U & Fischer, T 2009, 'Patient view in the assessment of quality of life in old age - Potentials and limits', ZEITSCHRIFT FUR GERONTOLOGIE UND GERIATRIE, vol. 42, no. 5, pp. 355-359.View/Download from: Publisher's site
Fischer, T 2008, 'Pain management and wound care: Implications for nursing', Zeitschrift fur Wundheilung, vol. 13, no. 2, pp. 98-102.
It is the ultimate goal of pain management in wound care for nurses to prevent pain from occurring, to eliminate pain or to relieve pain as completely as possible. Systematic pain detection and assessment is the corner stone of pain management. Pain intensity should be regarded as the "fifth vital sign" and monitored using standardized scales. Pain assessment should be part of wound assessment. Analgesic treatment is based on the collected data, prescribed by physicians. Local anesthetics are used as well as systemic opioids and non-opioid analgesics. Furthermore wound dressings with analgesic agents are a new treatment option. Pain prevention is paramount in wound care as well as the use of adequate wound dressings. Side effects should be prevented or counteracted by the nurse in co-operation with physicians. All patients should be offered non-drug interventions to alleviate pain, including central acting and peripheral acting approaches. Finally patient education should be an integral part of pain management. In clinical application all recommendations included in the guidelines have to be critically appraised by the nurse in the light of the needs of the individual patient.
Fischer, T & Wolf-Ostermann, K 2008, 'The berlin study on structures and outcomes of « Wohngemeinschaften» for people with dementia (DeWeGE), a small-scale living arrangement', Zeitschrift fur Gerontopsychologie und -psychiatrie, vol. 21, no. 3, pp. 179-183.View/Download from: Publisher's site
Small-scale living arrangements independent from nursing homes (Wohngemeinschaften, WG) are a new and rapidly growing option of care for people with dementia in Germany. They constitute an additional segment of care between home care and residential care. While some is known about structures offered and characteristics of residents in WGs, there is a lack of knowledge on health outcomes associated with these institutions. Therefore, in a longitudinal design, new residents of WG in the state of Berlin will be surveyed for one year and assessed for physical and psychological health outcomes. In a cross-sectional questionnaire design all WG in Berlin will be asked to provide information on their service structure and resident characteristics. In addition results will be compared with results for special care units for people with dementia in nursing homes in Berlin. © 2008 by Verlag Hans Huber.
Fischer, T, Kuhlmey, A, Sibbel, R & Nordheim, J 2008, 'The «serial trial intervention» German version (STI-D) - Development and testing of a nursing approach for reducing challenging behaviours in people with dementia', Zeitschrift fur Gerontopsychologie und -psychiatrie, vol. 21, no. 3, pp. 199-203.View/Download from: Publisher's site
Challenging behaviours often occur in advanced stages of dementia. They can be regarded as an expression of unmet need. In this study a German version of the Serial Trial Intervention (STI-D) will be developed and tested. The STI offers a structured framework for detecting unmet needs and thus reducing challenging behaviours, with a special focus on pain. In a first step the STI will be adapted to the German situation drawing on the knowledge of experts in the field. This will be followed by a cluster randomized controlled blinded clinical trial with three points of measurement to test the effectiveness of the approach. Primary outcome of the study is the occurrence of challenging behaviours, secondary outcomes include pain, quality of life and prescription of analgesics and psychotropic drugs. Results can be expected in 2010. © 2008 by Verlag Hans Huber.
Fischer, T 2007, 'Scales for pain assessment in persons with severe dementia: aids for observation', Pflege Zeitschrift, vol. 60, no. 6, pp. 308-311.
Fischer, T, Spahn, C & Kovach, C 2007, 'Targeted management of challenging behavior in persons with dementia: the "Serial Trial Intervention" (STI)', Pflege Zeitschrift, vol. 60, no. 7, pp. 370-373.
Fischer, T 2005, 'Pain management in the elderly--2: Recognizing and assessing pain accurately', Pflege Zeitschrift, vol. 58, no. 6, pp. 355-358.
Neumann, K & Fischer, T 2005, 'Pain management in the elderly--1: Recognizing and understanding the etiologies of pain', Pflege Zeitschrift, vol. 58, no. 5, pp. 287-291.
Fischer, T 2004, 'Primary nursing and case management: facilitating transitions', Pflege Zeitschrift, vol. 57, no. 4, pp. 275-277.