Memorandum Memorandum "Work and Technology 4.0 in Professional Care" - Paul Fuchs-Frohnhofen, Andreas Blume, Kurt-Georg Ciesinger, Helga ...
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Memorandum
“Work and Technology 4.0 in Professional Care”
Paul Fuchs-Frohnhofen, Andreas Blume, Kurt-Georg Ciesinger,
Helga Gessenich, Manfred Hülsken-Giesler, Michael Isfort,
Marc Jungtäubl, Andreas Kocks, Martina Patz, Margit Weihrich
Memorandum
Imprint Memorandum “Work and Technology 4.0 in Professional Care” ISBN 978-3-9820402-4-0 2nd Edition, November 2018 © 2018 MA&T Sell & Partner GmbH Karl-Carstens-Straße 1, 52146 Würselen, Germany Photo: fotolia.com This memorandum is the result of the cooperation by five research This collaboration within the scope of the focus group, “New groups in the funding priority initiative “Preventive measures for safe Approaches to Occupational Health and Safety in the Care and and healthy working tomorrow” from the German Federal Ministry of Services Sector”, formed the basis for discussions on the future Education and Research: design of “Work and Techniques 4.0” in care. The result of these • “empCare – Care for carers: development and establishment of discussions can be found in this memorandum. The research and an empathy-based relief concept in care work” (FKZ 02L14A150 - development projects are funded by the German Federal Ministry 02L14A153) represented by Andreas Kocks, Nursing Scientist at of Education and Research (BMBF) as part of the research pro- the University Hospital Bonn gramme, “Innovations for the Production, Services and Work of • “ITAGAP – Technique and Work Process Development for Health in Tomorrow” and overseen by the Karlsruhe project management Outpatient Care” (FKZ 02L14A240 - 02L14A243) agency (PTKA). Responsibility for the contents of this publication • “Pflege-Prävention 4.0 – New models for prevention in the care lies with the respective authors. of the elderly against the background of occupational biography orientation, diversity of services and high-tech“ (FKZ 02L14A180 - 02L14A184) • “PräFo – Prevention of stress and strain in formalised work in services and technical development“ (FKZ 02L14A250 - 02L14A253) • “Stress-Rekord – SeriousGame-based information and learning environment for reducing physical and psychological stress amongst caregivers“ (FKZ 02L14A230 - 02L14A233)
Memorandum
“Work and Technology 4.0 in Professional Care”
Part A: Summary
The following memorandum “Work and Tech- development and introduction processes. In
nology 4.0 in Professional Care” represents this way, the innovative potential of new tech-
the joint positioning of the signatories for the nologies in care work is not being utilised with
sustainable, long-term design and implemen- a view towards the future.
tation of technical innovations in the field of
nursing care. For successful organisation of Work 4.0 in nur-
sing, consistent, interdisciplinary and targeted
The starting point for this statement is an development, introduction and impact assess-
understanding of care as interactive work for ment of socio-technical innovations together
and with people that requires special organisa- with professional nursing are required. The use
tion and valuation. of technology in nursing work must have a
preventive and continuous supporting effect in
The undersigned agree that nursing staff should the interest of health and the “good work” of
benefit more from technology than in the past. caregivers as well as in the interest of the quality
To this end, they must be involved in the design of life of care recipient.
of the technology that concerns them and their
actual practical work.
The undersigned of this
memorandum propose:
This is the only way to ensure that employees
can benefit from the increasing use of techno- to recognise the special importance of care
logy in professional nursing practice. So far, work as interactive work, to evaluate it (also
there has been empirical evidence of inadequate economically!) and to consider it in every
integration of professional care in technology change process,
3
to examine existing care-supporting or care- to recognise the improvement of health as
relevant technology, to subject it to critical well as the work and quality of life of both
examination and to adapt or introduce it caregivers and care recipients as target criteria
to promote job satisfaction and wellbeing, for the use of technology,
respectively,
to make technology assessments that take
to develop and implement processes for into account the intricacies of professional
technical support in professional care as nursing as an integral part of technology
socio-technical innovation processes, development in the field of nursing care.
not only to develop technical functionality, The memorandum is addressed to politicians
but also to consider the integration of new and associations, to managers and employees
technologies into nursing work and organi- in care institutions and to companies in the
sational processes, including their specifics, field of care-related technology development;
in a timely and adequate manner, it is also addressed to research sponsors, foun-
dations and the scientific community.
to explicitly involve the relevant actors in
nursing care in these processes and to plan We call on the responsible actors to take these
sufficient resources for their participation suggestions into account when developing,
and qualification, planning and introducing new technologies for
improving the organisation of Care Work 4.0.
to define practical testing as an important
success criterion for new technologies in We expect politicians to create appropriate
nursing, framework conditions for nursing work and
to take the above-mentioned guidelines into
to develop suitable measures to mitigate exis- account when developing tenders and funding
ting pressures and future risks to which care programmes.
workers are exposed as a result of the
(digital) technology-driven formalisation of
work processes,
4
Memorandum
“Work and Technology 4.0 in Professional Care”
Part B: Extended Version
1. About this Memorandum
2. The Care Service Sector
3. Understanding the Professional Care Service
4. The Importance of New Technologies in Professional Care
5. Work 4.0 in Nursing – Technology Supports Nursing Work Processes
6. List of Authors
7. Bibliography
1. About this Memorandum
This memorandum is the culmination of coope- of “Work and Technology 4.0” in the care sector.
ration between five research alliances under The result of these discussions can be found in
the funding priority “Preventive measures for this memorandum.
the safe and healthy work of tomorrow” by the
German Federal Ministry of Education and Re- This memorandum is to be widely published.
search. This collaboration within the focus group The website http://www.memorandum-pflege
“New approaches to occupational health and arbeit-und-technik.de/ offers all those who
safety in the care and service sector” formed support the content of this memorandum the
the basis for discussions on the future design opportunity to register on a list of endorser
5
2. The Care Service Sector
The creation and safeguarding of nursing care Looking at key figures from federal health per-
for the general population and the requisite sonnel accounts, a total of 836,000 people are
(working) conditions for nursing staff are mega employed in the professions of health care and
topics in the current social debate. (child) nursing and 559,000 in the professions
of nursing care for the elderly. Nursing pro-
Key words such as: fessions are already considered to be in short
supply today. Prognostic studies assume that
economisation (and commercialisation)
demand will continue to rise and that there will
in healthcare,
be a growing shortage of professionally qualified
reduction in the number of hospitals
staff.
(i.e. centralisation),
demographic change,
Various research studies on occupational health
increase in the need for care,
and safety in the various nursing fields show
increase in multi- and co-morbidity and
that nursing is associated both with high physi-
chronic disease,
cal stress (e.g. through lifting, carrying, storage,
decrease in family care capacities,
shift work) and with psychological stress. In
further medical advances,
some cases, nursing staff are only able to cope
digitisation and mechanisation in the
inadequately with this due to a lack of resources
context of Work 4.0,
(scope for action, recognition, staffing).
shortage of skilled workers or a state of
nursing emergency and
The handling of people in sensitive, intimate
general nursing training as well as
and partly critical situations (patients, relatives),
academising of care
the experience of suffering, dying and death,
characterise developments in all sectors of as well as interruptions in work, lack of a holistic
health- and care-related services, which present approach to work, fragmentation of work, high
themselves as challenges but which, under cer- economic pressure and excessive volume of
tain conditions, (can) present opportunities. For work as well as shift work and demarcation
professional caregivers, the current challenges problems, all of which substantially belong to
in all care sectors focus on aspects of work the occupational field, create strong stress
concentration, patient and resident safety, as patterns, which are often already apparent
well as their own physical and mental health among younger nurses.
safeguarding - aspects that are only briefly des-
cribed here. At the same time, continuous processes of
increasing digitalisation of medical technology,
The focus of nursing work is on the sectors of administration and logistics in the healthcare
outpatient care, partial and full inpatient long- sector are underway, which also have pertinent
term care and acute care in hospital. As of effects on nursing work.
2016, around 1,950 hospitals were recorded.
According to care statistics (2015), 13,300 out- This memorandum aims to encourage the
patient care services and 13,600 partly and design of future development and introduction
fully inpatient care facilities are registered processes for technology that affects nursing
nationwide. work in such a way as to reduce stress and
improve job satisfaction.
The high number of facilities corresponds to a
high number of employees in nursing profession
6
3. Understanding the Professional Care Service
Definitions and theories of care cannot be set work and subjective work action)4 and – asso-
out in detail in this memorandum. In order to ciated with this – situational action as well as
understand the text as a whole, however, a few informal practices are of particular importance.
selected aspects should be mentioned which Situational-related action in specific interaction
appear relevant from the authors’ perspective matches the nursing staff with the respective
to classify possibilities and limits of supporting current knowledge of the identified problem
nursing work through technology-oriented (external evidence).
innovations from a starting point.
Nursing action is thus based on a case-oriented
Care as a professional service includes all combination of findings from research and the
aspects of preventive, rehabilitative, curative, specific situation of the person in need of care.
palliative and compensatory care of people with Like medicine, nursing can derive and justify
existing or anticipated needs1. It comes not at its particular duty exclusively from this “double-
the end of the care chain, but rather intervenes sidedness” of a scientifically as well as prac-
at all times of health and care-related processes tically based determination of the situation. It
in acute and chronic conditions using profes- also fulfils its social duty of mediating medically
sional concepts. Furthermore, nursing work also and socially oriented treatment and socially
has to take into account social care aspects – oriented nursing exclusively via this “double-
also with respect to the goals of the new sidedness” of scientific foundation as well as
concept of nursing needs2. Professional care is empathic, situational interaction work.
thus intrinsically tied to the interaction between
the (health) system and the world in which Such an understanding of professional nursing
people live (the recipient of care).3 work points to the fact that nursing cannot
be described alone by performance-oriented
In order to make decisions, implement and verify activities and individual achievements, but
suitable nursing interventions, nurses have a represents a complex professional achievement
clinical ability to assess the complexity of the for existentially affected people.
particular situation, the problems at hand and
the wishes of patients or residents (internal
evidence). Findings from occupational science Ströbel und Weidner 2003
1
2
point out that in this context interactive work Wingenfeld
3
und Büscher 2017
Hülsken-Giesler 2015
(cooperative work, emotional work, empathetic cf. e.g. Böhle et al. 2015
4
74. The Importance of New Technologies
in Professional Care
The application of new technologies is regarded developments, the following assessments are
as an important strategy to meet the challenges made in the field of nursing care:10
of professional care outlined above. Initial de-
velopment cycles focus primarily on functional ICT-supported care technologies are a rele-
support for nursing work5 (e.g. in the area of vant area of development for care providers.
nursing documentation, technologically assisted So far, project development has focused on
recording of vital parameters, physical relief, direct support for service recipients.
etc.). There are more ICT solutions for out-patient
and acute care than for long-term in-patient
Increasingly, however, this development is also care.
aimed at supporting educational, advisory and The technology perspective and not the
6
informational services for professional carers. application perspective dominates ICT pro-
It is expected that these technologies will play jects in nursing.
a significant role in health and care in the future Caregivers are inadequately involved in tech-
as they have, on the one hand, the potential to nology development and technology imple-
increase the autonomy of people in need and, mentation processes.
on the other hand, to contribute to the mental Technological language dominates technology
and physical easing of the burden on carers.7 development and implementation, while there
is no link between language and everyday
The use of technologies in nursing is justified nursing topics.
in many places by the expectation that it will The lack of further and advanced training
make a contribution to compensating for the programmes in the field of technical com-
shortage of skilled nursing personnel. At the petence potentially hampers the digitalisation
micro level, nursing technologies also explicitly of nursing.
target aspects of quality development, be it The ICT-based exchange of information bet-
through systems that contribute to error pre- ween actors in the care and health sector is
vention (e.g. in the area of drug management), insufficient.
be it through an improvement in the quality of ICT care solutions have thus far encountered
nursing planning or even through enhanced net- a lack of acceptance.
working among nursing staff (personnel control, ICT solutions in nursing (such as the digitisa-
work process control) and with other service tion of nursing care as a whole) are inade-
providers (interdisciplinary and inter-sectoral quately communicated and/or are inadequa-
communication). tely practical and practicable, with the result
that acceptance on the part of nursing staff
Most new care technologies currently being de- is reduced and the meaningfulness of tech-
veloped via external subsidies are still in the nology (its use) is not made apparent.
pre-market phase, but a number of products
have already reached market maturity.8 Digital
information and communication technologies
5
also play an important role in many care-related Weiß et al 2013
BMG 2017 6
technologies in the fields of documentation, Bundesanstalt für Arbeitsschutz und Arbeitsmedizin 2015
7
8
cf. e.g. Bundesministerium für Gesundheit 2013; Wegweiser Alter
assistance, mobility support and spinal support, und Technik [o.J.]
9
sensor technology, robotics, actuators or tele- cf. Rösler et al. 2018; Bräutigam et al., 2017
10
cf. e.g. BMG 2017, Fuchs-Frohnhofen et al. 2017b u.c, Krings et al. 2012,
9
care, and so on . In view of the current state of Merda et al. 2017, Elsbernd et al. 2014
8The ability of ICT solutions to be invoiced Caregivers call for better networking of actor
and refinanced poses challenges. groups and more support in the utilisation of
Security and protection of personal data are ICT solutions.
decisive for the acceptance of ICT solutions
in nursing care. In this context, the concerns set out in this
Beneficiaries call for greater involvement in memorandum are of particular relevance.
technology development and improved infor-
mation.
5. Work 4.0 in Nursing –
Technology Supports Nursing Work Processes
Decision-makers in the various care sectors ful situations as well as the feeling of stress
have the responsibility, together with carers, caused by unsafe situations. This applies in par-
to review existing care support technology ticular, for example, to the monitoring of (life-
and, amongst other things, to implement it saving) vital parameters. Similar results are as-
in order to promote job satisfaction and sociated with other monitoring applications that
wellbeing. provide caregivers with information about the
activity of patients or residents with restricted
There are already many technical aids on the mobility or poor orientation as well as support
market today that have the potential to positively their safety, even in the absence of a care-
support the work of nursing staff and the life giver14.
situation of people in need of care11.
For this reason, this memorandum seeks to
Mechanical/electrical support can relieve strain encourage the increased examination of existing
on the body, especially with regard to back nursing support technology and its implemen-
strain caused by typical postures, especially tation to support nursing staff. In doing so,
during lifting and holding work in the context of attention should be paid to the tangible con-
nursing activities12. For example, mobile stan- sequences of using this technology for practical
ding aids can provide a large proportion of the work activities and any (new) unintended side
power needed to mobilise the patient13. effects associated with it.
In addition, a user-oriented approach to tech-
nology also offers the opportunity to reduce
psychological stress: Technologies used to
monitor, prevent and support patients and
employees that, for example, reduce the risk of
falling of those being cared for, can reduce the 11
cf. Weiß et al., 2013, https://www.wegweiseralterundtechnik.de
12
cf. Landau et al. 2014
frequency and/or severity of the caregivers’ 13
Weiß et al. 2013, p. 115
confrontation with these psychologically stress- 14
Sowinski et al. 2013, p. 40
9Development and implementation processes Technological development is successful in the
for technical support in professional care are long term if elements of implementation into
to be conducted as socio-technical innovation organisational and working systems are anti-
processes. cipated. In this respect, nursing facilities should
be understood as socio-technical systems:
In the interim, it has often been pointed out “Human work activities mainly take place in
that previous efforts to develop new technolo- work systems that consist of a social and a
gies for nursing care do not take sufficient technical subsystem, each of which has to be
account of actual healthcare-oriented and analysed separately and in its relationship to
profession-specific nursing needs15. one another, but must be structured jointly”20.
More generally, innovations in the field of The implementation process of new technology
healthcare and nursing are regarded as “inno- for nursing work should be structured in such a
vations in healthcare that represent an improve- way that, taking into account findings from the
ment compared to what already exists for at le- field of ergonomics, the nursing work process
ast some of the actors”16. Social innovations is improved both with regard to the interaction
are needed that “generate new social practices between nurses and technology as well as bet-
that respond to the needs of nursing and social ween nurses and those in need of nursing care
professions and act as a significant support in and their relatives; the use of technology is
solving different problems in the context of adapted to the environmental conditions; and
work”17. In the future, however, it will increa- implementation is perceived as a management
singly be a question of thinking and designing task21.
care in terms of a “reflexive production of the
new”18. Reflexive Innovation in nursing means It is important not only to develop technical
the consideration of practices, guidelines and functionality, but also to take sufficient
processes in nursing as well as the interplay of account of the integration of new technologies
developments and dynamics (e.g. professio- into nursing work and organisational
nalisation, civic engagement and technology processes in a timely manner.
development) in the field of action, “whereby
the course of one innovation is observed, A primarily additive integration of new techno-
shaped and managed with respect to its various logies in nursing does not come close to meeting
institutional embeddedness, discursive justi- these challenges – even if fragmented evaluation
fications and with respect to the forms and processes can be ensured. Particular attention
courses of other innovations”19. should be paid to ensuring that questions of
process analysis, work process development and
Innovation in nursing – particularly innovation organisational development in nursing and
via technical improvements – must therefore beyond in the overall organisation are observed
be conceptualised against the background of sustainably and systematically. This is in order
reliable insights into the conditions prevailing to identify and communicate actual (and where
in the field of activity, taking into account appropriate technology-supported) innovations
the many factors influencing nursing care, in in nursing as well as undesirable developments
relation to further dynamics in the professional at an early stage.
field and in society as a whole. Technology
development in nursing thus has to consider 15
cf. e.g. BMG 2017; Elsbernd et al. 2014; Krings et al. 2012
the complex socio-dynamic context of using 16
17
Heyen und Reiß 2014, p. 245
Hinding und Kastner 2015, p. 2
technology and, as a socio-technical develop- 18
Hutter et al. 2011
19
ment, particularly the consequences (and Ebd., p. 7
20
Ulich 2013, p. 4
unintended side effects) of its development. 21
cf. Fuchs-Frohnhofen et al. 2017a, p. 34
10The relevant actors in care must be expressly Based on this expert assessment, the proposal
involved in these processes of technology has been developed to initiate corresponding
development and implementation (alongside qualification processes across the spectrum of
those in need of care and their relatives, for nursing education with the following objectives,
example), and sufficient resources must be
made available and taken into account for
to apply basic knowledge on the subjects of
involvement and qualification.
technology and informatics during nursing
training and to anchor an examination of
The participatory involvement of all process-
issues relating to nursing informatics as part
relevant actors, especially the carers themselves,
of initial, further and advanced training (in
is an essential prerequisite for effective inno-
particular in the area of academic primary
vation processes in nursing support technology.
qualifying training), and
This also includes enabling the actors involved
to participate in processes of technology de-
to establish technology-specific specialisati-
velopment, utilisation and evaluation. The cha-
ons within the nursing profession in order to
racteristics of the technologies presented and
train multipliers and networkers in order to
their conditions of use will result in long-term
enter into a dialogue with representatives of
demands on the skills required of potential
technology development and application.
users. In addition to determining the com-
petencies that carers and other users require in
dealing with equipment, machines and technical In addition, the aim should be to give nurses
solutions, there is also the task of integrating the opportunity to further their education in
them into initial, further and advanced training22. such a way that they can classify, assess and
reflect on the introduction and use of new
One step towards identifying the future require- technologies in nursing work contexts and, if
ments for those involved in technically suppor- necessary, pass them on to other persons26.
ted care is recognition that the use of these
technologies in the respective work contexts Ultimately, caregivers should and will define for
can lead to significant changes in work and themselves how the understanding of their own
communication processes, responsibilities and profession develops in this regard.
jurisdictions, which are also linked to the actors’
professional self-perception23. Practical experience must be defined
as an important success criterion for new
For some time now, the importance of computer technologies in nursing care.
literacy for the performance of care activities
has been emphasised: “The rapid expansion of Today, innovation projects for the development
such technology into every aspect of modern and implementation of new technologies in nur-
nursing suggests that the 21st century nurse sing often end too early. Promising utility models
must establish and maintain computer com- are proposed, but their everyday application in
petency“24.Research work with the aim of de-
veloping a competency model for nursing staff, 22
cf. Hülsken-Giesler 2010, 2017
such as that of the Informatics Competencies 23
cf. e.g. Manzei 2009; Remmers und Hülsken-Giesler 2007;
for Nurses, which was anchored as the result Courtney et al. 2005; Badura und Feuerstein 1996
24
Hobbs 2002, p. 63
of a Delphi study for three competency levels 25
Staggers et al. 2002a, 2002b, 2001
26
Hülsken-Giesler and others use the terms content-related-cognitive,
and four practical levels, also shows a strong social-communicative, emotional and reflexive competences (BMG, 2017,
connection to basic knowledge of computer p. 67), cf. also the discussion on “participation qualification“ in older work
on user-oriented technology design (e.g. Sell/Fuchs-Frohnhofen, 1993,
25
science and data processing . p. 102)
11real work processes over a longer period of Secondly, formalised specifications and pro-
time is not evaluated. Practical testing should cesses must be adapted to the requirements
be defined as an important success criterion of interactive work; this includes in particular
for new technologies, even in publicly funded securing scope for action. And thirdly, em-
projects for technology development and ployees must be involved in the evaluation and
implementation. If there is a case for any inno- design of existing and new guidelines and
vations under competition and subsidy law, this processes; they are the experts in their work
should also be addressed. and know best what facilitates and hinders good
work (and thus also good care)27.
Suitable measures should be developed to
reduce existing burdens and future risks to The improvement of the health and quality
which nursing staff are exposed as a result of of life of caregivers and persons in need of
the (digital) technology-driven formalisation care is to be recognised as a target criterion
of work processes. for the use of technology.
Those who work in nursing understand that The health and well-being of the caregiver and
work processes are becoming increasingly the person being cared for must be an essential
formalised. Everything a nurse does should be target criterion of the use of technology. Socio-
documentable, justifiable and formally com- technical design processes must therefore be
municable. Due to their formalistic character, combined in principle with prospective assess-
digitalisation and technical development are ments of the consequences for the health of
also driving this process forward. This is further employees (in the sense of the WHO definition).
reinforced by the fact that the use of equipment The legally enshrined risk assessment – applied
itself is formalised. preventively – is a suitable instrument for the
design of good, low-impact and healthy work in
Still, employees get into a dilemma if they have the care sector, but one that must be constantly
to comply with formal requirements and simul- developed further against the backdrop of
taneously work with people. That is because dynamics in the field of action.
nursing work is always interactive work. Situa-
tional activity, feelings and a sensitivity for the A technology assessment taking into
condition of the people to be cared for play an account the specific characteristics of
important role. All of this is put under pressure professional nursing should be made an
by the logic of formalisation. Nursing staff are integral part of technology development
faced with a special task: they have to con- in the field of nursing care.
stantly recreate scope for action, which is
essential for interactive work, and establish Initiatives for the technical support of profes-
elaborate strategies for this – this is stressful sional care must be accompanied and examined
and does not always succeed. Good work, with a view to their medium to long-term effects
employee health and – in the worst-case in the field of application and, in particular, their
scenario – the health of the people to be cared interactions with other development and inno-
for are endangered. vation dynamics. In particular, unintended side
effects should also be taken into consideration.
It is vitally important to develop design measu- Only on the basis of these findings28 can further
res for (technically) formalised work in nursing. development demands be derived from the field
Firstly, the special skills of employees in inter- of activity.
active work must be recognised; this also
includes the skills needed to integrate forma- 27
cf. Weihrich 2017; Jungtäubl et al. 2017
lisation requirements into interactive work. 28
cf. TAB 2017, DAA 2017, Steinmüller et al. 1999
126. List of authors
Dr.-Ing. Paul Fuchs-Frohnhofen is Managing Director The social and humanities scholar, Marc Jungtäubl,
of MA&T Sell and Partner GmbH and spokesman for is a research associate and doctoral candidate at the
the Federal Ministry of Education and Research focus “Research Unit for Socioeconomics in the World of
group, “New Approaches to Occupational Health and Work and Employment” (Prof. Dr. Fritz Böhle) at the
Safety in the Care and Service Sector”. University of Augsburg.
Andreas Blume is Innovation Consultant in the field Trained nurse, Andreas Kocks, works as a Nursing
of innovation management at Johanniter-Unfall-Hilfe Scientist (BScN, MScN) at the Nursing Directorate at
e.V. the University Hospital Bonn and is spokesman for
the “Association of Nursing Directors at University
Kurt-Georg Ciesinger (Dipl.-Psych/Dipl.-Arb.wiss.) Hospitals and Medical Colleges in Germany”.
is Senior Project Coordinator at the Department of
Development and Marketing at the Deutsche Ange- Martina Patz (occupational health and paediatric
stellten-Akademie GmbH. nurse/Social Work (BA)/Leadership in Social and
Health Management (MA)) is a research associate
Helga Gessenich (Dipl.-Pflegemanagerin (FH)/MA) on the "PräFo" sub-project, “Prevention of stress and
is a researcher in Dept. III at the German Institute of strain in formalised work in inpatient nursing” in the
Applied Nursing Research (DIP). nursing division at Augsburg hospital.
Prof. Dr. Manfred Hülsken-Giesler (Univ.-Prof./ Dr. Margit Weihrich (Dipl.-Soz.) is a research asso-
Dr. phil.) holds the Chair for Community Care at the ciate at the “Research Unit for Socioeconomics in
“Philosophical Theological College Vallendar” and is the World of Work and Employment” at the University
Dean of the “Faculty of Nursing Science”. of Augsburg.
Prof. Dr. Michael Isfort is Deputy Chairman of the
Executive Board and Head of Dept. III at the German
Institute of Applied Nursing Research (DIP).
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