PEKo

Violence towards people in need of care and towards caregivers is an everyday occurrence. This is confirmed by a survey among nursing professionals conducted by the German Institute for Applied Nursing Research (DIP). This is accompanied by a "culture of looking the other way", which must be transformed into a "culture of looking and being attentive". Facility-specific and cross-facility offers of prevention and reprocessing of experiences of violence can provide a remedy. Although experiences of violence are part of everyday care, there are only few offers for the prevention of violence in care. Moreover, there are only very few reliable studies that prove the effectiveness of such interventions. (Weidner et al. 2017)

With the Act to Strengthen Health Promotion and Prevention (Prevention Act - PrävG 2015), long-term care insurance funds are required to provide prevention services in inpatient care facilities. With the participation of the person in need of care and the care facility, long-term care insurance funds are obliged to develop proposals for improving the health situation and strengthening health resources and abilities, and to support their implementation. In the "Guidelines for Prevention in Inpatient Care" of the GKV-Spitzenverband (2018), explicit reference is made to the field of action "Prevention of Violence in Care". In order to generate findings on their effectiveness, interventions should also be scientifically accompanied and evaluated.
The PEKo project started at this point and developed concepts for the prevention of violence in care together with the participating facilities and implemented them sustainably in the facility structure. In addition, the interventions were scientifically monitored so that findings on their effectiveness could be generated. In the course of time, further follow-up projects were added to the original project PEKo 1.0: PEKo 1.1 Verstetigung, PEKo 2.0 Setting Krankenhaus, PEKo 2.0 Setting ambulante Pflege.

The PEKo 1.0 project was aimed at inpatient geriatric care facilities. Nationwide, a total of 53 facilities from Hesse (12), Mecklenburg-Western Pomerania (8), Lower Saxony (2), Saxony (10), Saxony-Anhalt (8) and Schleswig-Holstein (13) participated. The Fulda Study Centre supervised a total of 12 institutions from the Fulda and Frankfurt region.

Within the framework of the 12-month multimodal intervention, facility-specific measures for violence prevention were developed according to a participatory intervention approach and implemented sustainably in the facility structures.

Core elements of the multimodal intervention were:

• PEKo representative: In-house counselling and contact person who acted both internally and externally.
• PEKo team meetings: Monthly, internal meetings in which needs-based measures were developed and implemented in a participatory manner with staff from the facilities.
• PECo-circles: Quarterly, inter-facility meetings, which enabled the PECo officers to exchange information.

The PEKo 1.1 project followed on from the previous violence prevention project PEKo 1.0 in the setting of inpatient care for the elderly. On the one hand, it focused on the further support of the facilities already participating in the project in order to stabilise the PEKo 1.0 project. On the other hand, new interested facilities were accompanied and trained in the use of a module manual developed for the project, which enabled independent implementation of the developed prevention measures. This module manual was based on the findings, results and experiences of the original project PEKo 1.0.

The core elements from PEKo 1.0 were also retained in the implementation of this follow-up project: PEKo representatives, PEKo team meetings and PEKo circles (see PEKo 1.0). In addition, the participating institutions were trained in the use of the module manual. This was followed by an internal kick-off event for employees, residents and relatives to present the contents, goals and components of the project. During the project, the facilities were advised by the responsible study centre. The study centre in Fulda supervised a total of 12 facilities, and a further 9 facilities in the continuation of the original project PEKo 1.0. The staff of the study centre in Cologne will continue to advise the participating facilities until September 2023.

In the PEKo 2.0 project, the original PEKo 1.0 project was adapted to the hospital setting. The project was carried out in up to ten wards per hospital over a project duration of twelve months. The interventions were implemented in 10 hospitals of the care types maximum care provider/university hospital, basic and standard care provider as well as specialised care provider or specialised hospitals. Components that had already proven themselves in the PEKo 1.0 project were also used in the PEKo 2.0 Setting Hospital project. These included PEKo representatives, PEKo team meetings and PEKo circles (see PEKo 1.0). In addition to a kick-off event at the beginning of the project, a closing event was held at the end with the cooperation partners and other interested parties. The measures developed were presented to the respective organisations and aspects of continuity were discussed. For the entire duration of the project, the employees of the respective study centres were available to advise the PEKo representatives and the contact person at management level. A new supra-regional component is the Advisory Board: this is a group of experts from practice and science who accompanied the implementation of the PEKo 2.0 Setting Hospital project in an advisory capacity. Until the end of the overall project in October 2023, the 4 participating hospitals that were accompanied by the Fulda Study Centre will receive a follow-up advisory service from the Cologne Study Centre if required.

In the PEKo 2.0 project, the original PEKo 1.0 project was adapted to the setting of outpatient care. The project was implemented in two phases: In the first three months, measures to prevent and deal with violence were developed together with various actors in outpatient care (including outpatient care services, counselling centres, self-help/volunteer organisations, the police's protective outpatient department and victim protection). These were bundled in a violence prevention concept in the form of a handout. In the nine-month implementation phase, this concept was then individually adapted to the needs of the employees in seven outpatient care services, implemented and scientifically monitored. Similar to the other sub-projects, the components PEKo representatives, PEKo team meetings and PEKo circles (see PEKo1.0) were used in the implementation of the project. The Fulda Study Centre supervised a total of 2 outpatient services. Afterwards, the project partners can turn to the Halle Study Centre for advice until October 2023.

Further information on the project and contact persons after the end of the project can be found here!

Since the interventions are complex, both qualitative and quantitative methods were combined for the evaluation of the PEKo projects in the sense of a "mixed methods" approach. The various methods used in the individual sub-projects are summarised below:

• Written staff surveys at the beginning and end of the interventions. These provide information about changes in the occurrence of violence, about violence triggers, the handling of violent events, workload, socio-demographic characteristics and the implementation of the project.
• Focus groups, group and individual interviews with representatives of the management levels, the PEKo representatives and the PEKo team members at the end of the interventions.
• Ongoing structured documentation of the course of the project