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Accessible summary: What is known about the subject?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. What this paper adds to existing knowledge?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision‐making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. What are the implications for practice?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. Abstract: Introduction: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim: To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods: A cross‐sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self‐administered questionnaires were provided to mental health nurses. Results: Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion: Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision‐making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. [ABSTRACT FROM AUTHOR]

Aim This paper reports a study testing the content and face validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale. Background The ability of older residents to sexually express themselves is known to be influenced by the knowledge and attitudes of nursing home staff towards later-life sexuality. Although the Aging Sexual Knowledge and Attitudes Scale is a widely used instrument to measure this, there is no validated, Dutch translation available. Design Instrument development. Method Following a standard forward/backward translation into Dutch, the scale was further adapted for use in Flemish nursing home settings. Content and face validity and user-friendliness were assessed. The psychometric properties were determined by means of an exploratory study. Data were collected from March-April 2011 at eight Flemish nursing homes. Reliability was assessed using internal consistency and item-total correlations. Results Both subscales of the Flemish adaptation showed acceptable content validity. The face validity and user-friendliness were deemed favourable with hardly any remarks given by the expert panel. The Cronbach's α was 0·80 and 0·88 for the knowledge and attitude subscales, respectively. The item-total correlations ranged from 0·21-0·48 for the knowledge section and from 0·09-0·68 for the attitude subscale. Conclusion We conclude from our study that the Dutch version of the scale has acceptable to good psychometric properties. The Flemish adaptation therefore seems to be a valuable instrument for studying nursing staff's knowledge and attitudes towards aged sexuality in Flanders. [ABSTRACT FROM AUTHOR]

Aim: To explore final year nursing students' attitudes towards euthanasia due to unbearable mental suffering by using the adapted and validated Euthanasia Attitude Scale. Design: Cross‐sectional survey. Methods: Explorative, descriptive cross‐sectional study conducted using an e‐mail survey between October 2020 and March 2021 by a sample of final‐year baccalaureate nursing students (n = 273) from eight of the eleven Flemish university colleges. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations. The psychometric properties of the Euthanasia Attitude Scale were assessed, including reliability and validity. Independent‐sample Mann–Whitney U‐test was used to investigate relation between demographic and education‐related data, and domain and total score of the UMS‐EAS‐NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels, Belgium. Results: McDonald's omega was 0.838 for the total Euthanasia Attitude Scale scores, supporting the validity of the questionnaire. A statistically significant difference in 'Naturalistic beliefs' score was found relating to the year of birth. There are clinically important results between those students who have been involved in euthanasia and those who have not. Conclusions: Most of the final‐year nursing students supported the probability of patients' access to euthanasia due to unbearable mental suffering. To monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter. Impact To date, no large‐scale study has examined nursing students' attitudes towards euthanasia because of unbearable mental suffering. It is expected that nursing students may be confronted with such a euthanasia request during an internship, or later in their professional career, in countries where euthanasia is legal. Students showed a high acceptability towards UMS‐euthanasia. Clinically significant differences were found for students who had ever been involved in euthanasia. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to determine the optimal threshold for national early warning score in clinical practice. Background: The national early warning score is an aggregate early warning score aiming to predict patient mortality. Studies validating national early warning score did not use standardised patient outcomes or did not always include clinical workload in their results. Since all patients with a positive national early warning score require a clinical workup, it is crucial to determine the optimal threshold to limit false‐positive alerts. Design: An external validation study using retrospectively collected data of patient admissions in six Belgian hospitals. Methods: We adhered to the STARD guideline for reporting. Two sample groups were selected: the cross‐sectional sample (admitted patients, 1 day every 4 months) and the serious adverse event sample (all patients with unexpected death, cardiac arrest and unplanned admission to the intensive care unit). The maximum registered national early warning score value was collected in both groups. Predictive values were used as estimates for clinical workload. Results: We collected 1,523 in the cross‐sectional sample and 390 patients in the serious adverse event sample. A national early warning score ≥5 had a predictive value of 6.8% and a negative predictive value of 99.5% to predict unexpected death, cardiac arrest with cardiopulmonary resuscitation or unplanned admission to intensive care (AUROC 0.841). The performance of national early warning score differed between outcome measures. Considering the predictive value, the optimal threshold for national early warning score is ≥5. Conclusions: We validated national early warning score to be applied in general hospital wards and confirmed the optimal threshold (≥5). Relevance to clinical practice: When a patient has a national early warning score <5, we may assume that in the next 24 hr this patient is less likely to die unexpectedly, receive cardiopulmonary resuscitation or be transferred to the ICU. Because of the significant number of false positives when national early warning score is ≥5, hospitals should create workable guidelines for clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how Flemish nurses working in hospitals and home care experience their involvement in the care of patients requesting euthanasia 15 years after the legalisation of euthanasia. Background: Euthanasia was legalised in Belgium in 2002. Despite prior research that charted the experiences of nurses in euthanasia care before and right after legalisation in Belgium, it remains unclear how Flemish nurses currently, 15 years after the legalisation, experience their involvement. Design: A grounded theory design, using semi‐structured in‐depth interviews. Methods: We interviewed 26 nurses working in hospitals or in home care, who had experience with caring for patients requesting euthanasia. Data were collected using a purposive sample and then a snowball sample. Data collection and data analysis were conducted simultaneously. Data were analysed by using the Qualitative Analysis Guide of Leuven. The study adhered to the COREQ guidelines. Results: Caring for a patient requesting euthanasia continues to be an intense experience characterised by ambivalence. The nature of euthanasia itself contributes to the intensity of this care process. The nurses described euthanasia as something unnatural and planned that generated many questions and doubts. Nevertheless, most interviewees stated that they were able to contribute to a dignified end of life and make a difference, giving them a profound feeling of professional fulfilment. However, when nurses were not able to contribute to good euthanasia care, they struggled with strong negative feelings and frustrations. Conclusion: Although the results suggest some subtle shifts in nurses' experiences over time, they do not indicate perceptions of euthanasia as a normal practice by the nurses involved. Relevance to clinical practice: The study reveals the need for more clarification of nurses' ethical responsibility in euthanasia care and their role as moral agents. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. Background: The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. Design and methods: A qualitative research design, using semi‐structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. Results: Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. Conclusion: Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor–nurse game 50 years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. Relevance to clinical practice: The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well‐being and workplace learning. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore how nurses and care-assistants (nursing staff) working in six Flemish nursing homes experience and describe their involvement in grief care. Background Although grief in older people is widely described in literature, less is known about how nursing staff in nursing homes offer and perceive grief care. Design A qualitative research design with elements of constructivist grounded theory was used. Methods Loosely structured face-to-face interviews were done with fourteen nurses and care-assistants. Data were collected from October 2013-March 2014. Interview transcripts were analysed using the Qualitative Analysis Guide of Leuven ( QUAGOL) method with support of NVivo 10. Findings Grief care in nursing homes is characterized by a complex tension between two care dimensions: (1) being involved while keeping an appropriate distance; and (2) being while doing. Nursing staff described key enablers and influencing factors for grief care at the level of both the individual and the organizational context. Conclusion Findings suggest an established personal sensitivity for grief care considered from the nursing staff points of view. Nevertheless, a common denominator was the necessity to further develop a supportive and multidisciplinary grief care policy ingrained in the existing care culture. Suggested components of this grief care policy are: (a) centring attention on non-death-related loss and the cumulative nature of loss in residents; (b) building capacity by means of reflective practices; and (c) the importance of self-care strategies for nursing staff. Furthermore, the findings from this study point towards a need for education and training. [ABSTRACT FROM AUTHOR]

Aim To explore attitudes and confidence in professional competence of home nurses concerning depression and to evaluate the capacity of a minimal intervention in helping home nurses to detect depression in patients and their family caregivers. Background Long-term ill patients have an elevated risk to develop comorbid depression, as do their family caregivers. However, most primary care providers have little training to detect patients at risk. A minimal intervention to help home nurses detect symptoms of depression was therefore evaluated. Design Quasi-experimental field study with pre-measures, postmeasures and follow-up measures. Methods From the Fall of 2012-Spring of 2013, home nurses ( N = 92) in three regions in Antwerp (Belgium) were assigned to a 1-hour intervention (consisting of information, skill training and discussion; N = 63) or to a control condition ( N = 29). The Depression Attitude Questionnaire and the Morris Confidence Scale were completed before the intervention and 3 and 7 months afterwards. For 3 months, the number of detections of depression in patients in each region was monitored. Findings No significant changes were found in attitude or confidence in professional competences, except for a decline in the role attitude for home nurses in the intervention group. Home nurses who followed the intervention did detect significantly more depressed patients compared with controls. Conclusion These findings suggest that a minimal intervention can allow home nurses to be more responsive to symptoms of depression in patients and their family caregivers. The implications of these findings are discussed and suggestions for future research are made. [ABSTRACT FROM AUTHOR]

Background A tool to assist in optimal allocation of available nursing resources is of paramount importance. Aims The goals of this study were as follows: (1) to determine whether the standard time values of the Belgian Nursing Minimum Dataset are a valid basis for the development of a Workload Indicator for Nursing; (2) to quantify the impact of factors that most influence nursing workload; and (3) to examine the cross-impact of items of the Belgian Nursing Minimum Dataset. Design This research project is a prospective observational study with exploratory aspects. Methods The data for this prospective study were collected during September 2010 from a convenience sample of 23 nursing units in four hospitals in Belgium. The data collection included three parts: (1) the registration of the items of the Belgian Nursing Minimum Dataset; (2) the amount of time committed to direct patient care; and (3) analysis of variables, which influence the nursing workload at patient and unit level. Results The correlation coefficients for the sum of Direct and Indirect Patient Care and the Workload Indicator for Nursing-score of the surgical, internal medicine and intensive care units were 0·85, 0·88 and 0·89 respectively. Significant differences in standard time utilization for nursing activities at the patient level are directly related to the level of mobility assistance required. Units needing significantly more time for Direct and Indirect Patient Care than predicted by the Workload Indicator for Nursing-score had a higher mean number of complex nursing activities per patient. Conclusions The high correlation coefficients between the total time utilized for direct patient care and the WiN-score indicate that the standard time values of the Belgian Nursing Minimum Dataset are valid. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop a set of psychometrically sound instruments to assess knowledge, self-management and self-efficacy of diabetic patients. Furthermore, a survey to evaluate the satisfaction about diabetes education for patients was developed and tested. Background Treatment and secondary prevention of diabetes require a complex combination of care components. Patients' education has been accepted to improve diabetes knowledge, self-management and self-efficacy. Psychometrically sound instruments are needed to measure these patient-centred outcomes. Design Psychometric instrument validation. Methods The first phase included a systematic literature review to develop the instruments. Content validity was evaluated using a two-round Delphi procedure involving diabetes experts. The content validity of the instruments was excellent. In a second phase, a convenience sample of 188 diabetic patients in two hospitals in one specific care region in Belgium participated in the psychometric evaluation. The criterion-related validity and internal consistency reliability were evaluated. Results The study produced a 21-item knowledge instrument, reflecting knowledge about 'glycemic control' and 'medico-social management aspects'. The self-management instrument included 32 statements, reflecting 'treatment and compliance' and 'general lifestyle'. The self-efficacy instrument included 30 items, reflecting 'nutrition', 'treatment' and 'regimen'. The patient satisfaction survey included 36 items, reflecting satisfaction about the relationship among the diabetes specialist, the diabetes educator, podiatrist and dietician. Conclusions An instrument set with sound psychometric characteristics was developed to assess knowledge, self-management and self-efficacy of diabetic patients. Future studies should focus on the association between the instrument outcomes and clinical patient outcomes. Relevance to clinical practice The current instrument can support the design of educational interventions and training programmes and reduce inconsistencies in the information that patients receive. Furthermore, the instruments can be used for benchmarking the quality of diabetic patient education. [ABSTRACT FROM AUTHOR]

Aim To compare the self-construal of nurses and doctors and establish whether their roles affect perceptions of independence and interdependence. Background Previous research has identified that errors in patient care occur when health professionals do not work cohesively as a team and have divergent beliefs about collaboration. Thus, it is important to understand factors shaping these beliefs. Although these are usually explained by aspects of group norms, the concept of self-construal may serve as an underlying explanation. Design A quasi-experimental design was used. Participants One hundred and two nurses and doctors working in three nursing homes in Belgium took part in this study in 2009. Methods Nurses' and doctors' self-construal was measured at their workplace, using Singelis' self-construal scale. Statistical differences between nurses and doctors were investigated using analysis of covariance. Results Results showed statistically significant differences between doctors' and nurses' self-construal. Doctors reported higher and dominant levels of 'independent self-construal' compared with nurses. There were no differences between nurses and doctors for interdependence. However, gender differences emerged with male doctors reporting lower levels of interdependent self-construal than male nurses. Conversely, female doctors reported higher levels of interdependent self-construal than female nurses. Conclusions Differences in the roles and training of nurses and doctors and in knowledge of their interdependencies may explain differences in self-construal. This might be useful for understanding why nurses and doctors develop divergent attitudes towards teamwork. Training that focuses on sharing knowledge on team interdependencies may positively influence teamwork attitudes and behaviour. [ABSTRACT FROM AUTHOR]

Sarrechia M., Van Gerven E., Hermans L., Deneckere S., Sermeus W., Panella M., Spitz B. & Vanhaecht K. (2012) Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety?. Journal of Advanced Nursing 69(2), 278-285. doi: 10.1111/j.1365-2648.2012.06004.x Abstract Aim. To report a study to determine whether or not variations exist in evidence-based key interventions in pathway documents for normal delivery across hospitals. Background. Care pathways are used worldwide to standardize and follow up patient-focused care. Minimal variations in pathway documents increase standardization and patient safety. Design. A descriptive study design using qualitative methods was used, to examine the various key interventions present in care pathway documents for normal delivery. Methods. Between January-March 2009, we evaluated the content of the care pathway document for normal delivery from 17 different hospitals. The key interventions in these pathways were compared with the 40 evidence-based key interventions of Map of Medicine®. Results. There was much variation in the characteristics and the presence of key interventions in the pathway documents. Only 6 of the 40 evidence-based key interventions (15%) were found in all 17 pathway documents and 20 of the 40 interventions (50%) were found in only 10 pathway documents. Conclusion. If variation already exists among the care pathway documents, this may lead to a high probability of variation in the actual performance of daily care. In this study is shown that, even for highly predictable medical conditions, there are huge differences in the evidence-based content and structure of pathways. Lack of evidence base could potentially endanger both patient safety and the health professional. [ABSTRACT FROM AUTHOR]

van hecke a., goeman c., beeckman d., heinen m. & defloor t. (2011) Development and psychometric evaluation of an instrument to assess venous leg ulcer lifestyle knowledge among nurses. Journal of Advanced Nursing 67(12), 2574-2585. Abstract Aim. Development and psychometric testing of an instrument to assess venous leg ulcer lifestyle knowledge. Background. Nurses often lack knowledge to provide adequate leg ulcer advice. No valid and reliable instruments are available to assess knowledge on venous leg ulcer advice among nurses. Methods. The instrument was developed based on a literature review and patient cases. Content validity was evaluated in a Delphi procedure by nine leg ulcer experts. Item-analysis, construct validity and stability were assessed. A sample of 350 nurses and student nurses participated. Data collection took place between February and April 2009. Results. The instrument included four topics: (1) Compression therapy, (2) Physical activity/leg exercises, (3) Leg elevation and (4) Pain management. Multiple-choice questions were developed to assess factual knowledge. Patient cases were developed to assess more complex cognitive skills. Content validity was established. The quality of the response alternatives varied between 0·01 and 0·68. The difficulty index for questions evaluating factual knowledge ranged from 0·12 to 0·78. Patient cases' questions had a difficulty index between 0·07 and 0·60. The score of participants with (theoretically expected) more expertise was significantly higher than the score of participants with (theoretically expected) less expertise. The intraclass correlation coefficients ranged between 0·71 and 0·77. Eleven questions had moderate kappa-values (0·41-0·60), and in eight questions, there was fair agreement (0·30-0·40). Conclusion. An instrument with an acceptable content validity and construct validity was developed. The instrument can be applied in nursing education, nursing practice and nursing research to evaluate venous leg ulcer advice knowledge. [ABSTRACT FROM AUTHOR]