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Accessible Summary: What is known on the subject?: Aggression towards caregivers is a global phenomenon in mental health care.Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub‐par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression.Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. What this paper adds to existing knowledge?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non‐coercive techniques do not work.Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. What are the implications for practice?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de‐escalating aggression as well as diminishing the use of coercive measures.Further primary research exploring the opportunities of non‐coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well‐being of healthcare workers is also needed. Introduction: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non‐coercive measures. Aim: The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. Method: A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. Results: Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. Discussion: In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non‐coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression‐tolerating" workplace. Implications for Practice: Three implications for practice were identified: (1) It is vital for residential units to agree on a broad‐based definition of aggression, (2) further primary research exploring the opportunities of non‐coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well‐being of healthcare workers also needs further study. [ABSTRACT FROM AUTHOR]

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]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? To stimulate reminiscence of older adults with dementia performed individually or through group sessions is a well-known practice in nursing homes resulting in effects on behaviour and well-being as an alternative for medication., Robust scientific proof of the effectiveness of individual reminiscence therapy performed in nursing homes is sparse., What this paper adds to existing knowledge? We have provided individual standardized reminiscence therapy to residents with dementia. The therapy was developed and tested in a previous study and performed in this study by trained nursing home volunteers., In comparison with a control group who received usual care, residents who received the reminiscence therapy showed significant less depressive symptoms. Moreover, residents were, in general, attentive, open and collaborative during the sessions and volunteers experienced the sessions as useful and pleasant., What are the implications for practice? Individual reminiscence therapy can be learned and used by nursing home volunteers to improve care in nursing homes., Abstract Aim To investigate the effect of a standardized individualized intervention based on the SolCos transformational reminiscence model on depressive symptoms (primary outcome), cognition and behaviour (secondary outcomes) for older people with mild to moderate dementia, performed by trained nursing home volunteers as facilitators. Background Because of limited pharmacological treatment options for older adults with dementia relevant physical, sensory, psychological or social interventions offer alternative opportunities. Method Randomized controlled trial (ISRCTN74355073) was set up in two nursing homes with 29 and 31 residents in the intervention and the control groups respectively. Eighteen nursing home volunteers were trained to perform the reminiscence therapy. Various assessment scales were measured pre- and post-sessions. Results Linear regression analysis showed an impact on depressive symptoms. However, no impact was identified on cognition and behaviour. Facilitators experienced the sessions as useful and pleasant, and study participants were, in general, attentive, open and collaborative. Discussion Study results showed that organizing standardized individual reminiscence therapy with nursing home volunteers was feasible and study participants' attention and participation were overall good. Further study initiatives to explore the potential of individual reminiscence therapy within a person-centred framework are recommended in order to improve care in nursing homes. [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]

Aims. This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. Background. In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. Methods. In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. Results. The overall prevalence rate of malnutrition in wards for older people was 31.9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9.1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patient's individual risk. Conclusion. Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality. [ABSTRACT FROM AUTHOR]

dierckx de casterlé b., denier y., de bal n. & gastmans c. (2010) Nursing care for patients requesting euthanasia in general hospitals in Flanders, Belgium. Journal of Advanced Nursing 66(11), 2410-2420. Aim. This paper is a report of a study exploring nurses' involvement in the care process for mentally competent, terminally ill patients requesting euthanasia in general hospitals in Flanders, Belgium. Background. International literature shows that nurses are involved in the care process surrounding euthanasia, regardless of the legal status of euthanasia in the country being studied. However, their actual involvement remains unclear. Methods. A grounded theory approach was used. Data were collected over a 20-month period in 2005 and 2006, using individual in-depth interviews. The sample included 18 Registered Nurses employed in nine general hospitals geographically spread over the five provinces of Flanders, Belgium. Results. The care process for patients requesting euthanasia is complex and dynamic, consisting of several stages. Major themes characterized nurses' involvement: being on the alert for a euthanasia request; open and active listening; multidisciplinary team cooperation and analysis of the group dynamics; continuously providing maximum palliative care; multi-tasking; organizing and directing the euthanasia; and finally, providing support for the family, colleagues and oneself. Conclusion. Nurses make a unique and indispensable contribution to making the euthanasia care process a good care process. This has to do with their specific form of knowledge, expertise and responsibilities, and their willingness to personally, continually and fully care for the patients requesting euthanasia and for their relatives. [ABSTRACT FROM AUTHOR]

Title. Gerontological care in nursing education programmes. Aim. This paper is a report of a study conducted to identify the coverage of gerontological care in baccalaureate nursing education programmes. Background. Although in recent years the average age of patients has increased, nurses do not always have the knowledge, competencies, and attitudes necessary to care for older people. Its complexity is not recognized. Method. A descriptive cross-sectional mail survey of 17 baccalaureate nursing education programmes in Flanders, Belgium, was performed in 2007. Findings. While there was great variability among nursing education programmes in terms of gerontology courses, clinical placements, and number of experts, it was encouraging that most programmes had integrated gerontology content into non-gerontology courses, all programmes offered gerontology clinical placements, and many nursing educators were considered to be experts in gerontology. Lack of interest in care for older people in general, lack of gerontology-related competencies within curricula, and a negative image of gerontological care were reported as the most frequently-encountered barriers to incorporating gerontological care aspects into curricula. Conclusion. Because a minority of nursing students choose the gerontology specialist option, gerontology content in basic nursing curricula should be increased. A minimum standard curriculum and specific competencies for care of older people should be formulated for all baccalaureate nursing education programmes. Strengthening educators’ expertise and investing in role models remain important priorities for the nursing profession. [ABSTRACT FROM AUTHOR]