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There is a trend toward formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment in rehabilitation wards. So far, literature about the principles of CRE is scarce. This study aims to explore the opinions of rehabilitants and informal caregivers regarding CRE, through a qualitative study between 2019 and 2020. Three telephone interviews were conducted with informal caregivers, and also 3 focus groups with 15 rehabilitants and 3 informal caregivers, all with recent experience in rehabilitation. Nine themes emerged regarding the rehabilitation process: (1) rehabilitant (attention for resilience, motivation, cognitive and emotional aspects), (2) rehabilitant centered (goal setting, physical and cognitive functioning and coping), (3) informal caregivers (involving and attention for resilience and relation), (4) communication (aligning the rehabilitation process), (5) exercise (increasing intensity by using task-oriented exercise, patient-regulated exercise, and group training), (6) peer support (learning experiences and recognition), (7) daily schedule (influence on the planning and activities outside therapy), (8) nutrition (energy for rehabilitation), and (9) eHealth (makes rehabilitation more challenging and fun). Regarding organizational processes, 4 themes were identified: (1) environmental aspects (single bedrooms, shared room for activities and therapy options on the ward), (2) staff aspects (small team with an emphatic supportive and motivating attitude), (3) organizational aspects (organized in an efficient way), and (4) return home (the discharge process should be well prepared for instance with home visits). Organizing excellent rehabilitation care requires a thorough understanding of the concept of CRE, as it is a complex and comprehensive concept that concerns the whole rehabilitation process. Its effectiveness and efficiency should be researched in prospective studies.

Depressie is een groot probleem in verpleeghuizen. Gemiddeld heeft zo’n dertig procent van de bewoners een depressie, veel meer dan thuiswonende ouderen. Depressie heeft allerlei negatieve gevolgen voor de gezondheid en het welbevinden, maar is wel behandelbaar. Hoewel het opsporen en behandelen van depressie dus erg belangrijk is, worden depressiesymptomen vaak niet opgemerkt. Zorgmedewerkers weten dikwijls niet waarop ze moeten letten en depressieverschijnselen kunnen op symptomen van andere aandoeningen lijken, zoals dementie, diabetes en hart- en vaatziekten. Het zorgprogramma Doen bij Depressie, ontwikkeld door het Universitair Kennisnetwerk Ouderenzorg Nijmegen (UKON), kan hier uitkomst bieden.

Communication problems with their caregivers are common in people with dementia. Although interventions for improvement of communication are being developed, a tool to measure how participants experience their communication is lacking. The objective of this article is to describe the development of a questionnaire that measures the “experienced communication” of persons with dementia (ECD-P) as well as of their caregivers (ECD-C). Interviews were conducted with five person with dementia—caregiver dyads who had recently received a new communication intervention. Reflexive thematic analysis was performed on the transcripts using ATLAS.ti. Codes were created, categories and themes were identified, and items for the questionnaires were generated. Selection of items and response scales was done in collaboration with the same dyads. The final version was established after pilot testing with seven other dyads and discussion with five experts in the field of dementia care. Analysis of the transcripts resulted in 212 codes and 17 categories within four themes: caregiver competence, social communication, communication difficulties in daily life, and experienced emotions during conversations. The final version of the ECD-P consists of part 1 with 22 items and 4-point Likert scales, and part 2 with two items and 1 to 10 scales. In the final ECD-C (proxy version), part 1 and part 2 are similar to the ECD-P, while a part 3 was added to assess caregivers’ own perspective and emotions (five items). Based on the experiences of people with dementia and their caregivers, we constructed a face-valid questionnaire. This justifies future research to test its clinimetric characteristics.

Samenvatting: Binnen het Universitair Verpleeghuisnetwerk Nijmegen (UVNN) werken zorginstellingen en universiteit samen in onderwijs en onderzoek ten behoeve van verpleeghuiszorg en ouderenzorg. Ouderenzorg heeft in het nieuwe geneeskundecurriculum een meer prominente plaats gekregen, waardoor meer vraag naar stageplaatsen binnen verpleeghuiszorginstellingen is ontstaan. Verpleeghuizen hebben veel belangstelling om betrokken te zijn bij onderwijs en onderzoek, zo blijkt uit een onderzoek onder verpleeghuizen, die verbonden zijn aan de opleiding tot verpleeghuisarts van het UMC St. Radboud. Verpleeghuizen onderschrijven dat onderzoek en onderwijs noodzakelijk zijn voor de vakontwikkeling van de verpleeghuisarts/sociaal geriater, die gespecialiseerde en patiëntgerichte zorg biedt aan kwetsbare ouderen binnen en buiten het verpleeghuis.