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The aim of this study was to develop a valid instrument to measure student nurses' perceptions of community care (SCOPE). DeVellis' staged model for instrument development and validation was used. Scale construction of SCOPE was based on existing literature. Evaluation of its psychometric properties included exploratory factor analysis and reliability analysis. After pilot-testing, 1062 bachelor nursing students from six institutions in the Netherlands (response rate 81%) took part in the study. SCOPE is a 35-item scale containing: background variables, 11 measuring the affective component, 5 measuring community care perception as a placement, 17 as a future profession, and 2 on the reasons underlying student preference. Principal axis factoring yielded two factors in the affective component scale reflecting ‘enjoyment’ and ‘utility’, two in the placement scale reflecting ‘learning possibilities’ and ‘personal satisfaction’, and four in the profession scale: ‘professional development’, ‘collaboration’, ‘caregiving’, and ‘complexity and workload’. Cronbach's α of the complete scale was 0.892 and of the subscales 0.862, 0.696, and 0.810 respectively. SCOPE is a psychometrically sound instrument for measuring students' perceptions of community care. By determining these perceptions, it becomes possible to positively influence them with targeted curriculum redesign, eventually contributing to decreasing the workforce shortage in community nursing. [ABSTRACT FROM AUTHOR]

Background Despite the increasing labour market shortage of well-educated community nurses, few baccalaureate nursing students choose for a career in community care. Obtaining knowledge of how students perceive healthcare areas early in their education is important to take meaningful steps in counteracting any existing misconceptions with targeted curriculum redesign. Objective Determination of factors underlying perceptions of healthcare areas in first-year baccalaureate nursing students. Design A descriptive qualitative study using focus group inquiry. Methods This study follows up on a large-sample quantitative multicentre survey study. Fourteen first-year nursing students at a university of applied sciences in the Netherlands participated in focus group discussions in October 2014. Transcripts of the discussions were coded by two independent researchers at three levels – open, axial and selective coding – on the basis of two templates. The codes were sorted into categories and assigned to suitable main codes in the templates. The number of sub-codes per category and code were added together. Results Eight main themes were formulated, to wit (1) variety and diversity, (2) challenges, (3) improving people's health, (4) collaboration, (5) role models, (6) patient- or environment-based perceptions, (7) self-efficacy and (8) immediate vicinity. Data suggest that first-year students have clear ideas about the characteristics which they consider important in professional practice. Their perceptions do not necessarily reflect the actual situation, as they expect the hospital to possess all desired characteristics while community nursing seems to be undervalued. Conclusion To remedy students' misperceptions, four recommendations are formulated for curriculum redesign strategies deriving from the eight themes. These recommendations are based on collaboration between school and care organisations as well as on themes related to in-depth knowledge within the educational programme. The interventions will potentially help to strengthen the focus on community care, which will foster a more optimistic and realistic career outlook on this field. [ABSTRACT FROM AUTHOR]

Background Despite increasing shortages of highly educated community nurses, far too few nursing students choose community care. This means that a strong societal problem is emerging that desperately needs resolution. Objectives To acquire a solid understanding of the causes for the low popularity of community care by exploring first-year baccalaureate nursing students' perceptions of community care, their placement preferences, and the assumptions underlying these preferences. Design A quantitative cross-sectional design. Settings Six universities of applied sciences in the Netherlands. Participants Nursing students in the first semester of their 4-year programme (n = 1058). Methods Data were collected in September–December 2014. The students completed the ‘Scale on Community Care Perceptions’ (SCOPE), consisting of demographic data and three subscales measuring the affective component of community care perception, perceptions of a placement and a profession in community care, and students' current placement preferences. Descriptive statistics were used. Results For a practice placement, 71.2% of first-year students prefer the general hospital and 5.4% community care, whereas 23.4% opt for another healthcare area. Students consider opportunities for advancement and enjoyable relationships with patients as most important for choosing a placement. Community care is perceived as a ‘low-status-field’ with many elderly patients, where students expect to find little variety in caregiving and few opportunities for advancement. Students' perceptions of the field are at odds with things they believe to be important for their placement. Conclusion Due to misconceptions, students perceive community care as offering them few challenges. Strategies to positively influence students' perceptions of community nursing are urgently required to halt the dissonance between students' preference for the hospital and society's need for highly educated community nurses. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the effect of a more 'community-oriented' baccalaureate nursing curriculum on students' intervention choice in community care. Following a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students' care intervention choice in community nursing. A quasi-experimental quantitative study. This study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients' social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing' was assessed with a specially developed vignette instrument 'Assessment of Intervention choice in Community Nursing' (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students' intervention choice (more 'traditional' interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test. Students who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F (1461) = 14.827, p = <0.001, R2 =.031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p =.055). Students who experienced a more 'community-oriented' curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates. [ABSTRACT FROM AUTHOR]

Background: Loss of body tissue resulting in undernutrition can be caused by reduced food intake, altered metabolism, ageing, and physical inactivity. The predominant cause of undernutrition before cardiac operations is unknown. First, we explored the association of reduced food intake and inactivity with undernutrition in patients before elective cardiac operations. Second, we assessed if adding these reversible, cause-based items to the nutritional screening process improved diagnostic accuracy. Methods: A prospective observational study was performed. Undernutrition was defined by low fat-free mass index (LFFMI) measured by bioelectrical impedance spectroscopy and/or unintended weight loss (UWL). Reduced food intake was defined as the patient having a decreased appetite over the previous month. Patients admitted to hospital preoperatively were assumed to be less physically active than patients awaiting cardiac operations at home. Using these data, we developed a new tool and compared this with an existing cardiac surgery–specific tool (Cardiac Surgery–Specific Malnutrition Universal Screening Tool [CSSM]). Results: A total of 325 patients who underwent open cardiac operations were included. Reduced food intake and inactivity were associated with undernutrition (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.1–8.5 and OR, 2.0; 95% CI, 1.0–4.0). Reduced food intake and inactivity were integrated with body mass index (BMI) and UWL into a new scoring system: the Cardiac Surgery–Specific Undernutrition Screening Tool (CSSUST). Sensitivity in identification of undernourished patients was considerably higher with the CSSUST (90%) than with the CSSM (71%) (receiver operating characteristic [ROC] curve–based area under the curve [AUC], 0.79; 95% CI, 0.73–0.86 and ROC AUC, 0.71; 95% CI, 0.63–0.80). Conclusions: Results suggest that reduced food intake and inactivity partly explain undernutrition before cardiac operations. Our new cause-based CSSUST, which includes reduced food intake and inactivity, is superior to existing tools in identifying undernutrition in patients undergoing cardiac operations. [Copyright &y& Elsevier]

Summary: Background & aims: In cardiac surgical patients, undernutrition increases the risk of adverse clinical outcome. We investigated whether the bioelectrical impedance phase angle is an indicator of undernutrition and clinical outcome in cardiac surgery. Methods: In 325 cardiac surgical patients, we prospectively analyzed the associations between a preoperative low phase angle, measured by bioelectrical impedance spectroscopy, and well-established indicators of undernutrition such as body mass index (kg/m2), unintended weight loss, and fat free mass index (kg/m2), and muscle strength (handgrip strength (kg)), immune function (C-reactive protein and albumin), and adverse clinical outcomes. Results: A low phase angle (<5.38°) was present in 29.8% (n = 96) of the patients, and was associated with low body mass index (p < 0.001), low fat free mass index (p < 0.001), and less handgrip strength (p = 0.063), but not with unintended weight loss or immune function. Furthermore, a preoperative low phase angle was associated with a prolonged intensive care unit and hospital stay (adj. hazard ratio: 0.68; 95%CI: 0.49–0.94; p = 0.020 and adj. hazard ratio: 0.74; 95%CI: 0.55–0.99; p = 0.048, respectively). Conclusions: A preoperative low bioelectrical impedance phase angle is associated with undernutrition, and increases the risk of adverse clinical outcome after cardiac surgery. The phase angle might help to identify undernourished cardiac surgical patients. [Copyright &y& Elsevier]

Objective: Several studies have shown low fat-free mass index to be a stronger predictor for mortality than low body mass index. The main aim of this study was to assess the still unknown association between preoperative low fat-free mass index and adverse cardiac surgical outcomes. Methods: In a prospective observational study, fat-free mass index was determined by bioelectric impedance spectroscopy on hospital admission. Associations between low fat-free mass index and postoperative infections and mortality, as well as prolonged intensive care unit and hospital stays, were analyzed with logistic and Cox regression techniques. Results: Between February 2008 and December 2009, 325 adult patients admitted for elective heart surgery were included. Analyses showed that low fat-free mass index, present in 8.3% of patients, was independently associated with occurrence of infections after cardiac surgery (18.5% vs 4.7%; adjusted odds ratio, 6.9; 95% confidence interval, 1.8–27.7; P = .01). Low fat-free mass index also tended to be associated with higher risk of longer postoperative intensive care unit stay (adjusted hazard ratio, 0.7; 95% confidence interval, 0.4–1.1; P = .09). When classifying patients as undernourished by traditional methods (body mass index ≤21.0 kg/m2 or ≥10% weight loss in preceding 6 months), half of patients with low fat-free mass index were misclassified as well nourished. Conclusions: Low fat-free mass index is associated with increased occurrence of adverse outcomes after cardiac surgery. We advocate fat-free mass index as the leading parameter in classifying and treating undernourished cardiac surgical patients, which might improve recovery rates after cardiac surgery. [Copyright &y& Elsevier]

Summary: Background & aims: To measure undernutrition in terms of fat free mass (FFM), there are several options. The aim of this study was to assess agreement in FFM between the portable, bedside bioelectrical impedance spectrometry (BIS) and relatively expensive, non-portable dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Methods: In a prospective study, body composition measurements by BIS and DXA were performed two weeks prior and two months after cardiac surgery. Preoperative and postoperative agreement in FFM between BIS and DXA were analyzed with Bland and Altman plots. Results: Twenty-six patients were analyzed. BIS overestimated preoperative and postoperative FFM by 2 kg compared to DXA (2.3 kg (95%CI: −3.5–8.1 kg) and 2.1 kg (95%CI: −4.5–8.7 kg), respectively). BIS underestimated FFM change by −0.5% (95%CI: −8.4–7.5%). Conclusions: There is a large inter-individual variation between BIS and DXA. This hinders the interchange-ability of BIS and DXA in routine clinical practice and may lead to misclassifications and thereby inappropriate nutritional treatment and possible postoperative complications. To evaluate nutritional therapy in patients undergoing cardiac surgery, we advocate the use of DXA assessed FFM in parallel to BIS assessed extracellular and intracellular water and FFM. [Copyright &y& Elsevier]

Introduction: Our objectives were to determine the incidence of missed injuries and inappropriately managed cases in patients with minor injuries and illnesses and to evaluate diagnostic accuracy of the emergency nurse practitioners (ENPs) compared with junior doctors/senior house officers (SHOs). Methods: In a descriptive cohort study, 741 patients treated by ENPs were compared with a random sample of 741 patients treated by junior doctors/SHOs. Groups were compared regarding incidence and severity of missed injuries and inappropriately managed cases, waiting times, and length of stay. Results: Within the total group, 29 of the 1,482 patients (1.9%) had a missed injury or were inappropriately managed. No statistically significant difference was found between the ENP and physician groups in terms of missed injuries or inappropriate management, with 9 errors (1.2%) by junior doctors/SHOs and 20 errors (2.7%) by ENPs. The most common reason for missed injuries was misinterpretation of radiographs (13 of 17 missed injuries). There was no significant difference in waiting time for treatment by junior doctors/SHOs versus ENPs (20 minutes vs 19 minutes). The mean length of stay was significantly longer for junior doctors/SHOs (65 minutes for ENPs and 85 minutes for junior doctors/SHOs; P < .001; 95% confidence interval, 72.32-77.41). Discussion: ENPs showed high diagnostic accuracy, with 97.3% of the patients being correctly diagnosed and managed. No significant differences between nurse practitioners and physicians related to missed injuries and inappropriate management were detected. [Copyright &y& Elsevier]

Summary: Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospective study on intake in preoperatively well-nourished, non-hospitalized cardiac surgery patients (≥65y) was carried out. Methods: Between December 2004 and November 2005 preoperative protein and energy intake and postoperative outcome data were collected from 100 consecutive patients undergoing cardiac surgery. Results: Comparison of low protein intake (≤0.98g/kg/d) with high protein intake (>0.98g/kg/d) showed a low protein intake did not result in more complications or prolonged length of stay. In low-risk operation patients in particular, a high-energy intake (>22kcal/kg/d) resulted in more postoperative complications than a low energy intake (≤22kcal/kg/d) (33.3% and 13.2%, respectively; (OR 5.0 95% CI [1.5–16.9])). A preoperative protein intake ≤0.80g/kg/d was seen in 22.6%, and an energy intake ≤25kcal/kg/d in 72.2% of the patients. Conclusion: The outcome of this study suggests that detecting and correcting a preoperative low protein or energy intake is of no clinical relevance in the well-nourished, non-hospitalized elderly cardiac surgery patients. Caloric overfeeding may be associated with an increased complication rate. [Copyright &y& Elsevier]

Background: Since more sophisticated ventilation techniques have enabled patients to comply with the ventilator with little or no sedation, deep sedation levels can easily be avoided. However, successful ventilation techniques also expanded the treatment possibilities for more severely ill patients who require deeper sedation levels. We developed a new sedation score to improve the prevention of oversedation and to simplify scoring practice in the intensive care unit (ICU). Objective: The study’s objective was to establish the validity and reliability of a new sedation score (Sedic score) for critically ill, sedated adult patients. Methods: We prospectively evaluated the reliability and validity of the Sedic score. The study took place in a 30-bed ICU in a university teaching hospital. Forty-six consecutive mechanically ventilated and sedated ICU patients were included. The constructed scale consists of five levels of stimuli and five levels of responses. Sedation levels are defined by the sum of stimulus and response. The reliability of the Sedic score was assessed by simultaneous measurement by the research nurse and attending nurse (n = 70). Validity was expressed as (1) the hierarchic relation between stimulus and response (n = 443), (2) the prediction of wake-up time by the Sedic score (n = 46), and (3) the association between the Sedic score and the Ramsay scale (n = 88). Results: The method showed excellent reliability. Validity: Weighted kappa between stimulus and response was .82. Multivariate analysis: (recovery time as independent variable) regression line (Y = −2.53 + 2.16 * β; P < .001) (r2 = 42%). Correlation between the Sedic scores and the Ramsay scores was rs .74 (P = .01). Sixty-seven percent of the patients with a maximum Ramsay score of 6 had scores ranging between 6 and 10 on the Sedic scale, indicating that the Ramsay scale has a serious ceiling effect. Conclusion: The Sedic score demonstrates sufficient reliability and validity, and correlates well with wake-up time. It allows for frequent use by nurses to avoid oversedation in patients. [Copyright &y& Elsevier]

Examines the factors which affect the decision making process for the cardiopulmonary resuscitation of patients in hospitals. Assessment of the change of patients to survive; Examination of the sense of a resuscitation attempt; Preference of the patient whether to be resuscitated or not.