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Background: Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. Objective: To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture. Methods: A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. Results: Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore. Conclusions: Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes. [ABSTRACT FROM AUTHOR]

Introduction: In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care. Objective: This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization. Methods: A qualitative study was conducted using an interpretive phenomenological approach. To follow patients' experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process. Results: Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care. Conclusion: Awareness and responsiveness to patients' perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization. [ABSTRACT FROM AUTHOR]

Aims: To explore and describe hospital nurses' perceptions of leadership behaviours in facilitating patient participation in fundamental care. Design: An ethnographic interview study. Methods: Individual semi‐structured interviews with 12 nurses with a bachelor's or master's degree working at a university medical centre were conducted between February and April 2021. The interview data were analysed using thematic analysis. Results: Six themes were derived from the data: (1) nursing leadership; (2) patient participation; (3) using patients' preferences; (4) building relationships; (5) task‐focused nursing; (6) need for role modelling. Conclusion: Nurses indicated leadership behaviour to facilitate patient participation in fundamental care as inviting patients to participate and eliciting and supporting patients' preferences. Although nurses also regarded leadership as motivating colleagues to act and enhancing evidence‐based practice, they appeared not to practise this themselves about patient participation. Role modelling was indicated as a need for improvement. Impact The findings established that not all leadership behaviours mentioned were used in practice about patient participation in fundamental care. Role modelling and the use of evidence‐based practice are needed to increase patient participation. Further research will be necessary to develop and test leadership interventions to improve patient participation in fundamental care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. Background: In‐depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. Design: Multicentre cross‐sectional descriptive study. Method: A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. Results: The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. Conclusion: Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. Relevance to clinical practice: Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well‐positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To analyse oral care delivery in one hospital through exploring experiences from both nurses' and patients' perspectives and examining patients' oral health. Background: Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. Design: A context analysis in one hospital using a convergent parallel mixed‐methods design was reported following the EQUATOR guidelines using two checklists: COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research). Methods: Semi‐structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT). Results: Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). Conclusions: This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. Relevance to Clinical Practice: The behavioural factors indicate strategies for development of a multicomponent intervention to improve oral care in this hospital, nutritional status and general health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Rapid response systems aim to improve early recognition and treatment of deteriorating general ward patients. Sole reliance on deviating vital signs to escalate care in rapid response systems disregards nurses' judgments about a patient's condition based on worry and other indicators of deterioration. To make worry explicit, the Dutch-Early-Nurse-Worry-Indicator-Score was developed, summarising non-quantifiable signs of deterioration in the nine indicators: breathing, circulation, temperature, mentation, agitation, pain, unexpected trajectory, patient indicates not feeling well and nurses' subjective observations. Nurses' worry can be present even when vital signs are largely unchanged, enabling treatment to commence at an early stage. On the other hand, reliance on nurses' worry might lead to unnecessary calls for medical assistance or an overuse of rapid response teams. Objectives Explore the occurrence of nurses' worry in real time, determine whether acting on worry leads to unnecessary action and determine the indicators present at different levels of deterioration. Design A prospective cohort study. Setting: Three surgical wards in a tertiary, university affiliated teaching hospital. Participants All nurses participated and adult, surgical, native speaking patients were included in the study. Methods A descriptive analysis is performed on one year of data on surgical ward nurses' experience of worry and its underlying indicators in addition to routinely measured vital signs. Results Out of a total of 46,571 measurements, vital signs were normal 18,727 times, with worry expressed 605 times (3%), resulting in 62 calls (10.2%) to the attending physician. More than half of these calls resulted in necessary interventions. Calls for assistance and subsequent intervention after worry was expressed increase in parallel with early warning scores. The breathing indicator showed the highest increase in frequency with increasing deviation in vital signs. Conclusion This study suggests that worry has potential as an early indicator of deterioration, alerting nurses and encouraging them to start timely interventions. Overuse of medical assistance could not be determined, The Dutch-Early-Nurse-Worry-Indicator-Score objectifies worry when vital signs do not support its presence and systematic assessment of these indicators is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the perspectives of nursing students on their education concerning basic nursing care, learned either during theoretical education or clinical placement, with a specific focus on nutrition and communication. Background: Basic care activities lie at the core of nursing, but are ill‐informed by evidence and often poorly delivered. Nursing students’ education on basic care might be lacking, and the question remains how they learn to deliver basic care in clinical practice. Design: Descriptive study, using an online questionnaire. Methods: Nursing students at the vocational and bachelor level of six nursing schools in the Netherlands were invited to complete an online questionnaire regarding their perception of basic nursing care education in general (both theoretical education and clinical placement) and specifically in relation to nutrition and communication. Results: Nursing students (n = 226 bachelor students, n = 30 vocational students) completed the questionnaire. Most students reported that they learned more about basic nursing care during clinical placement than during theoretical education. Vocational students also reported learning more about basic nursing care in both theoretical education and clinical practice than bachelor students. In terms of nutrition, low numbers of students from both education levels reported learning about nutrition protocols and guidelines during theoretical education. In terms of communication, vocational students indicated that they learned more about different aspects of communication during clinical practice than theoretical education and were also more likely to learn about communication (in both theoretical education and clinical practice) than were bachelor students. Conclusion: Basic nursing care seems to be largely invisible in nursing education, especially at the bachelor level and during theoretical education. Relevance to clinical practice: Improved basic nursing care will enhance nurse‐sensitive outcomes and patient satisfaction and will contribute to lower healthcare costs. This study shows that there is scope within current nurse education in the Netherlands to focus more systematically and explicitly on basic nursing care. [ABSTRACT FROM AUTHOR]

Home-based nursing care continues to expand, delivering care to increasingly older clients with multiple, chronic and complex conditions that require the use of additional and more numerous invasive medical devices. Therefore, the prevention of infections poses a challenge for nurses, professional caregivers and clients. This article explores infection prevention practices and related behavioural factors in both nurses and clients to identify barriers and facilitators of infection prevention practices in home-based nursing care. A qualitative, exploratory design. Four healthcare organisations providing home-based nursing care in the Netherlands. Participant observations were used as the main source of data collection complemented with focus group discussions and semi-structured interviews. Participant observations: 16 nurses, three professional caregivers and 80 clients. Semi-structured interviews: 11 clients. Focus group discussions: 15 nurses and four professional caregivers. A total of 87 unique care delivery situations were observed for 55 h, complemented with three focus group discussions and 11 individual semi-structured client interviews. Infection prevention practices in home-based nursing care appeared to be challenged by 1. The specific context or environment in which the care occurred, which is more autonomous, less structured, less controlled and less predictable than other care settings; 2. Suboptimal and considerable variation in professional performance concerning the application of hand hygiene and the proper use of personal protective equipment such as face masks, barrier gowns and disposable gloves; 3. Extensive use in and outside the client's surroundings of communication devices that are irregularly cleaned and tend to interrupt nursing procedures; and 4. Inadequate organisational support in the implementation and evaluation of new information or policy changes and fragmentation, variation and conflicting information regarding professional guidelines and protocols. From a first-hand observational viewpoint, this study showed that the daily practice of infection prevention in home-based nursing care appears to be suboptimal. Furthermore, this research revealed considerable variation in the work environment, the application of hand hygiene, the proper use of personal protective equipment, the handling of communication devices and organisational policies, procedures and support. Finally, the study identified a number of important barriers and facilitators of infection prevention practices in the work environment, professional and team performance, clients and organisations. [ABSTRACT FROM AUTHOR]

Background: Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem.Objective: Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews.Methods: A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care.Results: In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48%) and 39 male (52%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95% CI -0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95% CI -0.21 to 0.46. No harm or unintended effects occurred.Conclusions: Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally.Trial Registration: ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789. [ABSTRACT FROM AUTHOR]

A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. A descriptive qualitative design informed by the Fundamentals of Care framework. The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework. Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing. [ABSTRACT FROM AUTHOR]