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Moving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes. This study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed. The majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home. This study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home. [ABSTRACT FROM AUTHOR]

Background: Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision‐making. Objective: To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision‐making. Methods: A qualitative descriptive study was conducted in the TRANS‐SENIOR consortium's collaborative research using semistructured in‐depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven. Findings: Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision‐making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors. Conclusions: Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision‐making. However, their preferences for greater involvement in decision‐making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age‐tuned and person‐centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment. Patient or Public Contribution: Older persons' representatives were involved in designing the TRANS‐SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated how patients with COVID‐19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges. Design: A qualitative research approach was adopted, including focus group discussions and semi‐structured interviews. Methods: Four different groups of participants were interviewed, that is, patients (n = 17), TM teams (n = 27), GPs (n = 16), and primary care nurses (n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis. Results: All participants agreed that RPM‐reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow‐up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID‐19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM. Conclusion: Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low. Clinical relevance: Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID‐19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging logistics within projects, lack of data integration and communication, and a lack of an overarching guiding framework. [ABSTRACT FROM AUTHOR]

Background: Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions.Methods: A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors': i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis.Results: Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors.Conclusions: Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to determine construct validity of the Dutch Essentials of Magnetism II © instrument, designed to assess nursing practice environments, using hypotheses testing. Background Reduction in hospital length of stay and the number of inpatient beds increases care intensity. Educational levels and numbers of nursing staff in hospitals, however, do not match this increase, resulting in a strain on quality of care and patient safety. A possible answer to existing concerns about quality of care may be the creation of a productive and healthy practice environment, as this has an impact on the quality of care. Therefore, areas requiring improvement of the practice environment have to be defined. Design A cross-sectional, correlational study design. Method We determined construct validity with hypotheses testing by relating the Dutch Essentials of Magnetism II to the Dutch Practice Environment Scale of the Nursing Work Index. We formulated 15 hypotheses prior to data-analysis; 10 related to convergent validity and five related to discriminant validity. Data were collected from qualified nurses ( N = 259) on nine randomly selected hospital wards from March to April 2012. Results Response rate was 47% ( n = 121). Total scores of both instruments are strongly correlated ( r = 0·88). In total, 12 of 15 hypotheses (80%) were confirmed and three were rejected. Conclusion The D- EOMII has satisfactory construct validity for measuring the nursing practice environment in hospitals and can be used by nurses, managers, health policy makers, hospitals and governments to assess and identify processes and relationships that are in need of improvement. [ABSTRACT FROM AUTHOR]

Background: As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore, retaining nurses for the profession is urgent. Objective: To determine factors associated with nurses' intention to leave the profession across European countries. Design: A multi-country, multi-centre, cross-sectional analysis of survey data. Setting: 2025 surgical and medical units from 385 hospitals in ten European countries that participated in the RN4Cast study. Hospital selection was based on a stratified randomised selection procedure. Participants: All nurses from the participating medical and surgical hospital wards received a survey. 23,159 nurses (64%) returned the survey. Methods: The nurse survey included questions about intention to leave the profession, nurse characteristics, factors related to work environment, patient-to-nurse staffing ratio, burnout and perceived quality and safety of care. Multilevel regression analyses with 'intention to leave the profession' as dependent variable were conducted for all 10 countries combined as well as per country. Results: Overall, 9% of the nurses intended to leave their profession. This varied from 5 to 17% between countries. Seven factors were associated with intention to leave the profession at European level: nurse-physician relationship (OR 0.86; 95%CI 0.79-0.93), leadership (OR 0.78; 95% CI 0.70-0.86), participation in hospital affairs (0.68; 95%CI 0.61- 0.76), older age (OR 1.13; 95%CI 1.07-1.20), female gender (OR 0.67; 95%CI 0.55-0.80), working fulltime (OR 0.76; 95%CI 0.66-0.86) and burnout (OR 2.02; 95%CI 1.91-2.14). The relevance of these factors differed for the individual countries. Nurse perceived staffing adequacy, patient-to-nurse staffing ratio, perceived quality and safety of care and hospital size were not associated with intention to leave at a European level. Conclusion: Burnout is consistently associated with nurses' intention to leave their profession across the 10 European countries. Elements of work environment are associated with intention to leave the nursing profession but differ between countries, indicating the importance of national contexts in explaining and preventing nurses' intention to leave their profession. [ABSTRACT FROM AUTHOR]

Background: The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method: This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results: All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients' motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from 'ignorer' to 'nurturer'. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion: GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the psychometric properties of the Nurses' Observation Scale for Cognitive Abilities. Background. Nurses' Observation Scale for Cognitive Abilities is a behavioural rating scale comprising eight subscales that represent different cognitive domains. It is based on observations during contact between nurse and patient. Design. Observational study. Methods. A total of 50 patients from two geriatric wards in acute care hospitals participated in this study. Reliability was examined via internal consistency and inter-rater reliability. Construct validity of the Nurses' Observation Scale for Cognitive Abilities and its subscales were explored by means of convergent and divergent validity and post hoc analyses for group differences. Results. Cronbach's αs of the total Nurses' Observation Scale for Cognitive Abilities and its subscales were 0·98 and 0·66-0·93, respectively. The item-total correlations were satisfactory (overall > 0·4). The intra-class coefficients were good (37 of 39 items > 0·4). The convergent validity of the Nurses' Observation Scale for Cognitive Abilities against cognitive ratings (MMSE, NOSGER) and severity of dementia (Clinical Dementia Rating) demonstrated satisfactory correlations (0·59-0·70, p < 0·01), except for IQCODE (0·30, p > 0·05). The divergent validity of the Nurses' Observation Scale for Cognitive Abilities against depressive symptoms was low (0·12, p > 0·05). The construct validity of the Nurses' Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0·18-0·74; 10 of 13 correlations p < 0·05). Conclusions. Validity and reliability of the total Nurses' Observation Scale for Cognitive Abilities are excellent. The correlations between the Nurses' Observation Scale for Cognitive Abilities subscales and standard neuropsychological tests were moderate. More conclusive results may be found if the Nurses' Observation Scale for Cognitive Abilities subscales were to be validated using more ecologically valid tests and in a patient population with less cognitive impairment. Relevance to clinical practice. Use of the Nurses' Observation Scale for Cognitive Abilities yields standardised, reliable and valid information about patient's cognitive behaviour in daily practice. The Nurses' Observation Scale for Cognitive Abilities aids in tailoring nursing interventions to patients' specific cognitive needs. We advocate the implementation of the Nurses' Observation Scale for Cognitive Abilities both in research and at geriatric units in acute care hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Care for the frail elderly is often provided by several professionals. Collaboration between them is essential, but remains difficult to achieve. Interprofessional education (IPE) can improve this collaboration. We developed a 9-hour IPE program for primary care professionals from 7 disciplines caring for the frail elderly, and aimed to establish whether the program improved professionals' interprofessional attitudes and attitudes toward collaboration, collaboration skills, and collaborative behavior. We also evaluated learners' reactions to the program. Methods: Before-after study, using the Interprofessional Attitudes Questionnaire (IAQ, score:1 to 7); Attitudes Toward Health Care Teams Scale (ATHCTS, score: 0 to 105); and Team Skills Scale (TSS, score:17 to 85). Additionally, semistructured interviews were conducted with 10 selected participants. Results: Participants' ( N = 80) overall interprofessional attitudes improved (IAQ baseline: 5.49; follow-up: 5.67, p = 0.001); attitudes toward geriatric teams did not change (ATHCTS baseline: 69.9; follow-up: 69.1, p = 0.32). Participants' self-reported team skills improved (TSS baseline: 45.7; follow-up: 48.1, p = 0.001). In the interviews, many interviewees reported increased collaboration with professionals of other disciplines due to the program. Interviewees considered the program's interprofessional nature and attending the program with local professionals important contributing factors to the experienced improvements in collaboration. However, they also noted that not all parts of the program had met the needs of all participating disciplines, due to differences in professional background and knowledge. Discussion: A brief IPE program can improve interprofessional attitudes, collaboration skills, and collaborative behavior. That such a program allows professionals to get acquainted with each other and each other's viewpoints appears to be as important as the educational content. [ABSTRACT FROM AUTHOR]

ABSTRACT The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments. Background. In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first step performed by nurses when a patient arrives at an emergency department. It includes the prioritisation of patients to ensure that doctors see patients with the highest medical needs first. Although the national guideline was developed and disseminated in 2004, three years on there was no insight into the level of implementation of the guideline in practice. Design. A cross-sectional descriptive design. Methods. In February 2007, data were collected from ward managers and triage nurses at all emergency departments in the Netherlands ( n = 108), using a questionnaire that was based on the recommendations and performance indicators of the guideline. Results. In total, 79% of all 108 Dutch emergency departments responded. The main findings showed that over 31% of the emergency departments did not use a triage system. Emergency departments using the Manchester Triage System had a mean adherence rate of 61% of the guideline's recommendations and emergency departments using the Emergency System Index adhered to a mean of 65%. Conclusion. The guideline Triage in emergency departments was disseminated in 2004, but results from this study indicate that an improvement in adherence to this guideline is required. Relevance to clinical practice. Adherence to guidelines is important to standardise practice to ensure that patients receive the appropriate treatment and to improve quality of care. [ABSTRACT FROM AUTHOR]

The article presents a two-round, electronic, quantitative Delphi study aimed at identifying North American Nursing Diagnosis Association (NANDA-I) diagnoses that are most relevant to hematology-oncology nursing in Europe. The NANDA-I diagnoses and health problems were assessed by 28 experts from nine European countries. Some of the relevant diagnoses identified by experts include diarrhea, fatigue, hyperthermia, nausea and pruritis. It discusses the impact of the NANDA-I nursing diagnoses on hematology-oncology nursing evidence-based care.

Previous studies on the effects of providing feedback about quality improvement measures to nurses show mixed results and the factors explaining the variance in effects are not yet well-understood. One of the factors that could explain the variance in outcomes is how nurses perceive the feedback. It is not the feedback per se that influences nurses, and consequently their performance, but rather the way the feedback is perceived. This article aims to enhance our understanding of Human Resource attributions and employee engagement and burnout in a feedback environment. An in-depth study of nurses' attributions about the 'why' of feedback on quality measurements, and its relation to engagement and burnout, was performed. A convergent mixed-methods, multiple case study design was used. Evidence was drawn from four comparable surgical wards within three teaching hospitals in the Netherlands that volunteered to participate in this study. Nurses on each ward were provided with oral and written feedback on quality measurements every two weeks, over a four month period. After this period, an online survey was distributed to all the nurses (n = 184) on the four participating wards. Data were collected from 91 nurses. Parallel to the survey, individual, semi-structured face-to-face interviews were conducted with eight nurses and their ward manager in each ward, resulting in interview data from 32 nurses and four ward managers. Results show that nurses – both as a group and individually – make varying attributions about their managers' purpose in providing feedback on quality measurements. The feedback environment is associated to nurses' attributions and these attributions are related to nurses' burnout. By showing that feedback on quality measurements can be attributed differently by nurses and that the feedback environment plays a role in this, the study provides an interesting mechanism for explaining how feedback is related to performance. Implications for theory, practice and future research are discussed. [ABSTRACT FROM AUTHOR]