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Many studies show discrepancies between patients' and professionals' ratings on the same questionnaire regarding the patient's health. A relevant question is whether the differences in ratings reflect real differences between patients and professionals or whether they are caused by characteristics of the instrument. In this study, we address the latter option by examining the effects of 3 item characteristics (item wording, observability and clarity) on the degree of patient/nurse discrepancies in ratings of the items of the Appraisal of Self-care Agency (ASA) scale. Secondary analysis on 252 patient/nurse ratings showed that item wording (positively and negatively formulated items), and the observability of the items have a significant effect on the mean absolute difference score. No effect was found for clarity. These results were generally confirmed by subgroup analyses.

Objective: To investigate the effects of specialized respiratory home nursing care after discharge from a pulmonary rehabilitation center., Design: Pretest-posttest control group design. Patients in the experimental group were visited by a nurse who specializes in respiratory care, whereas the control group received care from nurses who did not specialize in respiratory care., Setting: Data were collected on admission, at program discharge, and 4 months and 9 months after discharge from a pulmonary rehabilitation center., Patients: One hundred fifteen patients were included in the study and observed for 1 year., Outcome Measures: Health-related quality of life (HRQL), coping strategies, compliance, hospitalization, and satisfaction with the care provided., Results: Complete data sets were obtained from 78 patients with severe airflow obstruction (FEV1 = 41%; predicted +/- SD = 15). Corrections were made for the selective nonresponse, but did not lead to adjustments in outcome scores. In both groups, HRQL scores improved between admission and discharge, but deteriorated 4 months and 9 months after discharge. The only statistically significant short-term effect was found on the "activities" component of HRQL in favor of the control group. No differences were found between groups regarding coping, compliance, and hospitalization. Patients in the experimental group, however, were more satisfied with the care provided by the specialized community nurses., Conclusions: The treatment intervention of specialized respiratory home nursing might not have been specific or intensive enough to result in outcome benefits. Secondly, the initial benefits from baseline pulmonary rehabilitation alone may have led to positive outcomes in both patient groups.

The purpose of this study among patients with chronic heart failure (n = 138) was to develop and test both the Dutch Fatigue Scale (DUFS) and the Dutch Exertion Fatigue Scale (DEFS). Psychometric testing of these scales included measurement of internal consistency, construct validity and criterion-related validity. Statistical analyses of both scales showed sufficient reliability and validity. The DUFS (scale coefficient H = 0.48; Rho = 0.80; KR-20 = 0.79) is suitable as a measurement instrument for the diagnosis of fatigue and makes it possible to compare results of fatigue on the level of groups of patients. The DEFS (scale coefficient H = 0.61; Rho = 0.91; Cronbach's alpha = 0.91) can be used in clinical practice for the measurement of patients' exertion fatigue.

The literature often suggests and assumes that children are under-medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children's pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under-medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under-estimate the child's pain, while in others, nurses' attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted.

This article describes a study examining the influence of expertise on nurses' pain assessments and decisions regarding pharmacological interventions in children. In an experimental design, novices (n = 271), intermediates (n = 222), and experts (n = 202) in pediatric nursing, various cases were presented. Each case consisted of a combination of a vignette and a video. Subjects were asked (1) to assess the child's pain intensity, (2) to specify their confidence in the assessment, and (3) to state whether or not they would administer a non-narcotic analgesic. The results indicated that expertise did not influence assessments of pain intensity. However, expertise did have a distinct impact on both the subjects' confidence in their decisions, and the decision to administer analgesics. Experienced nurses were most confident and were most inclined to administer analgesics. The findings of this study are placed in the context of a general theory on the development of expertise, which assumes that experts' decision-making is based on cognitive structures that describe features of prototypical or even actual patients, so called "illness scripts". From this theory it can be deduced that mainly practical experience is responsible for the (lack of) differences in decision-making between novices, intermediates and experts.

The prevention of pressure sores is a major concern of rehabilitation nurses. Through the years, several methods have been used to prevent pressure sores. One of the most commonly used methods is massage of bony prominences and pressure areas. However, according to most contemporary clinical guidelines, massage should be avoided. This article analyzes the extent to which these guidelines are based on research findings through a literature review on the effectiveness of massage in the prevention of pressure sores. The results of the studies that were analyzed led to the conclusion that massage as therapy for preventing pressure sores in subjects at risk for developing them is not recommended.

The purpose of this article is to provide an overview of the literature on factors associated with hospital readmission of older heart failure patients. Important factors reported to be related to rehospitalization are sociodemographic and medical factors, premature discharge, failing support system, medication-related problems and noncompliance. To prevent readmission, interventions in the area of discharge planning, patient education and follow-up are recommended.

In this article the results of explorative research into the validity and reliability of a Dutch version of the Bradenscale are described. The Bradenscale is a risk assessment tool for measuring the risk of developing pressure sores. With a prospective longitudinal design the Bradenscale has been investigated in a hospital and a community setting in Belgium and the Netherlands. Results of the research in hospital indicate a fair to moderate agreement with respect to interraterreliability and a reasonable amount of predictive validity. In the community care setting interraterreliability indicates slight to fair agreement while predictive validity could not be established due to several reasons. Further research into the Bradenscale is recommended considering the limited research population in both studies and the results in community care.

This study was set up to test the effectiveness of primary nursing on the burnout level of psychiatric nurses. It was expected that, under certain conditions, such as a primary nursing care delivery with an adequate feedback system, the burnout level would decrease. In a quasi-experimental research design, a cohort of 161 psychiatric nurses was followed for 2.5 years. Results showed that although the burnout level did not change as a result of primary nursing, psychiatric nurses and the practical nurses seemed able to work according to the principles of primary nursing. Strong indications were found that the job turnover decreased as a result of the introduction of primary nursing. Because two main problems were encountered in this study, a high drop-out due to job turnover among nurses and the imitation of the intervention by the control group, several additional analyses were performed.

The primary question in this survey was: Is it possible for a panel of experts, by means of existing measurement scales, to weigh and rank criteria in order to get a more refined judgement of quality. For this purpose 134 criteria were presented to a panel of experts using the Delphi-method. In two Delphi-rounds the panel selected 28 most important and 18 least important criteria by means of the VAS and the Coombsscale. This resulted in a selection of 34% of the original number of 134 criteria. The results proved it to be possible, to rank and weigh criteria by means of the VAS and Coombsscale in a Delphi-survey. If it is desired that a numerical value be attributed to criteria which differ little on a notional continuum, the Coombsscale appears to be most suitable. The VAS is not adequate in reaching 70% consensus in regarding least important criteria in a group of existing criteria.

Fatigue is a universal complaint that may or may not be related to medical diagnoses or therapeutic treatment. Fatigue is a complex, multicausal, multidimensional, nonspecific, and subjective phenomenon for which no one definition is widely accepted. The absence of theories concerning the nursing diagnosis of fatigue limits insight into the phenomenon and hinders the development of valid and reliable instruments for the measurement of fatigue. Therefores, the authors have undertaken a concept of analysis of fatigue, to a) document how it is defined in the literature; b) which dimensions of the concept of fatigue are distinguished; and c) which indicators of both the content and forms of fatigue represent the concept in practice. This concept analysis has resulted in a theoretical frame of reference that can indicate directions not only for further research into the nursing diagnosis of fatigue, but also for the development of measuring instruments.

Background: The consequences of chronic obstructive pulmonary disease (COPD) on daily life, encapsulated by the term "health-related quality of life" (HRQL), are important in determining appropriate home care. There is a need to understand the relative contribution of respiratory impairment, physical disability, coping, age, and socioeconomic variables on HRQL., Methods: Patients with COPD were recruited on admission to a pulmonary rehabilitation centre. Respiratory impairment was assessed by lung function tests and physical disability was evaluated by a 12 minute walking test. HRQL was assessed by means of the St George's Respiratory Questionnaire (SGRQ) measuring "symptoms", "activity", and "impact". Because the SGRQ does not include a measure of "well being", this was taken from the medical psychological questionnaire for lung diseases. The COPD coping questionnaire and a questionnaire covering basic socioeconomic variables were also used., Results: One hundred and twenty six patients of mean (SD) age 65 (9) years and mean (SD) forced expiratory volume in one second (FEV1) 39 (9)% predicted were included. The scores on the SGRQ indicated severe impairment. Correlations were found between lung function parameters, 12 minute walking test, and the HRQL "activity" and "impact" components. Coping strategies were correlated with the "activity", "impact", and "well being" components. No correlations were found between age, socioeconomic variables, and HRQL. FEV1, 12 minute walking test, and the coping strategies "avoidance" and "emotional reaction" were the best predictors of HRQL., Conclusion: In patients with COPD methods of improving physical performance and teaching adequate coping strategies should be considered in order to improve HRQL.

Although some studies suggest that health locus-of-control beliefs are not affected by situational factors, others show that health locus of control is related to health status, indicating that this psychological construct is not as stable as suggested. In this study, the stability of health locus of control during a hospital admission for a surgical operation is investigated. Although test-retest coefficients suggest stability, mean scores of the powerful others health locus-of-control belief show an increase during hospital stay, and a decrease afterward toward the original level. Furthermore, this study shows that patients with fewer hospital experiences have a greater increase and decrease than patients with more hospital experiences. Under certain circumstances, health locus-of-control beliefs can be temporarily affected by situational factors.

Different methods have been developed in the past to prevent patients from developing pressure sores. The consensus guidelines developed in the Netherlands make a distinction between preventive methods useful for all patients, methods useful only in individual cases, and methods which are not useful at all. This study explores the extent of use of the different methods within Dutch hospitals, and the knowledge and beliefs of nurses regarding the usefulness of these methods. A mail questionnaire was sent to a representative sample of nurses working within Dutch hospitals. A total of 373 questionnaires were returned and used for the analyses. The results showed that many methods judged by the consensus report as not useful, or only useful in individual cases, are still being used. Some methods which are judged as useful, like the use of a risk assessment scale, are used on only a few wards. The opinion of nurses regarding the usefulness of the methods differ from the guidelines of the consensus committee. Although there is agreement about most of the useful methods, there is less agreement about the methods which are useful in individual cases or methods which are not useful at all. In particular the use of massage and cream are, in the opinion of the nurses, useful in individual or in all cases.

Research is lacking on factors influencing nurses' decision-making directed at the diagnosis of pain in children and its related interventions. This paper reports on two studies, namely a qualitative study and its replication, in which we explored factors influencing nurses' pain assessments and interventions in children. Those factors found to influence nurses' decisions were: medical diagnosis, child's expressions, age, and parents, and the nurses' knowledge, experience, attitude and workload. Some of these factors seem to have more influence than others. For example, the presence of a medical diagnosis seems to legitimate being in pain. Furthermore, it is suggested that mainly vocal expressions, especially crying, influence nurses' decisions to administer analgesics. Finally, nurses' negative views on non-narcotic analgesics were striking. In this paper, the results of both studies and their relationship to information reported in the literature are further elaborated and discussed, and hypotheses on strength and direction of influence of factors on pain assessment and intervention are generated.

It is common for professional literature to describe quality of care as based on standards. Yet little attention is given to the steps that precede the establishment of these standards. This study answers the question. "Which nursing care standards and criteria should be developed for chronic obstructive pulmonary disease (COPD) patients discharged from a pulmonary rehabilitation center? "Our approach included the following steps: delineating the scope of care and service, identifying indicators, and formulating standards and identifying criteria. Aspects of care included are: establishment and maintenance of a good care relationship with the patient; delineation of the care needs during the home visit; provision of health education, advice, and instruction; support in psychosocial problems; and coordination and continuity of the service. These standards and criteria were validated by the Delphi technique.

In the literature both advantages and disadvantages are mentioned for factor and prototype patient classification systems. In this study a secondary analysis is used to explore the variance which is explained by a prototype and a factor evaluation classification system of the same patients. In the prototype evaluation system, the care types which were applied resulted in heterogeneous visit times. To explore the factor evaluation system, multiple regression analyses were executed with the average visit time per patient as dependent variable and the activities (separate or aggregated per category) as independent variables. Results show that the activities explain the average visiting time per patient better than the developed care types do.

In clinical practice professional nurses appear to make different judgments regarding particular nursing situations. The purpose of this literature review is to gain insight into the way nurses make decisions related to nursing diagnoses and interventions. Literature on decision making can be divided into literature that focuses on how decisions are made, ie, information-processing model, and information that focuses on how decisions ought to be made, ie, mathematical models. Most of the literature about decision making in nursing in particular appears to focus on the former, specifically on the stages and strategies in the decision-making process and on factors influencing this process. These factors include the problem task (cues), the decision maker (his or her knowledge, experience, personal variability), and discipline. However, to date, most of the research that has been done with regard to these factors has been restricted to the performance between novice and expert. We conclude that further validation of nursing diagnoses is necessary to ensure accuracy in decision making in nursing.

This article reports on a qualitative study, that explored factors influencing nurses' pain assessment and interventions with children. Although many factors appear to influence decision-making processes, nurses seem to attach more weight to some factors than to others. For example, medical diagnosis and the intensity with which the child expresses its pain are used as determining factors for the decision to administer analgesics. In this article the results of the study, their relationship to information reported in the literature as well as their implications for practice and research are further elaborated and discussed.

In nursing literature no consensus exists on the phenomenon 'counseling'. A literature search of the concept 'counseling' makes clear that it is possible to distinguish two dimensions of the concept 'counseling', namely 'range' and 'intensity' of counseling. These two dimensions are the starting point of this study. The main purpose of this study is to gain insight in the range and intensity of the counseling given by district nurses and district assistant nurses. This article aims to discover how often psychosocial nursing problems are recognized and how often nursing interventions are executed by nurses, and with how many patients this was done. The research is designed as a secondary analysis. We used data collected by Wiersma et al. (1991). The results confirm earlier research but also offer new points of view. The study confirms that counseling is an essential aspect of district nursing. Some (significant) differences were discovered between district nurses and district assistant nurses in the psychosocial care that was given. Factors like level of education, patient population and organization will probably explain the differences between the two professional groups. This aspect of the study needs further inquiry.

In clinical practice professional nurses appear to make different judgments regarding particular nursing situations. Assuming that it is desirable that nurses, confronted with the same situation, make the same decisions, it is important to gain insight into the way decisions are made. The purpose of this literature review is to summarize what is already known about decision-making in nursing. It appears that most of the texts on decision-making in nursing are based on a general model on decision-making: the information-processing model. Factors influencing decision-making processes are discussed. Finally, an overview is given of research on decision-making in nursing.

Insomnia is an important nursing problem in hospitals. Although sleep medication is often criticized, it is one of the commonest interventions with regard to sleep problems. In this study, the prescription and provision of sleep medication in three Dutch general hospitals is investigated. Results show that on a random day 47% of all patients (n = 1076) of the surgical and medical wards were prescribed medication. Thirty-four per cent actually received sleep medication that evening or night. The prescription and provision of sleep medication was higher on medical than on surgical wards. Furthermore, hospitals were shown to differ regarding the prescription and provision of as-needed sleep medication. The study also explores whether attitudes of nurses are related to the provision of as-needed sleep medication. Although their influence does not seem to be great, it is concluded that more attention has to be paid to possible effective nursing interventions in educational programmes.