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While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers.

Contains fulltext : 290617.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To identify and structure potential informal antidepressant strategies that can be used in daily practice for nursing home residents alongside formal treatments. METHODS: In a first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies residents could use to prevent or alleviate depression. In a second study, the same participants (N = 110) reported strategies for use by others. Furthermore, participants rated the expected effectiveness and feasibility of the suggested strategies. Simultaneously, all strategies were sorted by experts and clustered using multidimensional scaling and hierarchical cluster analysis. RESULTS: Six clusters emerged for strategies by residents themselves and five clusters for strategies by others. For residents' strategies, the clusters Being socially connected and Participating in activities were perceived as most effective, as was the cluster Offering personal attention for strategies by others. Participants perceived Creating a healthy living environment as the most feasible cluster executed by residents. Within strategies by others, the clusters Offering personal attention, Using positive treatment/approach, and Using or adapting the physical environment were perceived as the most feasible. CONCLUSION: The results indicated the importance of social connectedness, a personalized and positive approach by significant others, and tailored activity programs. The results also suggest that adaptations to the physical environment within nursing homes may be an easy applicable strategy to prevent or alleviate depression in residents. Although more research is needed, these findings may guide daily practice and the development of interventions that include informal strategies. Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2057427 . 01 februari 2023

Objective: Conceptualize successful treatment of persons with dementia and severe challenging behavior as perceived by professionals. Methods: In this concept mapping study 82 experts in dementia care participated. The study followed two phases of data collection: (1) an online brainstorm where participants completed the focus prompt: ?I consider the treatment of people with severe challenging behavior in dementia successful if.?; (2) individual sorting and rating of the collected statements followed by data analysis using multidimensional scaling and hierarchical cluster analysis, resulting in a concept map. Results: Three clusters were identified, the first addressing treatment outcomes and the latter two addressing treatment processes, each divided into sub-clusters: (1) well-being, comprising well-being of the person with dementia and all people directly involved; (2) multidisciplinary analysis and treatment, comprising multidisciplinary analysis, process conditions, reduction in psychotropic drugs, and person-centered treatment; and (3) attitudes and skills of those involved, comprising consistent approach by the team, understanding behavior, knowing how to respond to behavior, and open attitudes. Conclusions: Successful treatment in people with dementia and severe challenging behavior focuses on well-being of all people involved wherein attention to treatment processes including process conditions is essential to achieve this.

Objectives:On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff.Design:Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes.Participants:Visitors and healthcare professionals.Intervention:Allowing visitors using local regulations based on national guidelines.Measurements:Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations.Results:National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects.Conclusion:The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.

A condition for good quality care for people with dementia is that nurses and carers have sufficient knowledge of dementia. To test this knowledge, to measure the effects of psychosocial interventions and to develop educational programs, knowledge tests for dementia have been developed. This review examined which knowledge tests are available for nurses and care workers. These are assessed by their method of development and their psychometric qualities. Eight measuring instruments were traced: KIDE, DKAT1, DKAT2, DKAS, ADKS, UJA Alzheimer's Care Scale, KASA and KDC-SAT. The DKAS had the best psychometric qualities: the instrument discriminates expectedly between groups with more versus less knowledge, education and experience with dementia, it is sensitive to change after education, it has a solid internal consistency and good reliability. It includes domains of the biomedical model as well as domains of the biopsychosocial model. The cross-cultural validity of the DKAS needs attention. For Dutch practice, the cross-cultural validity of the DKAS should be investigated in an applied study.Voorwaarde voor kwalitatief goede zorg voor mensen met dementie is dat verpleegkundigen en verzorgenden voldoende kennis van dementie hebben. Om deze kennis te toetsen, effecten te meten van psychosociale interventies en om educatieve programma’s te ontwikkelen, zijn kennistoetsen dementie ontwikkeld. In dit overzichtsartikel is onderzocht welke kennistoetsen er zijn voor verpleegkundigen en verzorgenden. Deze zijn beoordeeld op hun methode van ontwikkelen en hun psychometrische kwaliteiten. Er zijn acht meetinstrumenten getraceerd: KIDE, DKAT1, DKAT2, DKAS, ADKS, UJA Alzheimer’s Care Scale, KASA en KDC-SAT. De DKAS heeft de beste psychometrische kwaliteiten: conform de verwachting discrimineert het instrument tussen groepen met meer versus minder kennis, opleiding en ervaring met dementie, is het gevoelig voor verandering na educatie, heeft het een solide interne consistentie en een goede betrouwbaarheid. Het toetst zowel domeinen van het biomedische model als ook domeinen van het biopsychosociale model. De cross-culturele validiteit van de DKAS laat nog te wensen over. Voor de Nederlandse praktijk dient de cross-culturele validiteit van de DKAS onderzocht te worden in een toegepaste studie.

Contains fulltext : 287760.pdf (Publisher’s version ) (Open Access) BACKGROUND: Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires. OBJECTIVES: To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes. METHODS AND DESIGN: We conducted an integrative review (IR) using Whittemore and Knafl's method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis. RESULTS: Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams. CONCLUSIONS: It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care.

Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.

Background eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.

Background A group of clinician-scientists and managers working within a Dutch academic network, experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists. They found no role clarity in literature, nor did they find tools or methods suitable for clinician-scientists. Clarifying role expectations and providing accountability for funding these knowledge broker positions was difficult. The aim of this research was to design a theory-informed tool that allowed clinician-scientists to make their knowledge broker role visible. Methods A participatory design research was conducted in three phases, over a 21-month period, with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Phase 1 constituted a literature review, a context analysis and a needs analysis. Phase 2 constituted the design and development of a suitable tool and phase 3 was an evaluation of the tool’s perceived usefulness. Throughout the research process, the researcher logged the theoretic basis for all design decisions. Results The clinician-scientist’s knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible (phase 1). A tool (the SP-tool) was developed in Microsoft Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities (phase 2). The SP-tool contributed to the clinician-scientists’ ability to make their knowledge broker role visible to themselves and their stakeholders (phase 3). The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician-scientist’s knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of clinician-scientists broker functions, which is an element necessary for the professionalisation of an occupation. Conclusions The SP-tool that was developed in this research, contributes to creating work visibility of the clinician-scientists’ knowledge broker role. Further research using the SP-tool could establish a clearer description of the knowledge broker role at the day-to-day professional level and improved ability to support this role within organisations.

Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.

Contains fulltext : 229777.pdf (Publisher’s version ) (Closed access)

Background: Twelve clinician-scientists were employed in a Dutch academic network, which is a collaboration between fifteen nursing-homes and an academic medical research institute. The clinician-scientists were tasked with linking research and clinical practice by catalysing both care-informed research and evidence-informed implementation initiatives. The clinician-scientists and their manager experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists, a difficulty also reported in literature. They found no tools and methods suitable for make their knowledge broker role visible. Clarifying role expectations and accountability for funding these knowledge broker positions was difficult. They aimed to design a theory-informed performance appraisal tool that allowed clinician-scientists to explicate and develop their knowledge broker role in collaboration with management.Methods: A participatory design research was conducted over a 21 month period with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Results: A tool (the SP-tool) was developed in MS Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities. The tool contributed to their ability to make their knowledge broker role visible to themselves and their stakeholders. The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician scientists knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the clinician-scientist’s knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of CS broker functions, which is an element necessary for the professionalisation of an occupation.Conclusions: The CSs knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible. The SP-tool contributes to creating work visibility of the clinician-scientists’ knowledge broker role. This in turn could contribute to the professionalisation of this role, which is not well described in literature at the day-to-day professional level.

BACKGROUND eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. OBJECTIVE The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. METHODS We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. RESULTS In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. CONCLUSIONS eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.

Background Several efforts have been made to change management of neuropsychiatric symptoms (NPS) in nursing homes, however only few were successful. Numerous barriers to change in healthcare were identified, yet only one conceptual model is known to study their interrelationships. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in the management of NPS in nursing homes and to construct a conceptual framework providing insight into the relative importance and interrelationships of these barriers when improving quality of care. Methods Four focus groups were conducted in different dementia special care units of one Dutch nursing home. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases defined by Braun & Clarke. Finally, a conceptual framework showing the interrelations of barrier-themes was constructed using text fragments of the focus groups. Results We constructed a conceptual framework consisting of eight themes of barriers explaining the extent to which change in NPS-management can be achieved: ‘organizational barriers’, ‘personal barriers’, ‘deficiency of staff knowledge’, ‘suboptimal communication’, ‘inadequate (multidisciplinary) collaboration’, ‘disorganization of processes’, ‘reactive coping’ and ‘differences in perception’. Addressing ‘organizational barriers’ and ‘deficiency of staff knowledge’ is a precondition for change. ‘Suboptimal communication’ and ‘inadequate (multidisciplinary) collaboration’ play a key role in the extent of change achieved via the themes ‘differences in perception’ and ‘disorganization of processes’. Furthermore, ‘personal barriers’ influence all themes - except ‘organizational barriers’ - and may cause ‘reactive coping’, which in turn may lead to ‘difficulties to structure processes’. Conclusions A conceptual framework was created explaining the relationships between barriers towards achieving change focused on improving management of NPS in nursing homes. After this framework has been confirmed and refined in additional research, it can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing them for achieving change in the provided care.

Background In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the ‘Cochrane Effective Practice and Organisation of Care’ (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel–Haenszel risk ratios (95% CI) were calculated using a random effects model. Results Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). Conclusions The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. Trial registration The review is registered in Prospero (CRD42018105100).

Background Many studies have tried to achieve change in the treatment of neuropsychiatric symptoms in nursing homes, however only few of them succeeded. Numerous barriers to change were identified, yet only one conceptual model is known to study the relationships between these barriers in healthcare. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in nursing home organizations and to construct a framework providing insight into the relative importance of and the relationships between these barriers with regard to improving quality of care.Methods In order to explore the barriers to change in nursing home care, four focus groups were conducted in different dementia special care units of one nursing home in the Netherlands, with a specific focus on NPS and psychotropic drug use. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases constructed by Braun & Clarke. Finally, a conceptual framework showing the interrelations of themes was defined using text fragments of the focus groups.Results We constructed a framework consisting of eight themes of barriers explaining the extent to which change can be achieved: 'organizational barriers', 'personal barriers', 'deficiency of knowledge', 'suboptimal communication', 'inadequate (multidisciplinary) collaboration', 'disorganization of processes', 'reactive coping' and 'differences in perception'. Addressing 'organizational barriers' and a 'deficiency of knowledge' is a precondition for change. 'Suboptimal communication' and 'inadequate (multidisciplinary) collaboration' play a key role in the extent of change achieved via the themes 'differences in perception' and 'disorganization of processes'. Furthermore, 'personal barriers' influence all themes - except 'organizational barriers' - and influence the extent of change. 'Personal barriers' can cause 'reactive coping', which in turn may lead to 'difficulties t structure processes'.Conclusions A framework was created explaining the relationships between barriers towards achieving change in nursing homes, focused on improving quality of care. This framework can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing it in order to achieve change in the provided care.

Introduction:Little is known about the raising number of specialized units for patients with dementia and very severe challenging behavior in the Netherlands. This study describes organizational and treatment characteristics of a sample of these units.Methods:The organizational and treatment characteristics were studied with digital questionnaires completed by the unit managers, interviews with the main physician(s) and observation of the physical environment. The questionnaire consisted of questions about general patient characteristics, unit characteristics and staff characteristics. Furthermore, an interview was held with the main/treating physician often together with another physician or psychologist. The interview guide consisted of questions about admission criteria, the role of staff involved and the treatment process.Results:Thirteen units participated. Five units were part of a mental health (MH) institution, seven units were part of a nursing home (NH) organization and one unit was a cooperation of MH and NH. Unit sizes ranged from 10 to 28 places. Ten of thirteen units started in 2010 or later. The age of patients admitted was estimated at 75 years. The percentage of involuntary admitted patients was 53% at MH-units and 18% at NH-units. Unit managers mentioned that due to a difference in reimbursement between MH and NH units had difficulty providing the specialized care. Another problem managers faced was recruiting nursing staff. Units strived for expertise in general staffing from both MH and NH. The education level of the nursing staff was comparable between MH and NH. At every unit a physician with background in elderly care medicine or geriatrics and a psychiatrist was involved. Interviewees stressed the role of the nursing staff in the treatment. They were key in providing the care and treatment that, since the main goal of interventions is treatment of and coping with challenging behavior.Conclusion:The main finding of this study is that units caring for patients with dementia and challenging behavior, despite barriers in regulations and staffing shortage, search for combining expertise from nursing home care and psychiatry in their treatment.

Background:Although formal treatments like antidepressants and psychotherapy may effectively reduce depression in nursing home residents, side effects and poor treatment adherence are common. To improve depression care, it is important to also learn from informal strategies already used successfully in daily practice, alongside or in absence of formal treatment. For example, although not prescribed as formal treatment, a care provider may seat a resident with depression at a table near the window. This may have antidepressant effects due to extra day light or pleasant views from the window.Objectives:To identify, categorize, and prioritize informal antidepressant strategies for residents already used in daily practice as reported by residents themselves, their relatives, and professional caregivers.Method:In the first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies to prevent or improve depression that may be performed by residents themselves. In the second study, the same participants (N = 110) reported on strategies others involved in residents’ lives could perform. In a second round of both studies, participants rated the expected effectiveness (N = 54, N = 51 respectively) and feasibility (N = 50 for both studies) of the strategies mentioned. In addition, strategies for both studies were sorted based on similarity in meaning by experts.Results:Six clusters appeared for actions to be undertaken by residents themselves, and five clusters for actions by others. The results showed that, for strategies by residents, the clusters ‘Being socially connected’ and ‘Participating in activities’, and for strategies by others, the cluster ‘Offering personal attention’ stand out the most in terms of high expected effectiveness. The cluster with strategies executed by residents that stood out as the most feasible was ‘Having a healthy living environment’. The most feasible clusters performed by others were ‘Offering personal attention’, ‘Using positive treatment/approach’, and ‘Using or adapting the physical environment’.Conclusion:By using an innovative bottom-up participatory approach, this research shed light on various clusters of useful informal antidepressant strategies for daily practice. To test effectiveness and implementation, research is needed on these antidepressant strategies and their regular use in care.

Item does not contain fulltext AIMS: To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long-term care facilities and primary healthcare for the ageing population (primary aim) and to describe what influences the implementation (secondary aim). BACKGROUND: Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians. DESIGN: A systematic literature review. DATA SOURCES: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL, Web of Science; searched January 1995-August 2015. REVIEW METHODS: Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary. RESULTS: Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level. CONCLUSION: Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions.

Bij ouderen die kwetsbaar worden voor verdere verstoring van hun gezondheid, zelfredzaamheid, autonomie, regie en welbevinden, kan met het Easycare Instrument integraal zicht verkregen worden op de verschillende domeinen van somatisch, functioneel, maatschappelijk, psychisch en communicatief functioneren. Bij herhaalde afname helpt het instrument bij te houden welke verandering zich hierin voltrekt. Complexe zorg wordt dan overzichtelijker.

Item does not contain fulltext BACKGROUND: In recent years, there has been an increasing focus on the role of evidence-based practice (EBP) to increase the quality and safety of care. However, EBP implementation research has predominantly taken place in hospitals and hardly in nursing homes or home care. In these care settings, patients are attended by nursing assistants and registered vocationally trained nurses. A good EBP starting point is to assess their current attitude toward and use of EBP. However, current questionnaires are not valid for assistants and nurses with vocational education. AIMS: To adapt the Evidence-Based Practice Attitude Scale (EBPAS) and the Evidence-Based Practice Questionnaire (EBPQ) to a Dutch questionnaire for nursing assistants and registered vocationally trained nurses European Qualification Framework level 3-4 employed in home care or nursing homes. METHODS: Translation, adaptation through cross-cultural validation, pretesting, exploratory factor analysis, and evaluation of psychometric properties among a group of nursing assistants and registered vocationally trained nurses. RESULTS: Cross-cultural validation led to modified items of EBPQ and EBPAS. The sample comprised 273 nurses. Analysis of both instruments showed a robust factor structure. EBPAS-ve: internal consistency: alpha = 0.76; intra-rater reliability: ICC = 0.52. EBPQ-ve: alpha = 0.75; ICC = 0.60. Convergent validity (correlation EBPAS-ve and EBPQ-ve's subscale Attitude): r = .300 (p < .01). Construct validity: significantly higher scores (p < .01) in the group with higher education. LINKING EVIDENCE TO ACTION: Psychometric qualities of both instruments were satisfactory, although we recommend refinement of EBPAS-ve's subscale Divergence and extra instructions for the EBPQ's subscale Attitude. To our knowledge, this is the first adaptation of an EBP measurement instrument for nursing assistants and registered vocationally trained nurses. The questionnaires appeared to be feasible and showed multiple valid and reliable properties, including a satisfactory intra-rater reliability. Both questionnaires may facilitate the implementation of EBP as they contribute to a richer understanding of the attitude toward and use of EBP in nursing homes and home care.

Background More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. Methods In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. Results In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. Conclusions The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The establishment of a clear vision on primary healthcare for older people, including the organisation of proactive healthcare, is necessary to optimise the impact of skill mix change. Electronic supplementary material The online version of this article (10.1186/s12875-018-0746-1) contains supplementary material, which is available to authorized users.

Contains fulltext : 136104.pdf (Publisher’s version ) (Closed access) BACKGROUND: The objective of this study was to evaluate implementation of an innovative intervention designed to prevent complications and stimulate early rehabilitation among frail elderly inpatients. METHODS: The program was implemented in April 2011. A mixed-methods process evaluation and before-after study were performed. Primary effect outcomes included incidence of hospital-acquired delirium, cognitive decline, and decline in activities of daily living (ADL) during hospital stay. Secondary endpoints included ADL performance 3 months postdischarge, readmission, and caregiver burden. RESULTS: One hundred ninety-one preintervention and 195 postintervention patients aged 70 years or older were included. Overall, no significant differences in primary endpoints were found. Mean ADL between discharge and follow-up improved (3.2 vs 5.7, P = .058). Caregivers rated burden of care lower at 3 months postdischarge (.5 vs -.6, P = .049). CONCLUSIONS: The CareWell in Hospital program was implemented satisfactorily. Although the low baseline delirium incidence (11%), higher comorbidity, and an increasing learning curve during a restricted implementation period potentially influenced the overall effects, this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients.

RATIONALE, AIMS AND OBJECTIVES: Process evaluation is a highly essential element for the increasing number of studies regarding multi-component interventions. Yet, researchers are challenged to collect and present appropriate process outcomes in such way that it is easy and valuable to be used by other researchers and policy makers in interpreting and comparing intervention effects because of the absence of standards for conducting and publishing process evaluation. This article describes the development of a method to concisely summarize the results of process evaluations of complex multi-component interventions. METHODS: Development of a graph with the aim to facilitate the reporting of process evaluation's results, based on a narrative review of the literature for process measures used in complex interventions for elderly people. RESULTS: Seventeen articles of process evaluations alongside effect studies of complex interventions were reviewed. From these articles, it was found that process evaluations should address whether the intervention (1) was implemented successfully; (2) was evaluated properly; and (3) can be continued in the future. A flow chart based on the essential components of an adequate process evaluation was developed. A simplified but highly informative figure reporting a summary of the results of the process evaluation is proposed and its use is explained by administering the figure to two studies including a process and effect evaluation of a complex intervention. CONCLUSION: A graphical approach - which includes the core results of process evaluation and can be used directly in reporting effectiveness studies - will help researchers and policy makers to interpret and compare effects of complex multi-component interventions.

Given our aging society with an increasing number of frail elderly patients, we must provide integrated care tailored to their complex needs regarding health and well-being. The aim of this study was to develop and validate a questionnaire designed to assess how frail hospitalized elderly patients experience several important aspects of individualized and integrated care. An 8-item questionnaire was developed using input from a panel representing the target group and administered to patients age ≥70 years from surgical, medical, and geriatric departments to measure data characteristics, internal consistency, test-retest reliability, construct validity, and responsiveness. A total of 470 questionnaires were returned, including 78 for test-retest reliability. Data were missing from 1.7% to 7.0% within the individual questions. The percentage of questions answered with "don't know" ranged 3.8% to 21.9%. Cronbach's α for internal consistency was 0.70. Test-retest intraclass correlation was 0.75. Achievement of goals during the hospital stay was significantly correlated with the questionnaire score. Scores did not differ significantly between departments or between the before and after measurements related to an innovative intervention study in healthcare delivery. The CareWell in Hospital questionnaire has good content validity, internal consistency, and test-retest reliability and warrants further research to explore responsiveness.

ObjectivesThis study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.DesignA multiple-case study was conducted that draws on realist evaluation principles.SettingSeven nursing homes in the NetherlandsParticipantsThe primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78).Data collectionData collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.ResultsAn optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.ConclusionsCollaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.

Het groeiende aantal ouderen in Nederland vraagt om innovatieve oplossingen om deze groep goede zorg te (blijven) bieden. Een van deze oplossingen ligt mogelijk in taakherschikking, waarbij taken van artsen uitgevoerd worden door andere professionals zoals verpleegkundig specialisten en physician assistants.

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 as of the total Nurses’ Observation Scale for Cognitive Abilities and its subscales were 0AE98 and 0AE66–0AE93, respectively. The item–total correlations were satisfactory (overall > 0AE4). The intra-class coefficients were good (37 of 39 items > 0AE4). 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 (0AE59–0AE70, p except for IQCODE (0AE30, p > 0AE05). The divergent validity of the Nurses’ Observation Scale for Cognitive Abilities against depressive symptoms was low (0AE12, p > 0AE05). The construct validity of the Nurses’ Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0AE18–0AE74; 10 of 13 correlations p 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.

In cases of cognitive decline not due to delirium, the daily observation of cognitive function by nurses has not been standardised in hospital wards specialised in the care of older people. A qualitative study with purposive sampling and semi-structured interviews. Methods. Data were obtained by interviewing 10 Dutch nursing experts in the field of cognitive function in older patients. The interviews were recorded, transcribed and analysed by two independent researchers. All the respondents stated that daily observation of cognitive function yields valuable information. The concept of cognitive function was operationalised differently by institute and by nurse. Observation and reporting methods varied, as did the goals set by the nurses. Nurses reported using many days of observation to reach final judgements. Observations of cognitive functioning should include several cognitive domains, be restricted to a few days of observation and aim to both contribute to medical diagnoses and guide nursing interventions.

Contains fulltext : 52120.pdf (Publisher’s version ) (Closed access) BACKGROUND: Patients with leg ulceration often have long lasting and recurrent wounds. The treatment exists mainly of wound-care and compression therapy. International literature shows several indications of problems in relation to leg ulceration, but no studies were performed to give a comprehensive overview of all problems identified and care received related to these problems. OBJECTIVES: The aim of the study was to describe leg ulcer-related problems in patients with leg ulcers based on venous insufficiency or a mixed aetiology. Furthermore, an inventory of current care and care deficits in the care for leg ulcer patients was made. METHODS: The study had a descriptive, cross-sectional design. A sample of 141 patients was taken from the population of outpatient clinics of seven hospitals in the Netherlands. Data were collected through patient interviews, questionnaires and wound-observations. Medical information was provided by the dermatologist or derived from the patients' medical file. RESULTS: The study identified a number of serious problems. Main problems were pain (85%), outdoor mobility (47%) and problems in finding appropriate footwear (60%). Statistical analysis showed no differences between patients with ulcers based on a venous aetiology and ulcers based on mixed aetiology. Fifty to seventy percent of the patients did not receive any care in relation to these problems. Only a rather small proportion of the patients, however, regarded the help as insufficient. CONCLUSION: Care at outpatient clinics is mainly focused on wound care and compression therapy. Pain treatment and care related to problems encountered by patients appears to be insufficient. This is not only affecting the patient's quality of life, but is likely to affect also the healing process and prevention of leg ulcers. Nurses and dermatologist should take their responsibilities in this matter.

AIM: This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. BACKGROUND: Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking. DESIGN: A quantitative systematic literature review using Cochrane methods. METHODS: The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands. DISCUSSION: This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people.

Item does not contain fulltext OBJECTIVES: To develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DESIGN: Questionnaire development. SETTING: Twelve university and teaching hospitals. PARTICIPANTS: Thirteen experienced geriatric nurses and three geriatricians from 12 hospitals evaluated an initial version of the questionnaire. Two hundred seventy-one nurses, primarily registered nurses from 11 geriatric, medical, and surgical departments in six hospitals, validated the final questionnaire. MEASUREMENTS: Items from two published instruments were extracted for use in the questionnaire. Content validity was confirmed using the Delphi technique with an expert panel. Internal consistency was measured by calculating Cronbach alpha; intrarater reliability was measured using test-retest correlations and intraclass correlation coefficients (ICCs); differences between hospital departments were analyzed using analysis of variance. Sensitivity to detect before-and-after changes with implementation of a geriatric care program was determined using the Student t-test. RESULTS: Consensus was reached after three Delphi rounds. The GerINCQ is a self-administered questionnaire to be filled out by hospital nurses that comprises five subscales with 67 items. It has good content validity (each item content validity index >0.9) and good internal consistency (Cronbach alpha = 0.86). Intrarater reliability revealed high test-retest results (ICC = 0.87). The questionnaire detected significant differences between nurses in three types of hospital departments (medical, surgical, and geriatric (P < .01). The GerINCQ was sensitive to changes after an educational program (P < .02) and had a large effect size (0.5). CONCLUSION: The GerINCQ is a reliable and valid tool and is sensitive to change over time. It is clinically relevant because it provides a quantitative measure of hospital nurses' geriatric practices, attitudes, and perceptions. Moreover, the GerINCQ is suitable for monitoring progress after implementation of geriatric improvement programs.

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Contains fulltext : 47601.pdf (Publisher’s version ) (Closed access) BACKGROUND AND AIMS: Home parenteral nutrition (HPN) is a therapy that changes life radically and often means lifelong dependence on parenteral feeding. The aim of this study was to gain insight into problems experienced by adult patients who were dependent on long-term HPN. METHODS: A survey was performed on all patients at the ambulatory care clinics of two university centres. We used two techniques: written questionnaires and interviews. The questionnaires addressed fatigue (CIS), quality of sleep, anxiety, depression (BDI), social impairment (subscale SIP68), and sexual functioning. Data were analysed descriptively. Structured interviews inquired about the negative influence of HPN dependence on daily life. These data were quantified by content analysis. RESULTS: The response rate was 76% (n = 48). Questionnaire results: all the respondents had multiple physical symptoms, which they attributed to the underlying disease. Furthermore, severe fatigue (63%), sleeping disorders, (severe) depression (65%), social impairment (55%), and sexual disorders (33%) were present. Quality of life (QoL) correlated with fatigue, sleeping disorders, anxiety, depression, and social impairment (P