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Aim: To uncover and understand the core elements of how nurses in psychiatric hospitals make contact with patients experiencing suicidal ideation. Design: A qualitative study based on the principles of grounded theory was performed. Methods: Nineteen nurses on wards of four psychiatric hospitals were interviewed between May 2017 – February 2018. The Qualitative Analysis Guide of Leuven was used to facilitate the constant comparison of data. Findings: Nurses make contact with patients experiencing suicidal ideation by "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients". These interconnected core elements represent nurses' attention to relational processes like building trust as well as their predominant focus on assessing suicide risk. Nurses put other emphases in their contacts with patients depending on whether their approach is guided more by checking and controlling suicide risk or by acknowledging and connecting (with) the person. Conclusion: The study enhances the conceptual understanding of how nurses on psychiatric wards can involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. These findings can be used to underpin the nurses' role in and contribution to suicide prevention. Impact: The core elements "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients" can inform policies for nursing practice and education that aim to preserve and improve the capacity of nurses to involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. [ABSTRACT FROM AUTHOR]

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses' actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element 'promoting and preserving safety and a life‐oriented perspective'. This core element represents the three interconnected elements 'managing the risk of suicide', 'guiding patients away from suicidal ideation', and 'searching for balance in the minefield'. The enhanced understanding of nurses' actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses' capacity and ability to connect and collaborate with patients experiencing suicidal ideation. [ABSTRACT FROM AUTHOR]

Aim: To reflect on Lean experts' perspective on components of Lean management in health care and its implications for practice. Background: The involvement of Lean experts is one of the key succes factors of a sustainable Lean transformation in health care. Methods: Thirteen Lean experts participated in two focus groups. They all had experience in the implementation of Lean in healthcare organizations. Results: Lean experts all seem to have a unique perspective on Lean management in health care. Experts without a healthcare degree appear to focus more on the entire management system, where experts with a nursing degree seem to concentrate more on the soft Lean principles. Conclusion: It seems plausible their professional background appears to have an influence. Implications for Nursing Management: In selecting a Lean expert, nurse managers may want to gauge what elements the Lean expert tends to emphasize. It seems plausible to opt for a Lean expert without a healthcare degree to accomplish the Lean transformation as they have a broader view on Lean. It may also be useful for managers to involve several Lean experts, all with complementary perspectives and backgrounds. [ABSTRACT FROM AUTHOR]

Pressure ulcers are a global issue and substantial concern for healthcare systems. Various types of support surfaces that prevent pressure ulcer are available. Data about the effectiveness and cost of static air support surfaces and alternating air pressure mattresses is lacking. To compare the effectiveness and cost of static air support surfaces versus alternating air pressure support surfaces in a nursing home population at high risk for pressure ulcers. Prospective, multicentre, randomised controlled clinical, non-inferiority trial. Twenty-six nursing homes in Flanders, Belgium. A consecutive sample of 308 participants was selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair bound, aged > 65 years, and use of an alternating air pressure mattress. The participants were allocated to the intervention group (n = 154) using static air support surfaces and the control group (n = 154) using alternating air pressure support surfaces. The main outcome measures were cumulative incidence and incidence density of the participants developing a new category II–IV pressure ulcer within a 14-day observation period, time to develop a new pressure ulcer, and purchase costs of the support surfaces. The intention-to-treat analysis revealed a significantly lower incidence of category II–IV pressure ulcer in the intervention group (n = 8/154, 5.2%) than in the control group (n = 18/154, 11.7%) (p = 0.04). The median time to develop a pressure ulcer was significantly longer in the intervention group (10.5 days, interquartile range [IQR]: 1–14) than in the control group (5.4 days, [IQR]: 1–12; p = 0.05). The probability to remain pressure ulcer free differed significantly between the two study groups (log-rank X² = 4.051, df = 1, p = 0.04). The overall cost of the mattress was lower in the intervention group than in the control group. A static air mattress was significantly more effective than an alternating air pressure mattress in preventing pressure ulcer in a high-risk nursing home population. Considering multiple lifespans and purchase costs, static air mattresses were more cost-effective than alternating air pressure mattresses. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage, especially incontinence-associated dermatitis, continues to present significant health challenges and requires multidisciplinary input to provide effective prevention and treatment. In the absence of mandatory reporting such damage is under- or wrongfully reported, resulting in a lack of accurate data on prevalence and costs of associated care. In March this year, a multidisciplinary team of experts met in the UK to seek to determine measures to improve patient skin care. They aimed to identify activities to increase awareness and education, collect data, and improve prevention and treatment regimes. This article describes that discussion and the conclusions made by the group, such as the key actions required to effect policy changes. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage, especially incontinence-associated dermatitis, continues to present significant health challenges and requires multidisciplinary input to provide effective prevention and treatment. In the absence of mandatory reporting such damage is under- or wrongfully reported, resulting in a lack of accurate data on prevalence and costs of associated care. In March this year, a multidisciplinary team of experts met in the UK to seek to determine measures to improve patient skin care. They aimed to identify activities to increase awareness and education, collect data, and improve prevention and treatment regimes. This article describes that discussion and the conclusions made by the group, such as the key actions required to effect policy changes. [ABSTRACT FROM AUTHOR]

Aims: Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies. Background: No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care. Evaluation: Sixty studies were identified for the final analysis. Key Issue(s): Some Toyota Way principles appear more deeply embedded in health care institutions than others are. Conclusion: Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse. Implications for Nursing Management: This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level. [ABSTRACT FROM AUTHOR]

Objective: To explore nurses' self-perceived behavior of supporting patients' self-management, and its association with person-related and socio-structural factors.Methods: Correlational study in a sample of nurses from nine general hospitals, three community healthcare organizations, and six private community practices. Nurses with >50% of their patients living with a chronic condition were eligible to participate. Data were collected at two time-points. Self-management support behavior was measured by the SEPSS-36 instrument. The person-related and socio-structural associated factors were derived from behavioral theories and measured by validated questionnaires.Results: Nurses (N=477) scored overall low on self-management support behavior. Nurses lacked mainly competencies in collaborative goalsetting, shared decision making and organizing follow-up. Factors predicting nurses' behavior in supporting patients' self-management were self-efficacy, priority, perceived supervisor support and training in self-management support. This model explained 51.7% of the variance in nurses' behavior.Conclusion: To date, nurses do not optimally fulfil their role in supporting patients' self-management. Self-management support is practiced from a narrow medical point of view and primarily consists of informing patients, which is the lowest level of patient participation.Practice Implications: It is essential to better prepare and support nurses - and by extend all healthcare professionals - for the challenges of supporting patients' self-management. [ABSTRACT FROM AUTHOR]

Background Chronic conditions put a heavy burden on healthcare in every country. Supporting persons with a chronic illness to take an active role in the management of their condition is a core component in the Chronic Care Model. It implies confidence and good skills from professionals. To date, there is no evidence on final year nursing students’ performance in supporting patients’ self-management, nor on factors associated with this performance. Objectives To explore self-reported performance of supporting patients’ self-management by final year nursing students, and person-related factors associated with this performance. Design A correlational multi-centre study of final year nursing students (N = 256) from eight nursing schools. Methods Students were recruited from a convenience sample of eight nursing schools. All final year students were invited to participate. Data were collected between January 2015 and May 2016 using self-administered validated questionnaires. Theoretical behavioural frameworks were used to select hypothesized associated factors for self-management support: self-efficacy to perform self-management support and socio-structural factors (Social Cognitive Theory); needs for autonomy, competence and relatedness, and patient-invested contingent self-esteem (Self-Determination Theory); and attitudes towards supporting patients’ self-management (Theory of Planned Behaviour). Results Final year nursing students (N = 256) reported an overall low level of performance in delivering self-management support during internship. Students lacked mainly competencies in collaborative goal setting and shared decision making. Students reported a significant gap between their confidence and their actual performance in self-management support (p < 0.001). About 33% of the variance in students’ performance is predicted by four person-related factors, i.e. self-efficacy to perform self-management support, general feeling of competency on internship, belief on patients’ knowledge about condition management, and contingency of a student’s professional self-esteem upon patients’ achievements. Conclusion Final year nursing students are actually not ready to support patients’ self-management even though they will soon be in practice as qualified nurses. Nursing curricula should be further attuned to the complex competencies of self-management support. Special attention is needed to broaden the perspective on self-management support. Learning opportunities can be introduced in classroom activities and on internship. [ABSTRACT FROM AUTHOR]

Aim To increase the knowledge of the frequency and intensity of symptoms and the treatment interventions in older palliative cancer patients. Background Research on symptoms and the treatment modalities in older palliative cancer patients is scarce. Insight into these aspects is needed to enable healthcare professionals to alleviate the burden. Design A cross-sectional study. Methods Four hundred hospitalized older palliative cancer patients participated in the study between March 2013 - February 2015. Two validated instruments were used to assess 40 symptoms in multiple domains and collect data on the treatment modalities in older palliative cancer patients. Results Patients reported on average approximately 14 symptoms. Dry mouth, physical fatigue, lack of energy, lack of appetite and difficulty moving outside were the most prevalent. Psychological pain, psychological fatigue, lack of willpower, lack of energy and physical fatigue were reported as intensive. On average, 5·15 disciplines were consulted per patient. Few patients were referred to a palliative support team, spiritual consultant or psychologist. Patients received a variety of interventions to increase life expectancy and alleviate symptoms and the side effects of treatment. The occurrence of symptoms was associated with different clinical and treatment variables such as having a geriatric risk profile. Conclusions Older patients receiving palliative cancer care are confronted with multiple symptoms. Psychological symptoms are more often reported as intensive. Greater attention should be given to the early referral of patients to palliative care teams, assessment and management of multiple symptoms, particularly psychological symptoms. [ABSTRACT FROM AUTHOR]

Background Accurate detection of symptoms is essential in palliative care. Identification of clustering of symptom is valuable to develop target interventions. This area is largely understudied in older palliative cancer patients. Objectives To identify symptom clustering in older palliative cancer patients, and patient groups based on the clustering of symptoms, and to evaluate the difference in functional dependence and experiencing life as not meaningful between the identified patient groups. Design A cross-sectional study. Setting Geriatric and non-geriatric wards of seven acute care hospitals. Participants 400 palliative cancer patients aged 65 years and older. Methods Symptoms were collected using a validated instrument which assesses physical, psychological, functional, social, and existential symptoms by means of a structured interview with a researcher. An agglomerative hierarchical clustering analysis was used to analyse the data. Results The cluster analysis revealed five groups of symptoms: (1) urological and gastrointestinal symptoms, and their treatment complications, (2) psychological and existential symptoms, (3) pain, constipation, sleeplessness and airway problems, (4) functionality problems, and (5) fatigue-related symptoms. Three patient groups were identified: (1) symptom-free group, (2) physical discomfort group, and (3) physical and psychological discomfort group. In the last group, significant more patients had a geriatric risk profile and less of them received chemotherapy. Patients in this group were more often functionally dependent and experienced their life as not meaningful. Conclusion Five groups of symptoms were identified. Three patient groups were identified which reported different levels of functionality and experiencing life as meaningful. Healthcare professionals should be triggered to detect symptom clusters and be alert to the presence of the other symptoms in the cluster when identifying one symptom. They should also be alert to patients with a geriatric risk profile because of their higher risk of experiencing physical and psychological symptoms and the influence these symptoms have on being functionally dependent and experiencing life as not meaningful. [ABSTRACT FROM AUTHOR]

Background: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. Objectives: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. Design: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). Setting: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. Participants: In total, 464 nursing home residents and 118 healthcare professionals participated. Methods: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture. Results: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F = 16.4, P = 0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P = 0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F = 15.12, P < 0.001). [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is one of the clinical manifestations of moisture-associated skin damage. It is a common problem in community dwelling patients with faecal and/or urinary incontinence, and IAD management is an important challenge for community nurses. The aim of this practice focused article is to provide a brief update about the evidence of: (1) the pathophysiology of IAD, (2) the differentiationbetween IAD and pressure ulcers, and (3) the prevention/treatment of IAD. Recommendations for patient care in the community is described with reference to a patient case study. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a common skin disorder in patients with faecal and/or urinary incontinence. The past decade has seen a huge growth in publications focusing on the complexity and inconsistency of the clinical observation of IAD and the differentiation between IAD and pressure ulcers. IAD and superficial pressure ulcers cause confusion in clinical practice when trying to determine the true nature and underlying pathology of the lesion. It is a daily challenge for health professionals in hospitals, nursing homes and community care to maintain a healthy skin in patients with incontinence. The aim of this article is to provide a brief update on recent developments regarding the differentiation between pressure ulcers and IAD and the prevention of IAD. Recommendations for clinical practice and research are provided. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a common skin disorder in patients with faecal and/or urinary incontinence. The past decade has seen a huge growth in publications focusing on the complexity and inconsistency of the clinical observation of IAD and the differentiation between IAD and pressure ulcers. IAD and superficial pressure ulcers cause confusion in clinical practice when trying to determine the true nature and underlying pathology of the lesion. It is a daily challenge for health professionals in hospitals, nursing homes and community care to maintain a healthy skin in patients with incontinence. The aim of this article is to provide a brief update on recent developments regarding the differentiation between pressure ulcers and IAD and the prevention of IAD. Recommendations for clinical practice and research are provided. [ABSTRACT FROM AUTHOR]

The article discusses the development of core outcome sets (COS) for skin diseases, which are standardized sets of outcomes and measures to be collected in research studies. The lack of uniformity in outcomes for skin diseases hinders the comparison of research findings and optimal patient care. Historically, COS have had limited stakeholder involvement and lacked geographic diversity. However, recent projects have expanded stakeholder involvement and incorporated novel methodologies to ensure more representative COS. The article emphasizes the importance of training materials for patients and patient representatives. Overall, the move towards methodological innovation and broader stakeholder involvement in COS development aims to standardize outcomes and improve their uptake in clinical practice. [Extracted from the article]

The article discusses the importance of clinical trials contributing to evidence-based knowledge, practice and informed clinical decision making. It is noted that the Grading of Recommendations Assessment, Development and Evaluation (GRADE) cannot be applied for the same health condition. It is noted that a crucial aspect of the design of a clinical trial is the choice of the outcome measure to be studied.

Background: The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. Therefore, the primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-guidelines in four ICUs.Methods: A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Proportion of nursing shifts with documented PAD-assessment (PAD-QIs) were retrieved from the electronical medical chart from included adult ICU patient-stays in four participating ICUs. Difference between the two time periods was assessed using generalised mixed model for repeated measures with unstructured covariance matrix, and presented as Beta (B) with 95% confidence interval (CI).Results: Finally, 1049 ICU patient-stays were analysed; 534 in Before and 515 in Intervention. All three PAD-QIs significantly increased in Intervention by 31% (B = 30.7, 95%CI [25.7 to 35.8]), 26% (B = 25.8, 95%CI [19.4 to 32.2]) and 34% (B = 33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively.Conclusion: A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, particularly as social distancing impacts clinical education and training and new approaches are needed. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusion Implications for the profession Impact Reporting method Patient or public contribution The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.A co‐design development process was conducted.This study consisted of two consecutive stages (November 2020–December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high‐quality, patient‐centred care by advanced practice nurses in the years to come.This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e‐)portfolios. The competency framework can guide policymakers when establishing Belgian’s legal framework for advanced practice nurses. The authors have adhered to CONFERD‐HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework. [ABSTRACT FROM AUTHOR]

Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three‐stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test‐retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients' perceptions of contact experiences with nurses (CoNuPaS‐experience) and what they find important in that contact (CoNuPaS‐importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self‐determining individual, encountering nurses' availability/information‐sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78–1.00); test‐retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient‐nurse contact in mental health wards is central to improving understanding of nurses' contributions to suicide prevention and suicidal ideation treatment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: The nurse–patient relationship in mental health care is an important focus of mental health nursing theories and research.There is limited evidence about which factors influence nurse‐sensitive patient outcomes of the nurse–patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse–patient relationship in nursing practice and nursing education. What this paper adds to existing knowledge?: To our best knowledge, this is the first study to examine associations between nurse‐sensitive patient outcomes of the nurse–patient relationship and a range of patient characteristics and relationship‐contextual factors.In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse‐sensitive patient outcome scale. What are the implications for practice?: Having insight into the factors associated with nurse‐sensitive patient outcomes of the nurse–patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse–patient relationship, trying to influence outcomes of nursing care. Introduction: The lack of evidence on patient characteristics and relational‐contextual factors influencing nurse‐sensitive patient outcomes of a nurse–patient relationship is a possible threat to the quality and education of the nurse–patient relationship. Aim: To measure nurse‐sensitive patient outcomes of the nurse–patient relationship and to explore the associations between nurse‐sensitive patient outcomes and a range of patient characteristics and relational‐contextual factors. Method: In a multicenter cross‐sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse‐Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results: Overall, patient‐reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion: The results may help nurses to become more sensitive and responsive to factors associated with nurse‐sensitive patient outcomes of the nurse–patient relationship. Implications: The nurse‐sensitive results can support nurses in designing future nurse–patient relationships. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges and opportunities of the successful management of pressure ulcers, and mentions European Pressure Ulcer Advisory Panel guidelines for the treatment of the same; and impact of international guidelines on the health policies and clinical practice of the same.

Objectives: To explore the notion of patient‐invested contingent self‐esteem (Pa‐CSE) and investigate its association to nurses' self‐reported engagement in controlling or autonomy‐supportive interactions with chronic care patients. Background: Considering the high number of patients sub‐optimally managing their chronic condition, nurses might experience a drop and rise in self‐worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention. Design: Multivariate analysis employing cross‐sectional data according to STROBE guidelines. Methods: Self‐reports among nurses employed in chronic care (N = 394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted. Results: Success‐based and failure‐based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients' successes with feelings of professional success and self‐worth and patients' failures with feelings of professional failure, shame and inadequacy. Nurses' self‐esteem is fairly interwoven with patients' achievements in the management of their chronic condition. A success‐based orientation was positively related to autonomy‐supportive care in case a failure‐based orientation was low. Nurses with a simultaneous success‐based and failure‐based orientation interacted in a more controlling way. Conclusions: The findings of this study suggest that basing one's self‐worth on patients' accomplishments may be a double‐edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self‐worth is not interwoven with patients' failures. In fact, having both success‐ and failure‐oriented contingent self‐worth is related to a more pressuring approach. Relevance to clinical practice: To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients' behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations. [ABSTRACT FROM AUTHOR]

Background: Social media (SoMe) might be an alternative platform for communicating critical care topics to implement evidence-based practice in the intensive care unit (ICU). This survey aims to describe ICU nurses' and physicians' use of SoMe in general, and their perception of using closed Facebook-groups for receiving content on critical care topics.Methods: A cross-sectional, web-based, anonymous survey was distributed to ICU physicians and nurses in four ICUs in autumn 2017 via an email-campaign. Descriptive statistics with rates, percentages and median numeric rating scale (NRS) scores, interquartile ranges are presented.Results: The response-rate was 64% (253/ 394) including 210 nurses and 43 physicians. Overall, 93% had a SoMe-profile, and 77% had a profile on more than one network site. Facebook was the most used social network site, with 87% having a profile. Totally, 68% were daily users, but more nurses used Facebook daily vs physicians (81% vs 60%, respectively, P = 0.006). Nurses were also more positive toward being members of closed Facebook-groups aimed to exchange content on critical care topics (median NRS 9 (6-10) vs 6 (3-9), respectively, P = 0.014).Conclusion: The majority of ICU nurses and physicians were active SoMe users, mainly for personal purposes, and Facebook was the most popular SoMe. Nurses used Facebook daily more frequent and were more positive toward content on critical care topics on Facebook than physicians. These findings might be relevant to customize future communication about critical care topics via SoMe. [ABSTRACT FROM AUTHOR]

Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi‐structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self‐maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self‐maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self‐maintenance and positively influence their self‐development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers' self‐development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the National Service Framework for diabetes, which was introduced in Great Britain in 2001 to implement a set of national standards to develop a patient-centered service for diabetic foot care and for people with diabetes. They are supportive of the aims and objectives of the framework but suggest that its guidelines have not been implemented nationally and that more needs to be done to improve diabetic foot care.

Accessible Summary: What is known on the subject?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse–patient relationship.Collecting nurse‐sensitive patient outcomes is a strategy to provide outcomes of a nurse–patient relationship from patients' perspectives.Because there was no validated scale, the Mental Health Nurse‐Sensitive Patient Outcome‐Scale (six‐point Likert‐scale) was recently developed and psychometrically evaluated. What the paper adds to existing knowledge?: This is the first study using the Mental Health Nurse‐Sensitive Patient Outcome‐scale to measure nurse‐sensitive patient outcomes of the nurse–patient relationship in psychiatric hospitals. Moderate to good average scores for the MH‐NURSE‐POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60).Our results are consistent with the patient‐reported effect(s) of relation‐based nursing in qualitative research.The scores generate evidence to support the outcomes of the nurse–patient relationship and implicates that further investment in (re)defining and elaborating nurse–patient relationships in mental healthcare is meaningful and justified.More comparative patient‐reported data can determine how nurse‐sensitive patient outcomes are affected by the patient, nurse, and context. What are the implications for practice?: Demonstrating patient‐reported outcomes of the nurse–patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self‐awareness and cultural sensitivity, can be pivotal to achieving the patient‐reported outcomes for inpatients with mental health problems. Introduction: Identifying patient‐reported outcomes of the nurse–patient relationship is a priority in inpatient mental healthcare to guide clinical decision‐making and quality improvement initiatives. Moreover, demonstrating nurse‐sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. Aim/Question To measure nurse‐sensitive patient outcomes of the nurse–patient relationship. Method: In a multicentred cross‐sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse‐Sensitive Patient Outcome‐Scale (MH‐NURSE‐POS). The MH‐NURSE‐POS consists of 21 items (six‐point Likert‐scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. Results: Participants displayed moderate to good average scores for the MH‐NURSE‐POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Discussion The results demonstrate that patients perceive the nurse–patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. Implications for Practices: Patient‐reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse–patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in‐ and outside mental healthcare. [ABSTRACT FROM AUTHOR]

In this article the author discusses 2014's Stop Pressure Ulcer Day, which will be held on November 20th, and on guidelines on the treatment and prevention of pressure ulcers which have been issued by the European Pressure Ulcer Advisory Panel and the United States National Pressure Ulcer Advisory Panel. He is supportive of the guidelines and of the role that Stop Pressure Ulcer Day will play in raising awareness about pressure ulcers and improving patient care.

Abstract: In a mental healthcare that embraces a recovery‐oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role‐related competences in clinical practice. The aim of this study was to clarify and understand these self‐perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role‐related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role‐related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self‐assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training. [ABSTRACT FROM AUTHOR]

Abstract: There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health‐care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health‐care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health‐care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self‐preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self‐preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well‐being. [ABSTRACT FROM AUTHOR]

Objectives To identify peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services. Design Review of qualitative and quantitative studies. Data sources A comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch. Review methods All articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ statement. Results Eighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers’ perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals’ negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies. Conclusions This review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles. [ABSTRACT FROM AUTHOR]

The authors reflect on the use of randomized controlled trials and on whether they are the best source of evidence-based information which can be used in wound care. They suggest that randomized controlled trials are considered to provide the best evidence for wound care. They argue that while the trials are beneficial evidence based wound care should not be restricted to evidence obtained solely from the trials and from meta-analyses.

The authors reflect on the need for evidence-based practice in wound care. They suggest that that transferring and implementing guidelines for wound management into daily routine is complex. They argue that medical personnel need to decrease confusion about wound diagnosis, assessment, treatment and reassessment, and improve the quality of research on wound management to increase clinicians’ confidence about treating wounds effectively.

Background: Patient‐centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses' and patients' perceptions of the support and provision of patient‐centred care is limited and focuses solely on nurses and patients working and staying on surgical wards. Aims and objectives: Comparing patients' and nurses' perceptions of patient‐centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context‐related variables are associated with these perceptions. Design: Cross‐sectional design. Methods: Data were collected in ten Flemish (February–June 2016) and two Dutch (December 2014–May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient‐centred care, it is described using the term 'individualised care.' Results: Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections. Conclusion: Nurses perceived that they supported and provided individualised care more compared with patients. Relevance to clinical practice: Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient. [ABSTRACT FROM AUTHOR]

Background: The prevalence of pressure injuries among community-dwelling older adults in countries worldwide is still a serious problem. In Indonesia, older adults mostly rely on family members for (medical) care. Therefore, involving family members in the prevention and treatment of pressure injuries (PIs) could potentially decrease its prevalence rates. However, family members are usually not trained for such tasks. Hence, it is essential to first get more insight into the current state of affairs on family members' knowledge, attitude and actual practice of preventing PIs. Due to the lack of an existing instrument to measure knowledge, attitude and practice of family caregivers in preventing PIs, this study focuses on the development and evaluation of psychometric properties of such an instrument. Methods: Three phases of instrument development and evaluation were used, including item generation, instrument construction and psychometric testing of the instrument. A total of 372 family caregivers of community-dwelling older adults who randomly selected participated in this study. Principal factor analysis, confirmatory factor analysis and Cronbach's alpha were performed to evaluate factor structure and internal consistency of the Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) instrument. Results: The final version of the KAP-PI-instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach's Alpha values of 0.83, 0.93 and 0.89, respectively. The instrument appeared to be both reliable and valid. Conclusion: The KAP-PI instrument can be used in family nursing or community nursing practice, education, and research to assess knowledge, attitude and practice of pressure injury prevention of family caregivers. [ABSTRACT FROM AUTHOR]

Aim: To gain insight into which elements of the interpersonal care relationship (IPCR) are perceived as occurring (less) frequently and as (not) disturbing from the perspective of hospitalized older patients. Design A cross‐sectional study in three Belgian hospitals. Methods: A convenience sample of patients aged 75 years or older admitted to a non‐geriatric ward were recruited between May 2017 and April 2019. The Interpersonal Geriatric care relationship (InteGer) tool was used to identify elements of the IPCR and was completed by the researchers through structured patient interviews. Results: The mean total scale score for frequency was 3.74 (SD 1.51) [range 0–12]. On subscale level, the highest mean score was in the accessibility and the lowest mean score in the humanization subscale. Statistically significant differences between the hypothesized and experienced disturbance were observed in 18 of the 30 items. Ten items score in the category 'no action needed' (not occurring, not disturbing), nine items in the category 'remain attentive for patient experiences' (occurring, not disturbing), 10 items in the category 'further analyses or monitoring needed' (not occurring, disturbing) and one item in the category 'urgent action needed' (occurring and disturbing). Conclusion: Participants report mostly positive experiences related to the four subscales of the InteGer, that is, humanization, attentiveness, interest and accessibility. Insights from this study provide important opportunities in the context of care optimization for each category with the main focus on items with high experienced disturbance. Impact The InteGer can be used for monitoring IPCR and formulating action points at ward and hospital level to further improve the IPCR and quality of care. [ABSTRACT FROM AUTHOR]

Objectives To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients. Design Systematic review of qualitative and quantitative studies. Data sources The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles. Review methods Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies. Results Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients. Conclusions Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution. [ABSTRACT FROM AUTHOR]

Purpose: To explore mental health nurses' attitude and self‐efficacy to adult inpatient aggression, and to explore the association with nurse‐related characteristics. Design and Method: Cross‐sectional study in a sample of 219 mental health nurses in nine psychiatric hospitals, with stepwise linear regression analysis to detect predictive models. Findings: Female and less experienced nurses were less likely to blame patients for their behavior. Gender, burnout, secondary traumatic stress, and compassion satisfaction accounted for 26.2% of the variability in mental health nurses' self‐efficacy toward aggression. Practice Implications: There needs to be attention to professional quality of life for mental health nurses, to provide them with of self‐efficacy and a positive attitude toward coping with aggression. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To explore communication difficulties and the experience of loneliness among patients with cancer dealing with fertility issues.Design: Qualitative study based on grounded theory principles.Setting: One university hospital and two general hospitals in Flanders, Belgium.Sample: 21 female and 7 male patients with cancer with potential fertility problems as a result of treatment.Methods: Grounded theory approach using the constant comparison method; data collection (semistructured face-to-face interviews) and analysis occurred simultaneously.Findings: Loneliness was a central theme in the experience of potential fertility loss among patients with cancer. Feelings of loneliness resulted from communication difficulties between the patient and members of his or her social environment or healthcare professionals because of several underlying processes and influencing factors.Conclusions: Loneliness was a strong and common feeling among patients with cancer. Patients, members of their social environment, and healthcare professionals experienced difficulties in communicating about fertility in the context of cancer, leading to patients' feelings of loneliness.Implications for Nursing: Healthcare professionals must be attentive to signs indicating loneliness regarding fertility concerns, and they should provide adequate information and appropriate guidance to support patients. Professionals need further training to improve knowledge and skills. [ABSTRACT FROM AUTHOR]

Background: In‐hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in‐hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR). High‐quality CPR is essential for patient survival and good neurological outcome. Aims and objectives: To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. Design: Manikin‐based single‐blinded randomised controlled trial. Methods: Nursing students (N = 70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2‐minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference. Results: The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P =.043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P =.004). Conclusions: CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable. Mattress type, body weight and hand positioning appear to be significant predictors for adequate chest compression depth. Relevance to clinical practice: A firm surface under the patient is needed during CPR. Special attention must be paid to correct hand positioning during CPR. [ABSTRACT FROM AUTHOR]