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Introduction: The development of a pressure ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the pressure ulcer preventive interventions used in hospitals. Purpose: The aim of this study was to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals. Methods: A cross-sectional, multi-centre pressure ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure pressure ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention. Results: The total sample consisted of 19 968 patients. The overall prevalence of pressure ulcers Category IeIV was 12.1%. Only 10.8% of the patients at risk received fully adequate prevention in bed and while sitting. More than 70% of the patients not at risk received some pressure ulcer prevention while lying or sitting. Conclusion: Generally, there is a limited use of adequate preventive interventions for pressure ulcers in hospitals, which reflects a rather low quality of preventive care. The implementation of pressure ulcer guidelines requires more attention. The pressure ulcer prevention used in practice should be re-evaluated on a regular basis.

AIMS: The aim of this paper was to detect which non-direct patient care factors are related to nursing workload in acute hospital nursing care and to develop a conceptual model to describe the relationship between the non-direct patient care factors and nursing workload. BACKGROUND: Since the 1930s, efforts to measure nursing workload have been undertaken. Still, it remains unclear which of the non-direct patient care elements are essential to the nursing workload. DATA SOURCES: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Engineering Village 2, Elin and the British Nursing Index were searched from 1970 up to July 2009. REVIEW METHODS: Studies were included in this integrative review if they described factors that are related to nursing workload or if they presented models that explored the association between potential factors, excluding the factors related to direct patient care. RESULTS: Thirty publications were included. The influencing variables were classified in five categories based on their level of impact: the hospital and ward, nursing team, individual nurse, patient and family and meta-characteristics. The variables were also classified, based on their cause-effect relationship. Some factors have a direct impact on the patient-nurse relationship, while others have an effect on the work fluency or on the subjective perception of the nursing workload. A conceptual model was built, based on the interaction between both classifications and derived from the systems theory. CONCLUSIONS: Nursing workload has a multi-causal aetiology. The influencing factors from this review can be integrated in a workload measurement tool.

Background & aims: In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence. Methods: A cross-sectional, multi-centre study in elderly wards of Belgian hospitals. The nutritional status was assessed using the Mini Nutritional Assessment. A standardised questionnaire was used to record demographic data and data on potential factors associated with malnutrition. Results: Out of 2329 elderly patients, 33% suffered from malnutrition. Almost 43% of the patients were at risk of malnutrition and 24% were well-nourished. Having swallowing difficulties, taste difficulties, and being transferred from a nursing home were strongly associated with being malnourished. Conclusion: The malnutrition prevalence in Belgian elderly hospitals wards is similar to international figures. Elderly who have swallowing difficulties, taste difficulties, or coming from a nursing home may need adequate nutritional care. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy. (C) 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Introduction: Pressure ulcers are a serious complication of hospitalisation in terms of increased morbidity, mortality and health care expenditure as well as patient suffering. Multipathology and ageing make older patients vulnerable to pressure ulcers. The main aim of this study was to obtain insight into the adequacy of preventive measures for pressure ulcers in Belgian geriatric hospital wards. Methods and Materials: The setting for this cross-sectional multicentre prevalence study consisted of the Belgian geriatric hospital wards. All hospitals were invited to participate in this study. The methodology to measure pressure ulcer prevalence developed by the EPUAP was used. Results: The total sample consisted of 3222 geriatric patients (70 hospitals). The prevalence of pressure ulcers category 1–4 was 18Æ9% and of category 2–4 12Æ3%. Sacrum (45Æ4%) and heels (43Æ2%) were the most frequently affected locations. Only 12% of the at risk geriatric patients received fully effective prevention. The majority of the at risk patients (73%) received partly adequate prevention. Generally, a higher percentage at risk patients received effective prevention in an armchair (36Æ5%) than in bed (28Æ3%). Conclusion: The pressure ulcer prevalence in Belgian geriatric hospital wards was high according to international standards. Regretfully, the adequacy of pressure ulcer prevention in geriatric hospitals was suboptimal. Only one out of 10 patients at risk for pressure ulcers received fully adequate prevention. Conversely, many patients not at risk received some kind of preventive measures which was an unnecessary and expensive strategy. Barriers for adequate preventive pressure ulcer care such as knowledge, motivation, attitude, priority, and availability of equipment may partly explain these low figures. A challenge for the hospitals is to disseminate and implement pressure ulcer guidelines to individual wards and to address barriers.

Introduction: Malnutrition is a frequently occurring health-problem in eldery patients and has a number of consequences for both the patient and the hospitals, hence the significant need to track and treat malnutrition adequately. The aim of this study was to optimize nutritional care in acute geriatric settings. This was realized through an improved prospecting, the identification of malnourished patients and by conducting an adequate nutritional policy. Methods and Materials: A practice oriented research was conducted throughout 6 months on eight different geriatric wards in 2008. Malnutrition was traced by means of the Mini Nitritional Assessment. The attitude of the nurse staff was measured by means the Nutritional Nursing Care scale (SANN). Finally general patient characteristics were collected using a questionnaire. Results: The study included 634 geriatric patients. One out of three were undernourished on admission. The prevalence increased with the age of the patient and the presence of underlying diseases, e.g. cancer, dementia or a cerebro-vascular accident. The nutritional status of each geriatric patient was assessed and those who were malnourished (or had an increased risk) received a multidisciplinary treatment approach. Follow up took place by observing nutrition intake and weight evolution. A raised awareness was realized among the nursing staff by education. Despite the positive behaviour change, the attitude of the nurses did not show the expected alteration. A neutral attitude was found at the end of the study in the majority of the nursing staff. Conclusion: The practice oriented research allowed to implement evidence-based guidelines successfully. Success could be explained by the aim to fit the organization structure and the constructive dialogue with the different stakeholders. Feasible, individualized strategies were adapted to the ward and acquired by the nursing staff. This offered an optimal guaranty toward permanent quality enhancement.

Introduction: New communication tools – in particular internet – provide access to guidelines. The strength of the evidence supporting specific recommendations and their intellectual independence is not always guaranteed. Lack of time, lack of skills in critical appraisal or understanding of research language or other tools are mainly responsible for the fact that professionals make their own ‘local’ recommendations, only based on experts’ opinions. The aim of this study is to select best practice evidence-based guidelines and to put them at the nurses’ disposal in their own language. Materials and Method: The method was essentially based on literature review of best practice guidelines validated by nurses’ associations (Finland, Ontario, CBO, HAS), the Cochrane Collaboration Library, Medline, CINAHL, BNI. Only the guidelines of the last 7 years has been be explored. Each guideline has been assessed by AGREE, Shaneyfelt, Grilli & Cluzeau tools. Additional criteria have been used to assess the quality of the guidelines. All steps of guidelines selection were performed by two researchers. To put the recommendation at the nurses’ profession disposal a website has been developed. Results: Six main topics have been developed: disorientation, nausea and vomiting, wound care, sedation, diabetes, nutrition. A special attention was focused on geriatric care at hospital. For each topic, four guidelines are selected based on appraisal tools and additional criteria. The website was accessible since July 2009 at the URL address: http://www.sesa.ucl.ac.be/guidelines. According the satisfaction study, all users would recommend the website to a colleague and 9 respondents of 10 found the website very useful. Conclusion: The website is a tool in order to have an access at the evidence based information. This is a first step of a long process. The website was considered very useful by users. But, a next question is the implementation the evidence based guidelines in clinical work. Th

(résumé de BeST1, dont le présent rapport est une extension) Nombre d’échelles d’évaluation des besoins en soins sont utilisés dans les hôpitaux sans que leur validité et fiabilité soient prouvées. Dans le cadre de la révision de l’outil d’enregistrement de l’activité infirmière (DI-RHM) en Belgique, l’utilisation d’échelles valides et fiables est recommandée afin d’objectiver les problèmes de santé des patients, choisir les interventions adéquates et en évaluer les résultats. Le but du projet BEST est d’identifier les échelles fiables et valides dans la littérature scientifique et les mettre à disposition des praticiens de l’art infirmier. Pour ce, une procédure standardisée d’interrogation des bases de données scientifiques a été élaborée : par item, (1) revue systématique de la littérature sur base d’équations de recherche, (2) lecture critique des articles par 2 chercheurs indépendants, (3) Quorum Flow diagram détaillant le processus de sélection des articles, (4) analyse des articles retenus détaillant l’échelle, (5) rédaction d’une table d’évidence par article et par échelle. In fine, par échelle sélectionnée, un tableau récapitulatif reprend : objectif de l’échelle, public cible, résultats de validité et de fiabilité, remarques et références complètes, ainsi que l’outil. Actuellement, des échelles fiables et valides sont ainsi à disposition pour : douleur, nausées/vomissements, fatigue, sédation, soins de bouche, surveillance neurologique, évaluation cognitive, prévention des plaies de decubitus, désorientation, évaluation fonctionnelle et psychosociale. Le site web www.best.ugent.be constitue le produit final. Il permet la consultation et la recherche d’outils scientifiquement valides. Différents méthodes de consultation sont possibles : par mots clés, item, nom d’échelle, auteur, public-cible,... La réactualisation et la complétion du site sont prévues à l’agenda. Ce projet fait l’objet d’un nouveau financement visant d’une part à actualiser les données col

Dans le cadre d’un budget limité, d’une pléthore de sources scientifiques (dont la qualité et l’indépendance ne sont d’emblée garanties) et de l’évolution rapide des connaissances scientifiques, le nombre important de directives de bonnes pratiques, le plus souvent en anglais, est source de confusion et de perte de temps pour le praticien au chevet du patient. Où trouver les recommandations ? Comment et sur base de quels critères les sélectionner ? Comment les interpréter ? Cette recherche vise à sélectionner les recommandations de bonnes pratiques infirmières fondées sur des données scientifiques probantes, pour les mettre à la disposition des praticiens de l’art infirmier dans leur propre langue. Trois étapes structurent la méthode : (1) étude exploratoire auprès des praticiens de l’art infirmier exerçant en milieu hospitalier pour identifier leurs besoins prioritaires en termes de recommandations. (2) revue de la littérature ayant pour objet de recenser les recommandations de bonnes pratiques infirmières reposant exclusivement sur des données scientifiques probantes. (3) traduction des recommandations en français et/ou néerlandais pour les mettre à disposition des professionnels infirmiers, selon les modalités les plus appropriée sur base d’une étude exploratoire. Les résultats attendus de ce projet sont l’identification des besoins en termes de recommandations de bonnes pratiques pour la profession infirmière en milieu hospitalier, la mise à disposition de recommandations fondées sur les données probantes, la création d’un interface informatique pour la mise à disposition et l’évaluation de la satisfaction des usagers.