Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study.

OBJECTIVES: To explore how individuals with spinal cord injury self-manage the prevention and treatment of pressure ulcers and to provide insight into experiences with self-management support. DESIGN: Qualitative study using semi-structured interview and a deductive thematic analysis. SETTING: Community. PARTICIPANTS: Twelve of the 14 participating adults with a spinal cord injury had experience with pressure ulcers, and eight of these had a current pressure ulcer. RESULTS: Respondents suggested to tailor treatment of pressure ulcers to patients' individual wishes and capabilities of patients. Patients and caregivers need to be aware of the importance of determining the cause of pressure ulcers to prevent deterioration. Patients often depend on informal caregivers for follow-up and prevention, and healthcare professionals in non-SCI specialties often lack the knowledge needed to manage pressure ulcers in this specific patient group. Tailored education and peer support are important for patients to set boundaries, be assertive, and cultivate a positive attitude when dealing with pressure ulcers. It is difficult to combine treatment of severe pressure ulcers and preventive measures with work roles. Managing the social impact of pressure ulcers requires more coordination with caregivers. CONCLUSIONS: To support self-management of pressure ulcers in patients with a spinal cord injury, they must find out which preventive measures and treatments suit them best. Healthcare professionals play an important role in the self-management of pressure ulcers and can help patients deal with the emotional and social impact of pressure ulcers. To know patient's needs and tailor their education, healthcare professionals of non SCI organizations need to have knowledge of pressure ulcers management of this specific patient group.

Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: An observational study.

OBJECTIVE: This observational study explores advanced practice nurses' (APN) performance in secondary prevention and self-management support in patients with cardiovascular disease. METHODS: Real-life consultations in three outpatient clinics were recorded on audio and analysed. First, discussed (sub)categories were determined using five categories of self-management: symptom management, treatment, biomedical cardiovascular risk factors, psychosocial consequences, and lifestyle changes. Second, the extent in which motivational interviewing aspects were applied was determined using the Behaviour Change Counselling Index (BECCI). RESULTS: In total, 49 consultations performed by five female APNs were analysed. Physical topics were discussed in 98% and psychological subthemes in 41% of the consultations. Although not all components of motivational interviewing were applied, talking about current behaviour and behaviours that should change were discussed, and information was provided. Especially setting targets and exchanging ideas on how to reach behavioural goals were applied to a small extent. CONCLUSION: Well-trained APNs in the current study do not carry out motivational interviewing in a structural and complete manner according to BECCI and do not discuss all self-management categories. PRACTICE IMPLICATIONS: Psychological topics should be more integrated in providing self-management support by APNs and the application of motivational interviewing should be enhanced by regularly and repeated training.

[Quality of life of nursing home residents with dementia before, during and after playing with a magic table]. / Kwaliteit van leven van verpleeghuisbewoners met dementie voor, tijdens en na het spelen met de tovertafel.

The 'Active Cues Magic Table' is a new game concept within nursing home care. It consists of light animations projected on a dining table and responding to movements of the players. The aim of this exploratory, quasi-experimental study was to examine the quality of life of nursing home residents with moderately severe or severe dementia before, during and after playing with this magic table. Quality of life was assessed with the Qualidem and the DS-DAT. Of the 34 nursing home residents included, 62% were female and mean age was 86.5 years (standard deviation 6.2). The Qualidem showed a small to moderate improvement in 'negative affect', 'restless tense behavior' and 'positive self-image' up to the week after playing (p ≤ 0.04). The DS-DAT showed a moderate improvement up to one hour after playing compared to a quarter of an hour before playing (p < 0.001). In conclusion, the quality of life of nursing home residents with moderately severe or severe dementia seems to improve up to the week after playing with the magic table. However, future research is needed to confirm the results of this exploratory study and to examine whether the improvements can truly be ascribed to the magic table.

[Evaluation by case managers dementia : An explorative practice based study on types and content]. / Evaluatie door casemanagers dementie : Een explorerende praktijkstudie naar vormen en inhoud.

BACKGROUND: This practice based explorative study aims to provide insight into the ways in which case managers shape and fill up the evaluation phase of their support of the informal care network of persons with dementia. METHOD: A combination of quantitative and qualitative research methods were used. A group of 57 case managers of persons with dementia in three different organisational networks took part in this study. RESULTS: Results from the quantitative and qualitative data are organized into four themes: (1) attitude towards evaluation, (2) forms of evaluation, (3) implementation of evaluation and (4) content of evaluation. There are different ways in shaping evaluation and the content of it. The importance of interim and final evaluation is recognized, but is difficult to realize in a methodical way. Barriers experienced by the case managers include various factors associated both with clients as professionals. CONCLUSION: Case managers evaluate continuously and in an informal way to assess whether the extent of their assistance is meeting the needs of the client and informal network. Case managers do not use systematic evaluation to measure the quality of care they offer to persons with dementia and their caregivers. The findings demand a discussion on the level of clients, as well as on the professional and societal level about the way case managers should evaluate their support.

Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.

AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline. BACKGROUND: Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline. METHODS: This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors. RESULTS: Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested. CONCLUSION: Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department. RELEVANCE TO CLINICAL PRACTICE: Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.

Adherence to the guideline 'Triage in emergency departments': a survey of Dutch emergency departments.

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

Effects of a postqualification course in palliative care.

AIM: This paper reports a study to determine the effectiveness of a postqualification course in palliative care in terms of increased knowledge, insight and self-efficacy among Registered and Licensed Practical Nurses. BACKGROUND: The importance of measuring the effectiveness of postqualification courses in palliative care for nurses is widely recognized. The benefits of such courses are often merely described in terms of satisfaction of the course participants. METHOD: A convenience sample of nurses was studied. The effect measurement comprised a pretest/post-test quasi-experimental design. Two instruments were used: a comprehensive variant of the Palliative Care Quiz for Nurses and an especially developed domain specific self-efficacy instrument for palliative care. These were used before and after the course. FINDINGS: The course had a positive effect on knowledge and insight level as well as on level of self-efficacy. The main improvements were related to pain and symptom management. Participants seemed to be able to increase the effects of the course by implementing certain products on the wards, such as clinical lessons, a pain assessment scale and relaxation massage. CONCLUSIONS: Palliative care courses can make a significant contribution to nurses' knowledge and insight, as well as their self-efficacy in providing palliative care.

Design of a postgraduate course in palliative care.

BACKGROUND: Although palliative care is multidisciplinary in nature, nurses play an essential role in terminal care. Because new nurses frequently lack the specific skills for palliative nursing care as well as competence in interdisciplinary practice, there is a need for continuing education in palliative care. This article describes a postgraduate course in palliative care for nurses. METHOD: A postgraduate course was developed based on the needs of palliative patients and the subjective and objective needs of nurses. FINDINGS: Four roles assumed by nurses in palliative care were identified: bureaucratic, biomedical, social-therapeutic, and informal. The actual results of the course were influenced by the contextual aspects, which were determined by the nursing environment. Assignments were formulated according to the needs of the nursing unit, and a number of peer review meetings were organized. CONCLUSION: Successful implementation of a postgraduate course in palliative care increases nurses' expertise and offers an opportunity for nurses to exchange experiences and search for solutions to problems together.