Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health.

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.

[Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems in residential homes]. / Het effect van belevingsgerichte zorg op ouderen met cognitieve stoornissen en gedragsproblemen in verzorgingshuizen.

This study investigates the effects of emotion-oriented care on the behavior of elderly people with cognitive impairment and behavioral problems. This approach is mainly based on the validation approach, but uses also insights from other approaches like reminiscence and sensory stimulation. Sixteen homes for the aged with structured day care units were randomly allocated to an intervention or control group. 151 Residents with cognitive impairment and behavioral problems were included in the study. The eight intervention homes received a training program with regard to emotion-oriented care. In the eight control homes usual care was continued. Measurements were performed at baseline and after three, six and twelve months of follow-up (assessment by caregivers and relatives). The primary outcome measure was the change in behavior of the residents. The results of multilevel analyses (overall, subgroup and per protocol) showed no statistically significant, nor clinically relevant effects in favor of the intervention group on the behavioral outcome measures. A possible reason for this is that the intervention did not result in significant contrast between the study groups. There is insufficient scientific evidence yet to justify the implementation of emotion-oriented care in residential homes, for residents with moderate to severe cognitive impairment and behavioral problems, on a large scale. Additional studies are needed in which special attention should be given to the implementation process.

Effects of emotion-oriented care on work-related outcomes of professional caregivers in homes for elderly persons.

OBJECTIVES: A randomized controlled trial was conducted on the effects of emotion-oriented care on professional caregivers in homes for elderly persons. Emotion-oriented care is used in the care for cognitively impaired elderly persons and is mainly based on the validation approach. METHODS: Sixteen homes for the aged were randomly allocated to an intervention or control group. Three hundred professional caregivers were included in the study. The eight intervention homes received a training program in emotion-oriented care. In the eight control homes, usual care was continued. Measurements about job satisfaction, burnout, and sick leave were performed at baseline and after 3, 6, and 12 months of follow-up. RESULTS: Modest positive effects were found in favor of the intervention group. These related to various aspects of job satisfaction and burnout. The effects were not very consistent over time. No differences in sick leave were found. DISCUSSION: From this study, as well as other studies in this field, no strong effects were found of emotion-oriented care on work-related outcomes in professional caregivers. Additional research is therefore needed. In these new studies, special attention should be given to the optimization of the implementation process of emotion-oriented care programs.

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.

Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems.

OBJECTIVE: This study investigates the effects of emotion-oriented care on the behavior of elderly people with cognitive impairment and behavioral problems. This approach is mainly based on the validation approach, but also uses insights from other approaches like reminiscence and sensory stimulation. METHODS: 16 Homes for the aged with structured day care units were randomly allocated to an intervention or control group. 151 Residents with cognitive impairment and behavioral problems were included in the study. The eight intervention homes received a training program with regard to emotion-oriented care. In the eight control homes usual care was continued. Measurements were performed at baseline and after 3, 6 and 12 months of follow-up (assessment by caregivers and relatives). The primary outcome measure was the change in behavior of the residents. RESULTS: The results of multilevel analyses (overall, subgroup and per protocol) showed no statistically significant, nor clinically relevant effects in favor of the intervention group on the behavioral outcome measures. CONCLUSIONS: There is insufficient evidence yet to justify the implementation of emotion-oriented care on a large scale. Additional studies are needed in which special attention is given to the implementation process.

Coping and Quality of Life in relation to headache in Dutch schoolchildren.

The aim of this study was to describe the Quality of Life and pain coping strategies of school children in relation to headache severity. We conducted a cross-sectional study in 2815 children between the age of 9 and 17 years, who filled out Waters' Headache Questionnaire (WHQ), the Paediatric Pain Assessment Tool (PPAT), the Quality of Life Headache in Youth (QLH-Y) questionnaire and the Pain Coping Questionnaire (PCQ) in the class-room setting. Weekly headaches were reported by 22% of the sample. Low, medium, and high headache severity groups were constructed, based on headache frequency, duration and intensity criteria. Results show that children with the highest headache severity report the lowest Quality of Life in general and the lowest Quality of Health, as well as the most problems with regard to physical functioning, impact of headache on daily and leisure activities, physical symptoms other than headache, and social functioning at home. With regard to using pain coping strategies, children with the most severe headaches seek more social support, they internalize and externalize more, they use less behavioural and cognitive distraction techniques, and seek information less.

The cost of illness of pressure ulcers in The Netherlands.

OBJECTIVE: To conduct a cost-of-illness study of pressure ulcers in the Netherlands for different care settings, including home care, nursing homes, general hospitals, and university hospitals. DESIGN: A cost-of-illness study was conducted based on prevalence figures and expert opinion. A differential cost study approach was used, distinguishing among the 4 stages of pressure ulcer severity and the different care settings. To obtain expert opinion, structured interviews were conducted with pressure ulcer experts who were chosen randomly from the membership of the Dutch Society of Pressure Ulcer Experts. Information was gathered on volume of care parameters for each pressure ulcer stage, including personnel, extra days of care, and use of special beds and medical materials. Experts were asked to estimate the percentage of patients for which each care parameter was considered relevant; low and high estimates of each figure were given to determine the range of the calculations. Cost estimates were obtained from Dutch guidelines for cost calculations in health care, then converted to US dollars. SETTING: Home care, nursing homes, general hospitals, and university hospitals in the Netherlands. PARTICIPANTS: Experts on pressure ulcer management working in the different care settings. MAIN OUTCOME MEASURE: Cost-of-illness of pressure ulcers, converted to US dollars. MAIN RESULTS: The cost-of-illness of pressure ulcers ranged from a low estimate of $362 million to a high estimate of $2.8 billion. The most conservative estimate is approximately 1% of the total Dutch health care budget. CONCLUSION: The cost-of-illness of pressure ulcers in the Netherlands is considerable.

Evaluation of skills and knowledge on orthostatic blood pressure measurements in elderly patients.

OBJECTIVES: orthostatic hypotension is a common and potentially dangerous condition in elderly patients, often accompanied by dizziness and falls. To diagnose orthostatic hypotension, many physicians rely on blood pressure measurements performed by nurses. DESIGN: observational and descriptive study. SETTING: departments of Internal Medicine, Geriatric Medicine, and Surgery in eight hospitals throughout the Netherlands. SUBJECTS: 170 nurses working with elderly people in a general hospital. We selected a sample of 10 nurses on 17 participating wards. METHODS: to evaluate nurses' skills and knowledge on blood pressure measurements to diagnose orthostatic hypotension, we performed standardized observations, based on published guidelines, of supine and standing blood pressure determination in patients over 65 years. RESULTS: the most important deviations in technique of orthostatic blood pressure measurement from the published guidelines were: time between measuring supine and standing blood pressure varied from 0-30 minutes; in 28% the arm position was not at heart level during standing blood pressure measurements; in 46% the cuff was placed incorrectly. CONCLUSIONS: the skills and knowledge of nurses to measure supine and standing blood pressure are inaccurate for diagnosing orthostatic hypotension in elderly patients. Large differences in measurement technique and timing of standing blood pressure could influence the individual detection and treatment of orthostatic hypotension and the reported prevalence of orthostatic hypotension. The blood pressure measurement procedure to diagnose orthostatic hypotension needs more standardization and implementation of guidelines in daily practice.

Using ICIDH-2 in the classification of nursing diagnoses: results from two pilot studies.

BACKGROUND: Using ICIDH-2 in the classification of nursing diagnoses: results from two pilot studies Background. As an International Classification of Functioning and Disability, the ICIDH-2 is potentially relevant to the work of all health care professionals. Nurses, however, had little involvement in the development of this classification and have no tradition of using it. AIM: Two pilot studies were designed to explore the fit between ICIDH-2 and the nursing domain. METHODS: In the first study, experts (n=2) and nurses (n=9) were asked to identify and classify patient problems that they observed on a video taped case. In the second study, problem statements from nursing diagnoses (n=199) that had been retrieved from patient files were classified using ICIDH-2. Each problem statement was classified by a panel of three individuals. RESULTS AND CONCLUSION: Results from the two studies suggest that the ICIDH-2 is certainly relevant to the nursing discipline and allows a large majority of nursing diagnoses to be classified. It is recommended that nurses take an active role in the ongoing development of the ICIDH in order to further improve its usefulness to the nursing profession. LIMITATIONS: The studies were small-scale pilots performed in a single medical centre. Preliminary insight resulted from these pilots, but more research is needed.