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Involving mental healthcare patients in nursing handover practices seems a promising method for increasing patient participation, empowerment, and shared decision-making but is hardly found in practice. An explorative review on bedside handovers in mental health care was conducted. Searched databases included CINHAHL, Web of Science, PubMed, and Embase. The search strategy yielded 3126 articles. Nine articles met the inclusion criteria and were included in this review. Pre- and post-implementation perspectives were described, as well as strategies for implementation. After the implementation of bedside handover, nurses and patients experienced more time spent together and a greater sense of involvement with the care plans could be noticed. Being involved in bedside handovers facilitates active participation and open dialogue between nurses and patients. This accelerates the opportunities for patients to take part in shared decision-making and feel recognised as experts in their illness experience. More research on possible differences in effectiveness across different patient diagnoses is recommended. Involving patients in mental health care in handover practices seems a promising method but limited research has been done to explore the meaning it has to mental healthcare nurses and patients. • Being involved in bedside handovers facilitates active participation and open dialogue. • Patients can take part in shared decision-making and feel recognised. • An enhancement of the therapeutic relationship can be noticed after implementation. [ABSTRACT FROM AUTHOR]

To explore the perception of mental healthcare workers about participation of inpatients during multidisciplinary team meetings (MTMs) and to determine which demographic and contextual factors are associated with this perception. A cross-sectional multicentre study in 17 psychiatric hospitals with 701 mental healthcare workers was performed between 29 April and 19 May 2019. For measuring the perception of the mental healthcare workers, the Patient Participation during Multidisciplinary Team meetings Questionnaire was used. 93 % of the mental healthcare workers indicate that they are willing to allow patients to participate in a MTM. Most mental healthcare workers prefer an active role for the patient when participating in a MTM (93 %) and a collaborative role for the patient when making decisions in a MTM (75 %). Level of education, discipline, experience with patient participation in MTMs, working in a team where patient participation is applied, and recent training on patient participation, are associated with the mental healthcare worker's perception on patient participation in MTMs. Mental healthcare workers report a great willingness to involve inpatients in MTMs. However, social workers, nurses, and pedagogues feel less competent and are less positive about the effects of patient participation in MTMs. Mental healthcare workers with recent training in patient participation and experience in patient participation in MTMs feel more competent and believe more often that the patient should fulfil a more autonomous role when participating in a MTM. These results can be used to understand and improve patient participation in MTMs in mental healthcare. • Mental healthcare workers are willing to involve inpatients in MTMs • Eight out of ten mental healthcare workers feel capable to involve inpatients in MTMs • Nurses, pedagogues and social workers feel less competent and are therefore less willing to involve inpatients in MTMs • Experienced and trained mental healthcare workers tend to give more autonomy to the patient when participating in MTMs [ABSTRACT FROM AUTHOR]

To reflect on current practice analyses regarding the role of advanced practice nurse (APN) researcher in oncology, and report on the challenges that were faced and lessons we have learned when intensively working with APNs on doing research within the domain of oncology. Discussions with APNs supervised by or who collaborated with academics in nursing science during the past 10 years on doing research within the domain of oncology. Several misconceptions exist regarding the role of APNs as researchers. During the research process, APNs are confronted with a wide range of topics based on evidence gaps and unmet needs, challenges linked to specific research designs, and ethical issues. APNs also face challenges related to the dissemination of research. This step in the research process is often overlooked due to APNs' lack of time, limited financial resources, insufficient support for academic writing, or lower priority for APNs and other healthcare providers. The APN role of researcher in oncology is fundamental for the advancement of oncology nursing care, implementation of evidence‐based practice and innovations in oncology patient care, and further development of the nursing profession and nursing science. Participation in research is considered a main function that differentiates APNs from nurses in other clinical roles, such as specialized nurses. By embracing the role of researcher, oncology APNs can achieve professional growth that will stimulate them as an APN, open new opportunities, and keep them challenged. In addition to APN, organizational and structural related factors, support by relevant stakeholders, partnering with (nursing) research units and professional and patient organizations, and dedicated time for research can positively influence uptake of the APN researcher role. [ABSTRACT FROM AUTHOR]

Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways. [ABSTRACT FROM AUTHOR]

Purpose: Most patients with congenital heart disease (CHD) need lifelong cardiac follow-up. Transitioning to adulthood and transferring to adult-focused care are often challenging. We explored the experiences and needs of adolescents with CHD and parents during the entire transitional process, including the post-transfer period. Design and methods: We performed a qualitative study according to the phenomenological approach, focusing on adolescents with CHD and parents. Semi-structured interviews were carried out with patients (n = 9) and parents (n = 12) after being transferred to adult care facilities. Data were analyzed with inductive thematic analysis. Data collection and -analysis of both samples were done separately in a first step, after which results were merged to discover common themes. Results: Five common themes were identified: 1) Having mixed feelings about leaving pediatric care; 2) Being prepared and informed; 3) Shifting responsibilities and roles; 4) Being accompanied during consultations; and 5) Gaining trust in new healthcare providers. Conclusion: Adolescents with CHD and parents express a need for adequate preparation and personalized guidance to reduce anxiety and uncertainty during transition. The process may benefit from focusing on improving the adolescents´ transitional skills and disease-related knowledge, which may, in turn, facilitate handing over responsibilities and adapting to new roles by the parents. Adolescents appreciate the presence of parents during the consultation, albeit with reduced input. Finally, a transition coordinator and a joint transfer consultation involving the pediatric cardiologist seem paramount for a fluent transitional process, especially in establishing new treatment relationships. • Adolescents and parents have mixed feelings about leaving pediatric care. • Adolescents and parents seem to be less anxious about the transfer if they are well prepared and informed. • Improving the adolescents´ disease-related knowledge is reassuring for parents. • Joint transfer consultations and a transition coordinator seem to be of great importance for a fluent transitional process. [ABSTRACT FROM AUTHOR]

Insight was sought in how a childhood cancer experience plays a role in daily life of adolescents and young adults (AYA) survivors. A qualitative research in which semi-structured interviews were held with 21 AYA survivors of childhood cancer between the ages of 14 and 25. The AYA survivors were recruited from two pediatric oncology departments of two university hospitals in Belgium. The current situation and behavior of AYA-survivors who have been treated for childhood cancer are covered in 5 categories: The Feeling of Being Different while Aiming for Normalcy in Relationships, Living with Existential Uncertainty, The Conscious Protection of Health, The Attachment to the Parent(s) with Whom the Cancer Experience was Shared, and The Desire to Be Meaningful to Others. The AYA survivors did not feel that their cancer experience dominated their current daily life, yet, the cancer experience had an important impact on their functioning. The findings of the study can be used to optimize holistic psychosocial care of AYA survivors. By starting from the key elements in their current functioning, health care professionals can tailor their support to the way in which AYA survivors have integrated their cancer experience into their everyday lives. • Dealing with the late effects of cancer influences the AYA survivor's functioning. • Survivorship issues do not interfere with the AYA's feeling of progression in life. • Health practitioners need insight in the self-reported experiences of AYA survivors. [ABSTRACT FROM AUTHOR]

The process of education and counselling of patients treated with oral anticancer drugs, aimed to achieve adequate self-management, involves different stakeholders (i.e. physicians, oncology nurses, pharmacists) from primary and secondary care. However, currently no guiding principles exist on how to organize and perform education and counselling for these patients. Therefore, the purpose of this study was to develop and build consensus on key elements for the education and counselling in patients on oral anticancer drugs. A multi-method approach combining a literature search, semi-structured interviews with patients and healthcare professionals, and input from experts were used to develop an initial list of key elements. Subsequently, consensus was built in a two-round Delphi-study, involving patients and healthcare professionals from primary and secondary care. Key elements were retained if at least 80% of respondents in all groups considered the element as important or if in at least one group 90% consensus was reached. The initial list contained 110 key elements, divided in 7 themes: coordination of care, patient contacts: style and content, medication counselling at the start of the treatment and during follow-up, psychosocial support, and involvement of family and friends. After the first Delphi round, 80% consensus was reached for 23 elements; 6 new key elements were added. After the second round, 80% consensus was reached for 51 out of 116 elements; 31 elements were added following the 90%-rule, yielding a list of 82 elements. The final list of 82 key elements, obtained in this study, could be used to develop clinical pathways that guide adequate education and counselling of patients on oral anticancer drugs. Due to the open description, the implementation of these elements can be adapted to the specific context and composition of the oncology team. • Consensus among patients and healthcare professionals from primary and secondary care was obtained for 82 key elements. • The key elements are divided in themes based on the six dimensions of patient-centered care from the Institute of Medicine. • The implementation of each key element can be adapted to the specific context and composition of the oncology team. [ABSTRACT FROM AUTHOR]

Highlights • Preconception health care in men gains insufficient attention in comparison to women. • Increasing the focus on preconception health care in men could be beneficial for the role of women, pregnancy outcomes, and for preparing men for parenthood. • The intention to make preconception lifestyle changes amongst men was measured with a new questionnaire. • The overall intention to make preconception lifestyle changes was high. • Attitude, self-efficacy and social influence were associated with overall intention. • No socio-demographics were associated with overall intention. • Intervention should mainly focus on emphasizing the fact that men also have an important role in preconception health care. Abstract Objective To determine which socio-demographic and psychosocial factors are associated with the intention for preconception healthily behavioral changes in the general population of reproductive-aged men. Design A cross-sectional, multicenter study. Setting Four secondary schools, 4 Public Centers for Social Welfare, 7 Community Health Centers, and online. All data was collected in the X. Participants A convenience sample of 304 reproductive-aged men were recruited between July 2015 and July 2016. Measurements and Findings An existing questionnaire was adapted and validated to assess the intention, self-efficacy, attitude, social influence, knowledge, and barriers towards 10 preconception health behaviors. Simple and multiple logistic and linear regression analyses were performed. The overall intention to make preconception lifestyle changes was high (median score: 0.7 on the 0–1 scale). The multiple linear regression revealed that self-efficacy (p < 0.001), social influence of the close social environment (p = 0.02), and attitude (p = 0.05) were associated with a higher intention score. Experiencing negative emotions and beliefs about pre-pregnancy preparations was associated with less intention for preconception health behaviors (p = 0.001). None of the socio-demographic factors was significantly associated with the intention score. Key Conclusions The overall intention to make preconception lifestyle changes was high, and associated with different psychosocial factors including self-efficacy, social influence, and attitude. Implications for Practice Preconception interventions should target the identified factors to improve preconception health behaviors in men and negative emotions and beliefs about preconception. Interventions about preconception health care should primarily suggest that men bear the same responsibility as women, which will address the current gender politics and could have -in second instance- a positive outcome on pregnancy outcomes. Because socio-demographic characteristics were of no influence, a general approach should be used. [ABSTRACT FROM AUTHOR]

Pressure ulcers have a high impact on patients and their families. Profound and up-to-date knowledge among nurses is important given the effect on attitudes and preventative behaviour. To gain insight into educational needs and priorities, regular knowledge assessments are needed. To gain insight into the knowledge of nurses and nursing assistants about pressure ulcer prevention. Cross-sectional multicentre study. 474 nurses and nursing assistants recruited at 29 wards in 16 hospitals completed individually the PUKAT 2.0, a valid and reliable questionnaire to measure nurses knowledge about pressure ulcer prevention. Data were collected between February 2016 and December 2017. Independent sample t-tests, one-way analyses of variance and Kruskal-wallis tests were performed to analyse the results. The mean total score was 50.7%. The lowest scores were found in the themes knowledge about prevention (42.7%), aetiology (45.6%) and prevention for specific patient groups (46.6%). Higher educational level (H = 40.43, p < 0.001) and attending additional training about pressure ulcers or wound care in general (t = 2.93, p = 0.004) resulted in significant higher total knowledge scores. The results of this study highlight an important knowledge deficit about pressure ulcer prevention. The PUKAT 2.0 knowledge assessment tool made it possible to differentiate between a variety of cognitive process levels. This allowed to identify knowledge gaps and focus areas for continuing professional education. Education curricula for nurses and associated healthcare professionals are to be screened thoroughly and the identified knowledge gaps should be covered. Besides, multifaceted strategies are needed to improve clinical practice. • The mean total knowledge score about PU prevention was 50.7%. • Mean knowledge score decreased when the cognitive level of the question increased. • Nurses scored significant higher than nursing assistants. • Additional training in PU or wound care resulted in significant higher scores. [ABSTRACT FROM AUTHOR]

Although skin tears are among the most prevalent acute wounds in nursing homes, their recognition as a unique condition remains in its infancy. Elderly patients are at risk of developing skin tears due to increased skin fragility and other contributing risk factors. In order to provide (cost-) effective prevention, patients at risk should be identified in a timely manner. (1) To determine the point prevalence of skin tears and (2) to identify factors independently associated with skin tear presence in nursing home residents. A cross-sectional observational study was set up, including 1153 residents in 10 Belgian nursing homes. Data were collected by trained researchers and study nurses using patient records and skin observations. A multiple binary logistic regression model was designed to explore independent associated factors (significance level α < 0.05). The final sample consisted of 795 nursing home residents, of which 24 presented with skin tears, resulting in a point prevalence of 3.0%. Most skin tears were classified as category 3 (defined as complete flap loss) according to the International Skin Tear Advisory Panel (ISTAP) Classification System and 75.0% were located on the lower arms/legs. Five independent associated factors were identified: age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings. This study revealed a skin tear prevalence of 3.0% in nursing home residents. Age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings were independently associated with skin tear presence. • This study was the first prevalence investigation of skin tears in Belgian nursing homes. • Skin tear prevalence was 3.0%. • Age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings were independently associated with skin tear presence. • Our findings may enable benchmarking, contribute to timely identification of patients at risk, and support the selection of specific preventive interventions. [ABSTRACT FROM AUTHOR]

Highlights • Governmental funding is vital for advanced midwife practitioner role implementation. • Managers’ positive attitude towards such roles is crucial for implementation. • Policymakers stressing the necessity of these roles could facilitate implementation. • Obstetricians considered the implementation of these roles as a possible threat. • Participants seldom discussed population healthcare needs as implementation drivers. Abstract Objective To explore factors influencing the implementation of advanced midwife practitioner roles. Design Semi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method. Setting and participants A purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians. Findings Budgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers’ and midwives’ attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations’ heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles. Key conclusions and implications for practice Multiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful. [ABSTRACT FROM AUTHOR]

Abstract Study aim The aim of this study was to develop a Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD), to psychometrically evaluate and pilot test the instrument in nursing homes. Comparable to the MDS for pressure ulcers, the MDS-IAD aims to collect epidemiological data and evaluate the quality of care. Materials and methods After designing and content/face validation by experts and clinicians, staff nurses assessed 108 residents (75.9% female, 77.8% double incontinent) in a convenience sample of five wards. A second nurse independently assessed fifteen residents to calculate inter-rater agreement (p 0) and reliability [Cohen's Kappa (ĸ)]. Results The ĸ-value for 'urinary incontinence' was 0.68 [95% confidence interval (CI) 0.37–0.99] and 0.55 (95% CI 0.27–0.82) for 'faecal incontinence'. The p 0 for severity categorisation according to the Ghent Global IAD Categorisation Tool (GLOBIAD) was 0.60. IAD was diagnosed in 21.3% of the residents. IAD management mainly involved the application of a leave-on product (66.7%), no-rinse foams (49.1%), toilet paper (47.9%), and water and soap (38.8%). Fully adequate prevention or treatment was provided to respectively 3.6% and 8.7% of the residents. Conclusion This instrument provides valuable insights in IAD prevalence at organisational level, will allow benchmarking between organisations, and will support policy makers. Future testing in other healthcare settings is recommended. Highlights • The lack of an internationally standardised tool and procedure can partly explain the widespread epidemiological IAD data. • No tool existed to assess the adequacy of IAD prevention and treatment practices at organisational level. • The MDS-IAD to collect epidemiological data and to evaluate the quality of care was developed rigorously by future users. • The low inter-rater agreement and reliability estimates indicate the need for education and further testing. [ABSTRACT FROM AUTHOR]

Objectives (1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice. Design secondary data analysis of a cross-sectional study about pregnancy planning. Setting six Flemish Hospitals (Belgium). Participants four hundred and thirty women with a planned pregnancy ending in birth. Measurements preconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change. Findings most women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23–3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14–5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04–0.97) or having a lower educational level (OR 0.56, 95% CI 0.32–0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes. Key Conclusions and implications for practice multiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations. [ABSTRACT FROM AUTHOR]

Objective to examine the knowledge, attitude and practices (KAP) of Flemish midwives regarding miscarriage. Design and setting a cross-sectional KAP study was conducted in 28 hospitals in Flanders (Northern region of Belgium) from September 2015 to January 2016. Participants a total of 647 out of 1200 midwives (53.9%) working on maternity, labour and gynaecological wards, maternal and neonatal (intensive) care units, antenatal consultations, and reproductive medicine were recruited. Measurements data were collected using a semi-structured, self-administered questionnaire. Findings the mean knowledge score was 6.31 out of 10. Of all participants, 47% recently cared for couples with miscarriage, and the majority (97%) indicated a key role for midwives in the psychosocial support of those couples. Lack of time, incapability and fear of being overwhelmed by their own feelings were identified as main barriers for psychosocial support. Knowledge was more often evaluated as adequate when miscarriage was included in the midwifery education (31% vs. 17.3%, χ 2 = 12.965, df = 1, p<0.001). Midwives trained for the topic ‘miscarriage’ more often valued their role in miscarriage care (98.8% vs. 94.1%, χ 2 = 11.002, df = 1, p = 0.001). They considered themselves being more capable to provide adequate psychosocial support when feeling sufficiently trained in communicative skills (77.7% vs. 33.8%, χ 2 = 96.574, df = 1, p<0.001). The majority (72.4%) indicated a lack of knowledge regarding miscarriage. Almost 89% expressed a need for extra training. Conclusions and implications for practice midwives in Flanders assist in the care for couples with miscarriage and consider themselves as a key healthcare provider in the psychosocial support. This study highlighted several barriers regarding miscarriage care, e.g. a lack of knowledge and incapability. Adequate training in knowledge and communication skills is important and necessary in order to promote appropriate care to couples experiencing pregnancy loss and increase awareness among all health professionals involved in obstetric care. Further research should investigate to what extent miscarriage is included in the educational midwifery programmes, and how the current healthcare practice regarding miscarriage care is organised. [ABSTRACT FROM AUTHOR]

To provide in-depth insight in stakeholders' experiences with the self-directed co-creation of a care pathway for patients treated with oral anticancer drugs, and to identify influencing factors for the success of the co-creation process that are persistent throughout the prior pilot phase and the scale-up phase. This qualitative process evaluation was performed in 11 Belgian oncology departments participating in a scale-up project. Semi-structured interviews with local coordinators (n = 13) and members of the project teams (n = 19), responsible for the co-creation of the care pathway, were conducted. Data were thematically analyzed. Despite the external support (including group-level coaching and the use of well-defined supportive tools) to promote self-directedness, the co-creation process was perceived burdensome. Three influencing factors were persistent throughout the pilot and scale-up phase: a) shared leadership among the coordinator, physician and hospital management, b) an intrinsically motivated team driven by additional extrinsic factors, and c) a balance between external support and self-directedness. This study shows that the self-directed co-creation of a care pathway is feasible on the condition that important prerequisites are met, including shared leadership and team motivation. More concrete tools, such as a model care pathway, seem needed to increase feasibility of the self-directed co-creation of the care pathway. Yet, these tools should allow tailoring to the specific hospital context. The findings of this study can be useful for further scale-up to other oncology centers, but can also be extrapolated to other healthcare settings. • The self-directed co-creation is perceived burdensome by most coordinators. • Shared leadership between project coordinators, physicians and hospital management is needed. • Intrinsic motivation by the project team should be sufficiently high. • An appropriate balance between self-directedness and external support is crucial. • More concrete or stand-alone tools can enable a self-directed co-creation. [ABSTRACT FROM AUTHOR]

Patient participation is an important topic in mental health and receives increased attention along with deinstitutionalization. No tool exists to measure healthcare worker-related factors that influence patient participation. A three-staged study was conducted to develop and validate the ‘Patient Participation Culture Tool for inpatient PSYchiatric wards’ (PaCT-PSY), and to analyse its psychometric properties ( n = 603). The 60-items tool, comprising thirteen components, showed content validity, strong psychometric properties, and a high internal consistency. The PaCT-PSY measures the patient participation culture on psychiatric wards by exploring healthcare worker's factors influencing patient participation. It enables researchers, practitioners and administrators to develop tailored actions. [ABSTRACT FROM AUTHOR]

Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years. A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes. ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN. ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration. • ONN and APN experience a lonely journey during the integration and execution of their functions • There is a constant search for partners, (medical) knowledge and acknowledgement from the interprofessional team and patients • This search is driven by 3 contextual factors: role ambiguity, team environment and presence/absence of coaching and guidance • Knowledge of expert nursing roles in healthcare professionals and healthcare managers is needed to improve role integration [ABSTRACT FROM AUTHOR]

To investigate factors affecting the co-creation and implementation of care pathways for patients treated with oral anticancer drugs. An explorative qualitative process evaluation was performed at four Belgian hospitals, co-creating and implementing a care pathway for patients on oral anticancer drugs. Semistructured interviews and focus groups were performed by a) local coordinators leading an interprofessional project team during the co-creation and implementation stage, b) external implementation coaches, and c) teams of healthcare professionals with a role in the care pathway. In total, 47 stakeholders were interviewed. Interviews were audio-taped, transcribed verbatim, and analyzed thematically. We found four factors affecting co-creation and implementation of care pathways for patients on oral anticancer drugs. Developing an adequate supporting context using motivated interprofessional project teams of clinical and management staff led by competent coordinators is one important facilitator. Leadership of local coordinators and oncologists is crucial for progressing the co-creation. Other factors included the complexity of the oral anticancer drug intervention, the interprofessional character of the care pathway, and involving primary care. External coaching during co-creation proved an important facilitator. Prior investigation of willingness and motivation to change in clinical and management staff, competent coordinators, and leadership of oncologists are needed. In addition, external support determines the success of co-creating and implementing care pathways for patients on oral anticancer drugs. The complexity of co-creating and implementing a seamless care pathway for patients treated with oral anticancer drugs: a qualitative process-evaluation – highlights. • Oncology centers struggle to organize seamless care for patients on oral anticancer drugs (OACD) • Co-creating and implementing care pathways can be a strategy but is a challenging process • A supporting context and leadership in coordinators and oncologists facilitates co-creation • Aligning work processes in interprofessional teams and involving primary care was difficult • Tailoring care pathways and external coaching determine the success of co-creation [ABSTRACT FROM AUTHOR]

Aim: the concept of 'advanced midwifery practice' is explored to a limited extent in the international literature. However, a clear conception of advanced midwifery practice is vital to advance the discipline and to achieve both internal and external legitimacy. This concept analysis aims to clarify advanced midwifery practice and identify its components. Methods: a review of the literature was executed using Rodgers' evolutionary method of concept analysis to analyze the attributes, references, related terms, antecedents and consequences of advanced midwifery practice. Results: an international consensus definition of advanced midwifery practice is currently lacking. Four major attributes of advanced midwife practitioners (AMPs) are identified: autonomy in practice, leadership, expertise, and research skills. A consensus was found on the need of preparation at master's level for AMPs. Such midwives have a broad and internationally varied scope of practice, fulfilling different roles such as clinicians, clinical and professional leaders, educators, consultants, managers, change agents, researchers, and auditors. Evidence illustrating the important part AMPs play on a clinical and strategic level is mounting. Key conclusions: the findings of this concept analysis support a wide variety in the emergence, titles, roles, and scope of practice of AMPs. Research on clinical and strategic outcomes of care provided by AMPs supports further implementation of these roles. As the indistinctness of AMPs' titles and roles is one of the barriers for implementation, a clear conceptualization of advanced midwifery practice seems essential for successful implementation. Implications for practice: an international debate and consensus on the defining elements of advanced midwifery practice could enhance the further development of midwifery as a profession and is a prerequisite for its successful implementation. Due to rising numbers of AMPs, extension of practice and elevated quality requirements in healthcare, more outcomes research exclusively evaluating the contribution of AMPs to healthcare becomes possible and desirable. [ABSTRACT FROM AUTHOR]

Purpose To develop and validate an instrument to collect data on symptoms (frequency/intensity) in older palliative cancer patients. Methods A four-phase instrument development and validation study was performed. A preliminary version of the instrument was developed through a literature review. Face- and content validity were assessed in a Delphi-procedure with eleven experts. Cognitive interviewing with 24 older cancer patients was performed to enhance content validity of the instrument. Test–retest was performed to assess the stability. Results An 40-item instrument was developed. The Assessment Symptoms Palliative Elderly (ASPE) collects data on frequency and intensity of 24 physical, 10 psychological, 3 functional, 1 spiritual and 2 social symptoms. Content validity was excellent (I-CVI 81.8%–100.0% and S-CVI 92.9%). Cognitive interviewing allowed to improve the content validity. Test–retest showed substantial to almost perfect agreement for 87.5% of the items. No item had poor or fair agreement. Conclusion This study resulted in the development of the ASPE which reflects good properties for face- and content validity and reliability. Cognitive interviewing has a valuable contribution in the validation process. The instrument can be used to gain insight in symptoms in older palliative cancer patients. [ABSTRACT FROM AUTHOR]

Objective: to assess women's interest in preconception care, their organisational preferences, and their preconception-related information and support needs. Design: cross-sectional study design. Setting: participants were recruited online through social media and discussion forums for issues relating to (in)fertility, pregnancy and parenting, and at the Women's Clinic of Ghent University Hospital. Participants: 242 reproductive-aged women with a desire to have (more) children. Findings: the majority of women (75%) wanted to receive preconception care in the future. Gynaecologists (93%) were the preferred source of preconception care, followed by midwives (73%) and general practitioners (63%). Most women wanted information about lifestyle, environmental exposures, working conditions and medical issues. Information needs were higher among women with (history of) mental illness [odds ratio (OR) 3.50, 95% confidence interval (CI) 1.08-11.36], (history of) eye and otolar-yngological problems (OR 2.22, 95% CI 0.95-5.21) and overweight (OR 2.22, 95% CI 1.01-4.93). A few women indicated that they needed preconception-related support. Overweight women reported greater need for lifestyle-related support compared with women of healthy weight (p=0.001). Key conclusions: reproductive-aged women are interested in preconception care, and would prefer to receive this care directly from a professional caregiver. Most women had high preconception-related information needs and lower support needs. Implications for practice: although women reported that they would prefer to receive preconception care from gynaecologists, the results indicate that midwives can also play an important role in the provision of preconception care. They would need further training to improve their knowledge, skills and awareness regarding preconception care. [ABSTRACT FROM AUTHOR]

To evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses' competencies for self-management support. Non-randomized intervention study with mixed-methods evaluation approach (2019–2020). The multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees' attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations). Trainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p =.03), agree (p =.02), arrange (p <.01) phase and partnership skills (p <.01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p =.03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned. The outcome evaluation of the INTENNS training indicated most improvement in nurses' skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals. A training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where 'failure' is allowed and video-interaction guidance. Obligatory training participation can be questioned. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Malnutrition is a common problem in the elderly living in nursing homes. A clear understanding of associated factors is missing. The aim of this study was to evaluate prevalence of malnutrition and to determine factors independently associated with malnutrition in this setting. Methods: A cross-sectional, multi-centre study was conducted in 23 nursing homes in Flanders, Belgium. The nutritional status was assessed using the Mini Nutritional Assessment (MNA). Data on possible associated factors were collected using validated scales. Results: The study included 1188 elderly residents; 38.7% were at risk for malnutrition and 19.4% were malnourished. The presence of a wound/pressure ulcer, a recent hospitalization (<3 months ago), being involved in a tailored nutritional intervention, and suffering from a lower cognitive state were significantly associated with malnutrition. Receiving additional meals provided by family members was negatively associated with malnutrition. Conclusion: Malnutrition is a prevalent problem in nursing homes in Flanders. Systematic screening and well-defined tailored interventions should be further developed and evaluated in this population at risk. [Copyright &y& Elsevier]

To explore patient perspectives of muscle-invasive bladder cancer (MIBC) on how the health care team and their social network can support them during their cancer trajectory. Sixteen semi-structured interviews were conducted with MIBC survivors who underwent radical cystectomies at Ghent University Hospital. The interviews were audiotaped, transcribed verbatim, and analyzed with an iterative content analysis approach. Information to support people affected by bladder cancer (BC) in several aspects of their disease trajectory (eg, shared decision-making and self-management of their urinary diversion) was most important throughout the interviews (although type and source of required information varied). The clinical nurse specialist was important for informational and emotional support because receiving sufficient information might help patients reduce emotional stress. People affected by BC are still reluctant to consult a psychologist, and several barriers were indicated for this. Also physical needs in the early postoperative phase could be reduced with appropriate information. Communication skills of clinicians in the hospital and knowledge of general practitioners about the important aspects of BC care are also important aspects that should be further optimized. Furthermore, peer support groups and family members can offer important support throughout the BC pathway. This study provides an overview of how people affected by BC want to be supported by their health care team and their social network. This overview can serve as a basis to develop educational interventions for both patients and health care professionals to guide restructuring of BC pathways and can also be used to develop future intervention studies to improve BC outcomes. [ABSTRACT FROM AUTHOR]

The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19. To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program. A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate. Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave. Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team – increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out. We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship. • Clinical training is the most important factor in the retention of nursing students • Students with and without internship during CoViD-19 showed high commitment and low intent to leave the study program. • Need-supportive internship experiences and a willingness for the internship coincided with commitment • Feeling compelled to perform internship during CoViD-19 crisis led to intention-to-leave • Assess students' need-based experiences and motivation when making decisions on if and how to organize internships during a crisis. [ABSTRACT FROM AUTHOR]

Midwifery practice is essential in achieving high-quality maternal and newborn care in all settings and countries. However, midwifery practice has become more complex over the past decades. Considerable demands are being placed on midwives to meet increasing epidemiological, socio-economic, and technological challenges. These require a well-trained midwifery workforce ready to shape the care in the near and long-term future. To discuss advanced midwife practitioner role implementation in Belgium as a possible answer to healthcare-related challenges that impact midwifery practice. Furthermore, to stimulate a debate within the profession at all levels in Belgium and in countries considering advanced midwife practitioner roles. The framework by De Geest et al. (2008) served as a basis for discussing the drivers for advanced midwife practitioner role implementation: the legal, policy and economic context, workforce issues, education, practice patterns, and healthcare needs of the population. A legal basis for advanced midwife practitioner role implementation is lacking in Belgium. Remuneration opportunities for the non-clinical part of these roles (e.g. leadership and innovation activities) are missing. It might be challenging for healthcare organisations to support the implementation of such roles, as immediate revenues of non-clinical activities are absent. However, sufficient potential resources are available to fill in future advanced midwife practitioner positions. Additionally, advanced midwife practitioner specific master programmes are being planned in the near future. Although several barriers for the implementation of advanced midwife practitioner roles were identified, a discussion should be held on the opportunities of implementing these roles to facilitate the development of new models of care that meet current and future challenges in midwifery practice and healthcare. After initial discussions amongst midwives in academic, managerial, and policy positions, stakeholders such as obstetricians, general practitioners, associations representing healthcare organisations, and policy makers should be involved as a next step. [ABSTRACT FROM AUTHOR]