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Background: Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision‐making. Objective: To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision‐making. Methods: A qualitative descriptive study was conducted in the TRANS‐SENIOR consortium's collaborative research using semistructured in‐depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven. Findings: Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision‐making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors. Conclusions: Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision‐making. However, their preferences for greater involvement in decision‐making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age‐tuned and person‐centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment. Patient or Public Contribution: Older persons' representatives were involved in designing the TRANS‐SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated how patients with COVID‐19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges. Design: A qualitative research approach was adopted, including focus group discussions and semi‐structured interviews. Methods: Four different groups of participants were interviewed, that is, patients (n = 17), TM teams (n = 27), GPs (n = 16), and primary care nurses (n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis. Results: All participants agreed that RPM‐reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow‐up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID‐19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM. Conclusion: Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low. Clinical relevance: Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID‐19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging logistics within projects, lack of data integration and communication, and a lack of an overarching guiding framework. [ABSTRACT FROM AUTHOR]

PURPOSE: This study explored how well the Nursing Interventions Classification (NIC) covers adult inpatient psychiatric care. METHODS: By systematic analyses and a mapping approach, documented nursing interventions were assessed on concurrencies with the NIC. FINDINGS: From 2,153 intervention descriptions in nursing notes, 1,924 were recognizable as NIC interventions, and 229 did not match the NIC. 89.4% of all identified descriptions of interventions were recognizable as NIC interventions on the level of definition. CONCLUSIONS: This study demonstrates that the NIC describes adult inpatient psychiatric care to a large extent. Nevertheless, further development of the classification is important. PRACTICE IMPLICATIONS: The study results provide a basis for further developing the NIC and to reinforce its use in inpatient psychiatric settings. [ABSTRACT FROM AUTHOR]

The article presents a study on advanced-stage radiated head and neck cancer, which aims to determine the health-related quality of life (HRQoL), and provide supportive care for the patients. Methods used include the European Organization of Research and Treatment of Cancer (EORTC) questionnaire, and descriptive exploratory analysis. Result shows that HRQoL on patients treated with radiotherapy (RT) and surgery + RT (SRT) has higher impairment than those treated with chemoradiation (CRT).

ABSTRACT The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and stakeholders consensus meeting. Eight national dementia experts in scientific consensus meeting. Thirteen GPs in the demonstration project. MEASUREMENTS: Mean face validity and feasibility scores. Compliance rates using GPs' electronic medical record data. RESULTS: The initial set consisted of 31 QIs. Most indicators showed moderate or good face validity and feasibility scores. Consensus panels reduced the preliminary set used in the demonstration project to 24 QIs. The overall compliance to the QIs was 45.3%. Discriminative validity of the set was good; significant differences in adherence were found between GPs with high and low levels of patients aged 65 and older in their practice, with and without PCNs, and with positive and negative attitudes toward dementia (all P<.05). Based on the demonstration project, one QI was excluded. The final set consisted of 23 QIs; 15 QIs contained innovative quality criteria on collaboration between GPs and PCNs, referral criteria, and assessment of caregivers' needs. CONCLUSION: This new set of dementia QIs is feasible, reliable, and valid and can be used to improve primary dementia care. Because of the innovative quality criteria, the set is complementary to the existing dementia QIs. [ABSTRACT FROM AUTHOR]

Objective: The aim is to investigate the relationship between nurses' cue-responding behaviour and patient satisfaction. Methods: One hundred patient–nurse conversations about present concerns were videotaped and patients' expression of emotional cues and nurses' cue responses were coded using the Medical Interview Aural Rating Scale. Nurses (N=34) and patients (N=100) were recruited from seven oncology inpatient clinics from a University Medical Centre. Results: A mixed-model analysis was conducted to examine whether cue responding was related with patient satisfaction with the conversation, after adjusting for confounding variables and correlation due to repeated measure of each nurse. Nurses' cue responding was independently related to patient satisfaction. Controlling for the level of cue responding, palliatively treated patients were more satisfied with the communication than curatively treated patients. Conclusions: This study provides evidence that nurses' cue-responding behaviour is appreciated by the patients. Future studies might focus on the effect of improved cue-responding skill on more distal outcome measures, such as identification of concerns, mood and coping behaviour. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Title. Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management. Aim. This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. Background. After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. Methods. A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology ( N = 267) and the Dutch Society of Rheumatology Nurses ( N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. Results. A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. Conclusion. British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue. [ABSTRACT FROM AUTHOR]

Purpose: Evidence is not always used in practice, and many examples of problematic implementation of research into practice exist. The aim of this paper is to provide an introduction and overview of current developments in implementation science and to apply these to nursing. Methods: We discuss a framework for implementation, describe common implementation determinants, and provide a rationale for choosing implementation strategies using the available evidence from nursing research and general health services research. Findings: Common determinants for implementation relate to knowledge, cognitions, attitudes, routines, social influence, organization, and resources. Determinants are often specific for innovation, context, and target groups. Strategies focused on individual professionals and voluntary approaches currently dominate implementation research. Strategies such as reminders, decision support, use of information and communication technology (ICT), rewards, and combined strategies are often effective in encouraging implementation of evidence and innovations. Linking determinants to theory-based strategies, however, can facilitate optimal implementation plans. Conclusions: An analytical, deliberate process of clarifying implementation determinants and choosing strategies is needed to improve situations where suboptimal care exists. Use of theory and evidence from implementation science can facilitate evidence-based implementation. More research, especially in the area of nursing, is needed. This research should be focused on the effectiveness of innovative strategies directed to patients, individual professionals, teams, healthcare organizations, and finances. Clinical Relevance: Implementation of evidence-based interventions is crucial to professional nursing and the quality and safety of patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVE To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS Data were gathered from 52 adult renal transplant patients (35 men and 17 women, mean age 49 years), using a written questionnaire, medical records, frequency/volume charts, and urinary cultures. The mean time between transplantation and data collection was 5 months. Structural equation modelling (SEM) was used for the simultaneous assessment of direct and indirect relationships between explanatory variables and voiding frequency. RESULTS Frequency and nocturia were found in 54% and 60% of the study population, respectively. Frequency was directly associated with a small bladder capacity, bladder pain, urgency, and a high daytime urine volume, and indirectly by UTIs (via urgency and bladder pain). Nocturia was associated with high nocturnal urine volume, small bladder capacity and dysfunctional voiding. A quarter of the patients had small bladders and another quarter had large bladders, the latter being associated with nocturnal polyuria. CONCLUSIONS The presence of frequency, especially when accompanied by bladder pain, might aid the physician to identify patients with small bladders. The presence of nocturia can be the result of a high nocturnal urine volume, which increases the risk of bladder enlargement. Because both abnormal bladder conditions can contribute to graft dysfunction, we recommend a urological follow-up after renal transplantation, using frequency/volume charts. [ABSTRACT FROM AUTHOR]

Aims & objectives. The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self-catheterization (CISC) procedures in adults. Background. Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature. Methods. Relevant factors were explored in two studies. The first study ( n = 10) addressed mastery and short-term adherence, whereas the second study ( n = 20) addressed long-term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure. Results. A list of 16 determinants of mastery and short-term adherence and a list of 12 determinants of long-term adherence was found. Most of these determinants were found in both older (≥65 years of age) and younger patients. However, five determinants of mastery and short-term adherence and six determinants of long-term adherence were specific to patients under the age of 65. Conclusion. Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence. Relevance to clinical practice. Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues. [ABSTRACT FROM AUTHOR]

PURPOSE. To describe pilot testing of Quality of Diagnoses, Interventions and Outcomes (Q-DIO), an instrument to measure quality of nursing documentation. DESIGN. Instrument testing was performed using a random, stratified sample of 60 nursing documentations representing hospital nursing with and without implementation of standardized nursing language (30 for both strata) in a Swiss General Acute Hospital. METHODS. Internal consistency and intrarater and interrater reliabilities were tested. Through item analyses, the grades of difficulty and the discrimination validity of items were evaluated. FINDINGS. Internal consistency of nursing diagnoses as process produced Cronbach's alpha .83; nursing diagnoses as product .98; nursing interventions .90; and nursing-sensitive patient outcomes .99. With Kappas of .95, the intrarater and interrater reliabilities were good. Criteria for the grades of difficulty of items and discrimination validity were well met. The results of this study suggest that Q-DIO is a reliable instrument to measure the documentation quality of nursing diagnoses, interventions, and outcomes. Further testing of Q-DIO in other settings is recommended. Zusammenfassung ZIEL. Die Beschreibung der Pilot-Testung von Q-DIO (Quality of Nursing Diagnoses, Interventions and Outcomes), eines Instruments zur Messung der Qualität der Pflegedokumentation. DESIGN. Die Instrumenttestung wurde mittels einer zufällig gewählten, stratifizierten Stichprobe von 60 Pflegedokumentationen vorgenommen, welche klinische Pflege mit und ohne Einführung standardisierter Pflegefachsprache in einem Schweizer Akutspital repräsentierten (30 für beide Strata). METHODE. Interne Konsistenz, Intrarater und Interrater-Reliabilität wurden getestet. Mittels einer Itemanalyse wurden die Schwierigkeitsgrade und die Trennschärfe der Items evaluiert. ERGEBNISSE. Die interne Konsistenz der Subskala zu Pflegediagnosen als Prozess zeigte einen Crohnbach's alpha von 0.83; zu Pflegediagnosen als Produkt 0.98; zu Pflegeinterventionen 0.90 und zu pflegesensiblen Patientenergebnissen 0.99. Mit Kappa-Werten von 0.95 waren die Intra- und die Interrater-Reliabilitäten gut. Die Itemanalyse bestätigte die Erfüllung der Kriterien zu Schwierigkeitsgrad und Trennschärfe der Items. SCHLUSSFOLGERUNGEN. Die Resultate beschreiben Q-DIO als zuverlässiges Instrument zur Messung der Qualität von dokumentierten Pflegediagnosen, -interventionen und -ergebnissen. Studien zu weiteren Testungen von Q-DIO in anderen Settings werden empfohlen. [ABSTRACT FROM AUTHOR]

Aim. To determine whether persistent severe fatigue in patients with rheumatoid arthritis can be predicted by inflammation and disability. Methods. A follow-up study with a one-year duration was performed. From an existing rheumatoid arthritis cohort, 150 consecutive patients, with established rheumatoid arthritis, were asked to assess fatigue, using the subscale Checklist Individual Strength-fatigue of the Checklist Individual Strength at baseline and 12 months later. The Checklist Individual Strength-fatigue scores were classified into ‘normal’ (score between 8–27), ‘moderate’ (score between 27–34) or ‘severe’ (score 35 or above) fatigue. Disease-related variables were: tender joints, swollen joints, general health, disability and laboratory measures (erythrocyte sedimentation rate, rheumatoid factor and haemoglobin). Predictors of persistent severe fatigue were identified by multiple logistic regression analyses with backward selection (selection criteria: p<0·05). Results. At baseline, 137 patients agreed to participate and 123 patients completed the study. Severe fatigue was experienced by as many as 50% of the patients, both at baseline and at the end of the study ( n = 123). Moreover, 49 patients (40%) experienced severe fatigue at baseline as well as at follow-up, which we called ‘persistent severe fatigue’. Persistent severe fatigue was predicted by mean general health and disability at baseline [odds ratio (OR) = 2·03 and 2·83, respectively] in this group of rheumatoid arthritis patients with a low-to-moderate level of disease activity and disability. Conclusion. The data show that severe fatigue is not resolved spontaneously in rheumatoid arthritis patients, and persistent severe fatigue is mainly predicted by general health and disability. The relation with inflammation or a low level of haemoglobin, which is often assumed in clinical practice, was not found. Relevance to clinical practice. Fatigue in patients with rheumatoid arthritis has to be considered as a symptom that needs to be addressed by professionals in the same way as pain and disability. In current care, fatigue is insufficiently addressed. [ABSTRACT FROM AUTHOR]

PURPOSE. To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program. METHOD. In a pretest–posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention—an introductory class and consecutive classes, using a case discussion method—to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0–4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t -tests. FINDINGS. Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program. CONCLUSIONS. The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes. IMPLICATIONS FOR NURSING PRACTICE. Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes. Background. Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out. Method. A Medline, CINAHL, and Cochrane Database search (1982–2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned. Findings. Nursing diagnosis use improved the quality of documented patient assessments ( n = 14 studies), identification of commonly occurring diagnoses within similar settings ( n = 10), and coherence among nursing diagnoses, interventions, and outcomes ( n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta-analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes. Conclusion. Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study exploring the role perceptions and current activities in evidence-based practice promotion of professional nurses’ associations in the Netherlands. Background. The promotion of evidence-based practice contributes to professional standards in nursing and good quality care for patients. As professional nurses’ associations can be key players in this process, the nature of their roles and current activities deserves to be explored. Methods. Roles and activities were explored for 43 professional nurses’ associations (83% of all national associations). Data were collected using interviews with the associations’ board members. Findings from the interviews were validated with those from an analysis of the associations’ policy reports and other publications in the previous 2 years. Results. Board members primarily thought that they had roles in the selection and distribution of evidence. The roles of participant ( n = 13) and performer ( n = 13) in selecting evidence, and those of facilitator ( n = 12), initiator ( n = 15) and performer ( n = 41) in the distribution of evidence were often addressed. A few respondents reflected on roles in generating evidence and implementing evidence-based practice in patient care. A majority of the associations was contemplating activities in the promotion of evidence-based practice. Specific activities for each of six relevant aspects in the promotion of evidence-based practice were found in fewer than five associations. Conclusion. Professional nurses’ association roles in the promotion of evidence-based practice need to be viewed in relation to the tasks to be accomplished, especially those of selecting and distributing evidence. Although many organizations expressed motivation, professional nurses’ associations have a long way to go in the promotion of evidence-based practice among their members. [ABSTRACT FROM AUTHOR]

The article discusses basic nursing care serving people in their lifetimes. Infants, adults, and elderly alike in need of physical or psychosocial nursing care due to disease or incapacity. Basic care is generic across medical conditions and care settings. They include care for communication, breathing, eating and drinking, elimination, cleanliness and dressing, mobility, activities, rest, sleep, body temperature, working and playing, expressing sexuality, care for safety, and death care.

A call for papers on examination of basic nursing care is presented.

A letter to the editor is presented in response to the article about the medical care for patients in geriatric wards, which appeared in the previous issue.

The article presents an abstract of a research paper that analyzes the effectiveness of nursing staff education in enhancing the quality of documented nursing diagnoses, interventions and outcomes.