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Purpose: The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process., Design and Methods: The guideline is illustrated by a case report of a woman with ID with severe problems., Findings: It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment., Practice Implications: Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline., (© 2011 Wiley Periodicals, Inc.)

Background: Implementation of innovations is a complex and intensive procedure in which different strategies can be successful. In nursing, strategies often focus on intrinsic motivation, competencies and attitudes of individual nurses while ignoring the social context. Since nurses often work in teams, identifying relevant team characteristics and successful team directed strategies may contribute to the implementation of innovations. The literature was searched for evidence., Methods: A literature review was performed including key words related to nursing teams, innovations, team characteristics and team-directed strategies. On-line databases were searched (MEDLINE, CINAHL, PsycINFO, ERIC database and Cochrane reviews CENTRAL). The journal Quality and Safety in Healthcare (QSHC) was hand searched. Methodological quality was assessed., Results: Initially, 323 titles were found. Screening of titles and abstracts and full texts resulted in nine articles meeting the inclusion criteria. The methodological quality of the studies was generally low. The innovations included different types of practices. Fifteen different team characteristics were labeled according to six features of successful teams. Twenty-one different team-directed strategies were identified and inductively categorized., Conclusion: Few studies and little evidence were found for the relevance of team characteristics and team directed strategies in the implementation of nursing innovations. Feedback was most frequently used as a strategy. Leadership could be labeled as a team characteristic as well as a team directed strategy. Further research should be of good methodological quality and focusing on patient outcomes and time and costs invested in strategy delivery. This increases scientific knowledge on nursing implementation strategies focusing on leadership.

Purpose CHEMO-SUPPORT is a nursing intervention that supports cancer patients in dealing with chemotherapy-related symptoms at home. The aims of the current study were (1) to determine how patients had experienced the intervention, and (2) to identify and better understand the mechanisms underlying CHEMO-SUPPORT's effects, its essential elements and possible pitfalls. Methods All 71 patients who had received the CHEMO-SUPPORT intervention completed a questionnaire, asking their opinion on the helpfulness, strengths, and weaknesses of the individual components of the intervention. Semi-structured interviews were also conducted with a purposeful selection of 9 of the 71 patients to get a deeper understanding of the patient experience. Results Nurses' caring support, combined with competent care, gave patients a sense of reassurance and made them feel (better) able to deal with their symptoms. The importance patients ascribed to the intervention varied according to the individual symptom experience and coping mechanisms of the patients, and by their experience with regular care. Patients rated the informational brochure component of the intervention most helpful. It served as their ‘companion’, offering support and expert advice at home. Patients felt that a strength of the brochure was the support they received from the quotes of fellow patients. Conclusions The CHEMO-SUPPORT intervention made patients feel more reassured and empowered in dealing with symptoms at home. That the CHEMO-SUPPORT experience was influenced by personal and contextual factors highlights the importance of tailoring the intervention to each patient, as well as improving supportive and competent symptom-management support in daily oncology care. [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]

Aim The purpose of this study was to determine construct validity of the Dutch Essentials of Magnetism II © instrument, designed to assess nursing practice environments, using hypotheses testing. Background Reduction in hospital length of stay and the number of inpatient beds increases care intensity. Educational levels and numbers of nursing staff in hospitals, however, do not match this increase, resulting in a strain on quality of care and patient safety. A possible answer to existing concerns about quality of care may be the creation of a productive and healthy practice environment, as this has an impact on the quality of care. Therefore, areas requiring improvement of the practice environment have to be defined. Design A cross-sectional, correlational study design. Method We determined construct validity with hypotheses testing by relating the Dutch Essentials of Magnetism II to the Dutch Practice Environment Scale of the Nursing Work Index. We formulated 15 hypotheses prior to data-analysis; 10 related to convergent validity and five related to discriminant validity. Data were collected from qualified nurses ( N = 259) on nine randomly selected hospital wards from March to April 2012. Results Response rate was 47% ( n = 121). Total scores of both instruments are strongly correlated ( r = 0·88). In total, 12 of 15 hypotheses (80%) were confirmed and three were rejected. Conclusion The D- EOMII has satisfactory construct validity for measuring the nursing practice environment in hospitals and can be used by nurses, managers, health policy makers, hospitals and governments to assess and identify processes and relationships that are in need of improvement. [ABSTRACT FROM AUTHOR]

For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to be the treatment of choice.Objective:The objective of this article is to describe and evaluate the therapeutic process of a single case from a holistic perspective.Method:We present a case report of a 47-year-old woman treated for severe complex PTSD resulting from repeated sexual and physical abuse in early childhood and moderate psychotic symptoms stemming from Dandy Walker Syndrome with hydrocephalus.Results:The patient was treated with quetiapine (600–1,000 mg) and citalopram (40 mg). Stabilization consisted of intensive psychiatric nursing care in the home and stabilizing group treatment for complex PTSD. After stabilization, the following symptom domains showed improvement: self-regulation, self-esteem, assertiveness, avoidance of social activities, and negative cognitions. However, intrusions and arousal persisted and were therefore subsequently treated with prolonged imaginary exposure that also included narrative writing assignments and a final closing ritual. This intensive multidisciplinary, phase-based approach proved effective: All symptoms of complex PTSD were in full remission. Social integration and recovery were promoted with the reduction of polypharmacy and the provision of social skills training and lifestyle training.Conclusion:The present case shows a phase-based treatment approach with multidisciplinary collaborative care to be effective for the treatment of a case of complex PTSD with comorbid psychotic disorder stemming from severe neurological impairment. Replication of this promising approach is therefore called for. [ABSTRACT FROM PUBLISHER]

PURPOSE: The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS: The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS: It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS: Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study which examined the quality and quantity of care provided by health professionals to patients who relied with home parenteral nutrition. The authors reveal patients' satisfaction with the nutrition support team. They add that minimal attention was given to psychosocial problems of patients. They also mention the problem experienced by patients with the general practitioner's knowledge of home parenteral nutrition.

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]

PURPOSE. Patients with bipolar disorder in a euthymic mood state can suffer from subsyndromal or residual symptoms of depression or hypomania. This study was undertaken to gain insight into the broader spectrum of psychopathological symptoms and quality of life. DESIGN AND METHODS. Participants (n  = 157) completed the Symptoms Checklist-90, the World Health Organization Quality of Life Assessment Instrument–Bref, and a questionnaire addressing demographic and clinical characteristics. FINDINGS. Outpatients with bipolar disorder reported fewer symptoms of psychopathology than psychiatric outpatients in general, but relative to the general population, a significantly lower quality of life was reported. The number of symptoms showed consistently negative correlations with the quality of life. PRACTICE IMPLICATIONS. The results of this study urge nurses to not settle for treatment response in terms of reduced manic or depressive episodes, but instead to strive for full remission of all symptoms. [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]

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]

Aims Design Methods Results Conclusion Implications for the profession Impact Reporting method Patient or public contribution The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.A co‐design development process was conducted.This study consisted of two consecutive stages (November 2020–December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high‐quality, patient‐centred care by advanced practice nurses in the years to come.This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e‐)portfolios. The competency framework can guide policymakers when establishing Belgian’s legal framework for advanced practice nurses. The authors have adhered to CONFERD‐HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework. [ABSTRACT FROM AUTHOR]

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

The article presents a two-round, electronic, quantitative Delphi study aimed at identifying North American Nursing Diagnosis Association (NANDA-I) diagnoses that are most relevant to hematology-oncology nursing in Europe. The NANDA-I diagnoses and health problems were assessed by 28 experts from nine European countries. Some of the relevant diagnoses identified by experts include diarrhea, fatigue, hyperthermia, nausea and pruritis. It discusses the impact of the NANDA-I nursing diagnoses on hematology-oncology nursing evidence-based care.

Background Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses’ well-being and performance. Objectives Building on the Job Demands-Resources model this study explores: (1) whether and how nurses’ perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses’ well-being and performance; and (2) whether and how team reflection influences nurses’ perceptions. Design An embedded case study. Settings Four surgical wards within three different acute teaching-hospital settings in the Netherlands. Methods During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards. Results The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses’ well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses’ well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the feedback to jointly reflect and analyse their performance and strategies will be able to better translate information about quality measurements into corrective behaviours, which may result in more positive perceptions of feedback on quality measurements among individual nurses. Conclusions To better understand the impact of feedback to nursing teams on quality measurements, we should take nurses’ individual perceptions of this feedback into account. Supporting nursing teams in team reflection after them having received feedback on quality measurements may help in eliciting positive perceptions among nurses, and therewith create positive effects of feedback on both their well-being and performance. [ABSTRACT FROM AUTHOR]

Background: No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. Objectives: To compare bed baths for effects on skin integrity and resistance against bathing and costs. Design: Cluster randomized trial. Setting: Fifty six nursing home wards in the Netherlands. Participants: Five hundred adult care-dependent residents and 275 nurses from nursing home wards. Methods: The experimental condition 'washing without water' consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs. Results: Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p = 0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at €218.30 (95%CI 150.52-286.08) in the experimental group and €232.20 (95% CI: 203.80-260.60) in the control group (difference €13.90 (95%CI: 25.61-53.42). Conclusion: Washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative. [ABSTRACT FROM AUTHOR]

Objectives: The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy. Design: We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way. Results: We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%. Conclusion: Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Investigating the effectiveness of the Lively Legs program for promoting adherence with ambulant compression therapy and physical exercise as well as effects on leg ulcer recurrence. Design: A randomized controlled trial. Setting: Eleven outpatient clinics for dermatology in the Netherlands participated in the study. Patients: 184 patients attending the outpatient clinic with leg ulcers based dominantly on a venous aetiology. Randomization was stratified by centre, age, sex and aetiology (purely venous or mixed). Intervention: The intervention group received additionally to usual care, lifestyle counselling according to the Lively Legs program, the control group received care as usual. Patient behaviour on physical activity (IPAQ), adherence to compression therapy and wound status were assessed every 6 months during a follow-up period of 18 months. Data analysis was based on the intention to treat principle, using a generalized linear model with additive link function and Bernouilli distributions. Effects on recurrence were analyzed after the first ulcer had healed using proportional hazard regression. Results: The results showed an increase in adherence with compression therapy in both groups, with no significant difference between the groups. The intervention group performed significantly better on conducting leg exercises (p <0.01) and 10min walks at five days a week (p <0.01). There was no difference on reaching 30min of walking on 5 days a week. The intervention group had less wound days (p <0.01), time till recurrence did not differ significantly (p =0.07). Conclusion: The Lively Legs program effectively increased the use of leg exercises and walking behaviour, and decreased wound time, however it did not significantly enhance use of compression stockings. Non significant effects regarding secondary outcomes may relate to the frailty of the sample. [Copyright &y& Elsevier]

Abstract: Background: Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy. Objectives: The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses. Design: A cluster randomised trial was conducted between September 2006 and July 2008. Settings: Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward. Participants: All nurses from participating wards. Methods: A knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately. Results: After correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: −0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10–0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: −0.35 to 0.35) overall, nor for the separate subjects. Conclusion: The educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed. Trial registration: ClinicalTrials.gov ID [NCT00365430]. [Copyright &y& Elsevier]

Previous studies on the effects of providing feedback about quality improvement measures to nurses show mixed results and the factors explaining the variance in effects are not yet well-understood. One of the factors that could explain the variance in outcomes is how nurses perceive the feedback. It is not the feedback per se that influences nurses, and consequently their performance, but rather the way the feedback is perceived. This article aims to enhance our understanding of Human Resource attributions and employee engagement and burnout in a feedback environment. An in-depth study of nurses' attributions about the 'why' of feedback on quality measurements, and its relation to engagement and burnout, was performed. A convergent mixed-methods, multiple case study design was used. Evidence was drawn from four comparable surgical wards within three teaching hospitals in the Netherlands that volunteered to participate in this study. Nurses on each ward were provided with oral and written feedback on quality measurements every two weeks, over a four month period. After this period, an online survey was distributed to all the nurses (n = 184) on the four participating wards. Data were collected from 91 nurses. Parallel to the survey, individual, semi-structured face-to-face interviews were conducted with eight nurses and their ward manager in each ward, resulting in interview data from 32 nurses and four ward managers. Results show that nurses – both as a group and individually – make varying attributions about their managers' purpose in providing feedback on quality measurements. The feedback environment is associated to nurses' attributions and these attributions are related to nurses' burnout. By showing that feedback on quality measurements can be attributed differently by nurses and that the feedback environment plays a role in this, the study provides an interesting mechanism for explaining how feedback is related to performance. Implications for theory, practice and future research are discussed. [ABSTRACT FROM AUTHOR]