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Aim: To explore the knowledge, and health beliefs of patients with type 2 diabetes mellitus (T2DM) regarding management of infections of the urinary tract (UTIs) and lower respiratory tract (LRTIs)., Methods: Three semi-structured focus groups with 23 patients with T2DM were conducted and analyzed., Results: Only a few patients mentioned specific preventive measures for UTIs and LRTIs, like not smoking and taking enough fluids (n=3). Making a nuisance of oneself, denying the seriousness of the disease and fear of insulin therapy were barriers to health-seeking behaviour. Some people did not complete the course of antibiotics (n=2) or forgot to take the tablets, especially when tablets had to be taken more than once a day (n=4)., Conclusion: Our results showed that patients with T2DM lack knowledge and realistic health beliefs about common infections such as UTIs and LRTIs. Health education should aim to help patients with T2DM to interpret symptoms of infections correctly in order to take the appropriate action such as taking preventive measures or taking antibiotics. Identifying patients at high risk of a complicated infection may target education towards those who need it most., (Copyright © 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

This study describes strategies used by Dutch HIV nurse consultants to promote adherence to antiretroviral therapy (ART) and the assumptions on which these strategies were based. The study used a descriptive qualitative design with individual and focus group interviews. Individual semi-structured interviews (n = 23) focusing on adherence-supporting procedures and case-based focus groups (3 groups with 5-7 participants each) focusing on adherence strategies were held with HIV nurse consultants (n = 19). The strategies described were mainly based on experience. Theoretical principles were rarely discussed and participants seldom referred to the literature. Adherence-promoting strategies were identified for two phases: (a) before beginning ART and (b) during follow-up care while on ART. Strategies that were not used in one specific phase were categorized under "all phases." Data yielded useful ideas for the care of HIV-infected patients, and findings can be applied to the development and use of adherence-promoting strategies., (Copyright © 2010 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Objective: In the Netherlands HIV nursing consultants have participated in HIV-care since 1985; their profession has changed with developments in HIV-treatment over time. The study goal was to gather information about their role in HIV-care and to provide an useful example to other (HIV-)care settings over the world., Methods: Interviews were held with HIV nursing consultants from all AIDS treatment centres. Descriptive analyses and statistical tests to detect differences between centres categorized by care model (parallel/unstructured/alternating), were performed., Results: 58% centres perform substitution of care. HIV nursing consultants see almost all patients at least once a year and see all patients when treatment is started/altered. The frequency of consultations for HIV-patients in stable condition varies, 2-4 times a year. Substitution leads to a slight, non-significant decrease in number of consultations. Adherence support is provided at the start of and during treatment. Regular patient discussions are common. All respondents are acquainted with the guidelines. Detailed knowledge of the adherence issues is limited: 58.3% had read the adherence chapter., Conclusion: Substitution of care model is an appropriate and effective method for the management of HIV-infected patients., Practice Implications: Further development of and research into this new role of HIV nurse consultants is appropriate., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Aim: This study is a report of a study to determine the quality of protocols for pressure ulcer prevention in home care in the Netherlands., Background: If pressure ulcer prevention protocols are evidence-based and practitioners use them correctly in practice, this will result a reduction in pressure ulcers. Very little is known about the evidence-based content and quality of the pressure ulcer prevention protocols., Method: In 2008, current pressure ulcer prevention protocols from 24 home-care agencies in the Netherlands were evaluated. A checklist developed and validated by two pressure ulcer prevention experts was used to assess the quality of the protocols, and weighted and unweighted quality scores were computed and analysed using descriptive statistics., Results: The 24 pressure ulcer prevention protocols had a mean weighted quality score of 63.38 points out of a maximum of 100 (sd 5). The importance of observing the skin at the pressure points at least once a day was emphasized in 75% of the protocols. Only 42% correctly warned against the use of materials that were 'less effective or that could potentially cause harm'., Conclusion: Pressure ulcer prevention commands a reasonable amount of attention in home care, but the incidence of pressure ulcers and lack of a consistent, standardized document for use in actual practice indicate a need for systematic implementation of national pressure ulcer prevention standards in the Netherlands to ensure adherence to the established protocols.

In order to explore and clarify the underlying processes which lead to (non)-adherence behavior in patients treated with highly active antiretroviral therapy (HAART), a qualitative study was conducted. Thirty-seven in-depth interviews were held with 30 Caucasian HIV-positive patients. Additional data were collected by diaries kept by some participants. The analysis took place in a cyclic process; selection of themes was alternated with input of new material. Adherence to HAART is mainly influenced by the experience of being HIV positive. Acceptance or non-acceptance of HIV leads to one of two basic stances toward adherence: "being determined to be adherent" or "medication is subordinate to other priorities in life". This stance determines the commitment to therapy and influences how patients cope with adherence. Patients who are determined to be adherent find solutions to adherence problems. Patients who are not determined to be adherent solve problems only if the solution does not compromise important aspects of their lives. Insight is provided into the manner in which prevalent themes; "start of HAART", "attitude toward medication", "HAART in daily life", "contextual factors", "health and HAART" and "being informed", influence adherence behavior. Before starting HAART the focus should be on helping the patient to accept HIV as a part of life. The findings need to be taken into account in adherence-promoting interventions.

Aims and Objectives: To gain insight into the lived experience of parenting a child with leukaemia during treatment., Background: Diagnosis of leukaemia in children leads to an existential shock for parents and a reversal of normal family life. Today, in the Netherlands, after diagnosis, children stay at home most of the time. Therefore, their parents face considerable responsibilities for administering home-based treatment and for the support of their child during illness and treatment., Methods: A grounded theory study was undertaken at a Dutch University Hospital and involved one-time individual in-depth interviews with 12 mothers and 11 fathers (n = 23) of 12 children., Findings: 'Being there', was identified as the core concept. It means: 'I'll be there for you; I will never let you down'. 'Being there' is described as a parental response to the perceived vulnerability of the child and the parental need to give meaning to parenthood. It serves two purposes: protection and preservation. Protection means guarding the child against the negative aspects of illness and treatment. Preservation refers to the way parents influence the child's perception of his/her life, thus contributing to his/her coping and willingness to undergo treatment, to maximise the chances for survival. Six aspects were identified: a trusting relationship, presence, emotional support, advocacy, routines and rituals and effacing oneself., Conclusions: The concept provides a theoretical frame for parenting the child with cancer. It clarifies the actions and reactions of parents and increases insight into the underlying force that enables parents to provide continuing care despite their personal burden., Relevance to Clinical Practice: The concept offers an essential insight into parenting the child with acute lymphoblastic leukaemia and has relevance for nursing practice and education. Understanding of the concept would improve the ability to understand, communicate and work pro-actively in partnership with parents.

When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem.

In this study, the authors examined the process that family members go through when they are confronted with traumatic coma. They conducted 24 semistructured interviews with 22 family members of 16 coma patients and analyzed the data using the constant comparative method as proposed by grounded theory. Hope was the most prominent theme. It can be described as keeping a possible positive outcome in mind in an uncertain situation, knowing that this outcome is unlikely to happen. Hope was found to evolve stepwise up and down, dependent on further events and information: big steps at first, smaller later on. Hope helps family members to keep going and to manage care for the patient and for each other. Family members were found to protect themselves against false or unjustified hope by seeking valid information. They alternate their moments of despair, and in their interactions they respect each other's hope.

Objective: The purpose of this study was to gain insight into the availability and quality of protocols for pressure ulcer prevention in homecare agencies in the Netherlands., Design: A descriptive study was completed., Setting and Subjects: Forty-one homecare agencies in the Netherlands that provide nursing care were queried., Instruments: Three instruments were used to collect data: (1) a structured questionnaire containing 46 closed and open-ended questions, (2) a checklist used by experts to analyze the protocols for conformity to guidelines, and (3) a tool used to generate a numerical score for each protocol based on the experts' reviews., Methods: A questionnaire was mailed to all homecare agencies in the Netherlands that provided nursing care. The quality of each protocol was judged and scored by 3 pressure ulcer prevention experts. The scores were analyzed using descriptive statistics., Results: A pressure ulcer protocol was available in 78% of the agencies. Seventy-five percent had at least 1 wound care nurse who spent an average of 10 hours per week on pressure ulcer prevention. In 20% of the agencies, no introduction or instruction was given to the nurses when the protocol was implemented. In 25% of the agencies, nurses did not participate in the revision of the protocol. At the end of 2003, only 13% of the agencies had executed 1 or more revisions of their protocol since 2002, when the last Dutch pressure ulcer guideline was introduced. The 26 pressure ulcer prevention protocols had a mean score of 47 points out of a maximum of 100 points (range 9 to 82; SD, 18)., Conclusions: Although the use of protocols is considered an important adjunct in the prevention of pressure ulcers, 22% of the participating agencies did not have a pressure ulcer prevention protocol and 25% did not have wound care nurses, indicating a need for further promotion of standardized pressure ulcer prevention strategies. In addition, the available protocols were frequently of low quality or outdated, reflecting a need for increased attention to current and accurate tools to guide nursing practice.

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.

Purpose: To determine whether the use of relapse prevention plans (RPPs) in nursing practice is an effective intervention in reducing relapse rates among patients with schizophrenia., Design and Methods: Experimental design. Patients with schizophrenia (or a related psychotic disorder) and nurses from three mental health organizations were randomly assigned to either an experimental (RPP) or control condition (care as usual). The primary outcome measure was the psychotic relapses in the research groups., Results: The relapse rates in the experimental and control groups after 1-year follow-up were 12.5% and 26.2%, respectively (p=. 12, ns). The relative risk of a relapse in the experimental versus the control group was 0.48 (ns)., Conclusions: In this study no statistically significant effects of the intervention were found. Effectiveness research in this area should be continued with larger sample sizes and longer follow-up periods.

As is expressed in the term 'caregiving career', caregiving is a dynamic phenomenon. The present study addresses the total care phase in which spouses give direct and ongoing personal care to their partners with multiple sclerosis (MS). The dyadic nature of caregiving is stressed by examining the roles which both spouses play in establishing a commitment that results in the continuation of caregiving. For this purpose, 17 couples facing MS were selected in the Netherlands and Belgium. Ten females and seven males were disabled, and all were living with partners who provided a full range of care. Both partners were interviewed separately about their motivation to give care, dependency on help, the continuation of caregiving and their relationship. The analysis consisted of fragmenting and connecting the data, and involved close reading and constant comparison. The present findings support those previous studies, i.e. that continuation of caregiving is the result of an interchange between the partners. The commitment that is established can be expressed in terms of inevitability, shared misfortune, reciprocity and the desire to prevent admission to a nursing home. Three aspects appear to contribute to the creation of commitment and the ensuing continuation of caregiving: namely, marital loyalty, and the arbitrariness of the disease and its serious nature. For community care, it is important to consider the negotiations between partners and the impact of caregiving on their relationship.

This qualitative study examines how individuals in an advanced stage of multiple sclerosis (MS) who live at home, accommodate to their illness. The downward phase in the illness trajectory of MS often consists of a lengthy period of gradual decline. According to Corbin and Strauss's framework, accommodation is conceptualized as biographical work that refers to the actions taken to retain control over the life course and to give life meaning again. For our purpose semi-structured interviews with 22 people with MS were conducted and compared with 21 interviews with their family caregivers. The analysis consisted of fragmenting and connecting the data and involved close reading and constant comparison. The continuity of biography is at risk since body and performance failures lead to the loss of salient aspects of self. Participants interpret MS as an all-encompassing illness and emphasize the process of having to give up everything. Four case stories are described to demonstrate the complex intertwining of the biographical processes and to show the range in biographical accommodation. Some patients are capable of putting their lives back together again, while others retreat or do not consider MS a part of their lives. The unpredictable course of MS makes it impossible to give new direction to the life course.

Patients undergoing surgery are prone to develop pressure ulcers during the surgical procedure. The aim of the study was to gain insight into the problem by describing the incidence, clinical features and progression of pressure ulcers and closed pressure ulcers in patients undergoing surgery lasting more than 4 hours. A prospective follow-up study was conducted in a university hospital in the Netherlands. Two-hundred and eight patients from nine surgical specialities were included in the study. The skin of patients was observed the evening before surgery and, if the patient's condition allowed it, directly postoperatively and subsequently daily for 14 days or until discharge, whichever occurred first. When patients developed a pressure ulcer they were observed daily until discharge or until the pressure ulcer had healed. The size and colour of the lesion, stage and skin condition were described every day. In addition, data were collected concerning the operation, postoperative period, and general characteristics. Forty-four patients (21.2%) developed 70 pressure ulcers in the first 2 days following surgery. Twenty-one pressure ulcers deteriorated in the days following surgery. More than half (52.9%) of the lesions developed on the heels, and 15.7% developed in the sacral area. Twenty-five patients (12%) were impaired by the lesions they developed. None of the patients in the study developed closed pressure ulcers. Pressure ulcer development during a surgical procedure is a serious problem. Therefore, preventive measures should be taken during surgery and the first few days afterwards, until the patient is able to mobilize independently.

Adherence to treatment is a major issue for people with diabetes mellitus, and attention has been given to improving self-management in persons with this chronic disease. Most studies show that knowledge alone will not improve self-management behavior. Self-efficacy, a concept introduced by Bandura, has been shown to be an important variable in improving health behaviors. In order to determine whether self-efficacy can influence self-management of diabetes, however, instruments to measure self-efficacy are needed in native languages at an appropriate developmental level, and with good psychometric properties. The study reported here was part of a larger project in the Netherlands, Belgium and the United States in which several instruments, measuring diabetes management self-efficacy, have been developed, both in English and Dutch, for different types of diabetes and different age groups. This article reports on the development and psychometric testing of an instrument measuring self-efficacy in adolescents with type 1 diabetes mellitus. Initially 30 items for the instrument were generated through focus group interviews and their relevance was judged by a team of 10 experts on self-management behavior in adolescents. The final instrument contained 26 items. The sample for psychometric testing consisted of 90 patients with type 1 diabetes who were between 12 and 18 years old. Cronbach's alpha of the instrument was 0.86. An exploratory factor analysis produced two factors which reflect general and more difficult diabetes self-management situations.