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BACKGROUND: We have previously examined the professional self-image of practicing nurses in Belgium and its association with various professional decisions, however there is limited knowledge about the professional self-image of nurses-to-be. Despite prior research on nursing students' perceptions of nursing or their self-esteem, students' professional image, defined as 'the way students perceive themselves in their clinical practice environment and their anticipated work environment', has not been described nor compared to that of practicing nurses. OBJECTIVE: To describe the professional nursing self-image among students in their final year of baccalaureate education. DESIGN: Cross-sectional survey. SETTINGS: Nine geographically spread baccalaureate programs in the Flemish region of Belgium. PARTICIPANTS: 427 evaluable students from 455 recruited from 663 potential. METHODS: Data collected in each school during regular hours using an adapted version of the BELIMAGE (Belgian professional self-image instrument for hospital nurses) including questions on personal demographics, education and competence, nursing care, team and practice environment. Voluntary participation with returned questionnaire deemed informed consent. RESULTS: Respondents identified several curricular components as contributing to their perceived competence. They also identified several skills deemed important to professional nursing, however did not feel competent in all of these. Important nursing care aspects included individualizing patient care, detecting care problems and potential complications, and promoting patient well-being; within a care environment with open interdisciplinary communication, where care problems could be discussed with nursing colleagues, where one cares for the same patient regularly, and led by a team leader with vision. Society's view of nursing was generally more negative than students'. Most students planned on working in nursing after their studies and many had thought about additional education at some point. Most were proud of becoming a nurse, would recommend nursing to others, and would choose nursing again as field of study. CONCLUSIONS: Students' evolving professional self-image was positive, rich, and enthusiastic; and higher than that observed in working nurses in a prior study. There is a significant gap between nursing care aspects deemed important and perceived competence in these areas, which has implications for both educators and future employers. Once employed, students are likely to experience differences in their perceptions of professional self-image with those of senior colleagues; another area of attention for employers. [ABSTRACT FROM AUTHOR]

Aims. To determine the incidence of pressure ulcers occurring at least 48 hours after admission and risk factors for pressure ulcers grade 2-4 in a long-stay surgical Intensive Care Unit (ICU) population. Background. The incidence of pressure ulcers in intensive care units is larger than in non-intensive environments. Design. Prospective descriptive research design. Methods. Using pressure ulcers grade 2-4 as an outcome measure, a multivariate logistic regression analysis was used to identify the risk factors. Data were obtained on a daily basis in a surgical intensive care unit of the University Hospital Leuven between November 2003-March 2004. A total of 520 long-stay (>= 24 hours) intensive care patients were included. Results. Cumulative incidence of pressure ulcers grade 2-4 was 20·1%. The following variables were positively associated with pressure ulcers grade 2-4: history of vascular disease, treatment with Dopamine(R) or Dobutamine(R), intermittent haemodialysis (IHD) or continuous veno-venous haemofiltration (CVVH), mechanical ventilation. Also preventive measures were statistically positively associated with pressure ulcers grade 2-4: turning, floating heels, alternating mattresses, adequate prevention. The use of sedatives, body temperature above 38·5 °C and sitting in chair where negatively associated with pressure ulcers. Pressure ulcers are statistically associated with different risk factors and preventive measures. Conclusion. The identified risk factors are eligible to be included in a new risk assessment scale for patients admitted to intensive care units. Relevance to clinical practice. The novel insights have implications for risk assessment for patients in intensive care units. Patients admitted to intensive care units have other risk factors for pressure ulcers which are eligible to be included in a new risk assessment scale. [ABSTRACT FROM AUTHOR]

Aim This study explored the dynamics related to a leadership development programme and their impact on the clinical leader, the nursing team and the care-giving process. Background While there is a growing conviction about the need to invest in transformational leadership in nursing, further insight into the true complexity of leadership development and, more specifically, how leadership can make a difference in nursing and patient outcomes is essential. Method A single instrumental case study was conducted in a unit of a large academic hospital where a Clinical Leadership development Project (CLP) was implemented successfully. We used mixed methods with multiple sources of data to capture the complexity of leadership development. Data were collected through individual interviews, focus groups and observation of participants. A purposive sample of 17 participants representing a wide variety of team members has permitted data saturation. The data were categorized and conceptualized and finally organized into a framework describing leadership development on the unit and its impact on the leader, the nursing team and the care-giving process. Results Leadership development is an ongoing, interactive process between the clinical leader and the co-workers. The head nurse became more effective in areas of self-awareness, communication skills, performance and vision. The nursing team benefited because more effective leadership promoted effective communication, greater responsibility, empowerment and job clarity. Improved clinical leadership seemed also to influence patient-centred communication, continuity of care and interdisciplinary collaboration. Conclusions The results of the study give more insight into the processes underlying the leader's progress towards attaining a transformational leadership style and its impact on the team members. The impact of leadership on the care-giving process, however, remains difficult to describe. Implications for nursing management The interactive nature of leadership development makes CLP a challenge for the leader as well for the team members. Through its impact on the leader and the nursing team, CLP is a valuable instrument for improving work environments of nurses, contributing positively to patient-centred care. [ABSTRACT FROM AUTHOR]

This study aims to obtain insight into the care process surrounding mealtimes within a geriatric-psychiatric ward from the perspective of the caregivers. A qualitative study was carried out in accordance with the case study method. Data was generated by participant observation, semi-structured interviews, and focus groups. A mealtime turned out to be a much more complex event than it appears to be, looking at it superficially. The caregivers recognize the valuable therapeutic meaning of the mealtime. Nevertheless, they experience internal conflict when it comes to certain significant problem areas in their search for a balance between the functional-organizational approach and the patient-oriented approach. [ABSTRACT FROM AUTHOR]

Preventing in-hospital falls is an important goal in avoiding poor patient outcomes. In this quasi-experimental study, the authors evaluated the effectiveness of a nurse-led fall prevention program in a 300-bed Swiss hospital. Four hundred and nine patients (internal medicine) were included: intervention group (n = 198), usual-care group (n = 211). The program consisted of training nurses in the use of the Morse Fall Scale, and the implementation of 15 selected preventive interventions. In the intervention group, the proportion of patients at risk for falls was higher (p = .048), and fewer patients with multiple falls were observed (p = .009). The intervention program showed an effect in preventing multiple falls, but not first falls. The prolonged mean time to a first fall in a subgroup of fallers in the intervention group may indicate an increased awareness of the nurses and the appropriateness of the interventions used. [ABSTRACT FROM AUTHOR]

AIM: The aim of this systematic review was to determine the characteristics and efficacy of various multicomponent intervention strategies for delirium in hospitalized older people. BACKGROUND: Delirium is a common accompaniment to acute illness in hospitalized older people and has greater costs of care concurrent as well as greater morbidity and mortality. METHODS: A comprehensive search was undertaken involving all major databases (including the Cochrane Library, Medline, Cumulative Index for Nursing and Allied Health Literature and Invert) and reference lists of all relevant papers. Selection criteria were: evaluation of a multicomponent intervention for delirium, inclusion of an operational definition for delirium consistent with the Diagnostic and Statistical Manual of Mental Disorders-criteria, randomized controlled trials, studies with a quasi-experimental design and reporting on primary data. To generate a description of the characteristics of these multicomponent strategies, the components of these programmes were identified and categorized. Effects on incidence of delirium, cognitive functioning, duration and severity of delirium, functional status, hospital length of stay, and mortality were analysed. FINDINGS: Three randomized controlled trials, three controlled studies and one before-after study were identified. Intervention strategies to prevent delirium proved to be the most efficacious in reducing its incidence, both with surgical and medical patients. Some additional positive effects of preventive strategies were found on the duration and severity of delirium, and functional status. Conversely, strategies to treat delirium were rather ineffective in older people admitted to medical services. In a population of older people admitted for surgery, however, a shorter duration and a diminished severity of delirium were demonstrated. None of intervention strategies produced beneficial effects on length of stay or mortality. CONCLUSION: Multicomponent interventions to prevent delirium are the most effective and should be implemented through synergistic cooperation between the various healthcare disciplines. Nurses should play a pivotal role in prevention, early recognition and treatment. [ABSTRACT FROM AUTHOR]

This study evaluated content validity, internal consistency and construct validity of the Strain of Care for Delirium Index (SCDI), a newly constructed instrument to measure the strain nurses experience in caring for patients with delirium. Content validity, evaluated by eight experts, reduced the initial pool of items from 38 to 28. Using a convenience sample of 190 nurses, Cronbach's [Formula: see text] for the 28-item version was 0.88. Using non-linear principal components analysis another eight items were eliminated and a four-factor structure was identified. The proportion of variance explained by the remaining 20 items was 61.51%. Preliminary psychometric evaluation of the SCDI supported content validity, internal consistency and construct validity; however additional psychometric evaluation is warranted. [ABSTRACT FROM AUTHOR]

Regaining independence in the performance of activities of daily living (ADL) is a nursing priority in the postoperative care of hip fracture patients, though often impeded by a temporary yet reversible decrease in cognitive status postoperatively. This study investigated the incidence and evolution of decreased cognitive status in geriatric hip fracture patients from admission through to the fifth postoperative day, and the relationship between cognitive abilities and functional (ADL) status. Twenty-six elderly hip fracture patients (f: 21, m: 5) with a mean age of 79.5 years (SD = 8.2) admitted to the emergency room of an academic medical centre were monitored longitudinally from admission until the fifth postoperative day regarding neurocognitive status and ADL status, as measured by the mini-mental state exam (MMSE; including subscales of memory, linguistic ability, concentration and psychomotor executive skills) and an adapted version of the Katz ADL-scale, respectively. Patients were categorized on the basis of cognitive status as follows: no cognitive impairment (MMSE > or = 24), moderate (MMSE < or = 23 but > or = 18) and severe impairment (MMSE < or = 17). Nineteen of the 26 patients (73.1%) showed cognitive impairment (MMSE < or = 23) at some point in time before and/or after surgery. Some improvement in cognitive status was observed yet only selectively across patient cohorts and neurocognitive dimensions. Cognitive status, especially memorial ability and psychomotor executive skills, seemed to be most vulnerable to becoming impaired after hip fracture surgery. A relationship was found between cognitive and functional status, specifically, strong associations between memory and psychomotor skills relative to ADL and modest associations between linguistic ability and concentration relative to ADL. Further, patients with decreased cognitive status postoperatively remained more ADL-dependent than non-impaired patients. This study underscores the importance of a systematic assessment of the cognitive status of elderly hip fracture patients and linking these observations to functional ability in order to enhance the postoperative rehabilitation of this patient group. [ABSTRACT FROM AUTHOR]

The article presents a study regarding the screening of older patients at risk of falling during hospitalization by the Morse Fall Scale (MFS). The MFS is a tool that assess six risk factors including history of falls, mobility aids and mental status. During the study, MFS was administered by registered nurses on admission and the predictive values of the patient were calculated. The result demonstrates the use 55 as a cut off score for implementing preventive interventions.

Abstract Background The interRAI Suite contains comprehensive geriatric assessment tools designed for various healthcare settings. Although each instrument is developed for a particular population, together they form an integrated health evaluation system. The interRAI Acute Care Minimum Data Set (interRAI AC) is tailored for hospitalized older persons. Our aim in this study was to translate and adapt the interRAI AC to the Belgian hospital context, where it can be used together with the interRAI Home Care (HC) and the interRAI Long Term Care Facility (LTCF). Methods A systematic, comprehensive, and rigorous 10-step approach was used to adapt the interRAI AC to local requirements. After linguistic translation by an official translator, five researchers assessed the translation for appropriate hospital jargon. Three researchers double-checked for translation accuracy and proposed additional items. A provisional version was converted into the three official languages of Belgium—Flemish, French, and German. Next, a multidisciplinary panel of nine experts judged item relevance to the Belgian care context and advised which country-specific items should be added. After these suggestions were incorporated into the interRAI AC, hospital staff from nine Flemish hospitals field-tested the tool in their practice. After evaluating field-test results, we compared the interRAI AC with Belgian versions of the interRAI HC and interRAI LTCF. Next, the Flemish, French, and German versions of the Belgian interRAI portfolio were harmonized. Finally, we submitted the Belgian interRAI AC to the interRAI organization for ratification. Results Eighteen administrative items of the interRAI AC were adapted to the Belgian healthcare context (e.g., usual residence, formal community services prior to admission). Fourteen items assessing the ‘informal caregiver’, and 17 items, including country-specific items, were added (e.g., advanced directive for euthanasia). Conclusions The interRAI AC was adapted to local requirements using a meticulous and recursive 10-step approach. As use of the interRAI Suite continues to grow worldwide and as it continues to expand to other care settings and populations, this procedure can guide future translations. This procedure might also be used by others facing similar challenges of complex translation and adaptation situations, where multidimensional instruments are used across multiple care settings in multiple languages.

Abstract Background The purpose of this correspondence article is to report opinion amongst experts in the delirium field as to why, despite on-going training for all health professionals, delirium continues to be under recognised. Consensus was obtained by means of two conference workshops and an online survey of members of the European Delirium Association. Major barriers to recognition at an individual level include ignorance about the benefit of treating delirium. At an organisational level, reflecting socio-cultural attitudes, barriers include a low strategic and financial priority and the fact that delirium is an orphan condition falling between specialties.

Abstract Background Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time. Methods This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. Results A total of 34,972 hospitalized patients (mean age: 67.3, SD ± 19.3 years; female 53.6%, mean length of stay: 11.9 ± 13.2 days, mean nursing care time per day: 3.5 ± 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2%) of the hospitalized patients. From these falls, 2,552 (66.4%) were without injuries, while 1,142 (29.7%) falls resulted in minor injuries, and 148 (3.9%) falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p = 0.086). The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay), as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell. Conclusion Following the implementation of an interdisciplinary falls prevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

Abstract Background Falls and associated negative outcomes in hospitalized patients are of significant concerns. The etiology of hospital inpatient falls is multifactorial, including both intrinsic and extrinsic factors. Anecdotes from clinical practice exist in which health care professionals express the idea that the number of patient falls increases during times of full moon. The aim of this study was to examine in-hospital patient fall rates and their associations with days of the week, months, seasons and lunar cycles. Methods 3,842 fall incident reports of adult in-patients who fell while hospitalized in a 300-bed urban public hospital in Zurich, Switzerland were included. Adjusted fall rates per 1'000 patient days were compared with days of the week, months, and 62 complete lunar cycles from 1999 to 2003. Results The fall rate per 1000 patient days fluctuated slightly over the entire observation time, ranging from 8.4 falls to 9.7 falls per month (P = 0.757), and from 8.3 falls on Mondays to 9.3 falls on Saturdays (P = 0.587). The fall rate per 1000 patient days within the lunar days ranged from 7.2 falls on lunar day 17 to 10.6 falls on lunar day 20 (P = 0.575). Conclusion The inpatient fall rates in this hospital were neither associated with days of the week, months, or seasons nor with lunar cycles such as full moon or new moon. Preventive strategies should be focused on patients' modifiable fall risk factors and the provision of organizational conditions which support a safe hospital environment.

Abstract Background Determination of a patient's cognitive status by use of a valid and reliable screening instrument is of major importance as early recognition and accurate diagnosis of delirium is necessary for effective management. This study determined the reliability, validity and diagnostic value of the Flemish translation of the NEECHAM Confusion Scale. Methods A sample of 54 elderly hip fracture patients with a mean age of 80.9 years (SD = 7.85) were included. To test the psychometric properties of the NEECHAM Confusion Scale, performance on the NEECHAM was compared to the Confusion Assessment Method (CAM) and the Mini-Mental State Examination (MMSE), by using aggregated data based on 5 data collection measurement points (repeated measures). The CAM and MMSE served as gold standards. Results The alpha coefficient for the total NEECHAM score was high (0.88). Principal components analysis yielded a two-component solution accounting for 70.8% of the total variance. High correlations were found between the total NEECHAM scores and total MMSE (0.75) and total CAM severity scores (-0.73), respectively. Diagnostic values using the CAM algorithm as gold standard showed 76.9% sensitivity, 64.6% specificity, 13.5% positive and 97.5% negative predictive values, respectively. Conclusion This validation of the Flemish version of the NEECHAM Confusion Scale adds to previous evidence suggesting that this scale holds promise as a valuable screening instrument for delirium in clinical practice. Further validation studies in diverse clinical populations; however, are needed.

BACKGROUND: Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload. DESIGN AND OBJECTIVE: The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design. PARTICIPANTS: Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards. METHODS: Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1-5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as 'confused'. RESULTS: Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p=.004), while there was not a significant change on the other surgery wards. Sub-analyses for 'confused' patients found that the workload at night on the trauma ward decreased significantly by 23% (p=.01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses' labelling patients as 'confused' were associated with increased workload (p<.001). CONCLUSIONS: After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation. [ABSTRACT FROM AUTHOR]