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PURPOSE. To determine the extent possible of developing an unequivocal formulation of a conceptual, structural, and contextual definition of 'patient outcomes,' and the possibility of coming to an agreement on the criteria for classification of patient outcomes. METHODS. An international Delphi survey of 33 experts. FINDINGS. A conceptual, structural, and contextual definition of patient outcomes and priorities for the characteristics of patient outcome classification. CONCLUSIONS. The authors recommend the unequivocalness of nursing terminology, not only for reasons of effectiveness and efficiency, but also to clarify the nursing vocabulary for epistemological reasons. [ABSTRACT FROM AUTHOR]

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

Background: Diabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes., Methods: This study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory., Results: People with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring., Conclusion: Self-management consists of a complex and dynamic set of processes and it is deeply embedded in one's unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.

Background: In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting., Objectives: The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy., Design and Setting: This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands., Participants: The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home., Method: Data were analysed with a grounded-theory-like method., Result: The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship., Conclusion: Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.

What is characteristic of being a Parkinson's patient? This article intends to answer this question by means of an analysis of novels about people with Parkinson's disease, personal accounts, and scientific publications. The texts were analyzed from an existential-phenomenological perspective, using an adapted version of the existential analysis. Being a Parkinson's patient is apparently characterized by an existential paradox: life appears simultaneously immobile and unpredictably whimsical. This may manifest itself in the person's corporeality, in his being-in-time and in-space, in his relating to things and events, his life-world, and in his being-together-with-others as an individual. Finally, some specific characteristics of being a Parkinson's patient are described that may be relevant for purposes of adequate care, as is to be specified by further research.

The analysis of a paradigm-case (a person with an injured leg, an autobiographical history related by Dr Sacks) presented here is an illustration of how existential-phenomenological analysis can be done. The aim of existential-phenomenological research is to analyse and to describe some dimensions of being. The person with an injured leg appears 'to bescotomized'. Well then, 'being-scotomized' can be analysed and described as a particular mode of 'being', even as a particular mode of 'being-ill'. 'Being' has been studied (in the philosophical tradition of Husserl, Heidegger, Merleau-Ponty and Sartre) as that existential movement that brings an individual, the 'self', towards the world, meanwhile 'affecting' the personal body, personal time and space, the objects in a person's life-world, the individual's life-world and, finally, coexistence. The study of 'being-ill' is the study of the particular way the self, the body, time and space, the objects, the life-world, and coexistence are affected when being-ill. 'Being-scotomized' may appear as affecting: (i) the self, isolating the subject and leading to a personal disintegration; (ii) the body to which he maintains an ambiguous relationship: being a body and having a body, and not having a part of the body any more; (iii) time and space being vanished with the vanished leg. The subject is 'at' a nowhereness and 'at' a motionless time; there is no meaningful future; (iv) the things in the person's life-world, to which it appears impossible to give the 'right' sense; (v) the life-world, revealing itself as a noland, characterized by silence and motionlessness; (vi) the others in this life-world that appears no-man's-land, uninhabitable nearly by definition. Coexistence reveals not to be possible.

Within the context of the desired unambiguousness in definitions and classifications of the nursing terminology, this literature research attempts to inventory the divergent meanings in recent professional nursing literature of the concept 'patient outcome', as well as the classifications used. Data analysis and interpretation was carried out by means of analytic induction. The results clearly show the ambiguousness of the concept. Nursing literature appears to pay little attention to the study of the structure of (the) patient outcome(s). Then, the context in which the patient outcome has to be situated appears to be described in many divergent ways. Finally, classifications of patient outcomes are found in many variants. This report concludes with suggestions for an unequivocal definition of patient outcome, as well as for the construction of (a) classification(s) of patient outcomes.

This article concerns one of the research questions in the project on 'Terminology in Dutch Nursing: Towards clarification, classification and standardization of nursing concepts', i.c. related to the conceptual definition of nursing diagnosis. On the one hand those parts are reported on which agreement was reached, by means of literature research and analysis of documents, interviews with key-informants and group discussions and through a Delphi research. On the other hand, those aspects of the proposed conceptual definition are elucidated on which discussions seem not to be closed yet or that are missing in the definition for lack of agreement. These discussion points are explored, thus following one of the recommendations of the research project on 'Terminology in Dutch Nursing', namely for further refinement of the proposed working definition of the concept nursing diagnosis. Finally some suggestions are made to realize this solicited refinement.

Study Objective: The aim of our study was to investigate whether in the search for bronchiectasis a correlation exists between abnormalities on the chest radiograph and high-resolution CT (HRCT), and if HRCT has an additional value when the chest radiography is normal., Subjects and Methods: In a prospective study, chest radiographs were compared with HRCT in 84 patients. Analysis of presence and extent of bronchiectasis were made for each bronchopulmonary lobe., Results: Thirty-seven patients had a normal radiograph, from whom 32 had a normal HRCT. The other 5 had a low HRCT severity score with a mild cylindrical bronchiectasis. From the 47 patients with an abnormal radiograph, 36 had signs of bronchiectasis at HRCT; 11 patients, however, had a normal HRCT. The sensitivity for chest radiography to detect bronchiectasis appeared to be 87.8% with a specificity of 74.4%. We found a significant linear relationship between the severity of bronchiectasis at HRCT and abnormalities as seen on the chest radiograph (r=0.62, p=0.0001)., Conclusion: A normal chest radiograph almost always excludes relevant bronchiectasis and no further investigation seems necessary. There is a significant linear relationship between the severity of bronchiectasis at HRCT and abnormalities as seen on the chest radiograph.

Objective: Our goal was to ascertain the sensitivity of spiral CT for the detection of bronchiectasis in comparison with high resolution CT (HRCT)., Materials and Methods: Thirty-one patients with a suspected clinical diagnosis of bronchiectasis were evaluated with spiral CT (slice thickness 5 mm, pitch 1, reconstruction index 2 mm, 1 s rotation) and HRCT (1.5 mm, interval 10 mm). Analysis of the presence, type, and severity of bronchiectasis was performed for each bronchopulmonary lobe., Results: In 30 patients, 177 lobes were evaluated. At HRCT 14 patients showed signs of bronchiectasis in 32 lobes. Spiral CT confirmed the presence in 29 lobes. In one lobe spiral CT was false positive. The severity score was the same in 23 lobes, in 4 lobes higher at HRCT, and in 2 lobes higher at spiral CT. Spiral CT has a high sensitivity of 91% to detect bronchiectasis with a specificity of 99.3%. Spiral CT demonstrates adequately lack of tapering of the bronchus., Conclusion: In patients with suspected bronchiectasis, HRCT is the method of first choice based on greater sensitivity and lower radiation dose. However, spiral CT done for other indications is a reliable method for assessment of bronchiectasis. Inability of patients to hold their breath did not prove to interfere with diagnostic reliability.

This article reports on the results and method used in a literature review which was performed as a partial study in the Dutch National Pilot Research in Nursing Terminology. In this study literature stands for documents which are being used in nursing practice. The analysis of these documents points out that the Dutch practical nursing terminology is very heterogeneous. Concepts related to nursing diagnosis and nursing problems are used in many different ways. The arrangement of nursing terminology in general and of nursing diagnosis or nursing problems in particular, shows many dissimilarities. Indications for known classifications are small in number. There is a prodigious conceptual confusion. Community health care and mental health care show interesting efforts concerning classification, acute hospital care however only in a limited way. Community health care seems more advanced in establishing and systematizing nursing data. The results of this literature research indicate a large similarity with the results gathered at the other parts of the National Pilot Research in Nursing Terminology. The credibility of the results of this literature study is considered very high.