Pain Unheard? Postoperative Pain Assessment in Neonates and Infants

Study aim: The study aimed at answering two questions: • How reliable. valid, and feasible is the multidimensional COMFORT scale to assess postoperative pain in infants and toddlers 0-3 years of age? • What is the difference between intermittent morphine administration and continuous intravenous morphine in terms of quality and effectiveness of analgesia for postoperative pain in infants and toddlers 0-3 years of age? The studies described in this thesis deal primarily with the first question. The differences between the two morphine conditions in relation to hormonal and metabolic plasma levels and morphine plasma levels will be reported elsewhere. During data collection a third research question came up, inspired by the eventful hospital history of some children combined with the individual differences in pain response and morphine requirement after surgery in our sample. This question was also justified by publications on subsequent and long-tenn consequences of neonatal pain. The third, additional question is: • Are the present postoperative pain and stress response related to past experiences with pain

Supervisie doet ertoe

Het is van alle tijden dat professionals die met mensen werken zichzelf als instrument meenemen. Wanneer je in opleiding tot een dergelijke professional bent, is het dan ook zaak dat instrument te leren kennen, oppoetsen en bijschaven waar mogelijk. Je leert wat je talenten zijn en wat je zwakke kanten, welke casuïstiek je goed af gaat en welke je beter aan een collega kunt overlaten als die mogelijkheid er is. Dit leren gebeurt bij uitstek binnen supervisie

Niet zenden maar ontvangen

Met veel genoegen heb ik het boek van Henk de Roest gelezen waarin hij pleit voor samenwerkend onderzoek in de praktische theologie, waarbij onderzoeker en practicant gezamenlijk onderzoek verrichten. In deze bijdrage reageer ik met een methodologische doordenking, waarbij de focus ligt op de spanning tussen onderzoeker en practicant

Jugend auf der Suche nach Gott

"In der modernen pluralen Gesellschaft gibt es für die Jugendlichen eine große Auswahl an Lebenskonzepten und Glaubensüberzeugungen. Die Säkularisierung in Westeuropa bedeutet, dass die Religion nicht mehr exklusiv die Funktion der Sozialintegration des individuellen und gesellschaftlichen Lebens übernimmt. Religion und Moderne ist aber auch nicht notwendigerweise inkompatibel. Die Werte und Normen sind allerdings nicht mehr allein auf christlichen Glauben begründet. Für Jugendliche im Jahr 2006 ist es normal, dass man eine individuelle Auswahl hat aus vielen Glaubens- und Sinndeutungen. Die Verfasser nennen das auch bricolage oder Lego-Bildung. Es gibt aber keine religiöse Indifferenz, wie ihre Forschung unter 1.250 Jugendlichen in den Niederlanden zeigt. Die Normen und Werte der Jugendlichen sind nicht 'gottlos'. Noch immer ist Solidarität eine wichtige Sache für die Jugendlichen. Dass dies mit dem christlichen Glauben und mit der Kirche im Besonderen zu tun hat, ist vielen überhaupt nicht mehr bekannt. Trotzdem sahen sie, dass über 3.000 Jugendliche an den Weltjugendtagen in Köln teilgenommen haben. Ist das eine besondere Gruppe, ganz anders als alle anderen im gleichen Lebensalter? Sind diese Jugendlichen alle sehr aktiv in der Kirche? Oder hatte sie etwas anderes dazu bewogen, an den Weltjugendtagen teilzunehmen? Und außerdem: Was kann die Kirche genau dieser Gruppe in ihrer Suche nach sich selbst und nach einem höheren Lebensziel anbieten? Die niederländischen Jugendlichen haben die Vorbereitungen auf den Weltjugendtag ein Jahr vorab begonnen. In Gruppen sind sie dann am 13. August 2005 auf die Reise nach Köln gegangen, manche sogar mit dem Boot. Es gibt dabei viele Jugendliche, die sich mit der Kirche identifizieren, aber auch die, die 'nur' wegen der internationalen Begegnung dabei sind und sie vielleicht mit Freunden zusammen an dem Event teilnehmen. Die Erwartungen sind ganz verschieden. Insgesamt überwiegen jedoch Motive wie Spaßhaben und Menschen kennen lernen. Aber fast alle Jugendliche nehmen sehr gute Erfahrungen mit nach Hause. Und was dann?" (Autorenreferat

Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms

Background: Although stimulating patients’ mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. Methods: Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. Results:Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9–93.6). The median total daily step count was 1326 (range 22-5362). Conclusion: We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.</p

Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms

Background: Although stimulating patients’ mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. Methods: Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. Results:Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9–93.6). The median total daily step count was 1326 (range 22-5362). Conclusion: We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.</p

The Misprediction of emotions in Track Athletics.: Is experience the teacher of all things?

People commonly overestimate the intensity of their emotions toward future events. In other words, they display an impact bias. This research addresses the question whether people learn from their experiences and correct for the impact bias. We hypothesize that athletes display an impact bias and, counterintuitively, that increased experience with an event increases this impact bias. A field study in the context of competitive track athletics supported our hypotheses by showing that athletes clearly overestimated their emotions toward the outcome of a track event and that this impact bias was more pronounced for negative events than for positive events. Moreover, with increased athletic experience this impact bias became larger. This effect could not be explained by athletes’ forecasted emotions, but it could be explained by the emotions they actually felt following the race. The more experience athletes had with athletics, the less they felt negative emotions after unsuccessful goal attainment. These findings are discussed in relation to possible underlying emotion regulation processes

Barriers and facilitators for implementation of automated home medication dispensers in home care from Dutch professionals' perspective:a qualitative study

Introduction and aims:Present-day home care needs to be more efficiently organized in view of the aging of the population and the current nursing shortages. Ensuring safe medication use is part of the challenge. The number of required visits could be reduced if automated home medication dispensers (AHMD) are adequately implemented. However, the barriers and facilitators for implementation are unknown. This project explored determinants (barriers, facilitators, or both) for implementing AHMD in home care, from Dutch home care nurses' perspective.Methods:Semi-structured interviews were conducted with 15 home care nurses. Determinants were identified through thematic content analysis. The first four transcripts were coded inductively. Then, a code tree was developed based on the Tailored Implementation for Chronic Diseases checklist, consisting of seven domains. Each code/determinant was then labelled as a barrier, facilitator, or both.Results:The most relevant domains were innovation factors, individual health professional factors, and patient factors. The most frequently mentioned barrier was the required unplanned visits when patients did not withdraw medication within the scheduled time limit (alarm). According to our respondents, carefully assessing patients' eligibility (e.g., learnability) and properly instructing and guiding them will help prevent these alarms from occurring. Next to these determinants, motivating patients to start using an AHMD and professionals having sufficient knowledge and confidence were the most frequently mentioned facilitators.Conclusion:This project provided an overview of 78 determinants from nurses' perspective for implementation of AHMD in home care. This can form the basis for developing strategies for implementing AHMD in home care. Further research is recommended to investigate the perceived determinants from the patients', relatives', and informal caregivers' perspectives, and to prioritize the determinants from all perspectives