Strengthening Geriatric Expertise in Swiss Nursing Homes: Intercare Implementation Study Protocol

Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in-house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse-led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. DESIGN An effectiveness-implementation hybrid type 2 design to assess clinical outcomes of a nurse-led care model and a mixed-method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). SETTING NHs in the German-speaking region of Switzerland. PARTICIPANTS Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse-led care model. INTERVENTION The multilevel complex context-adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence-based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. MEASUREMENTS The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. CONCLUSION The INTERCARE study will provide evidence about the effectiveness of a nurse-led care model in the real-world setting and accompanying implementation strategies

Automatic and Deliberate Affective Associations with Sexual Stimuli in Women with Superficial Dyspareunia

Current views suggest that in women with superficial dyspareunia the prospect of penile–vaginal intercourse automatically activates fear-related associations. The automatic activation of negative associations is assumed to interfere with the development of sexual arousal. In turn, this may further aggravate the dyspareunia-related complaints. To assess whether automatic negative associations are involved in this sexual pain disorder, women with superficial dyspareunia (n = 35) and a control group (n = 35) completed a modified pictorial Affective Simon Task (AST). Questioning the role of dysfunctional automatic associations in superficial dyspareunia, the AST indicated that symptomatic women displayed relatively positive rather than negative automatic associations with sexual stimuli. At the self-report level, however, affective associations with sex cues were significantly more negative for women with dyspareunia than for controls. This discrepancy between “reflective” and “reflexive” affective associations with sexual stimuli in women with dyspareunia points to the relevance of conscious appraisal and deliberate rather than automatic processes in the onset and maintenance of dyspareunia

Effectiviteit van multicomponente en multifactoriël einterventies voor valpreventie bij thuiswonende ouderen: een update

status: Published onlin

Een kwalitatieve studie naar de perspectieven van interprofessionele zorgteams omtrent differentiatie tussen verpleegkundige expertfuncties

DOEL: Het doel van dit onderzoek was om de differentiatie tussen verpleegkundige expertfuncties in kaart te brengen, dit met een focus op verpleegkundig specialisten en verpleegkundig consulenten vanuit het perspectief van interprofessionele zorgteams in een Vlaamse ziekenhuiscontext. METHODE: Aan de hand van doelgerichte steekproeftrekking werden interprofessionele zorgteams gerekruteerd om deel te nemen aan semigestructureerde focusgroep-interviews. De volgende aspecten werden hierbij in beschouwing genomen: teamsamenstelling, type ziekenhuis, geografische locatie en beschikbaarheid. RESULTATEN: Hoewel Interprofessionele zorgteams beperkte kennis hebben over functiedifferentiatie tussen verpleegkundige expertfuncties, erkennen zij de toegevoegde waarde die deze functiedifferentiatie kan hebben voor zowel het team als voor de patiëntenzorg. Bovendien nemen verpleegkundig consulenten en verpleegkundig specialisten een aantal rollen op waarop zij zich differentiëren en elkaar aanvullen: opleider, coach en coördinator van zorg. Naast deze gemeenschappelijke rollen werd de wetenschappelijke rol alleen voor de verpleegkundig specialist geïdentificeerd. CONCLUSIES: De differentiatie tussen verpleegkundig consulenten en verpleegkundig specialisten stelt deze functies in staat om op een synergistische manier samen te werken, vandaar dat beide functies geïmplementeerd moeten worden om elkaars praktijkvoering aan te vullen. Hoewel interprofessionele teams beperkte kennis hebben over functiedifferentiatie in de verpleegkunde erkennen ze hiervan de meervoudige meerwaarde

Transitional care decision‐making through the eyes of older people and informal caregivers: An in‐depth interview‐based study

Abstract Background Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision‐making. Objective To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision‐making. Methods A qualitative descriptive study was conducted in the TRANS‐SENIOR consortium's collaborative research using semistructured in‐depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven. Findings Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision‐making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors. Conclusions Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision‐making. However, their preferences for greater involvement in decision‐making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age‐tuned and person‐centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment. Patient or Public Contribution Older persons' representatives were involved in designing the TRANS‐SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants

Expertisecentrum Val- en fractuurpreventie Vlaanderen (EVV): Jaarrapport 2015. In opdracht van het Ministerie van de Vlaamse Gemeenschap, Afdeling Welzijnszorg

status: publishe

Flanders’ falls awareness week: An example of promoting fall prevention strategies within the community and residential care settings

Introduction: Falls in older persons are common and may lead to serious consequences (e.g. fractures, fear of falling, economic burden). Ample evidence is available about effective fall prevention (FP) strategies, but implementation in routine practice remains problematic. Methods: The Center of Expertise for Falls & fracture Prevention (Expertisecentrum Val- en fractuurpreventie Vlaanderen) aims to improve FP by addressing local needs, barriers to and facilitators of implementing effective strategies. By means of an annual falls awareness week (FAW), anyone working with older persons co-operates to deliver a similar message; e.g. “Stay active, avoid falling!”. The overall objective of the FAW 2013 is to encourage older people to stay fit and physically active as long as possible. Participating organizations are provided with a wide range of evidence based materials, activities and resources to promote physical activity and FP (e.g. leaflets, an activity pyramid, advanced exercise programs, “Lifelong dancing”-parties, etc.). Results: As a result, 769 organizations in Flanders participated during the FAW 2013. More specifically, 244 home care organizations, 360 residential care facilities, 61 hospitals and 104 other organizations organized their own FAW event. Conclusions: The FAW can be considered a valuable strategy to promote FP within the community and residential care. By focusing on the positive effects of mobility rather than on the negative effects of immobilization, Flemish older persons are stimulated to stay active, hereby reducing their fall risk.status: publishe

Actief blijven, de preventie

Valpreventie ‘staat of valt’ met de actieve medewerking van ouderen en zorgverleners. Actief blijven, houdt de oudere fit en vermindert de kans op vallen. En de uitdaging voor de thuisverpleegkundige? Die ligt vooral in het actief blijven zoeken naar ‘effectieve’ valpreventiemaatregelen.no issnstatus: publishe

Expertisecentrum Val- en fractuurpreventie Vlaanderen (EVV): Jaarrapport 2014. In opdracht van het Ministerie van de Vlaamse Gemeenschap, Afdeling Welzijnszorg

status: publishe

Retrospective study on traffic acidents and falls of elderly in a Belgian university ED

status: publishe