Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Attractiveness of working in home care: An online focus group study among nurses

Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a “linchpin”, in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a “linchpin” are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home‐care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people‐centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home‐care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people‐centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home‐care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people‐centred, integrated home care as attractive. Specific aspects that home‐care nurses find attractive are promoting the patient′s self‐reliance and having a network in the community. Hospital nurses are mainly attracted to health‐related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home‐care nurses and a minority of hospital nurses feel attracted to people‐centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home‐care organisations who aim to expand the home‐care nursing workforce

Home-care nursing staff in self-directed teams are more satisfied with their job and feel they have more autonomy over patient care: a nationwide survey

Aims The aims of this study were: (1) To examine whether working in a self-directed team is related to home-care nursing staff's job satisfaction; (2) To assess the mediating effect of self-perceived autonomy over patient care; (3) To investigate the moderating effect of educational level on the association between autonomy over patient care and job satisfaction. Background Self-directed teams are being introduced in home care in several countries. It is unknown whether working in a self-directed team is related to nursing staff's job satisfaction. It is important to gain insight into this association since self-directed teams may help in retaining nursing staff. Design A cross-sectional study based on two questionnaire surveys in 2014 and 2015. Methods The study involved 191 certified nursing assistants and registered nurses employed in Dutch home-care organizations (mean age of 50). These were members of the Dutch Nursing Staff Panel, a nationwide panel of nursing staff working in various healthcare settings. Results Self-direction is positively related to nursing staff's job satisfaction. This relationship is partly mediated by autonomy over patient care. For certified nursing assistants and registered nurses with a bachelor's degree, a greater sense of autonomy over patient care in self-directed teams is positively related to job satisfaction. No significant association was found between autonomy over patient care and job satisfaction for registered nurses with an associate degree. Conclusions This study suggests that home-care organizations should consider the use of self-directed teams as this increases nursing staff's job satisfaction and may therefore help to retain nursing staff in home care

Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff

Background: Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct associated with incompetence and that associated with impairment. This study aimed to (1) quantify home-care nursing staff's experiences with actual or possible professional misconduct; (2) provide insight into the difficulty home-care nursing staff experience in reporting suspicions of professional misconduct within the organisation and whether this is related to the individual characteristics of nursing staff; and (3) show which aspects of professional practice home-care nursing staff consider important in preventing professional misconduct. Methods: A questionnaire survey was held among registered nurses and certified nursing assistants employed in Dutch home-care organisations in 2014. The 259 respondents (60 % response rate; mean age of 51; 95 % female) were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings. Results: Forty-two percent of the nursing staff in home care noticed or suspected professional misconduct by another healthcare worker during the previous year, predominantly a nursing colleague. Twenty to 52 % of the nursing staff experience difficulty in reporting suspicions of different forms of incompetence or impairment. This is related to educational level (in the case of incompetence), and managerial tasks (both in the case of incompetence and of impairment). Nursing staff consider a positive team climate (75 %), discussing incidents (67 %) and good communication between healthcare workers (57 %) most important in preventing professional misconduct among nursing staff. Conclusions: Suspicions of professional misconduct by colleagues occur quite frequently among nursing staff. However, many nursing staff members experience difficulty in reporting suspicions of professional misconduct, especially in the case of suspected impairment. Home-care employers and professional associations should eliminate the barriers that nursing staff may encounter when they attempt to raise an issue. Furthermore, advocating a positive team climate within nursing teams, encouraging nursing staff to discuss incidents and facilitating this, and promoting good communication between healthcare workers may be appropriate strategies that help reduce professional misconduct by nursing staff

Home-care nursing staff in self-directed teams are more satisfied with their job and feel they have more autonomy over patient care: a nationwide survey

Aims The aims of this study were: (1) To examine whether working in a self-directed team is related to home-care nursing staff's job satisfaction; (2) To assess the mediating effect of self-perceived autonomy over patient care; (3) To investigate the moderating effect of educational level on the association between autonomy over patient care and job satisfaction. Background Self-directed teams are being introduced in home care in several countries. It is unknown whether working in a self-directed team is related to nursing staff's job satisfaction. It is important to gain insight into this association since self-directed teams may help in retaining nursing staff. Design A cross-sectional study based on two questionnaire surveys in 2014 and 2015. Methods The study involved 191 certified nursing assistants and registered nurses employed in Dutch home-care organizations (mean age of 50). These were members of the Dutch Nursing Staff Panel, a nationwide panel of nursing staff working in various healthcare settings. Results Self-direction is positively related to nursing staff's job satisfaction. This relationship is partly mediated by autonomy over patient care. For certified nursing assistants and registered nurses with a bachelor's degree, a greater sense of autonomy over patient care in self-directed teams is positively related to job satisfaction. No significant association was found between autonomy over patient care and job satisfaction for registered nurses with an associate degree. Conclusions This study suggests that home-care organizations should consider the use of self-directed teams as this increases nursing staff's job satisfaction and may therefore help to retain nursing staff in home care

Societal costs of asthma, COPD and respiratory allergy

Objective: Asthma, COPD and respiratory allergy are important chronic respiratory diseases that affect more than one million people in the Netherlands. The economic burden on society and individuals is considerable, due to the notable healthcare utilization and production losses associated with these conditions. In this study, we determined the societal costs of asthma, COPD and respiratory allergy in the Netherlands for the year 2007 and estimated future healthcare costs by means of projections. Design: Descriptive study: Methods: The prevalence of the diseases was based on nationally representative primary care registries and was obtained from the website of The National Public Health Compass and from Statistics Netherlands. Data regarding health care costs were based on national registries and surveys. The following components of health resource were retrieved: disease-related general practitioner, physician and physiotherapy visits were obtained from a national survey among patients with asthma and COPD. For respiratory allergy, general practitioner and physician visits were based on the literature. Hospital admissions and length of stay were derived from the website of Statistics Netherlands. Prescribed medication was obtained from the Landelijk InformatieNetwerk Huisartsen, a nationwide primary care register. Prescribed medication for the three diseases and oxygen use for COPD patients were combined with cost data of the Drug Information System of the Health Care Insurance Board. Information on the uptake of the influenza vaccination was derived from the literature. Data on home care and nursing homes were extracted from the website of the Dutch Cost of Illness Study. Data on COPD-related lung transplantations were obtained from the Dutch Transplantation Foundation. Unit costs were gathered from standard unit cost lists and all costs were expressed in Euros price level of 2007. The quantity of asthma- and COPD-related sick leave and work incapacity in the Netherlands was based on the study: "Werken met een chronische longaandoening". Production losses were calculated using the friction-cost method. No reliable data were available concerning productivity losses for respiratory allergy. Projections were made to estimate disease prevalence for the period 2007 to 2032, using merely demographic data for respiratory allergy and a simulation model for asthma and COPD. The disease specific model projections of prevalence were combined with scenarios for healthcare costs developed by the Netherlands Bureau for Economic Policy Analysis. Results: Healthcare costs for asthma, COPD and respiratory allergy in 2007 were estimated at 287, 415 and 103 million euros respectively. This is on average annually 530, 1400 and 170 euros per patient with asthma, COPD and respiratory allergy. Main cost driver for all diseases was medication; hospitalizations and nursing lead to high medical costs for COPD patients as well. Annual costs of sick leave due to asthma were on average 1200 euros and for COPD 1900 euros per employee. Sick leave associated costs were highest among employees aged 55 years and over. The mean annual costs of work incapacity of an employee with COPD were 1200 euros. Up to 2032, projections show an increase of the number of asthma patients from 443,000 to 567,000; the number of patients with COPD will rise from 335,000 to 600,000. The primary causes for these increases are population growth and ageing. The number of patients with a respiratory allergy is likely to remain stable at 625,000 patients in this period, as the disease is less common among the elderly. The health care costs for respiratory allergy are expected to rise by 73%, those for asthma to double, and those for COPD to triple by 2032. Conclusion: Patients with asthma and COPD have significant healthcare costs. Costs of sick leave are substantial for employees with asthma and COPD. In addition, the costs of work incapacity for employees with COPD are high. Up to 2032 the number of patients with asthma and COPD will rise as well as the health care costs of asthma and COPD. The expected rise in the number of patients with asthma, COPD or respiratory allergy and the associated costs of healthcare and production losses provide important information for healthcare policy in the Netherlands. Efficient prevention and treatment of the diseases are indicated, especially the efficient use of medication. As the number of elderly with asthma or COPD will rise, providing them with support is essential