Investigating work-related stress among health professionals at different hierarchical levels: A cross-sectional study

Aim: To determine the extent of stress at work among health professionals working in upper-, middle- and lower-management positions and those not working in management positions. Design: Cross-sectional design and randomly selected hospitals, nursing homes and home care organizations. Methods: The study sample included nursing staff and midwives, physicians, medical– technical and medical–therapeutic professionals at all hierarchical levels (N = 8,112). Data were collected using self-report questionnaires and analysed using multiple regression models. Results: Health professionals in upper- and middle-management positions reported higher quantitative demands, severe work–private life conflicts (p < .05) as well as less role clarity in middle-management positions (B = −1.58, p < .05). In lower-management positions, health professionals reported higher physical (B = 3.80, p < .001) and emotional demands (B = 1.79, p < .01), stress symptoms (B = 1.81, p < .05) and job dissatisfaction (B = −1.17, p < .05). Health professionals without management responsibilities reported the poorest working conditions in relation to various stressors, job satisfaction (B = −5.20, p < .001) and health-related outcomes (e.g. burnout symptoms: B = 1.89, p < .01). KEYWORDS nurses, nursing, stress, work, workforc

Skin areas, clinical severity, duration and risk factors of intertrigo : a secondary data analysis

Aim: To describe the skin areas most often affected by intertrigo, the clinical severity and duration of intertrigo and possible risk factors. Materials and methods: Secondary analysis of data from 2013 to 2016 collected by the International Prevalence Measurement of Care Quality in Dutch hospitals, care homes and community care. Results: In total, n = 7865 (mean age 80.1 years) subjects were included in this analysis. The inguinal, breast and gluteal cleft skin areas were most often affected by intertrigo. The skin was often inflamed but not eroded. Strongest associations between intertrigo at inguinal skin and diabetes mellitus (OR 1.8; 95% CI 1.1-3.1), intertrigo at sub mammary folds and urinary incontinence (OR 1.6; 95% CI 0.9-2.9) and between intertrigo at gluteal cleft and urinary incontinence (OR 2.9; 95% CI 1.4-5.2) were observed. Conclusion: The inguinal region, sub mammary folds and gluteal clefts are most often affected by intertrigo. Female sex, urinary incontinence and high BMI seem to enhance intertrigo risk at all of these skin areas

Clustering of 27,525,663 death records from the United States based on health conditions associated with death: an example of big health data exploration

Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care

Uitdagingen in de geriatrische revalidatiezorg: de ontwikkeling van een zorgpad

De geriatrische revalidatiezorg heeft te maken met een aantal uitdagingen op het gebied van coördinatie en continuïteit van de zorg. Om deze uitdagingen aan te pakken is een zorgpad ontwikkeld voor de betrokken organisaties (ziekenhuis, geriatrische revalidatiezorg en eerstelijnszorg). Het doel van dit artikel is het proces van (door)ontwikkeling van dit zorgpad toe te lichten en het resultaat ervan te beschrijven en te bediscussiëren. Het zorgpad is (door)ontwikkeld op basis van de eerste vier stappen van het cyclische implementatiemodel van Grol en Wensing: (1) ontwikkeling voorstel voor verandering; (2) analyse feitelijke zorg; (3) analyse doelgroep en setting; (4) ontwikkeling en selectie van interventies/strategieën. Volgens de betrokken partijen moest het zorgpad zich primair richten op verbetering van de zorgprocessen, waaronder de transfers, overdrachten en communicatie tussen de instellingen. Om dit te bereiken werden via literatuuronderzoek, consultatie van experts, interviews met betrokkenen, en werkgroepen van zorgverleners, patiënten en mantelzorgers, de huidige zorg en bestaande problemen geanalyseerd en oplossingen aangedragen voor verbetering. Dit heeft geresulteerd in een zorgpad waarin afspraken zijn vastgelegd over: (a) triage in het ziekenhuis; (b) betrekken van patiënt en mantelzorger bij (keuzemomenten in) de zorg; (c) tijdige en kwalitatief hoogwaardige overdrachten; en (d) adequate communicatie en afstemming tussen zorgverleners

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Background: Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. Aim: To systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness. Methods: Pubmed, Embase, Cochrane central register of controlled trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible. Results: We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in partial pressure of carbon dioxide (0.27 kPa; 95% CI 0.08 to 0.45) and no significant change in partial pressure of oxygen and oxygen saturation (both p>0.05). Non-serious respiratory depression (definition variable/not stated) was described in 4/1064 patients. One cancer patient pre-treated with morphine for pain needed temporary respiratory support following nebulized morphine for breathlessness (single case study). Conclusions: We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed

Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review

INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care and therefore shared decision making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM: To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD: An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS: Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION: SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centered and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE: The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support

What governance roles do municipalities use in Dutch local social support networks?

Until now, there is no consensus about variations in governance roles. This consensus is necessary to enable researchers to examine how network are governed well. In this article, the governance roles are considered to be clusters of consistent choices on a top-down versus bottom-up continuum, regarding nine governance activities. Our results reveal that three governance roles can be discerned: top-down, intermediate and bottom-up governance roles. Furthermore, these roles are applied by municipalities with specific (network) characteristics. Our results pen the black box of network governance and might facilitate municipalities to make choices regarding their role in the new network erahttp://www.tandfonline.com/doi/full/10.1080/14719037.2012.664013#abstractDOI:10.1080/14719037.2012.66401