The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study

BACKGROUND: Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients. METHODS: A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients’ cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home. DISCUSSION: The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes. TRIAL REGISTRATION: TNR Our study has been documented in the Dutch Trial Registration, TC = 3871

De hbo-verpleegkundige in 2030 Een explorerend onderzoek naar de toekomstige hbo-verpleegkundige in een veranderend zorglandschap

INLEIDING: In dit onderzoek wordt geëxploreerd welke opvattingen de respondenten met bestuurlijke en beleidsfuncties binnen de zorgsector hebben omtrent de toekomstige zorg en de inzet van de hbo-verpleegkundige in 2030. METHODE: Een kwalitatieve onderzoeksmethode is toegepast waarbij elf een-op-een semigestructureerde interviews werden uitgevoerd. De verwachtingen over de hbo-verpleegkundige in 2030 zijn in kaart gebracht aan de hand van vier vragen. RESULTATEN: De cliënt verandert en beheert de regie over het zorgproces. De behoefte richt zich op het ontvangen van hoogwaardige zorg en begeleiding in het verduidelijken van de zorgvraag. De hbo-verpleegkundige kenmerkt zich door sociale vaardigheden, vakkennis, multidisciplinaire samenwerking, zorg op maat, een holistische visie en de attitude om de regie bij de cliënt te laten. CONCLUSIE: De hbo-verpleegkundige communiceert met de cliënt vanuit een holistische en positieve gezondheidsbenadering. Shared decision making staat tijdens zorg en welzijn in 2030 centraal. De hbo-verpleegkundige werkt intensief samen en krijgt een overkoepelende taak tijdens de zorgverlening om de continuïteit te optimaliseren en te waarborgen. Tegelijkertijd levert de verschuiving van zorg naar de wijk vragen op over de bereikbaarheid van zorg, de hbo-verpleegkundige en het informele netwerk. Het personeelstekort wordt beschouwd als een complexe uitdaging voor de toekomst

How to analyze time and change in qualitative longitudinal materials? : Insights from a literature review of longitudinal qualitative studies in nursing.

Background Longitudinal qualitative research can give new insights in social processes and experiences over time. In recent years, there has been a growing interest in conducting longitudinal qualitative research within nursing. However, the definition of what constitutes longitudinal qualitative research is unclear, the methodological literature scarce, and the variation of procedures great. This review of longitudinal qualitative articles within the nursing field aims to identify and describe various types of qualitative longitudinal approaches. Materials and Method Searches in pubmed identified over a hundred qualitative nursing articles with data collection over time. These articles were analyzed regarding 1) described analysis procedure, 2) how the results related to aspects of time and change, and 3) if results were person oriented vs category oriented. Results Five different types of longitudinal qualitative approaches were identified. In total, a large part of the papers described as having a longitudinal design performed a data collection over time, but did not integrate ideas of time or change in their analysis or results. Four fruitful approaches to analyzing longitudinal qualitative data were identified; time-line, pool, phase and pattern-oriented approaches. Articles classified as using any of these approaches have a clear perspective of time or change in the results. However, depending on type of approach different aspects of time, change, and process are in focus. Further, using different approaches yielded different kinds of results. Conclusion All approaches have pros and cons and researchers need to make informed decisions when choosing which approach they will take when analyzing qualitative longitudinal material