Het oplossen van problematische schuldsituaties. Een analyse vanb de invloed van hulperverlening, interorgani sationele samenwerking en huishoudkenmerken op de effectiviteit van schuldregelingen.

De mate waarin PSSs, waarvoor een schuldregeling is getroffen, daadwerkelijk zijn opgelost is afgemeten aan objectieve en subjectieve criteria. Als objectieve criteria zijn de financiele belasting van de gehanteerde aflos-capaciteit, de mate waarin alle schulden in de regeling zijn betrokken en de looptijd van de aflostermijn gehanteerd. Voor de subjectieve beoordeling zijn de opvatting van, huishoudens en hulpverleners over het oplossen van PSSs bij getroffen schuldregelingen als uitgangspunt genomen. ... Zie: Conclusies

The Bigger Picture:Research Strategy for a Photo-Elicitation Study Investigating Positive Health Perceptions of Older Adults With Low Socioeconomic Status

Research focussing on older adults of low socioeconomic status (SES) faces several methodological challenges, including high rates of non-response and drop-out. In addition, older adults of low SES tend to be less willing to participate in research and are more likely to experience cognitive impairments and literacy problems. Photo-elicitation studies do not require high levels of literacy, and they might therefore be suitable for use in research with older adults of low SES. To date, however, little is known about setting up such studies with this target group. Our aim was to demonstrate how we systematically set up a researcher-driven photo-elicitation study to generate greater insight into the positive health perceptions of older adults of low SES. Our strategy consisted of three phases: development, testing and execution. In this article, we discuss each step of the research strategy and describe the limitations and strengths of our study. We also formulate recommendations for further research using photo-elicitation methods with this target group. Based on the results of this study, we conclude that the use of researcher-driven photo-elicitation is a powerful tool for enhancing understanding with regard to positive health perceptions and experiences of older adults of low SES. The usefulness of the method is particularly dependent on the careful development and testing of the study

Assessing time use in long-term institutional care:development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC)

BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language. METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero. RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found. CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services

A clear definition of nocturnal leg cramps is essential for comparability of research

In 2012, our randomised trial demonstrated that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults.1 These episodic cramp attacks are characteristic: painful, sustained, involuntary muscle contractions of the calf muscles, hamstrings or feet. The sharp and intense pain may last from seconds to several minutes, accompanied by firm and tender muscles, and in some cases, with plantar flexion of feet and toes.2–5 In his letter, Garrison argues that prophylactic stretching is unlikely to prevent nocturnal leg cramps

KNGF-standaard: beweeginterventie kwetsbare ouderen

Gezien het steeds verder stijgende aantal mensen met één of meerdere chronische aandoeningen en de rechtstreeks daaraan gekoppelde stijging van de kosten in de gezondheidszorg, is het KNGF vanaf 2008 gestart met het ontwikkelen van de KNGF-standaarden beweeginterventies. Een KNGF-standaard Beweeginterventie stelt een voldoende competente fysiotherapeut in staat bij mensen met een chronische aandoening een actieve leefstijl te bevorderen en hun mate van fitheid te verhogen. Voorliggende standaard is gericht op kwetsbare ouderen. Er wordt, waar mogelijk, tot het niveau van de beweegnormen gestreefd naar het ontwikkelen en in stand houden van een actieve leefstijl en het verhogen van de fitheid. Daarnaast zal de fysiotherapeut aandacht besteden aan het inspanningsvermogen, de spierfunctie, verminderde range of motion (ROM) en balans, indien dit beperkende factoren zijn voor het opbouwen en/of onderhouden van een actieve leefstijl

Community Wise—effects and participant perceptions of a community- based -positive health intervention for older inhabitants of low SES neighbourhoods:a mixed-methods approach

Background: The Community Wise (CW) intervention applies a community-based approach to improve the physical fitness, self-management ability, loneliness, social cohesion, and well-being of older adults living in neighbourhoods characterized by lower socioeconomic status (SES).Methods: Participants (N = 108) were recruited using several strategies, including door-to-door visits and community key peers. The study was based on a pre-test/post-test design. Outcomes were assessed through mixed methods using questionnaires, performance tests, semi-structured interviews, and focus-group sessions.Results: Results showed significant improvements on aerobic endurance and shoulder flexibility, but no significant improvements on self-management ability, social cohesion, loneliness, or well-being. Qualitative data analysis did indicate that participants experienced improvements on social connectedness with members of the group, as well as on self-management ability.Conclusion: The results of the intervention seem to depend on programme fidelity and method of assessment. Adapting the intervention and including more older adults with poor health status could lead to better outcomes in the future. This results of this study should be interpreted in light of the complexity and methodological challenges of conducting a community-based health-promotion intervention for this target group

The consistency between planned and actually given nursing care in long-terminstitutional care

Continuous information exchange between healthcare professionals is facilitated by individualized care plans. Compliance with the planned care as documented in care plans is important to provide person-centered care which contributes to the continuity of care and quality of care outcomes. Using the Nursing Interventions Classification, this study examined the consistency between documented and actually provided interventions by type of nursing staff with 150 residents in long-term institutional care. The consistency was especially high for basic (93%) and complex (79%) physiological care. To a lesser extent for interventions in the behavioral domain (66%). Except for the safety domain, the probability that documented interventions were provided was high for all domains (≥ 91%, p > 0.05). NAs generally provided the interventions as documented. Findings suggest that HCAs worked beyond there scope of practice. The results may have implications for the deployment of nursing staff and are of importance to managers