Patients want to be seen: The top 3 information needs of patients with inguinal hernia.

Background Good patient information has shown to improve surgical outcomes. In this study we explore what kind of pre-surgical information patients need and if the provision of a 360˚ video of a surgical procedure can be of added value to the information provided by the hospital. Methods An explorative qualitative study using semi-structured interviews on information needs was conducted among 17 inguinal hernia patients to gain more insight in the patients’ present surgical information needs. Patients either were planned to receive or already had received a surgical procedure. Questions were asked about the current informatio

Nurse practitioners’ perceptions of their ability to enact leadership in hospital care

Aims and objective: To gain insight into nurse practitioners’ (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse. Background: To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practi

Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing

To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing complexity of healthcare, hospital boards have been implementing NPRs and PCSs. However, many nurses at the unit level believe that staffing levels have become critically low, endangering the quality and safety of their patient care. This descriptive phenomenological qualitative study was conducted in a 1000-bed Dutch university hospital among 24 wards of four specialties (surgery, internal medicine, neurology, gynaecology & obstetrics and paediatric care). Data were collected from September until December 2012. To collect data four focus groups (n=44 nurses) were organized. Additionally, a total of 27 interviews (20 head nurses, 4 nurse directors and 3 quality advisors) were conducted using purposive sampling. The focus groups and interviews were audiotaped, transcribed and subjected to thematic analysis. Nurse staffing issues appear to be merely the 'tip of the iceberg'. Below the surface three underlying main themes became clear - nursing behaviour, authority, and autonomy - which are linked by one overall theme: nurses' position. In general, nurses' behaviour, way of thinking, decision-making and communication of thoughts or information differs from other healthcare disciplines, e.g. physicians and quality advisors. This results in a perceived and actual lack of authority and autonomy. This in turn hinders them to plead for adequate nurse staffing in order to achieve the common goal of safe and high-quality patient care. Nurses desired a valid nursing care intensity system as an interdisciplinary and objective communication tool that makes nursing care visible and creates possibilities for better positioning of nurses in hospitals and further professionalization in terms of enhanced authority and autonomy. The perceived subservient position of nurses in the hospital appears to be the root cause of nurse staffing problems. It is yet unknown whether an objective PCS to measure nursing care intensity would help them communicate effectively and credibly, thereby improving their own positio

Developing and testing a computerized decision support system for nurse-to-patient assignment: A multimethod study

Nurse-to-patient assignment is a frequently recurring, time-consuming, and complex process owing to the many considerations involved. Creating well-balanced, high-quality assignments is crucial to ensuring patient safety, quality of care, and job satisfaction for nurses. A computerized decision support system can assist (charge) nurses in the nurse-to-patient assignment process. In this two-phase multimethod study, a computerized decision support system was developed and evaluated. Three nursing wards in a 1000-bed Dutch university hospital participated. In the first phase of this study, considerations relevant to the assignment process-and their relative importance-were investigated in a literature review, focus group sessionswith nurses, and a survey among nurses. Using information from the first phase, the computerized decision support system was developed based on an integer linear program. In the second phase, a before-and-after study was conducted to test and evaluate the computerized decision support system both quantitatively (duration of the assignment process) and qualitatively (survey on workload). Thirty-six measurements were performed to test the computerized decision support system. After implementation, a 30% time reduction was achieved in the nurse-to-patient assignments, and nurses (N = 138) experienced a lower workload. Therefore, the implementation of computerized decision support system would increase both the quality and safety of care as well as the nurses' job satisfaction and should be investigated rigorously in the coming years

The effect of structural empowerment of nurses on quality outcomes in hospitals:a scoping review

Item does not contain fulltextAIM: To assess and synthesise studies reporting direct associations between the structural empowerment of frontline nurses and quality outcomes, and to identify gaps in the current literature. BACKGROUND: The empowerment of nurses seems essential for delivering high-quality patient care. Understanding the relationship between empowerment and quality outcomes would enable nurse managers to make informed choices on improving the quality of care. METHODS: A scoping review examining the relationship between the structural empowerment of nurses and the quality, effectiveness, safety, efficiency and patient-centredness of care in hospitals. Searching in MEDLINE, CINAHL, Business Source Premier and Embase identified 672 potentially relevant articles. Independent selection, quality assessment, data extraction and analysis were completed. RESULTS: Twelve cross-sectional studies originating from North America were included. These studies showed a variety of quality outcomes and statistics used. All studies reported positive associations between the structural empowerment of nurses, nurse assessed quality of care and patient safety climate, and work and unit effectiveness. CONCLUSIONS: Nurses having access to empowering structures positively affects the quality outcomes, i.e. quality, effectiveness, safety, efficiency and patient-centredness of patient care in hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders should ensure empowering work conditions for nurses in order to increase hospitals' quality of patient care

Scoping reviews

De scoping review is een prille, maar opkomende onderzoeksmethode in het verpleegkundig onderzoek. Een scoping review is een vorm van kennissynthese, waarbij een verkennende onderzoeksvraag leidt tot een inventarisatie van sleutelconcepten, soorten bewijsmateriaal en hiaten in onderzoek met betrekking tot een onderwerp. Dit gebeurt door systematisch zoeken, selecteren en samenvoegen van bestaande kennis, vanuit verschillende bronnen. Scoping reviews zijn zeer geschikt om brede praktijkvraagstukken op nieuwe terreinen te beantwoorden. Dit maakt de scoping review een waardevolle methode in verpleegkundig onderzoek. Vraagstukken uit de praktijk gaan immers niet enkel over effectiviteit van behandelingen en interventies, maar veel vaker over complexe, multifactoriële fenomenen die zich moeilijk lenen voor systematisch literatuuronderzoek van kwantitatief onderzoek. Denk bijvoorbeeld aan vragen zoals: ‘Wat is er bekend over mogelijke manieren waarop verpleegkundige zorg kan bijdragen aan zelfredzaamheid bij thuiswonende ouderen?

Complexe interventies onderzoeken met het MRC-framework

Samenvatting Complexe interventies bestaan uit meerdere componenten waarbij verschillende organisaties of zorgverleners betrokken zijn. In dit hoofdstuk worden complexe interventies toegelicht aan de hand van de Cardiologische Zorgbrug. In deze verpleegkundig gecoordineerde interventie voor kwetsbare, oudere cardiologische patienten zijn het cardiologische en geriatrische team in het ziekenhuis betrokken en werken de wijkverpleegkundige, de fysiotherapeut en een apotheker samen in de thuissituatie. Het doel is om heropname en overlijden te verminderen binnen zes maanden na ontslag. Complexe interventies vragen om een uitgebreidere aanpak in uitvoering en evaluatie dan interventies met een component. Hiervoor wordt vaak gebruikgemaakt van het Medical Research Council (MRC)-framework. Dit framework bestaat uit vier fases: de ontwikkeling, pilot, evaluatie en implementatie. Daarnaast is het bij complexe interventies belangrijk dat, naast het onderzoeken van de effectiviteit, ook inzicht wordt verkregen in de werkzaamheid van de interventiecomponenten in de praktijk

Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals

Aims and objectives: To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Background: Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. Methods: This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses’ combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Results: Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. Conclusions: The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. Relevance to clinical practice: A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure for success