BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
DOCUMENT
When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem.
DOCUMENT
Introduction Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. Purpose To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. Methods A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. Results In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. Conclusion Reported effects of health care interventions on frail elderly persons’ quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.
MULTIFILE
Staffing practices in long-term care lack a clear evidence base and often seem to be guided by opinions instead of evidence. While stakeholders believe intuitively that there is a positive relationship between staffing levels and quality in nursing homes, the research literature is contradictory (1). In this editorial we consider the evidence found in a literature study that we conducted for the Dutch Ministry of Health, Welfare and Sports (VWS). The aim of this study was to summarize all available evidence on the relationship between staffing and quality in nursing homes. Specifically, we focused on the quantity and the educational background of staff and quality in nursing homes. The literature study has contributed to the recent Dutch quality framework for nursing homes (Kwaliteitskader verpleeghuiszorg in Dutch) of the National Health Care Institute. This quality framework was published in January 2017 and provides norms – among other quality aspects – for nursing home staffing. As well as a description of the main findings of the literature study, we present implications for different stakeholders charged with staffing issues in nursing homes.
DOCUMENT
Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
DOCUMENT
Presentatie gegeven over de review in Brussel Objectives: In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined.
MULTIFILE
Abstract Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. Study setting: Sixteen skilled nursing facilities. Study design: Prospective study, comparing three consecutive cohorts. Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71–85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients’ needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients’ and informal caregivers’ perceptions of health service delivery.
DOCUMENT
BACKGROUND: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement.METHODS: The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis.RESULTS: Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient.CONCLUSIONS: The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.
MULTIFILE
Background: The quality of care given by EMS staff is in part monitored by routine review of deployment reports that the providers must complete after each deployment. The assessment consists of determining whether a deployment was performed in a medically correct manner and thus whether the clinical reasoning process was appropriate. The time used during the deployment is also measured, as there are often time limits for performing different parts of the deployment and these must be adhered to. One might question whether measuring the time spent really gives insight into the quality of care, and if it might not be more useful to see how that time was spent. We therefore conceived a study to map the EMS care process and evaluate this process in relation to the time used.Methods: We used a focused ethnographic study design. Video recordings of EMS deployments in combination with semi-structured interviews of the EMS providers involved, were thematically analysed. This led to insights into the EMS care process and the embedded clinical reasoning. By categorising the professional activities we identified we were able to define a model that describes in general the EMS care process. We reported the first part of this study in which we developed this so called SPART model in a separate paper. In this second part of the study we determined the execution time within a deployment and measured the frequency of occurrence and the duration of the identified activities. We interpreted the operational content and the time variables both qualitatively and quantitatively. We also determined the distribution of activities over the three deployment operational periods (response, on-scene and transport period).Results: Using the SPART model, we gained insight into the different activities' nature, order, and duration. We could qualitatively judge the effectiveness of the clinical reasoning process, i.e., the quality of care delivered. Generally, the studied cases were followable, and the clinical reasoning process was medically logical. The diagnostic process sometimes continued after the clinical decision, which was not medically logical. Remarkably, this never changed the clinical decision. Although this could negatively affect the quality of care, we found no clinical evidence that this was the case.Conclusion: Our findings demonstrated that the quality of care in EMS can be measured by using the SPART model to evaluate EMS deployments. We concluded that qualitative judgment was more important than quantitative evaluation. Interpreting the order of different activities led to the clearest understanding of the clinical reasoning process. It was concluded that knowledge of the exact time used per activity and, in total, had the least impact on understanding the clinical reasoning process.
DOCUMENT
When it comes to hard to solve problems, the significance of situational knowledge construction and network coordination must not be underrated. Professional deliberation is directed toward understanding, acting and analysis. We need smart and flexible ways to direct systems information from practice to network reflection, and to guide results from network consultation to practice. This article presents a case study proposal, as follow-up to a recent dissertation about online simulation gaming for youth care network exchange (Van Haaster, 2014).
DOCUMENT
