A Nursing Process-Clinical Decision Support System (NP-CDSS) Standard with 25 criteria to guide future developments of Nursing Process-Clinical Decision Support Systems was developed. The NP-CDSS Standards' content validity was established in qualitative interviews yielding fourteen categories that demonstrate international expert consensus. All experts judged the Advanced Nursing Process being the centerpiece for Nursing Process-Clinical Decision Support System that should suggest research-based, pre-defined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions and patient outcomes.
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To evaluate the effect of the educational program "Guided Clinical Reasoning" (GCR) and the introduction of an intelligent electronic nursing documentation system (e-doc) on the quality of the nursing process.Evaluation was conducted at three measurement points and rated with the instrument "Quality of Nursing Diagnoses, Interventions and Outcomes" (Q-DIO).GCR showed the best Q-DIO-scores. No long-term effect was found after GCR cessation. The e-doc delivered the lowest scores, while showing adequate support in using nursing diagnoses.E-docs can support conducting the nursing process, but for meaningful e-doc use, clinical reasoning is essential.High-quality nursing documentation requires recognition of factors obstructing or supporting nurses in the use of e-docs while conducting the nursing process.
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This speech discusses how the professorship intends to support practitioners in the nursing domain and contribute to shaping nursing leadership and each person's professional individuality. The title of the speech, “Notes on Nursing 2.0,” is particularly intended to emphasize the need for these changes in the nursing domain. Not by assuming that nothing has changed in care and nursing since Nightingale's time. There has. Being educated in the professional domain is not only a given but a requirement. The knowledge domain of care and nursing has developed far and wide in nursing diagnostics and standards. Nursing science research, which Nightingale once started as the first female statistician in the British Kingdom, has firmly established itself in education and practice. Wanting to be of significance to others out of compassion is still the professional motivation, but there is no longer a subservient servitude (Cingel van der, 2012). At the same time, wholehearted leadership is not yet taken for granted in daily practice and optimal professional practice falters due to an equality principle of differently educated caregivers and nurses that has been held for too long. That is the need for change to which this 2.0 version “Notes on Nursing” and the lectorate want to contribute in the coming years. Chapter 1, through the metaphors in the story “The Cat Who Looked at the King,” describes the vision of emancipatory action research and the change principles that the lectorate will deploy. Chapter 2 contains the reason, mission and lines of research that are interrelated within the lectorate. Chapters 3 and 4 address the themes of identity and leadership, discussing their interrelationship with professional practice and developing a research culture. In addition, specific aspects that influence practice and work culture today are addressed, and how the lectorate contributes specifically to the development of nursing leadership and the formation of professional identity in the relevant domain is described. Chapter 5 contains a summary of the principles on which the research program is based, as well as information on current and future projects. Chapter 6 provides background information on the lector and the members of the knowledge circle.
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Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.
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Objective: To obtain insight into (a) the prevalence of nursing staff–experienced barriers regarding the promotion of functional activity among nursing home residents, and (b) the association between these barriers and nursing staff–perceived promotion of functional activity. Method: Barriers experienced by 368 nurses from 41 nursing homes in the Netherlands were measured with the MAastrIcht Nurses Activity INventory (MAINtAIN)-barriers; perceived promotion of functional activities was measured with the MAINtAIN-behaviors. Descriptive statistics and hierarchical linear regression analyses were performed. Results: Most often experienced barriers were staffing levels, capabilities of residents, and availability of resources. Barriers that were most strongly associated with the promotion of functional activity were communication within the team, (a lack of) referral to responsibilities, and care routines. Discussion: Barriers that are most often experienced among nursing staff are not necessarily the barriers that are most strongly associated with nursing staff–perceived promotion of functional activity.
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Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.
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Background: Nursing documentation could improve the quality of nursing care by being an important source of information about patients' needs and nursing interventions. Standardized terminologies (e.g. NANDA International and the Omaha System) are expected to enhance the accuracy of nursing documentation. However, it remains unclear whether nursing staff actually feel supported in providing nursing care by the use of electronic health records that include standardized terminologies.Objectives: a. To explore which standardized terminologies are being used by nursing staff in electronic health records. b. To explore to what extent they feel supported by the use of electronic health records. c. To examine whether the extent to which nursing staff feel supported is associated with the standardized terminologies that they use in electronic health records.Design: Cross-sectional survey design.Setting and participants: A representative sample of 667 Dutch registered nurses and certified nursing assistants working with electronic health records. The respondents were working in hospitals, mental health care, home care or nursing homes.Methods: A web-based questionnaire was used. Descriptive statistics were performed to explore which standardized terminologies were used by nursing staff, and to explore the extent to which nursing staff felt supported by the use of electronic health records. Multiple linear regression analyses examined the association between the extent of the perceived support provided by electronic health records and the use of specific standardized terminologies.Results: Only half of the respondents used standardized terminologies in their electronic health records. In general, nursing staff felt most supported by the use of electronic health records in their nursing activities during the provision of care. Nursing staff were often not positive about whether the nursing information in the electronic health records was complete, relevant and accurate, and whether the electronic health records were user-friendly. No association was found between the extent to which nursing staff felt supported by the electronic health records and the use of specific standardized terminologies.Conclusions: More user-friendly designs for electronic health records should be developed. The poor user-friendliness of electronic health records and the variety of ways in which software developers have integrated standardized terminologies might explain why these terminologies had less of an impact on the extent to which nursing staff felt supported by the use of electronic health records.
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Nursing Leadership is an important competence to develop for providing quality of care and preventing attrition of nurses. This study looked into the perceptions and experiences of nurses on practising leadership related to performing bachelor nursing competencies. Next to that awareness of the development of nursing leadership was addressed.
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There is a wide range of literature suggesting that implicit learning is more effective than explicit learning when acquiring motor skills. However, the acquisition of nursing skills in educational settings continues to rely heavily on detailed protocols and explicit instructions. This study aimed to examine the necessity for comprehensive protocols in the acquisition of nursing skills. In the context of bandaging techniques, three studies were conducted to investigate whether students who practiced with an instruction card containing minimal instructions (implicit group) performed comparably to the students who practiced with a protocol containing step-by-step instructions (explicit group). Study 1 was designed to determine whether both groups performed equally well in applying a bandage during training. Study 2 and 3 were designed to determine if both groups performed equally well during a retention and transfer (multitasking) test, administered after a series of three training sessions. In comparison with the explicit group, the implicit group demonstrated comparable performance with their practice attempts in Study 1 and performed equally well during the retention and transfer test in Study 2. Furthermore, several results from Study 3 indicated better performance of the implicit group. In conclusion, the use of protocols with explicit step-by-step instructions may not be essential for the acquisition of nursing skills. Instead, instructional methods that facilitate implicit learning may be preferable, as students in the implicit group demonstrated at least comparable performance in all studies and tended towards greater consistency when multitasking.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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