Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19′s impact on patients receiving district nursing care, district nursing teams, and their organisations during the first outbreak in March 2020 as well as one year later; and (2) identify the needs of district nurses regarding future outbreaks. A mixed-methods, two-phase, sequential exploratory design was followed. In total, 36 district nurses were interviewed during the first outbreak (March 2020), of which 18 participated in the follow-up questionnaire in April 2021. Thirteen themes emerged, which showed that the COVID pandemic has substantially impacted patient care and district nursing teams. During the first outbreak, nurses played a crucial role in organising care differently and worked under high pressure, leading to exhaustion, tiredness, and psychosocial problems, including fear of infection. A year later, nurses were better prepared to provide COVID care, but problems regarding work pressure and mental complaints remained. The identified needs focus on a sustainable implementation of leadership roles for district nurses. At the organisational and national levels, more support and appreciation are needed in terms of trust and appropriate policies.
LINK
Objectives To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses’ scope and domain of practice and that are influenced by nursing inputs and interventions. Design A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. Setting District nursing care in the community care setting in the Netherlands. Participants Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Main outcome measures Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. Results In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient’s autonomy, the patient’s ability to make decisions regarding the provision of care, the patient’s satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. Conclusions This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.
Objective To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important. Setting District nursing care as a part of primary care. Participants In this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000). Outcome measures The outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated. Results For the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors. Conclusions People in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.
De druk op de wijkverpleging neemt toe. Zelfredzaamheid van cliënten kan deze druk verlichten, maar zorgprofessionals krijgen onvoldoende steun om dit te bereiken. Data Nurse ondersteunt verpleegkundigen op een datagedreven manier door waardevolle inzichten uit cliëntendossiers te benutten om de zelfredzaamheid van cliënten te vergroten en de zorg te verbeteren.
De Beoordeling Eigen Medicatie (BEM) materialen ondersteunen zorgprofessionals in diverse zorgorganisaties bij de regelmatige beoordeling of er problemen zijn met het eigen beheer van medicatie van patiënten. In dit project evalueren we de bruikbaarheid van de materialen.
Kwaliteitsstandaarden ondersteunen zorgprofessionals in de wijkverpleging in het professioneel en onderbouwd uitoefenen van hun vak. In dit project leren zorgprofessionals met innovatieve reflectiemethodieken te werken met de kwaliteitsstandaarden voor eenzaamheid en mantelzorgbelasting. Daarmee vergroten we de kwaliteit van zorg aan cliënten thuis. Doel Een duurzame en continue cyclus van leren en verbeteren opzetten in de praktijk, door de introductie van reflectiemethodieken die het leren en werken met kwaliteitsstandaarden voor eenzaamheid en mantelzorgbelasting bevordert. Resultaten Zorgprofessionals in de wijkverpleging leren werken met de kwaliteitsstandaarden voor eenzaamheid en mantelzorgbelasting. Inzicht in hoeverre reflectiemethodieken bijdragen aan het ‘leren werken met’ en ‘reflecteren op’ het werken met kwaliteitsstandaarden. Looptijd 01 maart 2021 - 01 maart 2024 Aanpak Met een actiegeoriënteerde aanpak gaan onderzoekers en zorgprofessionals gezamenlijk aan de slag met verschillende reflectiemethodieken. De reflectiemethodieken zijn ‘mentoring’, ‘peer-to-peer shadowing’ en ‘het leren van de data’. Academische werkplaats in de wijk Dit project wordt uitgevoerd binnen de Academische werkplaats in de wijk. Dit is een samenwerkingsverband van Hogeschool Utrecht, de leerstoel verplegingswetenschap van het UMCU en vier verschillende zorgorganisaties in de eerstelijnszorg waaronder AxionContinu, Careyn, de Rijnhoven en Leidsche Rijn Julius Gezondheidscentrum. Het doel van de Academische werkplaats in de wijk is om de werkpraktijk, het onderwijs en het onderzoek meer met elkaar te verbinden en daarmee bij te dragen aan de kwaliteit van verpleegkundige zorg. Cofinanciering Dit onderzoeksproject wordt gefinancieerd door ZonMw, dossiernummer 80-87100-98-004.
