Zoekresultaten

Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic

Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences.

Nursing competencies for family-centred care in the hospital setting

Aim: to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers. Design: A multinational cross-sectional study using Q-methodology. Methods: First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed. Results: The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility. Conclusions: Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC. Impact: Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.

Current Practice of Airway Care in ICUs in the Netherlands

Development and validation of the PACPN

Crying by healthcare professionals in the medical setting is a common but understudied phenomenon. We aimed to develop a questionnaire which measures the attitudes of parent towards crying pediatricians and pediatric nurses. We assessed reliability and validity in a group of parents of children who are living with, have died from or survived a life-limiting or life-threatening-condition. The development of the PACPN was based on modification of an existing questionnaire and expert input. In a cross-sectional-design, we assessed reliability and validity for both pediatricians and pediatric nurses. Dimensionality was assessed using principal component analysis (PCA). Cronbach’s alphas were calculated for each subscale. For construct validity, participants were asked to rate an additional question regarding the goal to measure parents’ attitudes towards crying pediatricians/pediatric nurses. We hypothesized that a higher score would have a strong positive correlation with the total score of the PACPN. At the end of the questionnaire, participants were asked to rate and comment the completeness. The developed 25-item questionnaire was completed by 116 parents. The PCA revealed two dimensions: (1) family’s circumstances; (2) personal circumstances of the pediatrician/pediatric nurse. Internal consistency was good (pediatricians,.81–.93; pediatric nurses,.83–.93). The hypothesis regarding construct validity was confirmed (Spearman’s rho =.71–.75). The completeness score was 7.7 (min–max 1–10, SD = 1.51). Conclusion: The PACPN showed good internal consistency and some degree of construct validity. We assume that by adding some items with nuance to the situation and the degree of crying the completeness of the questionnaire will improve. (Table presented.)

Crossing boundaries

The aim of the present thesis was to contribute to the improvement of patient care communication across the integrated care setting of children with cerebral palsy. Hereto, we followed two subsequent phases: 1) obtaining a better understanding of the experienced quality of patient care communication across the integrated care setting of cerebral palsy in three Dutch care regions; and 2) investigating the feasibility and usability of an eHealth application to improve patient care communication in these care regions.

‘New worlds open up’

Within paediatric palliative care, it is essential for families and providers to have open, equal, and trusting relationships. In practice, however, building relationships can be challenging. Investing in better understanding the differences in each other's frames of reference and underlying values seems important. Wonder Lab practices provide a space to explore these differences by focusing together on life phenomena in curious and Socratic ways. Wonder Labs were organised with parents, healthcare professionals, and students involved in Dutch paediatric palliative care. The aim of this study was to develop an understanding of how participants experienced participating in Wonder Labs. We conducted twenty in-depth interviews with Wonder Lab participants and used inductive thematic analysis for data interpretation. Five themes were identified: Slowing down, Appreciating stories, Becoming vulnerable, Opening up and diving in, and Reframing perspectives. Participating in Wonder Labs allowed mothers, healthcare professionals, and students to contribute to deepening experiences and gain an expanded understanding of what is at play in caring for children with life-limiting and life-threatening conditions. Through working in pluralised groups, frames of reference and understandings complemented each other and could change. Participants often adopted a more open attitude towards others involved in care after participating and adapted day-to-day practices. Deliberating within paediatric palliative care on sensitive issues and their underlying personal and professional beliefs and values must be part of working together, without specific care situations being the catalyst. This may foster the mutual understanding needed in searching for quality of life, death, and bereavement.