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The first generation of Turkish and Northwest African immigrants in Belgium are ageing and at risk for developing cancer. Relatives play an important role and provide both emotional and practical care, including mental support and acting as a contact person and/or a translator for improving access to healthcare, as most patients and their spouses have only a limited command of the language. Although access to professional interpreters has shown to be the best guarantee for qualitative healthcare, oncology health providers working with relatives as interpreters is much more common than professional interpreters. The aim of this study was to provide insight into the process wherein relatives balance truth-telling in translating for an older family member diagnosed with cancer. This was a qualitative research study, with elements of constructivist grounded theory. Twenty-eight loosely structured interviews were conducted. Most relatives consider it their responsibility to contribute to a positive attitude of the patient. Relatives decided to what extent they inform the patient, based on several motives and embedded in their assessment of the patient's emotional strength, understanding and need to be informed. What they decide influences the way they act as a translator and/or a contact person between the patient and health professional(s). Some considered it best to omit medical information while others considered it best to inform the patient fully. The results emphasise the importance for healthcare providers to take into account the complexity and unpredictable character of the process of balancing truth-telling when family members translate for their ill older relative.
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Emigrantes e Inmigrantes , Familia , Neoplasias , Traducción , Revelación de la Verdad , Adulto , Anciano , Anciano de 80 o más Años , Argelia/etnología , Bélgica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos/etnología , Investigación Cualitativa , Túnez/etnología , Turquía/etnología , Adulto JovenRESUMEN
This study was undertaken to gain insight in the views and experiences of oncology healthcare providers in Flanders, the Dutch-speaking part of Belgium, on caring for patients of non-Western descent. A qualitative research design with the constant comparative method was used. Data were collected through five focus group interviews, with 23 oncology health workers as participants. Barriers and difficulties were paramount in the provision of care to patients of non-Western descent. Participants want to act according to their professional standards, which call for treating all patients equally and providing appropriate care. However, a focus on medical aspects occurs, wherein 'cure' takes precedence over 'care', when participants were not willing or not fully able to overcome barriers. This results in feelings of inadequacy in those participants who equate professional standards to care of equal quality. Participants who interpreted their professional standard as equivalent care were irritated by 'these' patients who restrained them from providing appropriate care. The findings indicate that professional standards provide protection against possible discrimination that may result from personal beliefs. Extending professional standards from 'treating all patients equally' to 'care attuned to each patient' might be a way to prevent 'cure' taking precedence over 'care'.
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Actitud del Personal de Salud , Cultura , Etnicidad , Enfermeras y Enfermeros , Nutricionistas , Oncólogos , Psicología , Trabajadores Sociales , Adulto , Bélgica , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Clínicas , Enfermería Oncológica , Investigación Cualitativa , Adulto JovenRESUMEN
Palliative patients may have strong hope, even hope for a cure, despite knowing their prognosis. Health professionals do not always understand patients who have this kind of hope. The aim of this article was to explore the meaning of hope among patients with cancer in the palliative phase. A secondary analysis was conducted including a constant comparative analysis to uncover the processes underlying the maintenance of hope, of previously collected interview data (n = 76). The meaning of hope is related to the importance of the object it is attached to, rather than to a real chance of achieving this object. Hope has a dual function: patients hope because they cannot forsake it and because they benefit so much from it. Hope can spring from many sources and is influenced by various factors. If there are fewer potent sources to tap into, people create hope themselves and this type of self-created hope takes more effort to maintain. Patients use different strategies to increase their hope, described as the 'the work of hope'. A better understanding of the work of hope can lead to better psychosocial support by health professionals. Health professionals convey many messages that affect the work of hope.
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Esperanza , Neoplasias/psicología , Cuidados Paliativos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
AIM: To explore the debate on the development of the nurse practitioner profession in the Netherlands. BACKGROUND: In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. METHOD: Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. RESULTS: Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. LIMITATIONS: All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. CONCLUSION: The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making.
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Enfermeras Practicantes , Rol de la Enfermera , Competencia Profesional , Actitud del Personal de Salud , Competencia Clínica , Eficiencia , Humanos , Liderazgo , Países Bajos , Autonomía ProfesionalRESUMEN
BACKGROUND: In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and-as advised by Belgian Medical Deontology--in the context of a trusted patient--physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. AIM: To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). RESULTS: Although GPs can understand a patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. CONCLUSIONS: Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and-if they grant it-to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.
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Actitud del Personal de Salud , Conducta de Elección/ética , Sedación Profunda , Eutanasia Activa , Médicos Generales , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Bélgica , Toma de Decisiones/ética , Sedación Profunda/ética , Sedación Profunda/métodos , Esquema de Medicación , Eutanasia Activa/ética , Eutanasia Activa/legislación & jurisprudencia , Eutanasia Activa/métodos , Femenino , Médicos Generales/ética , Médicos Generales/psicología , Médicos Generales/estadística & datos numéricos , Médicos Generales/tendencias , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Narración , Pacientes , Autonomía Personal , Relaciones Médico-Paciente , Investigación Cualitativa , Religión y Medicina , Encuestas y CuestionariosRESUMEN
The concept of a working alliance is rooted in psychotherapy and has been studied extensively in that field. Much less research has been conducted into working alliances between chronic psychiatric patients and their case managers. The aim of this review was to identify what is known about the working alliance between chronic psychiatric patients and their case managers. An extensive survey of the literature produced 14 articles for this review. The results of studies conducted show that a good working alliance has positive effects on the functioning of patients, and that the quality of the alliance depends on both patient characteristics and the behaviour of the case managers. The results also indicate that the working alliance is largely determined in the first 3 months of the contact. Further research into the development of working alliances is necessary.
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Manejo de Caso/normas , Trastornos Mentales/rehabilitación , Relaciones Profesional-Paciente , Enfermedad Crónica , HumanosRESUMEN
INTRODUCTION: The duration and the amount of pressure and shear must be reduced in order to minimize the risk of pressure ulcer development. Alternating low pressure air mattresses with multi-stage inflation and deflation cycle of the air cells have been developed to relieve pressure by sequentially inflating and deflating the air cells. Evidence about the effectiveness of this type of mattress in clinical practice is lacking. AIM: This study aimed to compare the effectiveness of an alternating low pressure air mattress that has a standard single-stage inflation and deflation cycle of the air cells with an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. METHODS AND MATERIALS: A randomised controlled trial was performed in a convenience sample of 25 wards in five hospitals in Belgium. In total, 610 patients were included and randomly assigned to the experimental group (n=298) or the control group (n=312). In the experimental group, patients were allocated to an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. In the control group, patients were allocated to an alternating low pressure air mattress with a standard single-stage inflation and deflation cycle of the air cells. The outcome was defined as cumulative pressure ulcer incidence (Grade II-IV). An intention-to-treat analysis was performed. RESULTS: There was no significant difference in cumulative pressure ulcer incidence (Grade II-IV) between both groups (Exp.=5.7%, Contr.=5.8%, p=0.97). When patients developed a pressure ulcer, the median time was 5.0 days in the experimental group (IQR=3.0-8.5) and 8.0 days in the control group (IQR=3.0-8.5) (Mann-Whitney U-test=113, p=0.182). The probability to remain pressure ulcer free during the observation period in this trial did not differ significantly between the experimental group and the control group (log-rank χ(2)=0.013, df=1, p=0.911). CONCLUSION: An alternating low pressure air mattress with multi-stage inflation and deflation of the air cells does not result in a significantly lower pressure ulcer incidence compared to an alternating low pressure air mattress with a standard single-stage inflation and deflation cycle of the air cells. Both alternating mattress types are equally effective to prevent pressure ulcer development.
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Lechos , Hospitalización , Pacientes Internos , Úlcera por Presión/prevención & control , Bélgica , Humanos , PresiónRESUMEN
AIM OF THE STUDY: With this study, we wanted to examine the needs of men with fertility problems in terms of communication, care and coping with the diagnosis. METHODOLOGY: data gathered prospectively by means of a written questionnaire (quantitative data), and semi-structured interviews (qualitative data). SAMPLE: 78 subfertile men who consulted for subfertility at the department for reproductive medicine at the University Hospital of Ghent, Belgium were included in the assessment; of these, 23 were interviewed for qualitative evaluation. RESULTS AND CONCLUSIONS: More than one fifth of the participants was dissatisfied with the way they had been informed about their fertility status. There was no significant difference in satisfaction with the care received immediately after diagnosis whether it was given by a general practitioner or by a specialist. A significant influence of nationality was noted on the satisfaction about being informed, Dutch men being much less satisfied than Flemish men. Some men suggested to have a consult with the doctor on a structural basis about a week after the diagnosis. The internet seemed to be a good medium for obtaining medical information IT COULD BE USEFUL TO CREATE AN EXTRA FUNCTION: a 'coach' supporting the couple throughout the entire process., adding another argument to the need for professional psychological support of patients attending clinics for human reproduction. The subfertile men often felt that they were watching from the sideline, and wanted to be more actively involved in the treatment.
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OBJECTIVE: To determine whether neurodevelopmental treatment (NDT) in the care of stroke patients is effective with respect to the functional status and quality of life (QoL) during one year after stroke onset. DESIGN: Prospective, non-randomised, comparative parallel group design. METHODS: 324 consecutive stroke patients from 12 Dutch hospitals were divided into 2 groups: an experimental group (n=223), in which nurses and physiotherapists used the NDT approach, and a control group who received conventional therapy (n=101). Functional status was assessed with the Barthel Index. Primary outcome was considered poor when the Barthel Index <12 after 1 year or when the patient had died. QoL was assessed with the 'Stroke adapted sickness impact profile'-30 and on a visual analogue scale. RESULTS: At 12 months, 59 patients in the NDT group (26%) and 24 patients in the control group (24%) had a poor outcome (corresponding adjusted odds ratio: 1.7; 95% CI: 0.8-3.5). At point of discharge and after 6 months, the adjusted odds ratio was 0.8 (95% CI: 0.4-1-5) and 1.6 (95% CI: 0.8-3.2) respectively. The adjusted mean differences of the QoL measurements did not show statistically significant differences between the 2 study groups at 6 and 12 months after stroke onset. CONCLUSION: The NDT approach was not an effective method in the care of stroke patients. Health care professionals need to reconsider the use of the NDT approach.
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BACKGROUND: The nursing programme 'Coping with Itch' aims at reducing itch and at helping patients with chronic pruritic skin diseases cope with itch. The programme consists of educational and cognitive behavioural interventions. Dermatology nurses carry out the programme, which supplements standard medical treatment given by a dermatologist, in individual sessions at a nurse clinic organized by the dermatology outpatient department. OBJECTIVES: To evaluate the effectiveness of the nursing programme 'Coping with Itch' in patients with chronic pruritic skin diseases. METHODS: A randomized controlled study was carried out. Patients with chronic pruritic skin diseases were randomly assigned to the intervention group or the control group. The intervention group received standard care from a dermatologist and nursing care according to the programme 'Coping with Itch' for a mean of 2.9 visits. The control group received usual care from a dermatologist. Data collection took place at baseline, at 3 months (t1) and at 9 months (t2) after baseline. Most visits to the nurse clinic took place during the first 3 months of the study. Main outcome measures were the frequency and intensity of itching and scratching, itch-related coping, and skin-related and general psychosocial morbidity. Secondary outcome measures were the number of visits to the dermatologist and the use of medication and ointments. Mann-Whitney tests and analyses of covariance were used to analyse differences between the two groups. RESULTS: Data on 29 patients in the intervention group and 36 patients in the control group were used in the analyses. A trend to significance (P = 0.07) was shown in the difference between the two groups in the frequency of itching and scratching at t1. A significant difference (P = 0.04) was shown between the two groups in catastrophizing and helpless itch-related coping at t1. No significant differences were revealed at t2 between the groups. Patients in the intervention group visited the dermatologist significantly less frequently during the intervention period than did control group patients. CONCLUSIONS: The nursing programme 'Coping with Itch' led to a reduction in the frequency of itching and scratching and to a reduction of catastrophizing and helpless coping in patients with chronic pruritic skin diseases during the period immediately following the intervention. We suggest further follow-up visits to the itch clinic to extend these results over a longer period.
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Prurito/enfermería , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Prurito/psicología , Encuestas y CuestionariosRESUMEN
AIM: This paper reports a study investigating whether repositioning patients lying on a pressure-reducing mattress alternately for 2 hours in a lateral position and 4 hours in a supine position reduces the incidence of pressure ulcers in comparison with repositioning every 4 hours. BACKGROUND: Repositioning is commonly recognized as an effective preventive measure. Almost no research has been carried out so far on the necessary turning frequencies to prevent pressure ulcer lesions. The pressure is higher in a lateral than in a supine position. METHOD: A two-arm randomized controlled trial was conducted in 16 Belgian elder care nursing homes. Patients with non-blanchable erythema were randomly assigned to either an experimental or a control group. In the experimental group (n = 122), patients were repositioned alternately 2 hours in a lateral position and 4 hours in a supine position. In the control group (n = 113), patients were repositioned every 4 hours. The sitting protocol was identical in both groups. Pressure areas were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. RESULTS: In the experimental group, 16.4% patients developed a pressure ulcer lesion (grade 2-4), while 21.2% did so in the control group. The incidence was not statistically significantly different between the two groups (P = 0.40). The severity (P = 0.65) and location (P = 0.19) of pressure ulcer lesions, and the time to developing them (P = 0.29) were also similar in both groups. No patient developed a pressure ulcer at the hips. A considerable number of patients changed from a lateral to a supine position between the turning intervals. CONCLUSION: More frequent repositioning on a pressure-reducing mattress does not necessarily lead to fewer pressure ulcer lesions and consequently cannot be considered as a more effective preventive measure.
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Modalidades de Fisioterapia , Postura , Úlcera por Presión/prevención & control , Anciano de 80 o más Años , Lechos , Femenino , Humanos , Incidencia , Masculino , Casas de Salud , Úlcera por Presión/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: Itch is a major symptom of many skin diseases and causes patients considerable distress, adversely affecting quality of life. Feelings of helplessness and lack of control can influence the perceived itch and psychosocial complaints. OBJECTIVES: To determine the prevalence of psychosocial morbidity among patients with pruritic skin diseases, and the influence of itch-related variables, coping strategies, and demographic variables on psychosocial morbidity. PATIENTS AND METHODS: One hundred and sixty-eight patients with pruritic skin diseases from five hospitals in the Netherlands participated in the study. Skin-related psychosocial morbidity was measured with the Adjustment to Chronic Skin Diseases questionnaire (ACS); general psychosocial morbidity was measured with the Symptom Checklist-90 (SCL-90). The frequency and intensity of itching and scratching was recorded in diaries. Itch-related coping was measured with the Itching Cognitions Questionnaire (ICQ). Multiple regression analyses were used. RESULTS: Patients with pruritic skin diseases had higher SCL-90 scores than a healthy Dutch population. All patients had psychosocial complaints as measured with the ACS. Thirty-nine per cent of the variance in skin-related psychosocial morbidity was explained by 'catastrophizing and helpless coping'; another 11% was explained by itching and scratching. Age and sex together explained another 10%. The frequency of itching and scratching (11%), 'catastrophizing and helpless coping' (19%) and skin-related psychosocial morbidity (10%) explained the variance in general psychosocial morbidity. CONCLUSIONS: Patients with a pruritic skin disease have a high level of psychosocial morbidity. Catastrophizing and helpless coping are the most important predictors of psychosocial morbidity, with itching, scratching and demographic variables having a limited influence.
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Trastornos Mentales/complicaciones , Prurito/psicología , Calidad de Vida , Enfermedades de la Piel/psicología , Adaptación Psicológica , Enfermedad Crónica , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
PURPOSE: To determine whether the use of relapse prevention plans (RPPs) in nursing practice is an effective intervention in reducing relapse rates among patients with schizophrenia. DESIGN AND METHODS: Experimental design. Patients with schizophrenia (or a related psychotic disorder) and nurses from three mental health organizations were randomly assigned to either an experimental (RPP) or control condition (care as usual). The primary outcome measure was the psychotic relapses in the research groups. RESULTS: The relapse rates in the experimental and control groups after 1-year follow-up were 12.5% and 26.2%, respectively (p=. 12, ns). The relative risk of a relapse in the experimental versus the control group was 0.48 (ns). CONCLUSIONS: In this study no statistically significant effects of the intervention were found. Effectiveness research in this area should be continued with larger sample sizes and longer follow-up periods.
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Planificación de Atención al Paciente/organización & administración , Enfermería Psiquiátrica/organización & administración , Esquizofrenia/prevención & control , Adaptación Psicológica , Adulto , Análisis de Varianza , Supervivencia sin Enfermedad , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Masculino , Países Bajos , Relaciones Enfermero-Paciente , Evaluación en Enfermería , Investigación en Evaluación de Enfermería , Educación del Paciente como Asunto , Participación del Paciente , Modelos de Riesgos Proporcionales , Enfermería Psiquiátrica/educación , Escalas de Valoración Psiquiátrica , Recurrencia , Esquizofrenia/enfermería , Psicología del Esquizofrénico , Autoevaluación (Psicología) , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development. DESIGN: The Prevention and Pressure Ulcer Risk Score Evaluation (prePURSE) study is a prospective cohort study in which patients are followed up once a week until pressure ulcer occurrence, discharge from hospital, or length of stay over 12 weeks. Data were collected between January 1999 and June 2000. SETTING: Two large hospitals in the Netherlands. PARTICIPANTS: Adult patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days were eligible. A consecutive sample of 1536 patients was visited, 1431 (93%) of whom agreed to participate. Complete follow up data were available for 1229 (80%) patients. MAIN OUTCOME MEASURES: Occurrence of a pressure ulcer grade 2 or worse during admission to hospital. RESULTS: Independent predictors of pressure ulcers were age, weight at admission, abnormal appearance of the skin, friction and shear, and planned surgery in coming week. The area under the curve of the final prediction rule was 0.70 after bootstrapping. At a cut off score of 20, 42% of the patient weeks were identified as at risk for pressure ulcer development, thus correctly identifying 70% of the patient weeks in which a pressure ulcer occurred. CONCLUSION: A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development and in need of preventive measures.
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Úlcera por Presión/epidemiología , Adulto , Anciano , Estudios de Cohortes , Interpretación Estadística de Datos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Úlcera por Presión/enfermería , Úlcera por Presión/prevención & control , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. OBJECTIVE: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. METHODS: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was "poor outcome", defined as Barthel index <12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. RESULTS: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. CONCLUSIONS: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach.
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Calidad de Vida , Perfil de Impacto de Enfermedad , Rehabilitación de Accidente Cerebrovascular , Anciano , Trastornos del Conocimiento/diagnóstico , Femenino , Hospitalización , Humanos , Tiempo de Internación , Masculino , Pruebas Neuropsicológicas , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: The call for evidence-based practice presents numerous challenges to nurses who are responsible for developing interventions and expanding the associated knowledge base. The challenge is compounded because there is limited literature concerning development of interventions and their evidence base. AIM: The purpose of this article is to present a model that has been successfully used to guide the process of developing and testing complex nursing interventions, especially those in which the experience of the client plays an important role. DISCUSSION: The model consists of four stages: problem definition, accumulation of building blocks for intervention design, intervention design and intervention validation. Each stage is described and examples from research studies are presented. Specific attention is given to the manner in which the model allows for the accumulation of empirical evidence and theory development during the development process. CONCLUSIONS: Use of the model could facilitate effective communication among nurses, researchers and educators when discussing the development and testing of nursing interventions.
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Atención a la Salud/normas , Atención de Enfermería/normas , Medicina Basada en la Evidencia/métodos , Humanos , Modelos de Enfermería , Proyectos de InvestigaciónRESUMEN
This article describes the development and content of a nursing intervention protocol for the recognition of the early signs of psychosis. Applying this protocol, nurses can contribute to the prevention of psychotic relapse in patients with schizophrenia or a related disorder. The background and construction of the intervention protocol are described. The judgment of experts in the care of patients with schizophrenia on the content and applicability of the protocol is presented. Finally, the experience is summarized that has been acquired during the conduct of a number of case studies of the application of the intervention protocol.
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Evaluación en Enfermería/métodos , Planificación de Atención al Paciente/normas , Enfermería Psiquiátrica/métodos , Esquizofrenia/prevención & control , Actitud del Personal de Salud , Actitud Frente a la Salud , Protocolos Clínicos/normas , Familia/psicología , Humanos , Modelos Psicológicos , Investigación en Evaluación de Enfermería , Personal de Enfermería/psicología , Investigación Cualitativa , Recurrencia , Esquizofrenia/etiología , Esquizofrenia/enfermería , Psicología del Esquizofrénico , Apoyo Social , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
In this article we describe the findings of an exploratory study into the application of early recognition and early intervention methods aimed at prevention of psychotic relapses in patients with schizophrenia. We addressed several models of symptom recognition plans and indicated how patients, healthcare professionals and other persons involved may be able to list and evaluate early warning signs systematically. We also paid attention to the role of the patient's family and to the potential effects of using early recognition and early intervention methods. In a follow-up article (part 2), we will focus more specifically on factors which favourably or adversely affect the use of early recognition and early intervention methods. The results of this exploratory study will be used to design an intervention protocol for nursing staff to serve as a tool for preparing symptoms recognition plans with the individual patient and his/her social network.
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Esquizofrenia/diagnóstico , Autocuidado , Adulto , Familia , Femenino , Humanos , Masculino , Modelos Psicológicos , Países Bajos , Esquizofrenia/terapia , Psicología del Esquizofrénico , Prevención SecundariaRESUMEN
In this article we describe the findings of an exploratory study into the application of early recognition and early intervention methods aimed at prevention of psychotic relapses in patients with schizophrenia. Following the results we described in part 1, we now focus specifically on factors which favourably or adversely affect the use of early recognition and early intervention methods. The following issues will be addressed: (i) information and education; (ii) attitude of health care professionals; (iii) the patient's insight; (iv) acceptance of illness; (v) motivation; (vi) other relevant patient characteristics; and (vii) continuity of care. Finally, the implications of the findings for the development of a nursing intervention protocol will be discussed.
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Esquizofrenia/diagnóstico , Autocuidado , Actitud del Personal de Salud , Continuidad de la Atención al Paciente , Humanos , Motivación , Países Bajos , Educación del Paciente como Asunto , Esquizofrenia/terapia , Psicología del Esquizofrénico , Prevención Secundaria , Autoevaluación (Psicología)RESUMEN
AIM OF THE PAPER: To describe how to develop a patient-centred nursing intervention (NI). BACKGROUND: The stimulus for scrutinizing methods and techniques to develop a NI was a research project concerning the contribution of information and support to the sexual adaptation of women with gynaecological cancer. Within this project, a NI for sexual teaching (ST) was developed because the literature review revealed no tested NI for this purpose. How patients experience and perceive received information influences the usefulness and efficacy of a teaching intervention. Qualitative methods provide insight and understanding of patients' experience. Consequently, qualitative methods are appropriate to use when developing interventions that aim to influence patients' situations through the provision of information. METHOD: Previously reported approaches for developing an intervention did not match the goals and underlying premises identified for the intervention under development. An alternative method, consisting of a design phase and a testing phase, was developed. The goal of the design phase was to develop a working definition of the intervention and to formulate recommendations for carrying out the intervention. Written guidelines provided concrete examples of the topics to discuss and how to discuss them. During the design phase, a qualitative study was conducted to describe the lived-experience of the phenomenon that the information should influence, namely sexuality after treatment for gynaecological cancer. In the testing phase, a different type of qualitative study took place. The patients' experience of receiving information and the nurses' experience of providing it were investigated in order to refine the proposed intervention, to identify the results patients hope to achieve (or achieved) and to explore the underlying theoretical explanation of the intervention. During the testing phase, the feasibility and acceptability of the modified intervention were both established. CONCLUSION: Even when the starting point is advice from care-givers, an intervention can be developed that is in harmony with the patient perspective when qualitative studies are part of the process.