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1.	Beeckman, Dimitri, Visiting Professor, 1982-, et al. (författare) Frånvaron av bevis inget bevis för frånvaro av samband 2020 Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
2.	Torsy, Tim, et al. (författare) Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients : A prospective observational study 2020 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 110 Tidskriftsartikel (refereegranskat)abstract Background: As nasogastric feeding tube insertion is a frequently applied, non-risk-free nursing technique, a high level of evidence-based nursing care is required. Little evidence is available regarding the accurate determination of the insertion length of nasogastric feeding tubes. The method of using the nose-earlobe-xiphoid distance as measurement is inadequate and not supported by evidence. Findings from a recent randomized trial led to an alternative calculation: the corrected nose-earlobe-xiphoid distance formula: (nose-earlobe-xiphoid distance × 0.38696) + 30.37 + 6 cm.Objectives: To test the accuracy of the corrected nose-earlobe-xiphoid distance formula for determining the required nasogastric feeding tube insertion length in adults admitted on an intensive care unit and to investigate the probability to successfully obtain gastric aspirate for pH measurement.Design: Prospective, single‐centre observational study.Participants and methods: Adult intensive care unit patients in a general hospital (N=218) needing a small-bore nasogastric feeding tube were included between March and September 2018. Correct tip positioning was defined as a tube tip located > 3 cm under the lower esophageal sphincter. Tip positioning was verified using X-ray.Results: All nasogastric feeding tube tips were correctly positioned > 3 cm under the lower esophageal sphincter. The chance of successfully obtaining gastric aspirate within 2 hours after placement of the tube was 77.9%.Conclusions: With all tips positioned > 3 cm in the stomach and zero tubes migrating back into the oesophagus, the corrected nose-earlobe-xiphoid distance formula can be considered a more accurate method to determine nasogastric feeding tube insertion length.
3.	Torsy, Tim, et al. (författare) Comment on Rigobello MCG, Elias Junior J, Bonacim CAG, et al. Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study 2020 Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
4.	Torsy, Tim, et al. (författare) Factors associated with insufficient nasogastric tube visibility on X-ray : a retrospective analysis 2021 Ingår i: European Radiology. - : Springer. - 0938-7994 .- 1432-1084. ; 31:4, s. 2444-2450 Tidskriftsartikel (refereegranskat)abstract Objectives: Chest X-ray imaging is frequently used for verifying the position of a blindly inserted nasogastric tube. A high-quality X-ray increases the likelihood of conclusive visibility of tube tip positioning, thus avoiding risks due to a misplaced tube (e.g., pulmonary intubation, pneumothorax, small bowel insertion). Therefore, this study aims to determine patient-related and environmental factors affecting the visibility of nasogastric tubes on X-ray in adults.Methods: A retrospective descriptive analysis of routinely collected clinical datawas performed on all included patients (N = 215) from a prospective randomized trial in a general hospital. A chest X-ray was taken of each patient needing a nasogastric feeding tube, after which visibility and positioning of the tube on X-ray was independently evaluated by 3 radiologists.Results: In 14.9% (n = 32) of all patients, image quality was insufficient, so no conclusive visibility of nasogastric tube positioning could be found. A patient-related predictor regression model (sex, age, body mass index) explained 21% of variance for an insufficient visibility of the nasogastric tube (Nagelkerke R2 = 0.21). An environmental factor regression model demonstrates a guidewire being inside the tube or not during X-ray as a predictor for a conclusive visibility on X-ray.Conclusions: High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest Xray are associated with a risk of insufficient visibility of the tube on X-ray. Patient profiles can be defined in which supplementary attention is needed when obtaining chest X-rays whose purpose is to confirm nasogastric tube positioning.
5.	Antierens, Alain, et al. (författare) How much of Toyota's philosophy is embedded in health care at the organisational level? A review 2018 Ingår i: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 26:4, s. 348-357 Forskningsöversikt (refereegranskat)abstract AIMS: Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies.BACKGROUND: No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care.EVALUATION: Sixty studies were identified for the final analysis.KEY ISSUE(S): Some Toyota Way principles appear more deeply embedded in health care institutions than others are.CONCLUSION: Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse.IMPLICATIONS FOR NURSING MANAGEMENT: This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level.
6.	Antierens, Alain, et al. (författare) Wanted in health care : Lean experts with a broad perspective 2019 Ingår i: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 27:6, s. 1332-1336 Tidskriftsartikel (refereegranskat)abstract AIM: To reflect on Lean experts' perspective on components of Lean management in health care and its implications for practice.BACKGROUND: The involvement of Lean experts is one of the key success factors of a sustainable Lean transformation in health care.EVALUATION: Thirteen Lean experts participated in two focus groups. They all had experience in the implementation of Lean in healthcare organizations.KEY ISSUES: Lean experts all seem to have a unique perspective on Lean management in health care. Experts without a healthcare degree appear to focus more on the entire management system, where experts with a nursing degree seem to concentrate more on the soft Lean principles.CONCLUSION: The description of Lean and its components in health care differed between Lean experts. Their professional background appears to have an influence.IMPLICATIONS FOR NURSING MANAGEMENT: In selecting a Lean expert, nurse managers may want to gauge what elements the Lean expert tends to emphasize. It seems plausible to opt for a Lean expert without a healthcare degree to accomplish the Lean transformation as they have a broader view on Lean. It may also be useful for managers to involve several Lean experts, all with complementary perspectives and backgrounds.
7.	Beeckman, Dimitri, Visiting Professor, 1982-, et al. (författare) A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents 2019 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 97, s. 105-113 Tidskriftsartikel (refereegranskat)abstract Background: Pressure ulcers are a global issue and substantial concern for healthcare systems. Various types of support surfaces that prevent pressure ulcer are available. Data about the effectiveness and cost of static air support surfaces and alternating air pressure mattresses is lacking.Objectives: To compare the effectiveness and cost of static air support surfaces versus alternating air pressure support surfaces in a nursing home population at high risk for pressure ulcers.Design: Prospective, multicentre, randomised controlled clinical, non-inferiority trial.Setting: Twenty-six nursing homes in Flanders, Belgium.Participants: A consecutive sample of 308 participants was selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair bound, aged > 65 years, and use of an alternating air pressure mattress.Methods: The participants were allocated to the intervention group (n = 154) using static air support surfaces and the control group (n = 154) using alternating air pressure support surfaces. The main outcome measures were cumulative incidence and incidence density of the participants developing a new category II-IV pressure ulcer within a 14-day observation period, time to develop a new pressure ulcer, and purchase costs of the support surfaces.Results: The intention-to-treat analysis revealed a significantly lower incidence of category II-IV pressure ulcer in the intervention group (n = 8/154, 5.2%) than in the control group (n = 18/154, 11.7%) (p = 0.04). The median time to develop a pressure ulcer was significantly longer in the intervention group (10.5 days, interquartile range [IQR]: 1-14) than in the control group (5.4 days, [IQR]: 1-12; p = 0.05). The probability to remain pressure ulcer free differed significantly between the two study groups (log-rank X-2 = 4.051, df =1, p = 0.04). The overall cost of the mattress was lower in the intervention group than in the control group.Conclusions: A static air mattress was significantly more effective than an alternating air pressure mattress in preventing pressure ulcer in a high-risk nursing home population. Considering multiple lifespans and purchase costs, static air mattresses were more cost-effective than alternating air pressure mattresses.
8.	Beeckman, Dimitri, Visiting Professor, 1982-, et al. (författare) Authors' reply to comment on "A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents" 2020 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 107 Tidskriftsartikel (refereegranskat)
9.	Beeckman, Dimitri, Visiting Professor, 1982-, et al. (författare) Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers : a pragmatic non-commercial multicentre randomised open label parallel group medical device trial 2021 Ingår i: British Journal of Dermatology. - : Blackwell Science Ltd.. - 0007-0963 .- 1365-2133. ; 185:1, s. 52-61 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital-acquired pressure ulcers (PUs).OBJECTIVES: Determine if silicone foam dressings in addition to standard prevention reduce PU incidence category 2 or worse compared to standard prevention alone.METHODS: Multicentre, randomised controlled, medical device trial conducted in eight Belgian hospitals. At risk adult patients were centrally randomised (n=1633) to study groups based on a 1:1:1 allocation: experimental group 1 (n=542) and 2 (n=545) - pooled as the treatment group - and the control group (n=546). Experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on these body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU category 2 or worse at these body sites.RESULTS: In the intention-to-treat population (n=1605); 4.0% of patients developed PUs category 2 or worse in the treatment group and 6.3% in the control group (RR=0.64, 95% CI 0.41 to 0.99, P=0.04). Sacral PUs were observed in 2.8% and 4.8% of the patients in the treatment group and the control group, respectively (RR=0.59, 95% CI 0.35 to 0.98, P=0.04). Heel PUs occurred in 1.4% and 1.9% of patients in the treatment and control group respectively (RR=0.76, 95% CI 0.34 to 1.68, P=0.49).CONCLUSIONS: Silicone foam dressings reduce the incidence of PUs category 2 or worse in hospitalised at-risk patients when used in addition to standard of care. Results show a decrease for sacrum, but no statistical difference for heel/trochanter areas.
10.	Beele, Hilde, et al. (författare) Incontinence-Associated Dermatitis : Pathogenesis, Contributing Factors, Prevention and Management Options 2018 Ingår i: Drugs & Aging. - : Wolters Kluwer. - 1170-229X .- 1179-1969. ; 35:1, s. 1-10 Tidskriftsartikel (refereegranskat)abstract Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis, seen in patients with urinary or faecal incontinence. Mechanical factors such as traumata and friction may aggravate the lesions. The fragile skin in elderly patients is more prone to developing IAD. The clinical picture of IAD consists of persistent redness on the one hand and skin loss on the other. Both categories may be associated with clinical signs of major colonisation or infection. It is important to distinguish IAD from pressure ulcers and other dermatoses in the genital region. Due to the lack of well-established clinical trials, recommendations about prevention and treatment are based on expert opinion and best practice. Gentle cleansing, use of hydrating topical agents and application of barrier products are the main elements in the prevention and treatment of IAD. It is important to translate these recommendations and general guidelines into ready-to-use protocols that can be implemented for each specific clinical manifestation of IAD.
11.	Browning, Paul, et al. (författare) Report of the proceedings of a UK skin safety advisory group 2018 Ingår i: British Journal of Nursing. - : Mark Allen Publishing Ltd.. - 0966-0461 .- 2052-2819. ; 27:20, s. S34-S40 Tidskriftsartikel (refereegranskat)abstract Moisture-associated skin damage, especially incontinence-associated dermatitis, continues to present significant health challenges and requires multidisciplinary input to provide effective prevention and treatment. In the absence of mandatory reporting such damage is under- or wrongfully reported, resulting in a lack of accurate data on prevalence and costs of associated care. In March this year, a multidisciplinary team of experts met in the UK to seek to determine measures to improve patient skin care. They aimed to identify activities to increase awareness and education, collect data, and improve prevention and treatment regimes. This article describes that discussion and the conclusions made by the group, such as the key actions required to effect policy changes.
12.	De Meyer, Dorien, et al. (författare) Delphi Procedure In Core Outcome Set Development : Rating Scale And Consensus Criteria Determined Outcome Selection 2019 Ingår i: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 111, s. 23-31 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To compare two different rating scales within one Delphi study for defining consensus in core outcome set development and to explore the influence of consensus criteria on the outcome selection.STUDY DESIGN: Randomized controlled parallel group trial with 1:1 allocation within the first Delphi round of the Core Outcome Set in the Incontinence-Associated Dermatitis (CONSIDER) project. Outcomes were rated on a three-point or nine-point Likert scale. Decisions about which outcomes to retain were determined by commonly used consensus criteria (i.e., (combinations of) proportions with restricted ranges, central tendency within a specific range and decrease in variance).RESULTS: Fifty-seven participants (group 1=28, group 2=29) rated 58 outcomes. The use of the nine-point scale resulted in almost twice as many outcomes being rated as 'critical' compared to the three-point scale (24 versus 13). Stricter criteria and combining criteria led to less outcomes being identified as 'critical'.CONCLUSION: The format of rating scales in Delphi studies for core outcome set development and the definition of the consensus criteria influence outcome selection. The use of the nine-point scale might be recommended to inform the consensus process for a subsequent rating or face-to-face meeting. The three-point scale might be preferred when determining final consensus.
13.	De Meyer, Dorien, et al. (författare) Knowledge of nurses and nursing assistants about pressure ulcer prevention : A survey in 16 Belgian hospitals using the PUKAT 2.0 tool 2019 Ingår i: Journal of tissue viability. - : Elsevier. - 0965-206X. ; 28:2, s. 59-69 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Pressure ulcers have a high impact on patients and their families. Profound and up-to-date knowledge among nurses is important given the effect on attitudes and preventative behaviour. To gain insight into educational needs and priorities, regular knowledge assessments are needed.OBJECTIVE: To gain insight into the knowledge of nurses and nursing assistants about pressure ulcer prevention.DESIGN: Cross-sectional multicentre study.METHODS: 474 nurses and nursing assistants recruited at 29 wards in 16 hospitals completed individually the PUKAT 2.0, a valid and reliable questionnaire to measure nurses knowledge about pressure ulcer prevention. Data were collected between February 2016 and December 2017. Independent sample t-tests, one-way analyses of variance and Kruskal-wallis tests were performed to analyse the results.RESULTS: The mean total score was 50.7%. The lowest scores were found in the themes knowledge about prevention (42.7%), aetiology (45.6%) and prevention for specific patient groups (46.6%). Higher educational level (H = 40.43, p < 0.001) and attending additional training about pressure ulcers or wound care in general (t = 2.93, p = 0.004) resulted in significant higher total knowledge scores.CONCLUSION: The results of this study highlight an important knowledge deficit about pressure ulcer prevention. The PUKAT 2.0 knowledge assessment tool made it possible to differentiate between a variety of cognitive process levels. This allowed to identify knowledge gaps and focus areas for continuing professional education. Education curricula for nurses and associated healthcare professionals are to be screened thoroughly and the identified knowledge gaps should be covered. Besides, multifaceted strategies are needed to improve clinical practice.
14.	De Meyer, Dorien, et al. (författare) Outcome measurement instruments for erythema associated with incontinence-associated dermatitis : systematic review 2019 Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 75:11, s. 2393-2417 Forskningsöversikt (refereegranskat)abstract AIM: To: (1) examine which outcome measurement instruments for erythema associated with incontinence-associated dermatitis with supporting evidence about measurement properties are available; (2) evaluate the methodological quality of the studies and the quality of the measurement properties; and (3) identify eligible instruments to measure erythema in incontinence-associated dermatitis research.DESIGN: Systematic review.DATA SOURCES: MEDLINE, EMBASE, CINAHL and CENTRAL were systematically searched until July 2018 (update December 2018). Additional input was gathered from 151 incontinence-associated dermatitis experts. Cited and citing references of included studies were screened.REVIEW METHODS: The COSMIN Risk of Bias checklist was applied to evaluate the methodological quality of the studies. Reported measurement properties were rated against criteria for good measurement properties.RESULTS: Fourteen studies, describing 10 measurement instruments, were included. In five instruments, erythema was captured as a separate concept, two studies provided empirical evidence about the measurement properties. The most studied measurement properties were reliability (9 studies), measurement error (4 studies) and criterion validity (4 studies). In one study, internal consistency was examined.CONCLUSION: No instrument measuring exclusively erythema associated with incontinence-associated dermatitis exists. There is no single composite incontinence-associated dermatitis measurement instrument that outperforms others. Development or adaption of an instrument to measure erythema associated with incontinence-associated dermatitis is one option to solve this challenge.IMPACT: The evidence about measurement properties of instruments measuring erythema associated with incontinence-associated dermatitis has not been summarized to date. The lack of an instrument should trigger activities to measure this domain accurately in future clinical trials.
15.	De Roose, Marjon, et al. (författare) Knowledge, attitude, and practices regarding miscarriage : A cross-sectional study among Flemish midwives 2018 Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 56, s. 44-52 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: to examine the knowledge, attitude and practices (KAP) of Flemish midwives regarding miscarriage.DESIGN AND SETTING: a cross-sectional KAP study was conducted in 28 hospitals in Flanders (Northern region of Belgium) from September 2015 to January 2016.PARTICIPANTS: a total of 647 out of 1200 midwives (53.9%) working on maternity, labour and gynaecological wards, maternal and neonatal (intensive) care units, antenatal consultations, and reproductive medicine were recruited.MEASUREMENTS: data were collected using a semi-structured, self-administered questionnaire.FINDINGS: = 96.574, df = 1, p<0.001). The majority (72.4%) indicated a lack of knowledge regarding miscarriage. Almost 89% expressed a need for extra training.CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives in Flanders assist in the care for couples with miscarriage and consider themselves as a key healthcare provider in the psychosocial support. This study highlighted several barriers regarding miscarriage care, e.g. a lack of knowledge and incapability. Adequate training in knowledge and communication skills is important and necessary in order to promote appropriate care to couples experiencing pregnancy loss and increase awareness among all health professionals involved in obstetric care. Further research should investigate to what extent miscarriage is included in the educational midwifery programmes, and how the current healthcare practice regarding miscarriage care is organised.
16.	Debyser, Bart, et al. (författare) Mental health nurses and mental health peer workers : Self-perceptions of role-related clinical competences 2018 Ingår i: International Journal of Mental Health Nursing. - : Blackwell Publishing. - 1445-8330 .- 1447-0349. ; 27:3, s. 987-1001 Tidskriftsartikel (refereegranskat)abstract In a mental healthcare that embraces a recovery-oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role-related competences in clinical practice. The aim of this study was to clarify and understand these self-perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role-related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role-related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self-assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training.
17.	Debyser, Bart, et al. (författare) The evaluation of nursing students by patients instrument (ENSPA) : Development and validation 2020 Ingår i: Nurse Education Today. - : Elsevier. - 0260-6917 .- 1532-2793. ; 89 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Patient participation is increasingly used in different aspects of healthcare due to its positive outcomes. Still, instruments for involving patients in the evaluation of nursing students during their internship are scarce.OBJECTIVES: To develop and validate an instrument that enables patients to evaluate nursing students during their internship.DESIGN AND METHODS: A 3-phased validation process was conducted: (1) development of an instrument through literature and patient interviews; (2) content and response process validation by use of cognitive interviews and pilot-testing; (3) testing construct validity and reliability of the instrument which was completed by 244 hospitalized patients.SETTINGS AND PARTICIPANTS: Patients from a variety of wards in a general hospital were recruited for the different phases. In phase 1, 17 interviews and 47 thought shower sessions with patients were performed. In phase 2, 9 cognitive interviews and pilot testing by 4 patients evaluating actual nursing students were used to refine the instrument. In phase 3, 380 patients were eligible to participate. Of these patients, 317 completed the instrument. A sample of 244 completed instruments was useful to perform the psychometric analyses. To assess the test-retest reliability, 50 patients completed the instrument twice with a 4 hour time interval.RESULTS: The 19-item Evaluation of Nursing Students by Patients instrument (ENSPa) is designed. The ENSPa-instrument comprises 7 items that assess whether the patient can place trust in the student, 5 items evaluating person-oriented skills, 4 items appraising caring and 3 items to grade the integrity and honesty of the nursing students. Each item is scored both for importance and rating. The instrument shows high reliability and consistency ratings.CONCLUSIONS: The ENSPa-instrument is a valuable instrument for collecting data on the performance and skills of nursing students during their internship from the patient's perspective. By receiving structured feedback from patients, important learning opportunities are created for nursing students.
18.	Duprez, Veerle, et al. (författare) Capturing motivating versus demotivating self-management support : Development and validation of a vignette-based tool grounded in Self-determination Theory 2021 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 116 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The trend towards more active involvement of patients in the management of their chronic condition requires professionals to interact in a way that facilitates patients' autonomy and motivation. A self-assessment tool that measures simultaneously motivating and demotivating interaction styles in counselling chronic ill patients is currently not available.OBJECTIVES: Grounded in Self-Determination Theory, this study aimed to develop and validate a self-report tool that captures healthcare professionals' motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) interaction styles while supporting patients towards self-management.METHODS: The Situations In Self-management support - HealthCare Professionals (SIS-HCP) was developed throughout a five-phased psychometric validation study with (1) construct definition, (2) development of the vignette-based questionnaire, (3) ecological validation and piloting, (4) psychometric evaluation (round 1) by multidimensional scaling analysis, and (5) psychometric evaluation (round 2) by internal and construct validity, and reliability testing procedures in 5 independent samples (total N = 1133), between August 2015 and March 2018.RESULTS: Multidimensional scaling analysis provided evidence for a two-dimensional structure, with motivating, relative to demotivating counselling and high, relative to low, directive counselling representing the two axes. Four styles could be distinguished: autonomy-support (rather motivating and non-directive), structure (rather motivating & directive), control (rather demotivating & directive) and chaos (rather demotivating & non-directive) within self-management support. The SIS-HCP demonstrated good construct validity, and high internal consistency and test-retest reliability.CONCLUSION: The SIS-HCP is a vignette-based tool, which allows to explore, in an integrative way, which motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) styles healthcare professionals use when counselling patients living with a chronic illness. The SIS-HCP might enhance professionals' awareness of their (de)motivating counselling styles and the extent to which they promote ownership among patients. The SIS-HCP represents an interesting addition to existing instruments which measure what professionals do in the field of self-management support, and how confident they feel doing so. The thorough process of development and validation led to a theoretical underpinned tool, with the identified (de)motivating dimensions yielding strong psychometric properties. The SIS-HCP can be used as a reflective tool for professionals and for tailored training.
19.	Duprez, Veerle, et al. (författare) Is nurses' self-esteem interwoven with patients' achievements? The concept of patient-invested contingent self-esteem 2019 Ingår i: Journal of Clinical Nursing. - : Blackwell Publishing. - 0962-1067 .- 1365-2702. ; 28:21-22, s. 3858-3865 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: To explore the notion of Patient-invested Contingent Self-Esteem (Pa-CSE) and investigate its association to nurses' self-reported engagement in controlling or autonomy-supportive interactions with chronic care patients.BACKGROUND: Considering the high number of patients sub-optimally managing their chronic condition, nurses might experience a drop and rise in self-worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention.DESIGN: Multivariate analysis employing cross-sectional data according to STROBE guidelines.METHODS: Self-reports among nurses employed in chronic care (N=394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted.RESULTS: Success-based and failure-based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients' successes with feelings of professional success and self-worth and patients' failures with feelings of professional failure, shame, and inadequacy. Nurses' self-esteem is fairly interwoven with patients' achievements in the management of their chronic condition. A success-based orientation was positively related to autonomy-supportive care in case a failure-based orientation was low. Nurses with a simultaneous success-based and failure-based orientation interacted in a more controlling way.CONCLUSIONS: The findings of this study suggest that basing one's self-worth on patients' accomplishments may be a double-edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self-worth is not interwoven with patients' failures. In fact, having both success- and failure-oriented contingent self-worth is related to a more pressuring approach.RELEVANCE TO CLINICAL PRACTICE: To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients' behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations.
20.	Duprez, Veerle, et al. (författare) Nurses' interaction styles when supporting patients in self-management : A profile approach 2020 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 110 Tidskriftsartikel (refereegranskat)abstract Background: The rising attention to participation and self-regulation in chronic care requires nurses to move towards an approach in which patients' perspectives and choices are central, and in which patients' competency is fostered. According to Self-Determination Theory, nurses can differ in the way they interact with patients living with a chronic illness. That is, they can interact in an autonomy-supportive, controlling, structuring or chaotic way. However, in practice, nurses often use these styles side by side depending on personal and situational demands.Objective: Rooted in Self-Determination Theory, this study sought to identify distinct profiles among nurses involving the co-occurrence of autonomy support, structure, control and chaos (aim 1), and to examine whether such profiles are meaningfully driven by nurse-related indicators (aim 2).Design: A cross-sectional design with latent profile analysis.Methods: Data were collected using validated self-report questionnaires among nurses counselling chronically ill patients (N = 389). Latent profile analysis was performed to shed light on how nurses use different styles side by side; and subsequent MANCOVA testing was used to examine differences between the profiles in terms of nurse-related indicators.Results: Four profiles could be identified, each characterised by a unique combination of differing degrees of autonomy support, structure, control and chaos. The profiles included a motivating profile (20.31%) characterised by the dominant presence of autonomy support and structure; a demotivating chaotic profile (17.74%) characterised by the dominant presence of chaos; an active profile (24.17%) where all styles were highly present; and an undifferentiated profile (37.79%) characterised by an average presence of all styles. These four profiles were meaningfully related to a set of nurse-related indicators. Multivariate analysis (Pillai's Trace test =.38, F(15, 756) = 7.28; p <.001; eta(2) =.13) indicated that job competency, job autonomy and high-quality motivation were most elevated in the motivating profile.Conclusion: Profiling has supported our understanding of the natural co-occurrence of more motivating and demotivating styles among nurses when counselling patients in self-managing their life with chronic illness. The pattern of retained profiles indicates that, for some nurses, it will be important to move away from controlling or chaotic interactions. Future intervention development should augment nurses' competence levels and high-quality motivation, with attention to reduce the pressure in nurses to act in a result-based manner. Profiling can also be valuable to better assign nurses to an employment in chronic care, and to support their personal professional growth.
21.	Duprez, Veerle, et al. (författare) Nurses' perceptions of success in self-management support : An exploratory qualitative study 2020 Ingår i: Research in Nursing & Health. - : John Wiley & Sons. - 0160-6891 .- 1098-240X. ; 43:3, s. 274-283 Tidskriftsartikel (refereegranskat)abstract Nurses play an important role in supporting patients in self-managing their chronic conditions. However, it is uncertain how nurses define their success and what might create feelings of disillusionment. This exploratory qualitative study sought to understand the origin, meanings, and processes underlying nurses' feelings of success in supporting patients to self-manage their life with a chronic illness. Semi-structured interviews were held with 16 nurses who were purposively sampled. Data were iteratively collected and analyzed (November 2017-September 2018). The origin and meaning of nurses' feelings of success in supporting patients in self-management converged around the intertwining of "maintaining and promoting health" as a primary goal in chronic care, while an "intrapersonal conflict" arises. Patients maintaining physical health by optimal medical management boost nurses' feelings of success, whereas patients dealing with sub-optimally provoke "an intrapersonal conflict". When nurses observe unhealthy patient behavior, this is difficult to accept as it conflicts with their normative ideas of good care and health. Nurses' perception of success is refined by three interconnected processes, namely "keeping on track", "considering own role," and "protecting self". Nurses experienced and processed success differently depending on whether they interacted with patients from a more directive approach or an attuning approach. This study highlighted the fact that nurses expect compliance from patients, and thereby often feel empty-handed. By adopting a broader perspective of what successful patient behavior is, nurses might be able to provide a more comprehensive meaning to their own success regarding the care of patients living with a chronic illness.
22.	Gethin, Georgina, et al. (författare) Nurses are research leaders in skin and wound care 2020 Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 17:6, s. 2005-2009 Forskningsöversikt (refereegranskat)abstract The World Health Assembly declared 2020, the International Year of the Nurse and the Midwife. Recent editorials and commentaries support the leading role of nurses and midwives as frontline caregivers emphasizing the need to invest in the nursing workforce worldwide to meet global health needs. Today nurses are also leaders in research and one example is skin and wound care. In order to reflect on the contribution of nurses as researchers we conducted a systematic review of published articles in five international leading wound care journals in the years 1998, 2008 and 2018. We aimed to determine the type of research publication and percentage of nurses as first, second or senior authors. The place in the authorship was selected as indicative of leadership as it implies responsibility and accountability for the published work. Across the years 1998, 2008 and 2018, 988 articles were published. The overall proportion of nurse-led articles was 29% (n = 286). The total numbers of articles increased over time and so too did the nurse-led contributions. Nurse-led research was strongest in the design categories 'cohort studies' (46%, n = 44), 'systematic reviews' (46%, n = 19), and 'critically appraised literature and evidence-based guidelines' (47%, n = 55).Results of this review indicate that, in addition to the crucial clinical roles, nurses also have a substantial impact on academia and development of the evidence base to guide clinical practice. Our results suggest that nurse led contributions were particularly strong in research summarizing research to guide skin and wound care practice.
23.	Ghijselings, Lynn, et al. (författare) The OptiLUTS trial : improving care for therapy-resistant symptoms of the pelvis in Belgium 2020 Ingår i: Acta Clinica Belgica. - : Taylor & Francis. - 1784-3286 .- 2295-3337. ; 75:5, s. 334-339 Tidskriftsartikel (refereegranskat)abstract Introduction/Background: The management of therapy-resistant lower urinary tract symptoms (LUTS) and symptoms resulting from pelvic organ dysfunctions are subject to a high variability in the Belgian health-care centres. Practical guidelines and standardized patient clinical care pathways are often lacking and unadapted to the Belgian healthcare system.Objectives: The OptiLUTS trial aims to improve the multidisciplinary care of therapy-resistant symptoms of the pelvis in the Belgian healthcare setting.Project A aims for the improvement of knowledge of 2nd line treatments for LUTS among general practitioners. In project B a treatment algorithm for the overactive bladder syndrome and non-obstructive urinary retention will be developed specifically for Belgium. In Project C a patient customized sacral neuromodulation (SNM) care pathway will be set up.Methods: Part A: Explorative study among general practitioners by distribution of a questionnaire.Part B: Review of existing guidelines and use of the Delphi method to obtain expert consensus. Part C: A single center comparative study to compare outcomes before and after implementation of the SNM care pathway. Patients scheduled for the first stage of Interstim therapy™ will be included (N=100). Primary endpoints are the sensitivity and specificity of a new pelvic symptom assessment tool, the conversion to implant and explantation rates.Conclusion: There is a margin for improvement in the care process of patients with therapy-resistant symptoms of the pelvis in the Belgium healthcare system. In the OptiLUTs trial adapted guidelines and a clinical care pathway will be developed to standardize and increase the efficiency of care.Trial registration: Approval for the trial by the Ethics Committee of the Ghent University hospital: EC/2018/0244.
24.	Goemaes, Régine, et al. (författare) Factors influencing the implementation of advanced midwife practitioners in healthcare settings : A qualitative study 2018 Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 66, s. 88-96 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To explore factors influencing the implementation of advanced midwife practitioner roles.DESIGN: Semi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method.SETTING AND PARTICIPANTS: A purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians.FINDINGS: Budgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers' and midwives' attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations' heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Multiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful.
25.	Goemaes, Régine, et al. (författare) Time use of advanced practice nurses in hospitals : A cross-sectional study 2019 Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 75:12, s. 3588-3601 Tidskriftsartikel (refereegranskat)abstract AIMS: To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.DESIGN: A cross-sectional, observational study.METHODS: Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.RESULTS: Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.CONCLUSION: Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.IMPACT: Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.
26.	Goossens, Joline, et al. (författare) Barriers and facilitators to the provision of preconception care by healthcare providers : A systematic review 2018 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 87, s. 113-130 Forskningsöversikt (refereegranskat)abstract BACKGROUND: Healthcare providers play an important role in providing preconception care to women and men of childbearing age. Yet, the provision of preconception care by healthcare providers remains low.OBJECTIVES: To provide an overview of barriers and facilitators at multiple levels that influence the provision of preconception care by healthcare providers.DESIGN: A mixed-methods systematic review.DATA SOURCES: PubMed, Web of Science, CINAHL, The Cochrane Library, and EMBASE were systematically searched up to April 27, 2017. The search strategy contained MeSH terms and key words related to preconception care and healthcare providers. Reference lists of included studies and systematic reviews on preconception care were screened.REVIEW METHODS: Publications were eligible if they reported on barriers and facilitators influencing the provision of preconception care by healthcare providers. Data were extracted by two independent reviewers using a data extraction form. Barriers and facilitators were organized based on the social ecological model. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme Qualitative checklist for qualitative studies, the Quality Assessment Tool for quantitative studies, and the Mixed Methods Appraisal Tool for mixed methods studies.RESULTS: Thirty-one articles were included. Barriers were more reported than facilitators. These were situated at provider level (unfavourable attitude and lack of knowledge of preconception care, not working in the field of obstetrics and gynaecology, lack of clarity on the responsibility for providing preconception care) and client level (not contacting a healthcare provider in the preconception stage, negative attitude, and lack of knowledge of preconception care). Limited resources (lack of time, tools, guidelines, and reimbursement) were frequently reported at the organizational and societal level.CONCLUSIONS: Healthcare providers reported more barriers than facilitators to provide preconception care, which might explain why the provision of preconception care is low. To overcome the different client, provider, organizational, and societal barriers, it is necessary to develop and implement multilevel interventions.
27.	Goossens, Joline, et al. (författare) Preconception lifestyle changes in women with planned pregnancies 2018 Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 56, s. 112-120 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: (1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice.DESIGN: secondary data analysis of a cross-sectional study about pregnancy planning.SETTING: six Flemish Hospitals (Belgium).PARTICIPANTS: four hundred and thirty women with a planned pregnancy ending in birth.MEASUREMENTS: preconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change.FINDINGS: most women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23-3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14-5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04-0.97) or having a lower educational level (OR 0.56, 95% CI 0.32-0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: multiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations.
28.	Goossens, Joline, et al. (författare) Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth 2018 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:4 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To evaluate the psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth.METHODS: A two-phase psychometric evaluation design was set-up. Phase I comprised the translation from English into Dutch and pretesting with 6 women using cognitive interviews. In phase II, the reliability and validity of the Dutch version of the LMUP was assessed in 517 women giving birth recently. Reliability (internal consistency) was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Exploratory Mokken scale analysis was carried out.RESULTS: 517 women aged 15-45 completed the Dutch version of the LMUP. Reliability testing showed acceptable internal consistency (alpha = 0.74, positive inter-item correlations between all items, all corrected item-total correlations >0.20). Validity testing confirmed the unidimensional structure of the scale and all hypotheses were confirmed. The overall Loevinger's H coefficient was 0.57, representing a 'strong' scale.CONCLUSION: The Dutch version of the LMUP is a reliable and valid measure that can be used in the Dutch-speaking population in Belgium to assess pregnancy planning. Future research is necessary to assess the stability of the Dutch version of the LMUP, and to evaluate its psychometric properties in women with abortions.
29.	Goossens, Joline, et al. (författare) The intention to make preconception lifestyle changes in men : Associated socio-demographic and psychosocial factors 2018 Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 73, s. 8-16 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To determine which socio-demographic and psychosocial factors are associated with the intention for preconception healthily behavioral changes in the general population of reproductive-aged men.DESIGN: A cross-sectional, multicenter study.SETTING: Four secondary schools, 4 Public Centers for Social Welfare, 7 Community Health Centers, and online. All data was collected in the X.PARTICIPANTS: A convenience sample of 304 reproductive-aged men were recruited between July 2015 and July 2016.MEASUREMENTS AND FINDINGS: An existing questionnaire was adapted and validated to assess the intention, self-efficacy, attitude, social influence, knowledge, and barriers towards 10 preconception health behaviors. Simple and multiple logistic and linear regression analyses were performed. The overall intention to make preconception lifestyle changes was high (median score: 0.7 on the 0-1 scale). The multiple linear regression revealed that self-efficacy (p < 0.001), social influence of the close social environment (p = 0.02), and attitude (p = 0.05) were associated with a higher intention score. Experiencing negative emotions and beliefs about pre-pregnancy preparations was associated with less intention for preconception health behaviors (p = 0.001). None of the socio-demographic factors was significantly associated with the intention score.KEY CONCLUSIONS: The overall intention to make preconception lifestyle changes was high, and associated with different psychosocial factors including self-efficacy, social influence, and attitude.IMPLICATIONS FOR PRACTICE: Preconception interventions should target the identified factors to improve preconception health behaviors in men and negative emotions and beliefs about preconception. Interventions about preconception health care should primarily suggest that men bear the same responsibility as women, which will address the current gender politics and could have -in second instance- a positive outcome on pregnancy outcomes. Because socio-demographic characteristics were of no influence, a general approach should be used.
30.	Knibbe, Nico E., et al. (författare) An automatic repositioning system to prevent pressure ulcers : a case series 2018 Ingår i: British Journal of Nursing. - : Mark Allen Publishing Ltd.. - 0966-0461 .- 2052-2819. ; 27:6, s. S16-S22 Tidskriftsartikel (refereegranskat)abstract The Danish automated Vendlet V5s repositioning system is intended to reduce pressure ulcer risk in patients and work-related musculoskeletal disorders (MSDs) in caregivers. In two Belgian nursing homes, 13 residents with mobility levels C, D and E experienced the repositioning system, operated by 35 caregivers, for 4 weeks. Data about skin condition, nursing time needed for repositioning and MSD symptoms were collected. The use of the repositioning system was not associated with the development of nor a reduction in skin problems; the study included residents who were vulnerable to or already had pressure ulcers. In addition, four pressure ulcers healed during the experiment. The research focused only on the automated repositioning system. Repositioning frequency and postures were determined by the standard nursing home protocol. Frequency depended on the support surface in use, and a limited number of patient criteria (mobility in bed, presence of bony prominences/pressure points and presence of non-blanchable erythema). In future studies, the Vendlet V5s system should be tested with a more individualised patient repositioning protocol, including more criteria such as fever and moisture. The automated system reduces nursing time so could potentially improve staff efficiency. Compared with manual repositioning, caregivers perceived fewer work-related MSD symptoms during repositioning when using the Vendlet V5s system. Controlled studies with larger samples are needed to verify these conclusions.
31.	LeBlanc, Kimberly, et al. (författare) Best Practice Recommendations for Prevention and Management of Skin Tears in Aged Skin : An Overview 2019 Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - : Lippincott Williams & Wilkins. - 1071-5754 .- 1528-3976. ; 45:6, s. 540-542 Tidskriftsartikel (refereegranskat)
32.	Lechner, Anna, et al. (författare) Outcomes for Pressure Ulcer Trials (OUTPUTs) : protocol for the development of a core domain set for trials evaluating the clinical efficacy or effectiveness of pressure ulcer prevention interventions 2019 Ingår i: Trials. - : BMC. - 1745-6215. ; 20 Tidskriftsartikel (refereegranskat)abstract Background: Core outcome sets (COS) are being developed in many clinical areas to increase the quality and comparability of clinical trial results as well as to ensure their relevance for patients. A COS represents an agreed standardized set of outcomes that describes the minimum that should be consistently reported in all clinical trials of a defined area. It comprises a core domain set (defining what core outcomes should be measured) and a core measurement set (defining measurement/assessment instruments for each core domain). For pressure ulcer prevention trials a COS is lacking. The great heterogeneity of reported outcomes in this field indicates the need for a COS.Methods/design: The first part of this project aims to develop a core domain set by following established methods, which incorporates four steps: (1) definition of the scope, (2) conducting a scoping review, (3) organizing facilitated workshops with service users, (4) performing Delphi surveys and establishing consensus in a face-to-face meeting with different stakeholders.Discussion: After achieving consensus on the core domain set, further work will be undertaken to determine a corresponding core measurement set. This will lead to better pressure ulcer prevention research in the future. There are a number of methodological challenges in the field of COS development. To meet these challenges and to ensure a high-quality COS, the OUTPUTS project affiliates to current standards and works in close collaboration with international experts and with existing international service user groups.Trial registration: The OUTPUTs project is registered in the COMET database: (http://www.comet-initiative.org/studies/details/283). Registered on 2015.
33.	Lechner, A., et al. (författare) Outcomes for Pressure Ulcer Trials (OUTPUTs) project : review and classification of outcomes reported in pressure ulcer prevention research 2021 Ingår i: British Journal of Dermatology. - : Blackwell Science Ltd.. - 0007-0963 .- 1365-2133. ; 184:4, s. 617-626 Forskningsöversikt (refereegranskat)abstract BACKGROUND: In order to overcome inconsistencies in the reporting of outcomes in clinical trials, core outcome sets (COS) have been developed in many clinical areas and the awareness of this concept is growing steadily. The Outcomes for Pressure Ulcer Trials (OUTPUTs) project aims to improve the quality of evidence on pressure ulcer prevention trials by developing a COS.OBJECTIVES: As an initial step in the COS process we aimed to identify and classify outcomes as well as concepts that represent potential outcomes for future trials that have been reported in pressure ulcer prevention research.METHODS: A review was conducted in twelve major databases covering the literature indexed until 2016. Outcomes and relevant concepts reported in primary studies and/or reviews on pressure ulcer prevention in adult patients were extracted as presented in the articles, and afterwards inductively grouped into outcome domains. The domains were then categorized according to the outcome domain taxonomy recently proposed by the Core Outcome Measures in Effectiveness Trials Group.RESULTS: 332 studies were included and 68 outcome domains were identified, covering multiple aspects of pressure ulcer prevention. Pressure ulcer occurrence was reported in 71% of all included studies representing the most frequent outcome, followed by costs (22% of all studies), and acceptability of intervention and comfort (18% of all studies).CONCLUSION: A plethora of different outcomes is applied in pressure ulcer prevention research and substantial variations in definitions and reporting of similar outcomes were observed. A COS for pressure ulcer prevention trials is needed to overcome the non-comparability of outcomes.
34.	Manderlier, Bénédicte, et al. (författare) Modifiable patient-related factors associated with pressure ulcers on the sacrum and heels : secondary data analyses 2019 Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 75:11, s. 2773-2785 Tidskriftsartikel (refereegranskat)abstract AIM: To explore factors associated with the presence of category I-IV pressure ulcers on the sacrum and heels.DESIGN: Cross-sectional, secondary data analysis using data collected from the Landelijke Prevalentiemeting Zorgproblemen (LPZ) project, a multicentre prevalence study including nursing home residents and community care clients (N = 4842) in the Netherlands in 2017.METHODS: A single binary logistic regression model was designed to identify factors associated with the presence of pressure ulcers. Additionally, a multiple binary logistic regression model including modifiable explanatory factors associated with the presence of pressure ulcers was designed.RESULTS: Impaired mobility, friction and shear (evaluated using the Braden Scale) are significantly associated with the presence of both sacral and heel category I-IV pressure ulcers. Incontinence-associated dermatitis is significantly associated with category I-IV sacral pressure ulcers.CONCLUSION: In pressure ulcer prevention, nursing interventions should focus on frequent repositioning and mobilisation while avoiding exposure of the skin to friction and shear. The need to consider incontinence-associated dermatitis, incontinence and moisture as important factors in pressure ulcer risk assessment is confirmed.IMPACT: Pressure ulcers occur when skin and tissues are deformed between bony prominences and the support surface in a sitting or lying position. They are the result of a complex interaction between direct causal factors and a wide range of indirect factors. Recognition of these factors influence risk assessment guidance and practice. Knowledge of skin-specific factors at the patient level, modifiable by nursing interventions, enable a better targeted and tailored preventive approach.
35.	Petosic, Antonija, et al. (författare) Use of social media for communicating about critical care topics : A Norwegian cross-sectional survey 2019 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 63:10, s. 1398-1405 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Social media (SoMe) might be an alternative platform for communicating critical care topics to implement evidence-based practice in the intensive care unit (ICU). This survey aims to describe ICU nurses' and physicians' use of SoMe in general, and their perception of using closed Facebook-groups for receiving content on critical care topics.METHODS: A cross-sectional, web-based, anonymous survey was distributed to ICU physicians and nurses in four ICUs in autumn 2017 via an email-campaign. Descriptive statistics with rates, percentages and median numeric rating scale (NRS) scores, interquartile ranges are presented.RESULTS: The response-rate was 64% (253/ 394) including 210 nurses and 43 physicians. Overall, 93% had a SoMe-profile, and 77% had a profile on more than one network site. Facebook was the most used social network site, with 87% having a profile. Totally, 68% were daily users, but more nurses used Facebook daily vs physicians (81% vs 60%, respectively, P = 0.006). Nurses were also more positive toward being members of closed Facebook-groups aimed to exchange content on critical care topics (median NRS 9 (6-10) vs 6 (3-9), respectively, P = 0.014).CONCLUSION: The majority of ICU nurses and physicians were active SoMe users, mainly for personal purposes, and Facebook was the most popular SoMe. Nurses used Facebook daily more frequent and were more positive toward content on critical care topics on Facebook than physicians. These findings might be relevant to customize future communication about critical care topics via SoMe.
36.	Prinsen, Cecilia A C, et al. (författare) Navigating the landscape of core outcome set development in dermatology. 2019 Ingår i: The Journal of American Academy of Dermatology. - : Elsevier. - 0190-9622 .- 1097-6787. ; 81:1, s. 297-305 Tidskriftsartikel (refereegranskat)abstract The development of core outcome sets (COSs; ie, a minimum set of core outcomes that should be measured and reported in all trials or in clinical practice for a specific condition) in dermatology is increasing in pace. A total of 44 dermatology-related COS projects have been registered in the online Core Outcome Measures in Effectiveness Trials database (http://www.comet-initiative.org/studies/search) and include studies on 26 different skin diseases. With the increasing number of COSs in dermatology, care is needed to ensure the delivery of high-quality COSs that meet quality standards when using state-of-the-art methods. In 2015, the Cochrane Skin-Core Outcome Set Initiative (CS-COUSIN) was established. CS-COUSIN is an international, multidisciplinary working group aiming to improve the development and implementation of COSs in dermatology. CS-COUSIN has developed guidance on how to develop high-quality COSs for skin diseases and supports dermatology-specific COS initiatives. Currently, 17 COS development groups are affiliated with CS-COUSIN and following standardized COS development processes. To ensure successful uptake of COSs in dermatology, researchers, clinicians, systematic reviewers, guideline developers, and other stakeholders should use existing COSs in their work.
37.	Raepsaet, Charlotte, et al. (författare) Management of incontinence-associated dermatitis : A systematic review of monetary data 2020 Ingår i: International Wound Journal. - : Wiley-Blackwell Publishing Inc.. - 1742-4801 .- 1742-481X. ; 18:1, s. 79-94 Forskningsöversikt (refereegranskat)abstract The objective was to systematically review monetary data related to management of incontinence-associated dermatitis (IAD) in an adult population. Six electronic databases were searched: MEDLINE, CINAHL, Web of Science, EMBASE, The Cochrane Library and EconLit. The search string combined index terms and text words related to IAD and monetary data. The quality of the articles was assessed using the consensus on Health Economic Criteria. Results were synthesised narratively because of methodological heterogeneity. Nine studies were included. Only direct medical costs were reported. The product cost per application for prevention ranged between $0.05 and $0.52, and for treatment between $0.20 and $0.35. The product cost per patient/day for prevention ranged between $0.23 and $20.17. The product cost of IAD prevention and treatment per patient/day ranged between $0.57 and $1.08. The cost to treat IAD did not consider the treatment of secondary infection. The calculation of labour cost and total cost differed considerably between studies. Summarising monetary data is a challenge because of heterogeneity in currencies, settings, samples, time horizons, health- and cost outcome valuation, IAD definition and measurements, and included costs. Procedures for health economic evaluations are to be clarified to guarantee valid interpretation and comparison with other studies.
38.	Riviere, M., et al. (författare) Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital : A mixed-methods systematic review 2019 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 92, s. 154-172 Forskningsöversikt (refereegranskat)abstract BACKGROUND: The fundamental importance of establishing an interpersonal care relationship for quality nursing care has been highlighted. However specific elements of the interpersonal care relationship of importance to older patients in the hospital have not been identified.OBJECTIVES: The aim of this review was to explore and synthesise research findings regarding the elements of the interpersonal care relationship concept from the perspectives of older patients.DESIGN: A systematic mixed-methods review.DATA SOURCES: An extensive search was conducted up until October 2018 for articles without any publication date time limit in PubMed, Web of Science, Cochrane Database of Systematic Reviews and CINAHL.REVIEW METHODS: Primary studies were included if they concerned patients aged 65 years or older and their perspectives on the elements of the interpersonal care relationship with nurses. Inclusion was limited to patients without cognitive impairment who were admitted to an acute hospital setting. The methodological quality of each study was assessed using the Critical Appraisal Skills Programme for qualitative studies, the Quality Assessment Tool for Quantitative Studies and the Mixed-Methods Appraisal Tool. Thematic analysis was used to structure the results of the included studies.RESULTS: Of the 7596 studies found, 24 were included in this review. Twenty articles had a qualitative, three a quantitative and one a mixed methods design. Older patients consider dignity and respect as core values that need to be met in the interpersonal care relationship. Five core elements of the interpersonal care relationship were identified to meet these core values: elements related to caring behaviour and attitude, person-centred care, patient participation, communication and situational aspects. These core elements were structured according to three categories, identified in the literature, that determine the quality of the interpersonal care relationship: nurse-, older-patient-related elements and situational aspects.CONCLUSIONS: The elements identified in this review can guide efforts to define the interpersonal care relationship between older patients and nurses. Nurses should be supported and motivated by education and practice to adapt their behaviour, attitudes and communication to meet older patients' expectations. Hospital management can also encourage nurses to communicate well. Investment in the current organisation of care is needed to improve nurses' work overload and presence. Further research is needed to clarify the underlying processes influencing the experience of the interpersonal care relationship from the perspectives of older patients, nurses, informal caregivers and hospital management.
39.	Serraes, Brecht, et al. (författare) An exploration of nursing home residents' experiences of a non-powered static air mattress overlay to prevent pressure ulcers 2020 Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 17:5, s. 1166-1182 Tidskriftsartikel (refereegranskat)abstract Pressure ulcers are injuries to the skin and underlying tissue and are associated with a negative impact on well-being and health-related quality of life. This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents' perspectives and critical success factors when implementing a new non-powered static air mattress overlay to prevent pressure ulcers. Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair-bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non-powered static air mattress overlay. Interviews were conducted in the participants' personal rooms between June 2017 and March 2018. Interviews included broad, open-ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14-day observation period between day 3 and day 14. All interviews were audio-recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay. Implementation of a non-powered static air mattress overlay to prevent pressure ulcers has a far-reaching impact on nursing home residents' experiences. This study provides insight into the true meaning of patients' perspectives by focusing on learning from the patients' experiences that provide valuable information for healthcare professionals and other stakeholders.
40.	Serraes, Brecht, et al. (författare) Prevention of pressure ulcers with a static air support surface : A systematic review 2018 Ingår i: International Wound Journal. - : Wiley-Blackwell Publishing Inc.. - 1742-4801 .- 1742-481X. ; 15:3, s. 333-343 Forskningsöversikt (refereegranskat)abstract The aims of this study were to identify, assess, and summarise available evidence about the effectiveness of static air mattress overlays to prevent pressure ulcers. The primary outcome was the incidence of pressure ulcers. Secondary outcomes included costs and patient comfort. This study was a systematic review. Six electronic databases were consulted: Cochrane Library, EMBASE, PubMed (Medline), CINAHL (EBSCOhost interface), Science direct, and Web of Science. In addition, a hand search through reviews, conference proceedings, and the reference lists of the included studies was performed to identify additional studies. Potential studies were reviewed and assessed by 2 independent authors based on the title and abstract. Decisions regarding inclusion or exclusion of the studies were based on a consensus between the authors. Studies were included if the following criteria were met: reporting an original study; the outcome was the incidence of pressure ulcer categories I to IV when using a static air mattress overlay and/or in comparison with other pressure-redistribution device(s); and studies published in English, French, and Dutch. No limitation was set on study setting, design, and date of publication. The methodological quality assessment was evaluated using the Critical Appraisal Skills Program Tool. Results were reported in a descriptive way to reflect the exploratory nature of the review. The searches included 13 studies: randomised controlled trials (n = 11) and cohort studies (n = 2). The mean pressure ulcer incidence figures found in the different settings were, respectively, 7.8% pressure ulcers of categories II to IV in nursing homes, 9.06% pressure ulcers of categories I to IV in intensive care settings, and 12% pressure ulcers of categories I to IV in orthopaedic wards. Seven comparative studies reported a lower incidence in the groups of patients on a static air mattress overlay. Three studies reported a statistical (P < .1) lower incidence compared with a standard hospital mattress (10 cm thick, density 35 kg/m(3)), a foam mattress (15 cm thick), and a viscoelastic foam mattress (15 cm thick). No significant difference in incidence, purchase costs, and patient comfort was found compared with dynamic air mattresses. This review focused on the effectiveness of static air mattress overlays to prevent pressure ulcers. There are indications that these mattress overlays are more effective in preventing pressure ulcers compared with the use of a standard mattress or a pressure-reducing foam mattress in nursing homes and intensive care settings. However, interpretation of the evidence should be performed with caution due to the wide variety of methodological and/or reporting quality levels of the included studies.
41.	Shanley, Emer, et al. (författare) Development and psychometric evaluation of the patient knowledge of, and attitudes and behaviours towards pressure ulcer prevention instrument (KPUP). 2020 Ingår i: International Wound Journal. - : Wiley-Blackwell Publishing Inc.. - 1742-4801 .- 1742-481X. ; 17:2, s. 339-350 Tidskriftsartikel (refereegranskat)abstract The Patient Knowledge of, and Attitude and Behaviour towards Pressure Ulcer Prevention Instrument (KPUP) was developed and validated using a two-stage prospective psychometric instrument validation study design. In Stage 1, the instrument was designed, and it is psychometrically evaluated in Stage 2. To establish content validity, two expert panels independently reviewed each item for appropriateness and relevance. Psychometric evaluation included construct validity and stability testing of the instrument. The questionnaire was administered to a convenience sample of 200 people aged more than 65 years, living independently in the community; reliability and stability were assessed by test/retest procedures, with a 1-week interval. Mean knowledge scores at 'test' were 11.54/20 (95% CI = 11.10-11.99, SD: 3.07), and 'retest' was 12.24 (95% CI = 11.81-12.66, SD: 2.93). For knowledge, correlation between the test/retest score was positive (r=. 60), attitude section-inter-item correlations ranged from r = -.31 to r = .57 (mean intraclass correlation coefficient of r = .42), and internal consistency for the retest was the same as the test (α = .41 for the eight items). For health behaviours, individual inter-item correlations for test items ranged from r = -.21 to r = .41 for the 13 standardised items. Psychometric testing of the KPUP in a sample of older persons in the community provided moderate internal consistency and general high test-retest stability.
42.	Smet, Steven, et al. (författare) The Belgian pressure ulcer risk assessment project : Is assessing mobility and skin status a more accurate, reliable, and feasible approach to assess pressure ulcer risk in hospitalised patients? 2019 Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 16:6, s. 1577-1578 Tidskriftsartikel (refereegranskat)
43.	Taradaj, Jakub, et al. (författare) Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers 2018 Ingår i: International Journal of Medical Sciences. - : Ivyspring International Publisher. - 1449-1907. ; 15:11, s. 1105-1112 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate the effect of laser irradiation at different wavelengths on the expression of selected growth factors and inflammatory mediators at particular stages of the wound healing process. Methods: Sixty-seven patients were recruited, treated, and analyzed (group A - 940 nm: 17 patients; group B - 808 nm: 18 patients; group C - 658 nm: 16 patients; group D - sham therapy: 17 patients). Patients received a basic treatment, including repositioning and mobilization, air pressure mattress and bed support surfaces, wound cleansing and drug therapy. Additionally, patients received laser therapy once a day, 5 times a week for 1 month in use of a semiconductor lasers (GaAlAs) which emitted a continuous radiation emission at separate wavelengths of 940 nm (group A), 808 nm (group B) and 658 nm (group C). In group D (sham therapy), laser therapy was applied in the same manner, but the device was off during each session (only the applicator was switched on to scan pressure ulcers using none coherent red visible light). Results: The positive changes in the measured serum (IL-2, IL-6 and TNF-α) and wound tissue (TNF-α, VEGF and TGFβ1) parameters appeared to be connected only with the wavelength of 658 nm. The significant change in pro-inflammatory mediator levels [interleukin 2 (IL-2) with p=0.008 and interleukin 6 (IL-6) with p=0.016] was noticed after two weeks of laser therapy. In the other groups, the inflammation was also reduced, but the process was not as marked as in group C. Similarly, in the case of tumor necrosis factor (TNF-α) concentration, where after two weeks of treatment with irradiation at a wavelength of 658 nm, a rapid suppression was observed (p=0.001), whereas in the other groups, these results were much slower and not as obvious. Interestingly, again in the case of group C, the change in TNF-α concentration in wound tissue was most intensive (≈75% reduction), whereas the changes in other groups were not as obvious (≈50% reduction). After irradiation (658 nm), the VEGF expression increased significantly within the first two weeks, and then it decreased and maintained a stable level. In contrast, the TGFβ1 activity remained level, but always higher in comparison to other groups Conclusions: The effective healing of pressure ulcers is connected with laser irradiation at a wavelength of 658 nm. We believe that this effect is related to the inhibition of inflammatory processes in the wound and stimulation of angiogenesis and fibroblast proliferation at this specific radiation (based both on concentration of interleukins and TNF-α serum level and VEGF, TGFβ1, TNF-α activities in wound biopsies). Laser therapy at wavelengths of 940 and 808 nm does not significantly affect the above-mentioned repair processes, which explains its low effectiveness in the treatment of pressure ulcers.
44.	Theys, Sofie, et al. (författare) Barriers and enablers for the implementation of a hospital communication tool for patient participation : a qualitative study 2020 Ingår i: Journal of Clinical Nursing. - : Blackwell Science Ltd.. - 0962-1067 .- 1365-2702. ; :11-12, s. 1945-1956 Tidskriftsartikel (refereegranskat)abstract AIMS AND OBJECTIVES: To investigate potential barriers and enablers prior to the implementation of the Tell-us card.BACKGROUND: Patient participation has the potential to improve quality of care and has a positive effect on health outcomes. In order to enhance participation of patients, adequate communication between patients, their relatives and healthcare professionals is vital. Communication is considered as a fundament of care according to the Fundamentals of Care Framework. A strategy to improve patient participation is the use of the Tell-us card; a communication tool that patients and relatives can use during hospitalization to point out what is important for them during their admission and before discharge. Investigating barriers and enablers is needed before implementation.DESIGN: A qualitative study.METHODS: Semi-structured, individual interviews with (head)nurses, nurse assistants and midwifes. Interviews were audio-recorded, transcribed and analysed using the framework analysis method. The COREQ checklist has been used.RESULTS: The need to maintain control over care, reluctance to engage in in-depth conversations, fear of being seen as unprofessional by patients, fear of repercussions from physicians, the lack of insight in the meaning of patient participation, and the lack of appreciation of the importance of patient participation appeared to be majors barriers. Participants also elaborated on several prerequisites for successful implementation and regarded the cooperation of the multidisciplinary team as an essential enabler.CONCLUSION: The identified barriers and enablers revealed that nurses and midwives are rather reluctant towards patient participation and actively facilitating that by using the Tell-us card communication tool.RELEVANCE TO CLINICAL PRACTICE: A number of issues will have to be factored into the implementation plan of the communication tool. Tailored implementation strategies will be crucial to overcome barriers and to accomplish a successful and sustainable implementation of the Tell-us card.
45.	Theys, Sofie, et al. (författare) Patient empowerment in Flemish hospital wards : a cross-sectional study 2021 Ingår i: Acta Clinica Belgica. - : Taylor & Francis. - 1784-3286 .- 2295-3337. ; 76:6, s. 453-461 Tidskriftsartikel (refereegranskat)abstract Objective: Measuring empowerment of patients on Flemish hospital wards by the short form of the Patient Activation Measure (PAM-13) and exploring the association between patient empowerment and patient-centred care, health literacy, patient- and context-related characteristics.Methods: Secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders between February and June 2016. Patients needed to be admitted for a least 1 day, aged 18 years or over, and mentally competent with adequate ability to speak and read the Dutch language. Independent t-tests, one-way ANOVA and multivariable regression analysis were performed.Results: Mean empowerment was 58. Of the 670 patients, 22.7% tended to be unprepared to play an active role in their health care, 22.2% were struggling to manage own health, 39.4% reported to take action to maintain and improve own health, and 15.7% reported having confidence to perform adequate behaviours in most circumstances. Multivariable analysis showed that patients living together with family, a partner or a friend (p = 0.018), with higher health literacy (p < 0.001), and with higher perceptions of individuality in patients' care (p < 0.001) had higher empowerment scores.Conclusion: The multivariable analysis found three variables associated with patient empowerment and provided empirical evidence for the interrelatedness between patient-centred care and patient empowerment. Future research should use a clear framework to make sure that all relevant determinants of patient empowerment are included. Interventions to improve patient empowerment should incorporate patient characteristics and elements of both health literacy and patient-centred care.
46.	Torsy, Tim, et al. (författare) Comment on Taylor SJ, Allan K, Clemente R. Undetected Cortrak tube misplacements in the United Kingdom 2010–17: An audit of trace interpretation. Intensive Crit Care Nurs. 2019 Dec;55:102766 2020 Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 58 Tidskriftsartikel (refereegranskat)
47.	Torsy, Tim, et al. (författare) Comparison of Two Methods for Estimating the Tip Position of a Nasogastric Feeding Tube : A Randomized Controlled Trial 2018 Ingår i: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. - : John Wiley & Sons. - 1941-2452. ; 33:6, s. 843-850 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Several studies have shown that the nose-earlobe-xiphoid distance (NEX) is inadequate to estimate the insertion length of nasogastric tubes. An alternative approach tested in these studies, which leads to > 90% well-placed nasogastric tubes, used a corrected calculation of the NEX: (NEX × 0.38696) + 30.37. The primary aim of this study was to determine whether using the corrected NEX was more successful than the NEX in determining the insertion length. The secondary aim was to investigate the likelihood to successfully obtain gastric aspirate.METHODS: Adult patients in a general hospital (N = 215) needing a nasogastric tube were randomized to the control (NEX) or intervention group (corrected NEX). Tip positioning was verified using X-ray. Correct tip positioning was defined as between 3 and 10 cm under the lower esophageal sphincter (LES).RESULTS: In >20% of all patients, both methods underestimated the required tube length for correct positioning. The NEX showed an overestimation (17.2%) of the insertion length (>10 cm under the LES) compared with the corrected NEX (4.8%). There was no difference (P = 0.938) between the 2 groups in obtaining gastric aspirate (55.6% vs 56%). However, correct tip positioning resulted in a fourfold increase of obtaining gastric aspirate.CONCLUSIONS: Both methods resulted in a high risk of incorrectly placed tubes due to malposition of the tip near the LES or distal esophagus. This may increase the risk of reflux and pulmonary aspiration. Based on these results, the development of more reliable methods requires consideration.
48.	Van Damme, Nele, et al. (författare) Design and psychometric testing of the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD) 2019 Ingår i: International Wound Journal. - : Wiley-Blackwell Publishing Inc.. - 1742-4801 .- 1742-481X. ; 16:2, s. 492-502 Tidskriftsartikel (refereegranskat)abstract Despite the availability of a range of skin care products for the prevention of incontinence-associated dermatitis (IAD), prevalence remains high. Nurses' attitude is an important determinant to take into account in quality improvement projects. This study aimed to design a psychometrically test the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD). A prospective psychometric instrument validation study was performed in a convenience sample of 217 Belgian nurses. Construct validity and reliability (internal consistency, stability) were tested. The exploratory factor analysis demonstrated a model consisting of four factors and 14 items: (a) beliefs about the impact of IAD on patients, (b) beliefs about team responsibility to prevent IAD, (c) beliefs about personal responsibility to prevent IAD, and (d) beliefs about the effectiveness of IAD prevention products and procedures. Cronbach's α was 0.72 for factor 1, 0.65 for factor 2, 0.63 for factor 3, and 0.47 for factor 4. The intra-class correlation coefficient was 0.689 (95% confidence interval [CI] 0.477-0.825) for the total instrument, 0.591 (95% CI 0.388-0.764) for factor 1, 0.387 (95% CI 0.080-0.626) for factor 2, 0.640 (95% CI 0.406-0.795) for factor 3, and 0.768 (95% CI 0.597-0.872) for factor 4. Psychometric testing of the APrIAD demonstrated adequate validity and reliability measures.
49.	Van Damme, Nele, et al. (författare) Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence : A cross-sectional observational study in 48 ICU units 2018 Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 81, s. 30-39 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely.OBJECTIVES: To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence.DESIGN: A cross-sectional observational study.SETTING AND PARTICIPANTS: The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded.METHODS: and Hosmer-Lemeshow statistic were calculated as measures of model fit.RESULTS: was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301).CONCLUSIONS: Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.
50.	Van Damme, Nele, et al. (författare) Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues : A scoping review 2020 Ingår i: Wound Repair and Regeneration. - : John Wiley & Sons. - 1067-1927 .- 1524-475X. ; 28:2, s. 242-265 Forskningsöversikt (refereegranskat)abstract Deep tissue injuries are pressure ulcers which initiate in the subcutaneous tissues and extend through a bottom-up pathway. Once deep tissue injuries are visual at skin level, serious irreversible tissue damage has already occurred. In pressure ulcer development, inflammation and edema are coupled physiological processes associated with tissue damage arising due to sustained mechanical loading. This study aimed to provide an in-depth overview of the physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues, in the context of pressure ulceration. A scoping review was performed according to the framework by Arksey and O'Malley. The databases MEDLINE, EMBASE, Web of Science, and Scopus, and the reference lists of included studies were searched for in vivo (animal, human), and in vitro studies matching the study objectives (from inception to 28 May 2018). No restrictions for inclusion were applied for study design, setting, participants, and year of publication. A total of 12 studies were included, varying in study design, sample characteristics, amount and duration of mechanical loads that were applied, follow-up time, and assessment methods. Neutrophil infiltration and edema occur in the subcutaneous tissues nearly immediately after the application of load on soft tissues. The amount of neutrophils and edema increase in the first days after the mechanical insult and decrease once healing has been initiated and no supplementary mechanical load was applied. One study indicated that edema may extend up to the level of the dermo-epidermal junction. Further research should focus on how deep tissue inflammation and edema are reflected into unique tissue changes at skin level, and how abnormal inflammatory responses manifest (e.g. when the nervous system is not functioning normally).

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