| 1. |
- Theys, Sofie, et al.
(author)
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Barriers and enablers for the implementation of a hospital communication tool for patient participation : a qualitative study
- 2020
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In: Journal of Clinical Nursing. - : Blackwell Science Ltd.. - 0962-1067 .- 1365-2702. ; :11-12, s. 1945-1956
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Journal article (peer-reviewed)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.
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| 2. |
- Theys, Sofie, et al.
(author)
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Individualised care in Flemish and Dutch hospitals : Comparing patients' and nurses' perceptions
- 2022
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In: Scandinavian Journal of Caring Sciences. - : Blackwell Publishing. - 0283-9318 .- 1471-6712. ; 36:3, s. 635-649
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Journal article (peer-reviewed)abstract
- Background: Patient-centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses' and patients' perceptions of the support and provision of patient-centred care is limited and focuses solely on nurses and patients working and staying on surgical wards.Aims and objectives: Comparing patients' and nurses' perceptions of patient-centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context-related variables are associated with these perceptions.Design: Cross-sectional design.Methods: Data were collected in ten Flemish (February-June 2016) and two Dutch (December 2014-May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient-centred care, it is described using the term 'individualised care.'Results: Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections.Conclusion: Nurses perceived that they supported and provided individualised care more compared with patients.Relevance to clinical practice: Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient.
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| 3. |
- Theys, Sofie, et al.
(author)
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Patient empowerment in Flemish hospital wards : a cross-sectional study
- 2021
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In: Acta Clinica Belgica. - : Taylor & Francis. - 1784-3286 .- 2295-3337. ; 76:6, s. 453-461
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Journal article (peer-reviewed)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.
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| 4. |
- Van Tiggelen, Hanne, et al.
(author)
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The prevalence and associated factors of skin tears in Belgian nursing homes : A cross-sectional observational study
- 2019
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In: Journal of tissue viability. - : Elsevier. - 0965-206X. ; 28:2, s. 100-106
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Journal article (peer-reviewed)abstract
- BACKGROUND: Although skin tears are among the most prevalent acute wounds in nursing homes, their recognition as a unique condition remains in its infancy. Elderly patients are at risk of developing skin tears due to increased skin fragility and other contributing risk factors. In order to provide (cost-) effective prevention, patients at risk should be identified in a timely manner.OBJECTIVES: (1) To determine the point prevalence of skin tears and (2) to identify factors independently associated with skin tear presence in nursing home residents.METHODS: A cross-sectional observational study was set up, including 1153 residents in 10 Belgian nursing homes. Data were collected by trained researchers and study nurses using patient records and skin observations. A multiple binary logistic regression model was designed to explore independent associated factors (significance level α < 0.05).RESULTS: The final sample consisted of 795 nursing home residents, of which 24 presented with skin tears, resulting in a point prevalence of 3.0%. Most skin tears were classified as category 3 (defined as complete flap loss) according to the International Skin Tear Advisory Panel (ISTAP) Classification System and 75.0% were located on the lower arms/legs. Five independent associated factors were identified: age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings.CONCLUSIONS: This study revealed a skin tear prevalence of 3.0% in nursing home residents. Age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings were independently associated with skin tear presence.
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| 5. |
- Anrys, Charlotte, et al.
(author)
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Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention : Results from a study in 26 nursing homes in Belgium
- 2019
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In: International Wound Journal. - : Wiley-Blackwell Publishing Inc.. - 1742-4801 .- 1742-481X. ; 16:2, s. 325-333
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Journal article (peer-reviewed)abstract
- The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.
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| 6. |
- Antierens, Alain, et al.
(author)
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How much of Toyota's philosophy is embedded in health care at the organisational level? A review
- 2018
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In: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 26:4, s. 348-357
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Research review (peer-reviewed)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.
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| 7. |
- Antierens, Alain, et al.
(author)
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Wanted in health care : Lean experts with a broad perspective
- 2019
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In: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 27:6, s. 1332-1336
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Journal article (peer-reviewed)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.
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| 8. |
- Beeckman, Dimitri, Visiting Professor, 1982-, et al.
(author)
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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
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 97, s. 105-113
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Journal article (peer-reviewed)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.
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| 9. |
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| 10. |
- De Meyer, Dorien, et al.
(author)
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Delphi Procedure In Core Outcome Set Development : Rating Scale And Consensus Criteria Determined Outcome Selection
- 2019
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In: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 111, s. 23-31
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Journal article (peer-reviewed)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.
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| 11. |
- De Meyer, Dorien, et al.
(author)
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Knowledge of nurses and nursing assistants about pressure ulcer prevention : A survey in 16 Belgian hospitals using the PUKAT 2.0 tool
- 2019
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In: Journal of tissue viability. - : Elsevier. - 0965-206X. ; 28:2, s. 59-69
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Journal article (peer-reviewed)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.
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| 12. |
- De Meyer, Dorien, et al.
(author)
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Outcome measurement instruments for erythema associated with incontinence-associated dermatitis : systematic review
- 2019
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In: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 75:11, s. 2393-2417
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Research review (peer-reviewed)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.
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| 13. |
- De Roose, Marjon, et al.
(author)
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Knowledge, attitude, and practices regarding miscarriage : A cross-sectional study among Flemish midwives
- 2018
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In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 56, s. 44-52
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Journal article (peer-reviewed)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.
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| 14. |
- Debyser, Bart, et al.
(author)
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Mental health nurses and mental health peer workers : Self-perceptions of role-related clinical competences
- 2018
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In: International Journal of Mental Health Nursing. - : Blackwell Publishing. - 1445-8330 .- 1447-0349. ; 27:3, s. 987-1001
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Journal article (peer-reviewed)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.
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| 15. |
- Debyser, Bart, et al.
(author)
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The evaluation of nursing students by patients instrument (ENSPA) : Development and validation
- 2020
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In: Nurse Education Today. - : Elsevier. - 0260-6917 .- 1532-2793. ; 89
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Journal article (peer-reviewed)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.
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| 16. |
- Debyser, Bart, et al.
(author)
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The transition from patient to mental health peer worker : A grounded theory approach
- 2019
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In: International Journal of Mental Health Nursing. - : Blackwell Publishing. - 1445-8330 .- 1447-0349. ; 28:2, s. 560-571
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Journal article (peer-reviewed)abstract
- Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi-structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self-maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self-maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self-maintenance and positively influence their self-development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers' self-development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare.
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| 17. |
- Desmet, Karel, et al.
(author)
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Associated factors of nurse-sensitive patient outcomes : A multicentred cross-sectional study in psychiatric inpatient hospitals
- 2023
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In: Journal of Psychiatric and Mental Health Nursing. - : Blackwell Publishing. - 1351-0126 .- 1365-2850. ; 30:6, s. 1231-1244
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Journal article (peer-reviewed)abstract
- Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship.Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors.Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted.Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital.Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship.Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.
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| 18. |
- Desmet, Karel, et al.
(author)
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Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatients hospitals : a multicentred descriptive cross-sectional study
- 2023
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In: Journal of Psychiatric and Mental Health Nursing. - : Blackwell Publishing. - 1351-0126 .- 1365-2850. ; 30:3, s. 568-579
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing.AIM/QUESTION: To measure nurse-sensitive patient outcomes of the nurse-patient relationship.METHOD: In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'.RESULTS: Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60).DISCUSSION: The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment.IMPLICATIONS FOR PRACTICES: Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.
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| 19. |
- Desmet, Karel, et al.
(author)
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The development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings
- 2021
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In: International Journal of Mental Health Nursing. - : John Wiley & Sons. - 1445-8330 .- 1447-0349. ; 30:4, s. 988-1000
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Journal article (peer-reviewed)abstract
- Mental health nurses are struggling to describe their nursing identity as professional discipline in a changing mental health care. Measuring nurse-sensitive patient outcomes and demonstrating nursing's effect(s) experienced by patients contribute to (re)discover the specific nursing identity. However, a valid and reliable scale is currently lacking. The aim of this study was the development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings. This three-staged study resulted in a scale capturing how inpatients experience the contribution of nurses in their treatment in psychiatric hospitals. First, a draft questionnaire was developed based on a literature review, an independent expert's advice, and an experts panel. Second, the content validity was tested in a two-round Delphi-procedure and focus groups with patients. A pilot test, based on cognitive interviews, confirmed the feasibility of the questionnaire. Third, the psychometric properties of the mental health nurse-sensitive patient outcomes were determined in a sample of 353 patients. The cross-sectional study included a convenience sample of five psychiatric hospitals (Belgium). The factor structure (Kaiser-Meyer-Olkin measure of sampling adequacy 0.924; Bartlett's test of sphericity χ2 = 4162.537; df = 231; P < 0.001), convergent validity by the Individualized Care Scale (Pearson correlation 0.660; P < 0.001), and reliability (Cronbach's Alpha 0.854) were evaluated. The factor analysis resulted in a four-factor solution representing growth, expression, control, and motivation. The Mental Health Nurse-Sensitive Patient Outcome Scale is a valid and reliable tool to measure the effectiveness of mental health nurses from the patient perspective.
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| 20. |
- Duprez, Veerle, et al.
(author)
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Capturing motivating versus demotivating self-management support : Development and validation of a vignette-based tool grounded in Self-determination Theory
- 2021
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 116
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Journal article (peer-reviewed)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.
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| 21. |
- Duprez, Veerle, et al.
(author)
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Is nurses' self-esteem interwoven with patients' achievements? The concept of patient-invested contingent self-esteem
- 2019
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In: Journal of Clinical Nursing. - : Blackwell Publishing. - 0962-1067 .- 1365-2702. ; 28:21-22, s. 3858-3865
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Journal article (peer-reviewed)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.
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| 22. |
- Duprez, Veerle, et al.
(author)
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Nurses' interaction styles when supporting patients in self-management : A profile approach
- 2020
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 110
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Journal article (peer-reviewed)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.
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| 23. |
- Duprez, Veerle, et al.
(author)
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Nurses' perceptions of success in self-management support : An exploratory qualitative study
- 2020
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In: Research in Nursing & Health. - : John Wiley & Sons. - 0160-6891 .- 1098-240X. ; 43:3, s. 274-283
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Journal article (peer-reviewed)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.
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| 24. |
- Goemaes, Régine, et al.
(author)
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Factors influencing the implementation of advanced midwife practitioners in healthcare settings : A qualitative study
- 2018
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In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 66, s. 88-96
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Journal article (peer-reviewed)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.
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| 25. |
- Goemaes, Régine, et al.
(author)
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Time use of advanced practice nurses in hospitals : A cross-sectional study
- 2019
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In: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 75:12, s. 3588-3601
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Journal article (peer-reviewed)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.
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