Co-Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics.

AIMS: To explore patterns and dynamics during the co-design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital. DESIGN: Participatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics. METHODS: Sixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis. RESULTS: Stakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team-related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co-design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented. CONCLUSION: This study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co-design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses. IMPACT: Identified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium. REPORTING METHOD: The 'Standards for Reporting Qualitative Research' were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: This study did not involve direct participation from patients or the public.

The effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes: A systematic review with narrative synthesis.

AIM: To synthesize and assess the effectiveness of different care delivery models in a hospital setting, taking into account patient- and nurse-related outcomes. DESIGN: A systematic review with narrative synthesis in which a comparison was made between different care delivery models. METHODS: The search string consisted of four clusters: 'nursing', 'care delivery models', 'hospital setting' and 'quantitative research designs'. Four electronic databases were searched from the inception of the databases to January 2023: Medline, Embase, CINAHL and Web of Science. RESULTS: In total, 19 studies were included in the systematic review. The most commonly compared care delivery models were functional nursing to primary nursing (n = 6), patient allocation to team nursing (n = 4), team nursing to primary nursing (n = 3) and functional nursing to modular nursing (n = 3). Only one randomized crossover trial was found, other included studies were pretest-posttest designs or quasi-experimental designs. The implementation of a nursing care delivery model was the study intervention. The following aspects of the intervention were not reported or inadequately described by the majority of the authors; tailoring of an intervention, modifications to an intervention and the adherence or fidelity to the intervention. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. Due to a high heterogeneity in outcome measures between the studies, a meta-analysis of the included studies was not possible. All included studies had a high risk of overall bias. CONCLUSION: This systematic review found mixed evidence, inconsistent reporting of certain elements of the interventions, high heterogeneity in outcome measures and low methodological quality. Although this systematic review could not answer which nursing care delivery model is the most effective or most promising, other important findings from this review may inform future research. IMPACT: There are differences in care delivery model descriptions and a lack of agreement on the strengths and weaknesses of the care delivery models. No clear-cut answer can be given about the effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. This review can support the development of future care delivery redesign strategies. REPORTING METHOD: The systematic review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

How to choose between single-use and reusable medical materials for sustainable nursing: Methodological lessons learned from a national study.

AIM: To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single-use healthcare materials. DESIGN: A cross-sectional multi-centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials. METHODS: A hospital survey was conducted to collect the procurement data for single-use medical materials. Based on consumption and cost, five single-use medical materials with sustainable alternatives were selected using different reuse strategies. Single-use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency. RESULTS: A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single-use options. First, an inventory of single-use medical materials consumed was collected. Next, single-use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single-use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material. CONCLUSION: This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide. IMPACT: Patient care involves a large consumption of single-use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single-use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single-use medical materials, thereby yielding positive outcomes for the entire population. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

How much do we know about nursing care delivery models in a hospital setting? A mapping review.

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta-level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

AIM: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION: Prospero ID CRD42021292290.

Adaptation and validation of the encoding of observations using CONSUL-MCC: A self-determination theory-based tool to observe consultations in maternity care.

Objective: During autonomy-supportive consultations, professionals use a need-supportive interaction style to facilitate patients' self-regulated behaviour. To improve maternity care professionals' need-supportive interactions, it is important to provide insights into their interaction style. No tool is currently available for measuring need-supportive interactions in maternity care. Therefore, the aim of this study was to adapt the COUNSEL-CCE to evaluate need-supportive interactions in maternity care and to validate their measurements. Methods: A five-step adaptation and validation process was performed based on the guideline of Sousa and Rojjanasrirat: 1) adaptation of COUNSEL-CCE by two authors independently; 2) development of a consensus-based tool: CONSUL-MCC; 3) qualitative assessment of CONSUL-MCC; 4) pilot testing of CONSUL-MCC in the target population (N = 10) and 5) psychometric testing in the target population (N = 453). Results: All indicators of the original tool remained relevant. Four items were rephrased, one indicator was added, and all examples were adapted to maternity care. The results of psychometric testing indicated good construct validity. However, the data characteristics made it impossible to prove the presumed factor structure and perform an accurate intraclass correlation. Conclusions and innovation: COUNSEL-CCE proved to be a new instrument to gain insights into professionals' interactions and be applied to maternity care.

Perspectives on self-management of individuals living with chronic illnesses: A qualitative study in the Asian context.

Living with a chronic illness requires individuals to perform a critical role in self-managing their illness to improve their quality of life and prevent disease-related complications. To our knowledge, no studies have explored how individuals perceive managing their illness in daily living within the Asian context. This exploratory-descriptive qualitative study aimed to explore the individuals' perspectives regarding self-managing their life with a chronic illness within the Asian context. Individual interviews were conducted with 15 adults living with chronic illness, from three teaching hospitals in Pakistan. An iterative process was followed for data collection and analysis. The analysis identified self-management as complex and situation-driven with variable roles for individuals, namely follower, selective follower, self-permitting role, and active role. Three interrelated elements were found to be influencing these roles: the components of self-management; individuals' relationship with agencies (significant people and power); and their inner drives. Individuals keep moving between these four self-management roles to avoid disharmony and reciprocate the efforts of their significant others. The interdependent community structure, which is a reality in Asian society, was reflected in our data. With this in view, a great deal of authority was given to family relationships and healthcare professionals (HCPs). This study found a lack of collaborative partnership role between individuals and HCPs. The findings and a suggested conceptual figure can facilitate redefining the individuals' and professionals' roles in the healthcare system to promote collaborative partnership and improve individuals' experience of living with a chronic illness within the Asian context. Members of the research team have extensive experience in research around chronic illness management, and self-management (support) from the Western context. The researcher did not need the patient or public contribution in this preliminary exploratory study from the Asian context.

The self-regulation skills instrument in transplantation (SSIt): Development and measurement properties of a self-report self-management instrument.

OBJECTIVE: To develop a self-management instrument for organ transplant recipients that incorporates self-regulations skills and to determine its measurement properties. METHODS: The instrument includes concepts from social cognitive models: problem awareness, attitude, self-efficacy, motivation, social support, goal setting, goal pursuit, skills and goal affect. The measurement properties were evaluated based on the COSMIN guidelines. Face and content validity were determined through patient assessment, Three-Step Test-Interview and expert assessment using the Content Validity Index. Structural validity and reliability were tested using exploratory factor analysis and Cronbach's alpha. Construct validity was tested by comparing subscales with the Health Education Impact Questionnaire (heiQ). RESULTS: After face and content validity assessment 47 items were entered into the exploratory factor analysis. The analysis showed two meaningful factors, with internal consistency of 0.90 and 0.89. Spearman correlations between the subscales and heiQ were moderate (0.55; 0.46). The final version consists of 21 items, divided into two scales: 'Setbacks' and 'Successes'. CONCLUSIONS: The Self-regulation skills instrument in transplantation (SSIt) is a valid and reliable instrument to asses necessary skills for self-management after transplantation and may be useful for other patients as well. PRACTICE IMPLICATIONS: Insight into self-regulation competencies can help healthcare professionals to tailor self-management support.

Application of NRS2002 to detect malnutrition in a tertiary care centre: agreement between nurse and dietician's screening steps and relation with clinical outcomes.

OBJECTIVE: To evaluate the agreement between nurse and dietician nutritional risk assessments when using the Nutritional Risk Screening 2002 (NRS2002) protocol, and to explore the relations of falsely labeling patients 'not at risk' for malnutrition and the screening time difference (STD) between nurse and dietician with the length of stay (LoS). METHODS: Included are all patients hospitalized in a tertiary care center between January 2017 and December 2019 and screened for malnutrition by both a nurse and a dietician. The inter-rater reliability is evaluated using Cohen's Kappa. The relation between STD and the patient classification (PCET) is assessed by a linear mixed effect model. The relation between the LoS and PCET is evaluated with the Kaplan-Meier method and multivariable Cox regression including STD with pathology group and severity of illness as random effect. RESULTS: 9085 patients are assessed by nurse and dietician. 72% of all assessments agree (Kappa = 0.44 [0.43-0.46]). The dietician is involved later for patients falsely labeled 'not at risk' (1.06 [0.92-1.20] days; p < 0.001). Compared to patients where the dietician is involved within 3 days, the LoS is 7.37 days (Hazard Ratio (HR): 0.51 [0.43-0.61]) longer for patients falsely labeled 'not at risk', while only 3.51 days (HR: 0.72 [0.64-0.80]) longer for patients correctly labeled 'at risk'. CONCLUSIONS: Agreement of screening for malnutrition between nurses and dieticians is weak. Avoiding falsely labeling patients 'not at risk' should be a main concern upon patient admission as later involvement of dieticians is correlated with a longer LoS.

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation.

AIM: To evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses' competencies for self-management support. DESIGN: Non-randomized intervention study with mixed-methods evaluation approach (2019-2020). METHODS: The multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees' attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations). RESULTS: Trainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned. CONCLUSION: The outcome evaluation of the INTENNS training indicated most improvement in nurses' skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals. IMPACT: A training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where 'failure' is allowed and video-interaction guidance. Obligatory training participation can be questioned.

Experiences of patients with cancer and their relatives confronted with COVID-19 related delay or change in care: A qualitative study.

AIMS: To provide in-depth insight into how patients and their relatives experienced change or delay in cancer treatment and care due to COVID-19. DESIGN: A qualitative study including semi-structured interviews with patients with cancer and their relatives. METHODS: Between July and October 2020, 42 patients who were confronted with a change or delay in cancer treatment or care, and 11 relatives were interviewed. Data collection and analysis were performed according to the most important methods of grounded theory, including iterative data collection and analysis, theoretical sampling, constant comparative analysis and theoretical sensitivity. RESULTS: This study shows that patients with cancer and relatives experienced paradoxical feelings when confronted with change or delay in treatment or care due to COVID-19. Patients and relatives felt relieved (e.g. less risk of infection), but were also concerned and anxious (e.g. fear for progression, fear for more side effects). Due to these ambivalent feelings, it was difficult for patients and relatives to cope with the change or delay in treatment or care, both when this was decided by the physician and by themselves. In combination with the general impact of COVID-19 on their daily lives, the change or delay led to additional distress. The interviews showed that exploring the meaning of change or delay of care for patients and their relatives and discussing what would help them might prevent or relieve distress. CONCLUSION: The findings of our study show that COVID-19 and the associated delay or changes in cancer treatment and care had a major impact on the well-being of patients and their relatives. Person-oriented care is even more important during (emergency) situations in which care might be changed or delayed.

Implementing mixed nursing care teams in intensive care units during COVID-19: A rapid qualitative descriptive study.

AIMS: The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing-care delivery model during the COVID-19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds. DESIGN: A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist. METHODS: Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university-affiliated hospital in the Flemish-speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods. RESULTS: The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high-quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing-care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing-care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly. CONCLUSION: In this rapid qualitative descriptive study, the implementation of a new nursing-care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges. IMPACT: When rethinking nursing-care delivery models, the findings of this study may help guide the process of implementing mixed nursing-care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account.

The interpersonal care relationship between nurses and older patients: A cross-sectional study in three hospitals.

AIM: To gain insight into which elements of the interpersonal care relationship (IPCR) are perceived as occurring (less) frequently and as (not) disturbing from the perspective of hospitalized older patients. DESIGN: A cross-sectional study in three Belgian hospitals. METHODS: A convenience sample of patients aged 75 years or older admitted to a non-geriatric ward were recruited between May 2017 and April 2019. The Interpersonal Geriatric care relationship (InteGer) tool was used to identify elements of the IPCR and was completed by the researchers through structured patient interviews. RESULTS: The mean total scale score for frequency was 3.74 (SD 1.51) [range 0-12]. On subscale level, the highest mean score was in the accessibility and the lowest mean score in the humanization subscale. Statistically significant differences between the hypothesized and experienced disturbance were observed in 18 of the 30 items. Ten items score in the category 'no action needed' (not occurring, not disturbing), nine items in the category 'remain attentive for patient experiences' (occurring, not disturbing), 10 items in the category 'further analyses or monitoring needed' (not occurring, disturbing) and one item in the category 'urgent action needed' (occurring and disturbing). CONCLUSION: Participants report mostly positive experiences related to the four subscales of the InteGer, that is, humanization, attentiveness, interest and accessibility. Insights from this study provide important opportunities in the context of care optimization for each category with the main focus on items with high experienced disturbance. IMPACT: The InteGer can be used for monitoring IPCR and formulating action points at ward and hospital level to further improve the IPCR and quality of care.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study.

BACKGROUND: The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19. OBJECTIVES: To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate. METHODS: Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave. RESULTS: Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out. CONCLUSIONS: We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

Factors influencing nurses' provision of self-management support for patients with chronic illnesses: A systematic mixed studies review.

BACKGROUND: Self-management support is considered an important task for nurses working in chronic care provision. The complex nature of self-management support makes it necessary to clarify the factors affecting the behaviour of nurses in supporting patients living with chronic illnesses. OBJECTIVE: The aim of this review is to synthesize the factors influencing the provision of self-management support as perceived by nurses in the care for patients living with a chronic illness. DESIGN: A systematic mixed studies review. DATA SOURCE: Studies published in English from 1999 to April 2020 were extracted from five databases: CINAHL, PubMed, Cochrane library, EMBASE, and Web of Science. REVIEW METHOD: The selection process was guided by PICo (Population, phenomenon of Interest, and Context). Studies that highlighted factors associated with the provision of self-management support among nurses, within the context of the top four non-communicable chronic diseases, were included. The risk of bias was carefully assessed. Using data-based convergent synthesis, the identified factors were synthesized and tabulated. The clusters of factors organized under each theme were approved by all researchers in discussion meetings. RESULTS: In total, sixteen studies met the inclusion criteria; out of these, seven were qualitative, seven quantitative, and two mixed methods studies. The review identified nurses' perspectives regarding factors influencing self-management support at the patient, nurse, care relationship, education and training, organization and healthcare system, and intra- and inter-professional levels. The review provided evidence that these factors are interdependent in nature. CONCLUSION: This review proposed considering a framework of interdependent factors influencing self-management support. It highlighted the need to come up with a comprehensive definition of self-management support that takes into account the emotional aspect as well as patient-as-partner approach. The proposed framework can be useful in tailoring multi-faceted interventions to strengthen nurses' supportive role in self-management of chronic care. Future studies should focus on exploring contextually relevant factors impacting nurses' supportive role in self-management.

The development and psychometric validation of the interpersonal geriatric care relationship (InteGer) tool.

AIM: To develop and psychometrically test the Interpersonal Geriatric care relationship tool. BACKGROUND: The quality of nursing care is highly influenced by the quality of the interpersonal care relationship, yet there are no tools available that capture the conceptual breadth of the interpersonal care relationship. DESIGN: Instrument development and psychometric testing of the content and construct validity, factor structure and reliability. METHODS: A four-phased validation procedure was conducted (January 2016-April 2019): defining the construct measured by the tool, tool development, content validation and psychometric evaluation. RESULTS: The 30-item Interpersonal Geriatric care relationship tool was subjected to exploratory factor analysis. Four components (humanization, attentiveness, interest and accessibility) were extracted. The tool demonstrated discriminating power and good internal consistency. Cronbach's alphas for the components ranged between 0.69 and 0.84. CONCLUSION: The Interpersonal Geriatric care relationship tool is a valuable measure that can be used by scientists, educators and healthcare professionals to benchmark the interpersonal care relationship culture in hospitals and optimize the quality of care.

The development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings.

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.

Training interventions for healthcare providers offering group-based patient education. A scoping review.

OBJECTIVES: To provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education. METHODS: A systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis. RESULTS: Twenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers' reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers' experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support. CONCLUSIONS: Further evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation. PRACTICE IMPLICATIONS: Efficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.

Contact between patients with suicidal ideation and nurses in mental health wards: Development and psychometric evaluation of a questionnaire.

Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three-stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test-retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients' perceptions of contact experiences with nurses (CoNuPaS-experience) and what they find important in that contact (CoNuPaS-importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self-determining individual, encountering nurses' availability/information-sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78-1.00); test-retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient-nurse contact in mental health wards is central to improving understanding of nurses' contributions to suicide prevention and suicidal ideation treatment.

Capturing motivating versus demotivating self-management support: Development and validation of a vignette-based tool grounded in Self-determination Theory.

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.