Staff attitudes towards aggression in health care: a review of the literature.

The aim of this literature review was to explore the attitudes of health care workers towards inpatient aggression and to analyse the extent to which attitudes, as defined from a theoretical point of view, were addressed in the selected studies. Databases from 1980 up to the present were searched, and a content analysis was done on the items of the selected studies. The concepts 'cognition' and 'attitude' from the framework of 'The Theory of Reasoned Action' served as categories. The self-report questionnaire was the most common instrument used and three instruments specifically designed to measure attitudes were found. These instruments lacked profound validity testing. From a total of 74 items, two thirds focussed on cognitions and only a quarter really addressed attitudes towards aggression. Research was particularly concerned with the cognitions that nurses had about aggression, and attitudes were studied only to a limited extent. Researchers used different instruments, which makes it difficult to compare results across settings.

[The 'Soarchmjitter'. The use of a Frisian lingual measurement instrument in care of the elderly]. / De 'Soarchmjitter'. Het gebruik van een Friestalig meetinstrument in de ouderenzorg.

In this article a research has been described funded by the province Fryslân. The aim of this research project is bipartite. First, to determine the reliability and the validity of the instrument and, secondly, to inquire the involved residents living in old people's homes after the valuation of the use of the Frisian language in the care. The research is conducted among 73 residents living in nine old people's homes in the province Fryslân. On two moments in time residents of the old people's homes are asked to fill in a questionnaire with regard to their own care (in)dependency and once with regard to the use of the Frisian language in the care. Reliability analysis shows with regard to internal consistency high Cronbach's alpha values. Test-retest reliability (Cohen's kappa and Spearman Correlation) reveals fair to moderate values. Factor analysis (principal components analysis) results in a one-factor solution. According to the residents, the 'Soarchmjitter' gives a good picture of their care dependency and its questions and answers join their needs. It can be concluded that the 'Soarchmjitter' is a useful instrument to communicate in the own spoken language of the resident and to come in this way to an agreement with nurses about their care demands.

Using the nursing minimum data set for the Netherlands (NMDSN) to illustrate differences in patient populations and variations in nursing activities.

RATIONALE: A nursing minimum data set (NMDS) provides data that are useful to legitimate nurses' contribution to healthcare. In Belgium and the US, such NMDS are operational, other countries are developing it, among which is the Netherlands. OBJECTIVE: To evaluate whether the nursing minimum data set for the Netherlands (NMDSN) is suitable to describe the diversity of patient populations and the variability of nursing care. METHODOLOGY: Using the NMDSN data collection forms, patient data were collected from 15 different hospital wards. During one week, nurses manually completed the NMDSN list for every patient. The data analysis methodology from the Belgian MVG was used, including ridit analysis and graphs. RESULTS: The NMDSN includes items related to hospital, patient demographics, medical condition, nursing process, nursing phenomena, nursing interventions, outcomes of nursing care, and complexity of care. There were 686 individual patients in the study, while for the data analysis their 2090 patient days in the hospital were used. Frequencies of nursing phenomena, nursing activities and results of care were calculated, transformed into ridit scores, and presented graphically as 'fingerprints'. CONCLUSION: The set of NMDSN items allows illustrating the diversity of patient populations, and variation in nursing care by means of 'fingerprints'.

[Care dependency of nursing home patients with dementia: assessment from European perspective]. / Zorgafhankelijkheid van verpleeghuispatiënten met dementie: gemeten in Europees perspectief.

In an international, study psychometric properties of the Care Dependency Scale (in Dutch shortened as: ZAS) were examined by analysing data gathered in nursing homes in Germany, Finland, Italy, The Netherlands, Norway and Wales (UK). For that purpose, from these countries a convenience sample was developed consisting of 832 patients with dementia. The English, Finnish, German, Italian and Norwegian research instruments were translations of the original Dutch ZAS. Psychometric evaluations of the ZAS were carried out for each country separately as well as for the countries combined. High alpha coefficients between 0.93 and 0.97 were calculated. Subsequent interrater and test-retest reliability revealed moderate to substantial kappa values. Factor analysis resulted in a one-factor solution. One of the main outcomes of the cross-cultural comparison was that the findings in the six countries show more similarities than differences, so that the scale can be used appropriately in nursing home practice and for international comparison of care dependency.

Factors related to fatigue; priority of interventions to reduce or eliminate fatigue and the exploration of a multidisciplinary research model for further study of fatigue.

A growing interest in the health problem presented by fatigue, both in clinical practice and research, coupled with a decreasing number of reported studies on fatigue in the last decade, make an updated and systematic review of factors related to fatigue necessary. A search of the literature, comprising 53 studies, was therefore undertaken to explore the following research questions: Which significantly social-demographic, cure-related, and care-related factors are significantly correlated with fatigue? And which nursing interventions need priority in experimental research to reduce or eliminate fatigue? Reported factors related to fatigue in analysed studies show that the correlations between the specific cure- and care-related factors and fatigue are similar among the various investigated (patient) populations. This result supports the concept of the non-specific character of fatigue. The intervention of primary effectiveness most suggested in this study is 'energy management'. Interventions of secondary importance which emerge are those of 'emotional support', 'activity therapy' and 'coping enhancement'. This study makes clear that the exploration of a research model for fatigue, with social-demographic, cure- and care-related factors is useful and that care-related factors have their own effects on fatigue not necessarily dependent upon the presence of medical diseases or cure-related factors. In general, multi-related factors could be assessed. Implications and relevant questions for further research on fatigue are also given.

Care dependency and survival among female patients with Alzheimer's disease: a two-year follow-up.

AIM: To investigate the relationship between the severity of the patient's care dependency on the one hand, and causes of death, co-morbidity, and survival on the other, and to find out which of these factors might be longitudinal predictors of survival. METHODS: A two-year follow-up study started in 1994 in the Netherlands. Subjects were 130 female nursing-home patients with Alzheimer's disease (91 severely dependent, and 39 mildly dependent). Features analyzed in 1994 included the scale of care dependency, demographic data, and clinical information. RESULTS: In 1994, both subsamples differed significantly with respect to the duration of Alzheimer's disease, duration of stay, and all nursing-care dependency features, but they did not differ significantly in age, age of disease onset, and co-morbidity. In both groups, the main causes of death were cachexia and/or dehydration. Survival prognosis varied with the level of care dependency. Compared to mildly dependent patients, patients with severe dependency had a 20% higher mortality than expected for the general population of the same age. Marital status, education, cardiovascular disease, and four care dependency features: body posture, day/night pattern, communication, and contact with others, are factors that significantly predict survival. CONCLUSION: Survival prognosis of patients with Alzheimer's disease varies with the level of care dependency.

DUFS and DEFS: development, reliability and validity of the Dutch Fatigue Scale and the Dutch Exertion Fatigue Scale.

The purpose of this study among patients with chronic heart failure (n = 138) was to develop and test both the Dutch Fatigue Scale (DUFS) and the Dutch Exertion Fatigue Scale (DEFS). Psychometric testing of these scales included measurement of internal consistency, construct validity and criterion-related validity. Statistical analyses of both scales showed sufficient reliability and validity. The DUFS (scale coefficient H = 0.48; Rho = 0.80; KR-20 = 0.79) is suitable as a measurement instrument for the diagnosis of fatigue and makes it possible to compare results of fatigue on the level of groups of patients. The DEFS (scale coefficient H = 0.61; Rho = 0.91; Cronbach's alpha = 0.91) can be used in clinical practice for the measurement of patients' exertion fatigue.

A comparison of nursing minimal data sets.

It is often argued that Nursing Minimal Data Sets (NMDSs) have advantages for the nursing profession. The NMDSs that have been developed and applied in some countries have many features in common, but there are differences in purpose, content, sampling, collection approach, and developmental stage as well. This paper examines the advantages and disadvantages of data sets of nursing practice, and the differences and similarities of five national and international NMDS systems. The purpose is to apply this information toward an NMDS initiative in the Netherlands. Future initiatives in NMDS development should include international coordination.

Can we solve current problems with nursing information systems?

Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.

The nursing process in crisis-oriented psychiatric home care.

Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.

Nursing information in electronic patient records: criteria established in a Delphi study.

Nursing lacks an adequate tool to assist in determining the essential components of an information policy in health care institutions, and to outline the nursing component of the electronic patient record. The objective of this study was to determine the criteria to which a nursing information system, and its developmental process, should comply with, when such system is part of an electronic patient record system. Using the Delphi methodology, criteria for nursing information systems were determined by an international panel of 36 experts in three succeeding rounds. Most criteria gained consensus and are very useful for use in practice for those involved in nursing system development. Eventually the list of criteria will be included in a nursing information reference model. Nursing will benefit from the application of the reference instrument and criteria to express their information needs and to develop adequate information technology.

[Towards congruence in nursing information provision in The Netherlands]. / Naar een samenhang in de verpleegkundige informatievoorziening in Nederland.

Few reliable data are available about nursing care in the Netherlands, whereas pressure from society to support the contributions of the discipline of nursing to health care delivery increases. This paper presents an information model to support analytical access to nursing labour and services. This model, the nursing information reference model (Dutch acronym 'VIRM') focuses on the structure to achieve congruence between data from the primary process of nursing care and data derived from that process for clinical practice, management, research, and policy purposes. The model is based on the 'collect-once/use-often' principle of data collection and management, which emphasizes single collection and registration through the patient record for multiple subsequent uses and purposes. In this paper core elements of the VIRM are being discussed. Determination of data from the primary process of nursing care to be provided for certain aims is currently being conducted by the Dutch Nursing Minimum Data Set (VMDNS) initiative. The article at issue should be understood as a starting point in the discussion about the development of a Nursing Minimum Data Set in the Netherlands.

Fatigue: a summary of the definitions, dimensions, and indicators.

Fatigue is a universal complaint that may or may not be related to medical diagnoses or therapeutic treatment. Fatigue is a complex, multicausal, multidimensional, nonspecific, and subjective phenomenon for which no one definition is widely accepted. The absence of theories concerning the nursing diagnosis of fatigue limits insight into the phenomenon and hinders the development of valid and reliable instruments for the measurement of fatigue. Therefores, the authors have undertaken a concept of analysis of fatigue, to a) document how it is defined in the literature; b) which dimensions of the concept of fatigue are distinguished; and c) which indicators of both the content and forms of fatigue represent the concept in practice. This concept analysis has resulted in a theoretical frame of reference that can indicate directions not only for further research into the nursing diagnosis of fatigue, but also for the development of measuring instruments.

An analysis of the nursing diagnosis ineffective management of therapeutic regimen compared to noncompliance and Orem's self-care deficit theory of nursing.

The authors compare the nursing diagnosis ineffective management of therapeutic regimen with that of noncompliance and with Orem's concept of self-care deficit. The article describes how the diagnosis of ineffective management of therapeutic regimen is more comprehensive than noncompliance. A question of patient autonomy is raised considering how the patient manages his or her therapeutic regimen. The major conclusion is that the nursing diagnosis of ineffective management of therapeutic regimen is based on continuous interaction between patient and nurse. The authors recommend that noncompliance be eliminated as a nursing diagnosis.

Male and female nurses in intensive-care wards in The Netherlands.

This article presents the results of a national survey among intensive-care nurses, establishing whether male nurses and female nurses can be distinguished with respect to issues such as professionalization, career orientation and their preference for technical departments. The study showed that there is an over-representation of men in technical wards. At IC/CC-units the percentage of male nurses is twice as large as in the hospital as a whole (IC/CCU included). The distribution of labour among male and female nurses is taking place according to traditional sex-specific role patterns. Male nurses are more oriented towards professionalization than female nurses. Male IC-nurses see their jobs more in a medical perspective and they also show a higher frequency in the performance of medically reserved activities. Male IC-nurses seem to be particularly directed at upgrading their own profession. The differences between male and female nurses can also be explained by culturally determined differences between men and women regarding their own career perspective and career development, as well as by internal staff policy.