Applying ICF in nursing practice: classifying elements of nursing diagnoses.

AIM: This study explores the relevance of the International Classification of Functioning, Disability and Health (ICF) to nursing diagnoses. BACKGROUND: As a multidisciplinary classification of human functioning, the ICF (previously known as ICIDH-2) is potentially relevant to nursing care. However, nurses have rarely used the classification during the 23 years of its existence. METHOD: In part 1 of the study, 51 nursing diagnoses from anonymous patients were deliberately selected for diversity from an existing database. The 427 diagnostic elements from these diagnoses (problem statements, aetiological factors, signs and symptoms) were classified, using the ICF, by a panel of six nurses. In part 2 of the study, the panel classified 223 elements from 30 diagnoses of patients they had actually cared for. RESULTS: Nearly all diagnostic elements could be classified, most often in the sub-dimensions of body functions and activities. Agreement on appropriate ICF components was 61% for anonymous patients and 75% for familiar patients. Agreement at the more detailed 3-digit level of the classification was 42% for anonymous and 60% for familiar patients. CONCLUSION: The ICF has relevance to nursing care. As a general classification, it was not designed by nurses or specifically for nursing care. This can explain some difficulties in using the classification that were identified in this study, as well as the rather low levels of agreement. To resolve these issues and to further improve the classification, nurses should further explore the use of the ICF and participate in future revision processes.

Lower urinary tract symptoms after renal transplantation.

PURPOSE: We investigated the prevalence and nature of lower urinary tract symptoms after renal transplantation. In addition, we studied how these symptoms affect the quality of life and whether function of the lower urinary tract before transplantation was related to postoperative occurrence of lower urinary tract symptoms. MATERIALS AND METHODS: Data were gathered by a written questionnaire. The research group consisted of 63 patients who underwent renal transplantation in 1998 at the University Medical Center St Radboud Nijmegen. The control group consisted of 74 patients with nonurological complaints who visited an outpatient clinic at the same university. RESULTS: The most important finding was that patients who underwent renal transplantation needed to void more often than controls, both during the day and at night. After renal transplantation, almost 50% of the patients complained of frequency and 62% nocturia. Patients with a transplant had tended to perceive frequency and nocturia less as problems than those in the control group. CONCLUSIONS: No relation was found between the functioning of the lower urinary tract before transplantation, and occurrence of frequency and nocturia after. The amount of fluid intake at the interview was not related to the occurrence of frequency and nocturia. No abnormalities were found regarding bladder evacuation.

Prevalence and characteristics of headache in Dutch schoolchildren.

The aim of this study was to determine whether there has been an increase in headache prevalence in Dutch children and to compare headache characteristics of children with low, medium and high headache severity.A sample of 2358 schoolchildren between the ages of 10 and 17 years filled out Waters' Headache Questionnaire and the Paediatric Pain Assessment Tool. Results showed that 21% of the boys and 26% of the girls at elementary school, and 14% of the boys and 28% of the girls at high school reported weekly headaches. When compared to figures from a previous study in the Netherlands published in 1985, the prevalence of weekly headaches in 10-17-year-olds has increased by 6%. In boys at elementary school, the prevalence of headaches with a frequency of a few times a week has doubled. Children with low, medium and high headache severity differed with respect to all headache characteristics, i.e. pain quality, accompanying symptoms, warning signals, location, onset, impact of headache, family occurrence, perceived cause, medical consultation, and school absence.

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items.

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items Rationale Currently, there is no systematic collection of nursing care data in the Netherlands, while pressure is growing from the profession, policy-makers and society to justify the contribution of nursing and its costs. A nursing minimum data set can provide data to demonstrate nursing's contribution to health care as it can be used to describe the diversity of different patient populations and the variability of nursing activities, and to calculate the associated nursing workload. Objective To identify categories and items for inclusion in the Nursing Minimum Data Set for the Netherlands. Design A multimethod, exploratory approach was used. This included interviews, document analysis, consensus rounds, seeking validation in the literature, and drawing up lists of most frequently occurring patient problems, interventions and outcomes of care. Eight hospitals, with a total of 16 wards, participated in the study. Results Relevant categories and items emerged after analysis and grouping of the material and included: five hospital-related items, six patient demographics items, seven medical condition items, 10 nursing process items, 24 patient problems, 32 nursing interventions, four outcomes of nursing care, and three complexity of care items. Almost every item could be located in the existing documentation systems, the lists of patient problems, outcomes and interventions, or in the literature. Conclusion A set of categories and items of nursing data has been identified. The content validity of this set is partly supported by its consistency with the literature, findings from practice and the judgement of potential users. Nursing outcomes need further development. The data set will be tested in practice to find out whether the categories and items are useful, and whether they can be minimized.

The effects of aftercare on chronic patients and frail elderly patients when discharged from hospital: a systematic review.

The purpose of this systematic review was an assessment of the efficacy of aftercare in chronic patients and the frail elderly when discharged from hospital, as regards quality of life, compliance, costs, medical consumption and quality of care. In pursuit of this goal, 17 publications on the effects of aftercare after discharge from hospital were examined. A systematic assessment of methodological quality by two blinded independent reviewers resulted in a consensus score (0-100 points), based on four categories: the study population, description of the interventions, measurement of the outcome and the analysis and presentation of the data. Only three of the 17 studies scored more than 50 points, indicating that most of the studies were of poor methodological quality. The most prevalent methodological problems were that co-interventions were not avoided, a placebo group was lacking, the assessment was not blinded and the analysis was not made on the basis of the intention-to-treat principle. The majority of the studies did not report clear beneficial effects in favour of the intervention group. The positive effects reported were limited to costs and quality of care.

Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence.

UNLABELLED: We performed a randomized clinical trial on the efficacy of physical therapy on genuine stress incontinence. STUDY OBJECTIVE: "Is a physical therapeutical training program (pelvic floor muscle training) combined with biofeedback, more effective than the same program without biofeedback in patients with mild or moderate stress incontinence?" Forty-four patients were referred by a general practitioner or a urologist. After informed consent, 40 patients were randomized in an exercises and biofeedback group (BF), or treated with exercises exclusively (pelvic floor muscle training = PFMT). After a diagnostic phase of 1 week every patient received twelve treatment sessions, three times weekly. The primary measure of effect, the quantity of involuntary urine loss, was measured with the 48 hours PAD test (Inco-test Mölnlycke). Before every treatment session the Symptoms questionnaire was filed out by the patient and the Patient dairy was controlled. The data of the trial were analysed according to the principal of intention to treat. During the trial there was 100% compliance. There were no drop-outs. Both treatment modalities appeared to be effective. After twelve treatment sessions there was a mean improvement of +/- 55% (P = 0.00) in both treatment groups, measured by the primary measure of effect. In the group with BF this improvement was already realized after six treatment sessions (P = 0.01). Yet, the difference between BF and PFMT faded to reach significance at six treatment sessions (P = 0.08). Although differences in treatment effects between both groups were not significant, our findings suggest that adding biofeedback to pelvic floor muscle exercises might be more effective than pelvic floor muscle exercises alone after six treatments.

[Effectiveness of validation. A literature study]. / De effectiviteit van validation. Eeen literatuuronderzoek.

This review-article reports on literature on the effectiveness of validation; and approach used for disoriented elderly. Literature has been searched for by means of several (computerized) indexes and references. By contacting Feil, who developed validation, unpublished articles and reports became available. This search resulted in 13 effect-studies, of which 7 are unpublished, 2 descriptive reports, and 1 research-proposal. The effect-studies have varying designs with different methodological restrictions causing bias. The analysis showed that the quality and therefore the evidential value of the effect-studies is limited. The better the study, the less validation appeared to be effective. It is concluded that the hypothesis, that validation has positive effects on disoriented elderly and their caregivers, has no or minimal scientific basis. Before validation is implemented more and more in Dutch health care, scientific research addressing its effects is indicated.

Care dependence and individual care provision.

For policy purposes as well as for the provision of individual care, it is relevant to known which individual characteristics have impact upon the level of care dependence. For purposes of individual care provision, characteristics which can be influenced and which also have an important impact upon the care dependence are of interest. This study showed that the profoundly mentally handicapped are almost all totally dependent upon care, and therefore additional information about individual characteristics is superfluous. The results of logistic regression analyses showed a statistically significant and important impact of ADL-functions. Exactly which other characteristics are relevant to consider depends upon the level of care dependence and the level of mental handicap.

[Validation: its effect in residents and staff in a home for the aged]. / Validation: effecten bij bewoners en personeel in een verzorgingshuis.

In a quasi-experimental study the effectiveness of the method Validation is evaluated. This approach for disoriented institutionalized old people was developed by Naomi Feil in the U.S.A. This study evaluated the effect of Validation on the behaviour of institutionalized 'old-old' suffering from dementia and of those who deliver care to them. The study group included 19 demented residents of a home for the aged and 29 nurses, of whom 15 nurses had followed the basic course in Validation. The other 14 nurses were selected as members of the control group. The behaviour of the residents was measured with the BPS (a scale for Mental and Social Problems). This measurement was performed by the nurses of the two groups on three different points of time (before the course, immediately after the course and 4 months after the course). At the same time the nurses evaluated their own behaviour by a questionnaire developed by Verpoort. Differences between pre- and post-testscores showed some improvement in behaviour of residents and staff. However, contamination, social desirability and enthusiasm of the researcher and the staff may have influenced the results. It is concluded that Validation contributes to an improvement of the attitude and job satisfaction of nurses too. This benefits the residents.

[Information on osteoporosis among ward nurses. Deficient knowledge and need for information regarding osteoporosis in women from 45 to 54 years]. / Voorlichting over osteoporose door wijkverpleegkundigen. Kennistekorten en informatiebehoeften ten aanzien van osteoporose bij vrouwen van 45-54 jaar.

This article describes the results of a cross-sectional study in which an inventory is made of the level of knowledge of and the need for information about osteoporosis among women in Breda aged 44-54 years. Subsequently the relation between self care agency and the level of knowledge is explored. Orem's self care theory was used as theoretical framework for this study.

Effects of preventive home visits to elderly people.

OBJECTIVES: To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home. DESIGN: Randomised controlled trial. SETTING: General population of elderly people in one of the southern regions of the Netherlands. SUBJECTS: 580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control (288) group. INTERVENTIONS: Four visits a year over three years in intervention group. Control group received no home visits. MAIN OUTCOME MEASURES: Self rated health, functional state, well being, loneliness, aspects of the mental state (depressive complaints, memory disturbances), and mortality. Use of services and costs. RESULTS: Visits had no effect on the health of the subjects. In the group visited no higher scores were seen on health related measures, fewer died (42 (14%) v 50 (17%)), and community care increased slightly. In the control group more were referred to outpatient clinics (166 (66%) v 132 (55%)), and they had a 40% increased risk of admission (incidence rate ratio 1.4; 90% confidence interval 1.2 to 1.6). No differences were found in long term institutional care, and overall expenditure per person in the intervention group exceeded that in the control group by 4%. Additional analyses showed that visits were effective for subjects who initially rated their health as poor. CONCLUSIONS: Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health.

[The course of nursing home admission. A follow-up study in chronic and rehabilitation patients]. / Het verloop van verpleeghuisopnamen. Een follow-up onderzoek bij chronische en reactiveringspatiënten.

This article describes the course of the nursing home stays of 157 newly admitted patients (55 years and older) using the Behaviour Rating Scale for Elderly Patients ('Beoordelingsschaal Oudere Patiënten'). The follow-up period lasted maximally one year. Differences in the course in relation to the objective of the admission (rehabilitation versus continuous support) and possible factors which impeded or advanced the discharge of the rehabilitation patients, were investigated. For that purpose, information on diagnoses, prognosis, treatment goals and their achievement, and disability according to SIVIS (SIG Nursing Home Information System) was also obtained from the physicians in charge at the nursing home. The course of the nursing home stay appeared to differ for chronic and rehabilitation patients. In addition to physical disability and depressive behavior, the chronic patients, from the time of admission onwards, had more behavioural problems than the rehabilitation patients. Moreover, their dependency, physical and mental disability and inactivity increased in different degree during the stay. For two thirds of the rehabilitation patients, the stay did not end in discharge from the nursing home. For this group, the dependency, depressive behaviour, and to a lesser extent, aggressiveness increased during the stay. The outcome of rehabilitation appeared to be related to the extent of behavioural problems, to the level of disability, and to the medical condition on admission. The least disabled and the 'medically least complex' patients could usually be discharged with an improved level of functioning, which seemed to justify the nursing home stay. The absence of other services impeded discharge in a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Why do elderly people seek professional home care? Methodologies compared.

In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed. To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n = 2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems. From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.

[Nursing home admission; a study among elderly applicants]. / Verpleeghuisopname; een onderzoek bij op te nemen ouderen.

This article describes the care needs, social network, housing conditions, utilization of care and diagnoses of 157 elderly applicants to nursing homes in Maastricht. The study was conducted during the period of February 1987 to July 1988. Possible differences in these characteristics in relation to the goal of the admission (rehabilitation versus continuous support) and in relation to prior living arrangements (home versus hospital) were investigated. In addition, the question to what extent substitution of care is possible is discussed. Within the group of nursing home applicants, a fairly clear distinction could be made between a number of subgroups, although care needs, social network (with the exception of the number of visits paid), and demographic characteristics showed no differences in relation to admission goals and prior living arrangements. The distinction was based particularly on the nature of the disorders (psychogeriatric versus somatic and chronic versus more or less acute), which was reflected not only in the main diagnosis itself, but also in differences in housing conditions, numbers of visits paid to others, and utilization of care prior to admission. Under the proposed policies for substitution, about a quarter of the applicants would be eligible for substitution. However, the major care needs, and the levels of formal and informal care prior to admission, as well as the shortage of alternative services, would seem to indicate that the actual possibilities for substitution are more limited.

A scale for the functional status of the elderly living at home.

Many scales have been developed to describe the functional status of geriatric patients. These scales are of limited use for describing the functional status of elderly people living at home, because of their poor capacity for differentiation. This article reports the results of a postal questionnaire among elderly people living at home. The findings will be analysed to see whether the inventory on performance of household and daily living activities describes the functional status of elderly people in a useful manner. A combined scale was constructed, which has satisfactory Guttman coefficients when applied to elderly people living at home. In addition, the scale is informative for those providing home care with regard to the elderly person's quantitative and qualitative needs for assistance. As such, it could be an instrument to be applied in community nursing. The applicability of the scale to institutionalized elderly people remains to be investigated.

Factors associated with differential utilization of professional care among elderly people: residents of old people's homes compared to elderly people living at home.

To investigate factors that explain differential utilization of professional care among elderly people a study was performed in Maastricht, the Netherlands. For that purpose 657 interviews with elderly people were held. In this article a comparison is made between elderly people living at home, with or without professional home care, and residents of old people's homes. Besides the functional status, as measured by limitations in household activities and activities of daily living, the composition of the household of the elderly person is recognized as a major discriminating factor between the three groups. The role of depressive complaints in care utilization is less prominent than expected from an earlier study. A bivariate analysis clearly showed the frequency of mental problems and the poorly developed social network among elderly persons using professional care. Implications for caregiving and policy planning are discussed.

The functional status and utilization of care of elderly people living at home.

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international. The more limitations, the higher the proportion of professional care utilization. The factors "use of informal care" and "not living alone" were inversely related to the utilization of professional care. The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful. The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.

[Health care needs and wish to be admitted of subjects with positive indications; a comparison with residents of homes for the aged]. / De hulpbehoefte en opnamewens van positief geïndiceerden; een vergelijking met verzorgingshuisbewoners.

The care needs, utilization of care and the wish to be admitted on a short or long term basis of 135 applicants to homes for the aged are presented and their interrelations considered. The care needs of the applicants to and 207 residents of homes for the aged are compared. With an increasing number of housekeeping disabilities, depressive complaints, memory disorders and, as expected, the use of formal and informal care increased. The care needs of the applicants were at least as large as those of the residents. They had (nearly) as much housekeeping and ADL disabilities and even more feelings of loneliness and depressive complaints. Yet, for those applicants with few housekeeping disabilities the necessity of admission to a home for the aged can be questioned. That is, the wish to be admitted on short term was strongly associated with depressive complaints and feelings of loneliness. Provided that these mental problems can be handled effectively, (more) home care may be an alternative for them.