Biomedical subjects

A L Francke

Publications and source records attributed to A L Francke.

At least 19 recordsLinked to original sources

PubMed2003

Home care for terminally ill Turks and Moroccans and their families in the Netherlands: carers' experiences and factors influencing ease of access and use of services.

The aim of this study was to explore the experiences of relatives of elderly terminally ill Turks and Moroccans regarding Dutch professional home care and the barriers to the use this care. Nine Turkish and ten Moroccan family members, who recently looked after dying members of their families, were interviewed using a semi-structured topic list. The data was analyzed using the method described by Glaser and Strauss. The results of this study make it clear that there is no uniform pattern in the use of home care. However, family members who did use home care facilities were all satisfied. Furthermore, on the basis of this study, several factors influencing access to and use of home care were discerned, e.g., illness, family structure, decision making, pressure from the community, information and formal referrals. In addition, the authors found that 'preferences regarding family care' influenced all former factors.

Aged↗

PubMed2001

Rheumatology outpatient nurse clinics: a valuable addition?

OBJECTIVES: "Transmural rheumatology nurse clinics," where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics. METHODS: Patients with rheumatologic conditions who attended a transmural nurse clinic, in addition to receiving regular care, were compared with patients with rheumatologic conditions who received regular care only. The main outcome measures were the need for rheumatology-related information, the use of aids and adaptations, the use of health care services, and daily functioning. RESULTS: Attending a transmural nurse clinic does not influence patients' need for information, the application of practical aids and adaptations, or daily functioning. However, attending a transmural nurse clinic does result in more contacts with rheumatologists and occupational therapists. CONCLUSIONS: Attending transmural nurse clinics does not result in major differences in outcomes compared with regular care. Further studies are needed to appreciate the long-term effects of transmural nurse clinics.

Humans↗

PubMed2001

Content and outcomes of Dutch nurse clinics for children with asthma.

Dutch specialist asthma nurses run extramural and transmural nurse clinics for children with asthma. Extramural clinics are run under the responsibility and in the premises of a home care organization. Transmural clinics are run in an outpatient clinic in close collaboration and joint responsibility between home care organizations and hospitals. Effects of and differences between these clinics were determined by using a quasiexperimental design. Visiting a nurse clinic appears to result in a reduced information need and reduced use of health care services. Parents of asthmatic children visiting transmural nurse clinics appeared to have a lower information need than those attending extramural nurse clinics.

Asthma↗

PubMed2000

Palliative care services in The Netherlands: a descriptive study.

In this paper several types of specialized palliative care services in The Netherlands are presented. These include palliative care units in homes for the elderly, in nursing homes, in a general hospital and in an oncology clinic. In addition, a description is given of private hospices and of a home specializing in the care of terminally ill children. Furthermore, a number of other services relevant to palliative care are presented, such as professional and volunteer services for patients dying at home. Although many different types of services can be distinguished, regional distribution is not always optimal. The policy of the Dutch government on palliative care is also discussed. This policy is characterized by a strong emphasis on the further integration of palliative care in the regular health care system.

Humans↗

PubMed2000

Evaluative research on palliative support teams: a literature review.

Sixteen studies on the effectiveness of palliative support teams were analyzed. It was established that in most cases uncontrolled designs with repeated measurements were used. The assessment methods varied strongly. However, the Support Team Assessment Schedule was the most frequently used instrument. Effects reported on patients' physical symptoms, such as pain, were for the most part positive. Fewer effects were reported regarding psychosocial and spiritual problems of patients and relatives. For instance, various studies indicated that feelings of anxiety did not diminish after referral to a palliative support team. Results about the effects on use and costs of health care services did not point in a clear direction. Accordingly it is unclear whether palliative support teams reduce or increase care consumption and costs. Given the sometimes contradictory findings and the small number of studies conducted, future high-quality research into the effectiveness of palliative support teams is needed.

Evaluation Studies as Topic↗

PubMed2000

Dutch transmural nurse clinics for chronic patients: a descriptive study.

'Transmural care' can be defined as patient-tailored care provided on the basis of close collaboration and joint responsibility between hospitals and home care organizations. One form of transmural care is transmural nurse clinics for chronically ill. This study describes 62 transmural nurse clinics in the Netherlands. It was established that most of these nurse clinics are held by a specialized community nurse at a hospital outpatient clinic. The principal tasks of the specialized nurse at the clinic are providing illness-related information and supporting patients in dealing with the illness. Only a few unpublished evaluations of Dutch transmural nurse clinics have been conducted. Future research has to provide more insight into the impact of transmural nurse clinics on the quality and continuity of care.

Chronic Disease↗

PubMed2000

Evaluation of communication training programs in nursing care: a review of the literature.

An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al. [8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses' behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program's degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses' skills, on nurses' behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Clinical Competence↗

PubMed2000

Innovations in the nursing care of the chronically ill: a literature review from an international perspective.

This literature review focuses on substitution-related innovations in the nursing care of chronic patients in six western industrialized countries. Differences between primary and secondary care-orientated countries in the kind of innovations implemented are discussed. Health care systems are increasingly being confronted with chronic patients who need complex interventions tailored to their individual needs. However, it seems that today's health care professionals, organizations and budgets are not sufficiently prepared to provide this kind of care. As a result, health care policy in many countries targets innovations which reduce health care costs and, at the same time, improve the quality of care. Frequently, these innovations are related directly to the 'substitution of care' phenomenon, in which care is provided by the most appropriate professional at the lowest cost level, and encompass advanced nursing practice, hospital-at-home care and integrated care. The main conclusion of this paper is that integrated care innovations are implemented in both primary care as well as in secondary care-orientated countries. However, innovations in hospital-at-home care and advanced nursing practice are primarily implemented in primary care-orientated countries. Whether these innovations positively influence the quality of care, costs of care or patients' use of health care facilities remains rather unclear.

Canada↗

PubMed2000

Liaison nursing for stroke patients: results of a Dutch evaluation study.

Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related outcomes. After the introduction of liaison nursing, hospital nurses completed a questionnaire on satisfaction with the liaison nurse. In addition, both before and after the introduction of liaison nursing, two groups of discharged stroke patients were interviewed by telephone. The records of these patients were also studied with respect to background characteristics and duration of hospital stays. The hospital nurses were, generally, positive about the liaison nurse and the job she did (e.g. they found that home care was better organized). Further, after the introduction of liaison nursing, more patients stated that their post-discharge needs had been discussed not later than 48 hours prior to discharge, and more patients said their aftercare had been discussed with community nurses. However, the number of patients whose medication had arrived at home on time had decreased. The results also indicated that there was no significant difference in the duration of stay between the before and after group. The overall conclusion is that the liaison nurses have been moderately successful in their jobs. However, since the study was conducted in only two Dutch hospitals, findings may not be representative of other settings. Future research on liaison nursing is therefore recommended.

Aged↗

PubMed2000

Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases.

OBJECTIVE: Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics. DESIGN: Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care. Semi-structured interviews with professionals were used to gather information about their perceptions. SETTING: The study was carried out at five locations in The Netherlands where a home care organization and a general hospital collaborated closely and had joint responsibility for a transmural rheumatology nurse clinic. STUDY PARTICIPANTS: A total of 128 patients, six specialist rheumatology nurses and four rheumatologists. INTERVENTION: Transmural nurse clinics for people with rheumatic diseases. RESULTS: In general, patients were positive about the quality and continuity of care given at the clinics. Some continuity aspects, like the presence of a locum nurse and providing the locum with sufficient information could be improved. Professionals were positive about the information given at the clinics, which is additional to the information given by a rheumatologist. Professionals were less positive about some of the clinics' preconditions. CONCLUSION: In this study, a control group (e.g. patients who received standard rheumatologist care) was not available. However, in comparison with patients' experiences of standard medical care in other (comparable) research, patients' experiences in this study were very positive. It was concluded that Dutch transmural nurse clinics, to a large extent, meet patients' and professionals' expectations and were a positive development in the care of rheumatic patients.

Adult↗

PubMed1997

Effects of a nursing pain programme on patient outcomes.

The effectiveness of a continuing pain education program, directed to surgical cancer nurses, was investigated in a pretest posttest controlled intervention study. ANCOVA for repeated measures revealed that the programme resulted in a lower pain intensity of surgical colon and breast cancer patients (p = 0.02). However, no effects were found on pain duration, sleepless hours as a result of pain, state anxiety, mood disturbances, and duration of hospitalization. It is assumed that because the pain CE programme had a moderate impact on pain intensity, this had no consequences for the other outcome variables mentioned.

Affect↗

PubMed1997

Effects of a continuing education program on nurses' pain assessment practices.

Surgical nurses from five Dutch general hospitals participated in a continuing education program on pain assessment and management. A pretest-posttest controlled intervention study revealed that the program led to an increase in the quality of activities relevant to taking pain histories. Although this increase in quality was most apparent 1 month after the program, it was still observable 6 months after the program. There were, however, no effects on the number of activities relevant to taking pain histories, or on the number of nurses who used direct questioning as a method to determine pain. There may be several explanations for these results, including nurses' limited openness to new approaches, a lack of support from physicians and nurse superiors, and that program items were not translated into ward policy.

Education, Nursing, Continuing↗

PubMed1997

Nurses' perceptions of factors influencing the use of a pain program.

Factors that, according to nurse participants, influenced the application of what was learned in a pain program were explored by means of qualitative interviews. Participants indicated that the correspondence between the program and their personal view on pain management, attitudes toward the program and innovations in general, self-efficacy perceptions, and (un)familiarity and taboos with respect to program items influenced what they put into practice. In addition, participants indicated that interactions with colleagues, nursing managers, patients, and physicians affected their application of the program. Furthermore, organizational factors, such as limited time and lack of formal program implementation, were mentioned as influential.

Adult↗

PubMed1997

Feelings of powerlessness in relation to pain: ascribed causes and reported strategies. A qualitative study among Dutch community nurses caring for cancer patients with pain.

This qualitative study focused on the causes for the feelings of powerlessness experienced by dutch community nurses in caring for cancer patients with pain. In addition, the study focused on the strategies community nurses employed to cope with feelings of powerlessness. Semistructured interviews revealed the following ascribed causes for feelings of powerlessness: problems in communication between community nurses and patients and between community nurses and personal physicians, dilemmas concerning physical care and opiates, and discrepancies between community nurses' pain management goals and what can realistically be achieved. The main strategies for reducing feelings of powerlessness were sharing feelings with the patient and colleagues, increasing knowledge and skills, and standing back from the situation.

Communication↗

PubMed1996

Continuing pain education in nursing: a literature review.

Twelve studies on the effects of pain programmes for nurses were reviewed. Most of the programmes focused on aspects of pain, pain medication or pain assessment. Only two programmes (Ferrell et al., 1993, J. Pain Symptom Management, Vol. 8, No. 8, pp. 549-556; Sofaer, 1983, Nurs. Times, Vol. 79, No. 47, pp. 38-42; 1984, Ph.D. Thesis, University of Edinburgh) also paid attention to non-pharmacological nursing interventions. Randomized control groups, established measurement instruments, testing statistics, and long-term follow-up measurements, were not often used in the effect evaluation of the programmes. Effects reported on both nurses and patients were for the most part positive. Given the small number of studies and their methodological limitations, further research into the effectiveness of continuing pain education in nursing is indicated.

Data Interpretation, Statistical↗

PubMed1996

Effects of a pain programme on nurses' psychosocial, physical and relaxation interventions.

The effectiveness of a continuing education programme on pain assessment and management was investigated in 106 surgical cancer nurses. It was found that the programme led to a more positive attitude towards physical and relaxation interventions (such as the use of relaxation, distraction and massage techniques). In addition, an increase in the duration and quality of psychosocial interventions (provision of information, emotional support, and promotion of autonomy) was established. Furthermore, the programme resulted in an increase in the quality of physical and relaxation interventions. However, the programme did not lead to more positive attitudes towards psychosocial interventions, or to increases in the numbers of psychosocial, physical and relaxation interventions.

Adult↗

PubMed1995

Determinants of changes in nurses' behaviour after continuing education: a literature review.

Nursing continuing-education programmes may differ in the extent to which they affect nursing practice. Differences may be explained by characteristics of the participants' background, the programme itself, teacher(s), relationship between participants, relationship between participants and teacher(s), physical environment during the programme, participants' social system, knowledge, skills and attitudes, and intention to change. In this literature review, a model is presented which integrates these variables and which may be used to explain why continuing-education programmes have no, little or considerable effect. On the basis of current scientific knowledge, colleagues' and superiors' support emerges as the most important determinant of behavioural changes in nursing practice.

Clinical Competence↗

PubMed1994

Confluent education: an integrative method for nursing (continuing) education.

Confluent education is presented as a method to bridge the gap between cognitive and affective learning. Attention is focused on three main characteristics of confluent education: (a) the integration of four overlapping domains in a learning process (readiness, the cognitive domain, the affective domain and responsibility); (b) the promotion of personal growth and interpersonal relationships by the development of awareness, and (c) the identification and dis-identification of teacher and participants. How confluent education can take place in practice is illustrated by presenting the way in which this method is applied in a nursing continuing education programme entitled 'Pain assessment and management in surgical-oncological patients'.

Affect↗