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Biomedical subjects

Ruud Halfens

Publications and source records attributed to Ruud Halfens.

13 recordsLinked to original sources
PubMed2006

Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application.

BACKGROUND: Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the Brøset-Violence-Checklist (BVC) with an overall subjective clinical risk-assessment and to test the application of the combined measure in daily practice. METHOD: We conducted a prospective cohort study with two samples of newly admitted psychiatric patients for instrument development (219 patients) and clinical application (300 patients). Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale. Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve (AUCROC). RESULTS: The AUCROC of the new VAS-complemented BVC-version (BVC-VAS) was 0.95 in and 0.89 in the derivation and validation study respectively. CONCLUSION: The BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards. The inclusion of the VAS-derived data did not change the accuracy of the original BVC.

Acute Disease↗
PubMed2006

A comparison of pressure ulcer prevalence rates in nursing homes in the Netherlands and Germany, adjusted for population characteristics.

Annual pressure ulcer surveys in the Netherlands and Germany have shown remarkable differences in prevalence rates. We explored the differences between the two populations, and the degree to which these differences were associated with differences in prevalence. To this end, data from 48 Dutch and 45 German facilities (n = 9772) from 2003 were analyzed. The prevalence of pressure ulcers (excluding grade 1) was 12.5% in the Netherlands and 4.3% in Germany. After adjusting for age, sex, and other risk factors, the probability of developing a pressure ulcer of stage 2 or higher in Dutch nursing homes was three times greater than in German homes.

Activities of Daily Living↗
PubMed2006

[Effect of a training course in management of aggression and violence on nursing students].

The aim of this study was to test the effect of a training course in aggression management on nursing students in their basic training. The research question was: Do nursing students feel more competent and more secure in dealing with aggressive patients after the training course than prior to the training? To test the effect of the training the nursing students' self-efficacy and confidence was measured in a quasi-experimental investigation. The experimental group (n = 57) completed a four day training course in aggression management. The control group (n = 60) had no comparable educational intervention but was measured on the same variables as the experimental group. Analysis was conducted by univariate analysis of variance using repeated measures and demonstrated that the nursing students in the experimental group had significantly higher (p < or = 0.001) self reported self-efficacy scores after the training course compared with the control group. The self reported feeling of security also demonstrated improvement, although not statistically significant in all areas. Nevertheless, the nursing students' self reports demonstrated that participants completing the training feel more secure in dealing with aggressive patients. The results show that the training course can lead to improvements in nursing students' self-efficacy and confidence.

Aggression↗
PubMed2006

Quality of life in palliative care cancer patients: a literature review.

AIMS AND OBJECTIVES: [corrected] This review of the literature intended to get insight into the international standards of quality of life assessment in palliative care, the conceptual and research literature addressing illness related quality of life and an examination of how nurse researchers define and assess this concept in the context of terminally ill cancer patients. Clearly stated goals for measuring quality of life as well as an understanding of the pragmatic and theoretical explanations for current trends in quality of life measurement are fundamental to this focus. BACKGROUND: Most clinicians and researchers agree that the primary goal of palliative care is to optimize the quality of life of patients with advanced incurable diseases through control of physical symptoms and attention to the patient's psychological, social and spiritual needs. Palliative care therefore is the achievement of the best quality of life for patients and their families. Consequently, the outcomes of care should be measured in terms of the extent to which this goal is achieved. Quality of life is difficult to define and measure; it is a multidimensional, dynamic and subjective concept. During the past decade, multidisciplinary research measuring the impact of cancer and its treatment on the quality of people's lives escalated rapidly in international literature but not in the German speaking European countries. This international escalation was accompanied by a proliferation of measurement strategies and tools. Nursing shared this interest and began to generate substantive research of the phenomenon. In the oncology and palliative care nursing societies quality of life and numerous closely related areas of symptom management rank among the highest research priorities. METHOD: This paper examines nursing literature published between 1990 and 2004, retrieved through a computer review of MEDLINE and Cumulative Index of Nursing and Allied Health Literature. The review includes reports that systematically describe or measure the quality of life of people with a terminal cancer in palliative care as a variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. RESULTS: Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. CONCLUSION: Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. RELEVANCE TO CLINICAL PRACTICE: There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.

Attitude to Death↗
PubMed2006

A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery.

AIMS AND OBJECTIVES: In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. BACKGROUND: Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. METHODS: A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. INSTRUMENTS: The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. RESULTS: The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. CONCLUSIONS: The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. RELEVANCE TO CLINICAL PRACTICE: Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

Adult↗
PubMed2006

Pressure ulcer: Prevention protocols and prevalence.

AIMS AND OBJECTIVES: The aim of this paper is to analyse the protocols used in German hospitals and nursing homes for the prevention of pressure ulcers with regard to their contents and accordance with the national standard of the Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP) and the European Pressure Ulcer Advisory Panel (EPUAP) and Royal College of Nursing (RCN) guidelines. Additionally, it is to show the relation between the existence and contents of the protocols of pressure ulcer prevention and pressure ulcer prevalence in the institutions. METHODS: On a fixed date trained nursing staff gathers data regarding the frequency of pressure ulcers during a prevalence survey. The existence of a pressure ulcer is established by physical examination after the risk assessment with the Braden-Scale. The patient's or resident's informed consent is a precondition for his or her participation in the survey. The protocols are available as hard copies on paper or electronic files. RESULTS: Only two out of the 21 protocols developed in-house are completely concurrent with the expert standard. The EPUAP and RCN guidelines include the aspect of training and further education that is missing in the in-house protocols and the DNQP expert standard. Evaluation of the data reveals that there is no relation between the availability of protocols and pressure ulcer prevalence. Neither is there any relation between the contents and pressure ulcer prevalence. The institutions currently developing protocols have the lowest prevalence rates. CONCLUSION: It is obvious that, while developing in-house protocols, the discussion about pressure ulcer prevention has led to a higher problem awareness in nurses and thus to an increased attentiveness in daily nursing practice which then results in improved outcomes. Two years after its publication, the expert standard is still not very well known, therefore this concentrated form of the most up-to-date knowledge is not available to all nursing staff as a basis for evidence-based practice. In addition, the sometimes outdated knowledge of nursing staff impedes the implementation of evidence-based practice guidelines. A systematic implementation strategy that assists guidelines being applied in practice is therefore required.

Aged↗
PubMed2004

A comparison of pressure ulcer prevalence: concerted data collection in the Netherlands and Germany.

OBJECTIVES: Because of a lack of epidemiological data of pressure ulcer (PU) among care dependent patients yearly prevalence measurements are held in the Netherlands and in Germany with identical methods. A comparison shows remarkable differences in the PU prevalence so that further analysis is needed to enlighten the reasons. DESIGN: With a standardized questionnaire all patients were examined by trained nurses of the participating facilities. SETTING: In-patients in 42 Dutch and 10 German acute care Hospitals. PARTICIPANTS: All patients who handed in their informed consent were included. In the Netherlands n = 8734, and in Germany n = 2832. MAIN OUTCOME MEASURES: For calculating the PU prevalence the sample was divided inpatients at risk and not at risk for PU in accordance to the Bradenscale. Comparisons between the Netherlands and Germany refer to population details, quota of patients at risk for PU and PU prevalence. Finally the impact of eight controlled variables on the PU occurrence was calculated in a logistic regression. RESULTS: Both samples showed the same sex distribution, the same mean age and the same distribution among the medical specialties. The share of patients at risk for PU is higher in the Netherlands (55%) than in Germany (38%). The frequency of PU is higher in the Dutch population (22%) than in the German one (12%). Regarding only the risk-patients the differences reduce. The prevalence in the Netherlands was 33%, in Germany it was 28%. The highest impact on PU occurrence had the age and the length of stay in hospital. The Country ranges on third position. CONCLUSIONS: The Dutch sample had a higher share of risk-patients and a higher PU frequency. A standardization appropriate to a risk assessment reduce the differences. For enlightening the remaining differences further research is needed.

Aged↗
PubMed2003

[Prevention of decubitus ulcer: theory and practice].

In Spring 2001, the Department of Nursing Science, Humboldt-University in Berlin, conducted a pressure ulcer prevalence study on 3012 patients of eleven hospitals. The investigation revealed the use of pressure ulcer prevention on patients with different stages, or without a pressure ulcer. The study also focused on the use of interventions and bed-aids on patients both at risk and not at risk. Interventions without the use of bed-aids were used more often than interventions using bed-aids. The main type of intervention used was the mobilisation of the patient. This was found in all groups (at risk or not at risk; with or without a pressure ulcer). The bed-aids which were most frequently used were pressure-relieving cushions and heel-protectors. Because of the differences in pressure ulcer management among the hospitals, this article also shows evidence on bed-aids and the interventions as known from literature. In four of the interventions as used in practice, the highest degree of evidence could be found. However, in five cases no evidence could be found at all. The comparison of the use in practice and the literature revealed that interventions which are often used as pressure reduction are well tested and can be recommended. However, the (sheep-) skins, which are frequently used, are not reducing the pressure significantly.

Aged↗
PubMed1990

On the development of a multidimensional Dutch pain assessment tool for children.

The Abu-Saad Pediatric Pain Assessment Tool consists of 30 word descriptors in the sensory, affective and evaluative domains as well as a 10 cm scale that measures present and worst pain experienced by the child. In the first phase of the study an inventory was carried out of pain word descriptors used by hospitalized Dutch children. In the second phase, these word descriptors were given an intensity value on the 10 cm scale by 355 children. Alpha reliability coefficient of 0.83 supported instrument homogeneity. Factor analysis (N = 355) was used to investigate construct validity. A 3-factor solution was carried out to evaluate the validity of the 3 dimensions of pain. Factor I consisted of items in the affective and evaluative domains and factors II and III items from the sensory domain. Ultimately a 2-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition and discussion of these factors are discussed and elaborated.

Adolescent↗