PubMed Health⌕ Search

Biomedical subjects

Ruud J G Halfens

Publications and source records attributed to Ruud J G Halfens.

16 recordsLinked to original sources
PubMed2006

Psychometric evaluation of the Hendrich Fall Risk Model.

AIMS: The aim of this paper is to report a psychometric evaluation of the Hendrich Fall Risk Model. BACKGROUND: Thoroughly developed and tested instruments for assessment of fall risk are needed to identify patients at risk of falling, to enable the implementation of preventative measures. METHOD: Data from 1977 patients/residents in 45 nursing homes and 7197 patients from 47 hospitals were evaluated in a cross-sectional survey. The internal consistency of the Hendrich Fall Risk Model was examined using the Kuder-Richardson Test. The dimensions of the model were revealed by exploratory factor analysis and the Care Dependency Scale was used to investigate construct validity. Using Spearman Rho the sum of weighted items was correlated with the sum of unweighted items to obtain information about the practicability of a weighted total score. The study was carried out in 2003. RESULTS: The internal consistency of the model was not high (alpha = 0.54). Additionally, factor analysis showed that the model had more than one dimension. The correlation between the fall risk model and Care Dependency Scale was quite high for hospital patients and the total group (Spearman Rho = -0.71 or -0.76 respectively, P < 0.01) and medium for nursing home residents (Spearman Rho = -0.51, P < 0.01). The total scores of the weighted and unweighted items correlated highly (Spearman Rho = 0.96, P < 0.01). CONCLUSIONS: The use of this risk model is not recommended for nursing homes. For hospitals, we advise the use of unweighted items.

Accidental Falls↗
PubMed2006

Effect of non-response bias in pressure ulcer prevalence studies.

AIM: This paper reports a study to determine the prevalence of pressure ulcers in German hospitals and nursing homes for national and international comparison, and analyses the influence of non-response bias. BACKGROUND: Outcome rates are often used to evaluate provider performance. The prevalence of pressure ulcers is seen as a possible parameter of outcome healthcare quality. However, the results from different pressure ulcer prevalence studies cannot be compared, because there is no standardized methodology and terminology. Observed and published prevalence rates may reflect variations in quality of care, but differences could also relate to differences in case-mix or to random variation. METHODS: A point prevalence survey was carried out for 2002 and 2003 using data from 21,574 patients and residents in 147 different kinds of institutions throughout Germany. Participation rates and reasons for not participating in the study were documented. Non-responders were considered in different calculations to show the range of possible prevalence rate for a hypothetic 100% participation. RESULTS: In 2002 and 2003, the calculated prevalence rate (among participating persons at risk) in hospitals was 25.1% and 24.2% respectively, while in nursing homes it was 17.3% and 12.5% respectively. Non-response varied from 15.1% to 25.1%. The majority of non-responders in hospitals and nursing homes had not been willing to participate in the study. Based on different assumptions about the characteristics of the non-responders, we calculated minimum and maximum prevalence rates as if 100% participation was achieved. CONCLUSIONS: Calculating the non-response bias of prevalence rates is an inconvenient but necessary thing to do because its influence on calculated prevalence rates was high in this study. High participation rates in clinical studies will minimize non-response bias. If non-response cannot be avoided, the formula provided will help researchers calculate possible minimum and maximum prevalence rates for the total sample of both the responding and non-responding groups.

Aged↗
PubMed2005

Risk factors for urinary incontinence in nursing home residents.

QUESTION: What are potential risk factors for urinary incontinence in nursing home residents older than 65 years at the time of admission and over time? METHOD: Secondary analysis of data from the Minimum Data Set of the Resident Assessment Instrument in a cross-section as well as a longitudinal section. The sample contained data of 2722 residents from 42 different geriatric and nursing homes in north-west Switzerland. RESULTS: The cross-sectional analysis showed the variable "moving in bed" as the most important personal variable for incontinence at admission. LONGITUDINAL ANALYSES: The most important risk factor was 'moving in bed' as it continued its action even at 12 months. In a further analysis (incontinence one year after admission with the risk factors at admission) the items "long-term memory, state season and walking in room" were important factors. CONCLUSION: The data suggest that mental and physical exercises could be a way to reduce urinary incontinence. However, physical exercises would be the most important, because "moving in bed" continued its action even at 12 months. Despite some limitations attributable to the data collection, this is the first study in Switzerland to examine risk factors for urinary incontinence among nursing home residents.

Age Factors↗
PubMed2005

[Experiencing the disease of breast cancer and getting life under control again].

Women experiencing breast cancer are confronted with a live threatening disease and find themselves in a situation that changes and restricts their life psychologically, physically and socially. This qualitative investigation examined the experience of living with breast cancer from the perspective of newly diagnosed women. Ten women were interviewed at the end of their radiotherapy. The interviews are analysed with the method of content analysis. The findings show three domains. First domain: From living in fear of having breast cancer to the confirmation of its diagnosis. These women perceive the confirmation of the diagnosis as a shock and initially plunge into an existential crisis. The life threatening disease with an unpredictable future, feelings of vulnerability, uncertainty, hopelessness and anxiety often make them depressed. They need all their energy to maintain control over their life, by suppressing emotions to protect themselves from overwhelming feelings and suffering. Second domain: Experiencing the therapy. The women undergo weakening aggressive and invasive treatment regimes, leaving them in a condition worse than before. Physically exhausted, they sometimes don't know how to go through and overcome this time. Lack of energy, tiredness and fatigue are ongoing problems. Being diagnosed with breast cancer, the suddenly become patients, having to cope with a complex healthcare system. From doctors and nurses they expect empathy, caring and expertise. When in contact with health care, they often hide their suffering, while in fact, they are extremely vulnerable and in deep despair. Third domain: Hold out and live. Women living with breast cancer have no choice but to go through this situation. By motivating their self they regain and mobilise their vital energy. They try to suppress their suffering and dark, intrusive memories. Support from relatives is very important, however, such women tend to protect them from their suffering. The definition of the role of these relatives and their suffering remain unclear. In a future study, research is needed to determine precisely which psychosocial variables are effective in promoting greater health for women with breast cancer and their families, taking into consideration the dynamic of the relationship between women with breast cancer and their relatives as well as the influence of their mutual support.

Adaptation, Psychological↗
PubMed2005

Non-somatic effects of patient aggression on nurses: a systematic review.

AIM: This paper describes a systematic review of the predominant non-somatic effects of patient assault on nurses. Background. Patient aggression towards nurses is a longstanding problem in most nursing domains. Although reports on the consequences of physical aggression are more numerous, the non-physical effects create much suffering. METHOD: A systematic review of literature from 1983 to May 2003 was conducted using the Medline, CINAHL, PsychINFO and PSYINDEX databases. Articles from international journals in English or German and reporting at least three non-somatic responses to patient aggression were included. FINDINGS: The electronic search produced 6616 articles. After application of the inclusion and exclusion criteria, 25 texts from eight countries and four domains of nursing remained. Twenty-eight main effects were found, and these were categorized using a system suggested by Lanza and including bio-physiological, emotional, cognitive, and social dimensions. The predominant responses were anger, fear or anxiety, post-traumatic stress disorder symptoms, guilt, self-blame, and shame. These main effects occurred across most countries and nursing domains. CONCLUSION: Despite differing countries, cultures, research designs and settings, nurses' responses to patient aggression are similar. Standardized questionnaires could help improve estimations of the real prevalence of non-somatic effects. Given the suffering caused by non-somatic effects, research should be aimed at preventing patient aggression and at developing better ways to prepare nurses to cope with this problem.

Aggression↗
PubMed2005

Prevalence of pressure ulcers in Germany.

AIMS AND OBJECTIVES: This article establishes the prevalence of pressure ulcers in hospitals and nursing homes for national and international comparison. BACKGROUND: Although many European countries evaluate the prevalence of pressure ulcers, it has not recently been examined in German healthcare facilities. DESIGN: Descriptive study design, point prevalence survey in 2001 and 2002. A total of 11 584 patients and residents in 66 institutions throughout Germany took part in the study. METHODS: Prevalence rates were calculated for the different types of institutions, different years, different risk groups and different disciplines. All calculations were made by including as well as excluding pressure ulcer grade 1. The Braden scale (cut-off < or =20) was applied to define at risk and not at risk patients/residents. RESULTS: The prevalence including (excluding) grade 1 pressure ulcers was 11.7% (5.2%) for the whole sample, while in the group at risk it was 24.5% (11.5%). The size of the group at risk in the nursing homes was 63.9% and less than 40% in the hospitals. Comparisons between disciplines showed a great range of prevalence rates. The use of special surface devices for persons at risk was more common in nursing homes than in hospitals. CONCLUSION: The prevalence of pressure ulcers bears resemblance to results produced by other studies, but it is uncertain if these similarities are more than coincidental. Due to the influence of sampling the use of a standardized samples method is essential. For comparisons of groups with differences regarding their risk assessment it would be more appropriate to use the prevalence of patients and residents at risk. RELEVANCE TO CLINICAL PRACTICE: The study provides accurate data about the extent of the problem of pressure ulcers in German healthcare facilities.

Age Distribution↗
PubMed2005

The effects of massage as a method to prevent pressure ulcers. A review of the literature.

General information about the effects of massage to prevent pressure ulcers is limited. A literature search was conducted to provide more detailed knowledge about the effects of massage in general and in preventing the development of pressure ulcers in particular. Using the keywords massage, rubbing, prevention of pressure ulcers/pressure ulcers, and paying particular attention to referenced articles yielded a summary of different manual massage techniques and indications/contraindications of this intervention for both healthy tissues and tissues in patients at risk for developing pressure ulcers. A careful review of this information; the clinical, physical, and pathophysiological aspects of pressure ulcers, including extrinsic and intrinsic factor; and the time-pressure relationship suggests that one type of massage may be beneficial for persons who are at risk for developing pressure ulcers. Specifically, effleurage applied with moderate pressure is the most preferred massage in the treatment of pressure ulcers, although based on currently existing studies, it cannot be proven statistically that massage is an adequate preventive method for pressure ulcers. Although many guidelines advised against use of massage in people at risk for pressure ulcers, current evidence suggests that research to increase knowledge about the mechanism behind the effects of massage as part of an individualized prevention and treatment plan should be conducted.

Humans↗
PubMed2004

A pressure ulcer audit and feedback project across multi-hospital settings in the Netherlands.

OBJECTIVE: To examine whether participating in a pressure ulcer prevalence survey and receiving feedback results in an improvement in quality of care. DESIGN: Cross-sectional studies from 1998 to 2002 were compared over time. SETTING: Sixty-two acute care hospitals in the Netherlands. STUDY PARTICIPANTS: Patients hospitalized at the moment of the surveys. INTERVENTIONS: Each hospital was given hospital-specific performance data and national aggregate data, and peer comparisons to improve the quality of care. MAIN OUTCOME MEASURES: The case-mix-adjusted prevalence of pressure ulcers of grade >or=2, the percentage of high-risk patients receiving adequate prevention, and the total number of enabling conditions present were compared between successive surveys using multi-level analysis, in order to estimate a linear trend model and trend differences for each hospital. RESULTS: The case-mix-adjusted prevalence of pressure ulcers decreased over the 5-year period, while the percentage of patients receiving adequate prevention and the total number of enabling conditions present increased. The total number of enabling conditions had a significant effect on the decrease in case-mix-adjusted prevalence: more enabling conditions led to a lower case-mix-adjusted prevalence (chi(2) = 125; degrees of freedom = 1; P < 0.00). The percentage of patients receiving adequate prevention also had an effect on the change in case-mix-adjusted prevalence, with a higher percentage leading to a lower case-mix-adjusted prevalence. This effect, however, was not significant. CONCLUSIONS: Monitoring prevalence and giving feedback results in an improvement in quality of care in terms of pressure ulcer prevention. It is very important to continue conducting surveys to avoid attention moving away from this topic, which may in turn lead to a deterioration in the quality of pressure ulcer care. Further research to find the most effective feedback approach is needed.

Aged↗
PubMed2004

Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers.

UNLABELLED: BACKGROUND In the Netherlands much attention has been paid to pressure ulcer prevention. National guidelines on pressure ulcer prevention were developed in 1985 and adapted in 1992 at the request of a national organization for quality assurance in health care. Several studies indicate that nurses seem to be insufficiently informed about pressure ulcer preventive activities. There is, however, no information available about the reasons why nurses seem to be insufficiently informed. AIMS AND OBJECTIVES: This study was planned to elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention. DESIGN: A qualitative study with semi-structured, tape-recorded interviews. METHOD: Interviews were conducted with enrolled nurses, team leaders, head nurses, staff nurses and physicians. The interviews were coded and analysed. RESULTS: Analysis of the interviews revealed that today's pressure ulcer preventive activities are very much based on old traditions in nursing. It also showed that enrolled nurses have no intention to change the care they deliver with regard to pressure ulcer prevention. CONCLUSIONS: It is concluded that a systematic approach is necessary to change nursing thinking and acting with regard to pressure ulcer prevention. RELEVANCE TO CLINICAL PRACTICE: This study gives an overview of the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention. These views and beliefs can be used as a starting point for effective implementation of guidelines regarding the prevention of pressure ulcers.

Aged↗
PubMed2003

Development of a model for case-mix adjustment of pressure ulcer prevalence rates.

BACKGROUND: Acute care hospitals participating in the Dutch national pressure ulcer prevalence survey use the results of this survey to compare their outcomes and assess their quality of care regarding pressure ulcer prevention. The development of a model for case-mix adjustment is essential for the use of these prevalence rates as an outcome measure. OBJECTIVE: The development of a valid model for case-mix adjustment to compare the prevalence rates in the acute care hospitals that participated in the 1998 Dutch pressure ulcer prevalence survey, for the purpose of performance comparisons among the hospitals. DESIGN: Cross-sectional design. SUBJECTS: Subjects were patients residing in the 43 acute care hospitals that participated in the national pressure ulcer prevalence survey on May 26, 1998. MEASURES: The study examined the validity of a model for case-mix adjustment of pressure ulcer prevalence rates and compared hospitals to evaluate the impact of adjusted prevalence rates on their performance. RESULTS: A logistic model was developed for case-mix adjustment, using age, malnutrition, incontinence, activity, mobility, sensory perception, friction and shear, and ward specialty. This model was found to have content, construct, and internal validity. Case-mix adjustment influenced the hospitals' performance. CONCLUSION: The data of the national pressure ulcer prevalence survey can be used to develop a valid model for case-mix adjustment. Conclusions about the quality of care were influenced by the use of case-mix adjusted outcomes as a measure of this quality.

Adolescent↗
PubMed2002

Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands.

The purpose of the present study was to assess the prevalence of pressure ulcers and the use of Dutch guidelines for the prevention and treatment of pressure ulcers. A survey of 16,344 patients in 89 health care institutions on 1 day showed a mean prevalence of pressure ulcers of 23.1%. It was found that Dutch guidelines on some aspects of prevention and treatment of pressure ulcers were not being followed. Only 53% of the patients who should have been positioned on a support surface were positioned on such a device. Fewer than one-third of the patients who should have been repositioned, should have received nutritional support, or should have been educated received these interventions, and only 33.6% of all pressure ulcers were dressed as recommended. More attention to the dissemination and implementation of the guidelines is needed to reduce this high prevalence of pressure ulcers.

Aged↗
PubMed2002

Are nurses able to assess fatigue, exertion fatigue and types of fatigue in residential home patients?

Are nurses able to assess fatigue, exertion fatigue and types of fatigue in residential home patients? Although fatigue is recognized as a subjective, generalized, extensive and disabling health care problem with a relatively high prevalence among the chronically ill, there have been no studies to show whether nurses caring for fatigued subjects are able to accurately assess the level of fatigue that exists in these patients. The aim of the present study is to investigate this issue. The following research questions are formulated: (1) To what degree do the assessments of fatigue and exertion fatigue given by nurses and patients agree? and (2) To what degree do the assessments of types of fatigue given by nurses and patients agree? The method adopted employed a correlational design approach applied to residential home patients and nurses. Data were gathered by questionnaire. Data collected from 44 selected patients and two assessors (nurses) for each patient are used in the analyses. Measurement instruments used are the Dutch fatigue scale (DUFS), the Dutch exertion fatigue scale (DEFS), types of fatigue and sociodemographic variables. Measurement correlations between the patients and the nurses, both for the DUFS and DEFS, showed fair agreement (fatigue and exertion fatigue) and slight agreement (types of fatigue). The main conclusion of this study is that nurses working in residential home care are unable, in comparison with the patients themselves, to accurately assess patient's fatigue (fair agreement), exertion fatigue (fair agreement) and types of fatigue (slight agreement).

Aged↗
PubMed1996

The influence of children's vocal expressions, age, medical diagnosis and information obtained from parents on nurses' pain assessments and decisions regarding interventions.

This article reports on a study that examines the influence of task-related factors on nurses' pain assessments and decision regarding interventions. In an experimental design pediatric nurses (n = 202), were exposed to different cases, each case being a combination of a vignette and a videotape. For every case subjects were asked to assess the child's pain and to state whether they would administer an analgesic. The results indicated that pediatric nurses attributed more pain and were more inclined to administer non-narcotic analgesics to children who vocally expressed their pain than to children who were less expressive. Furthermore, the interaction results between the child's expression and the medical diagnosis revealed a trend indicating that nurses attributed the most pain to the child when the diagnosis was severe and the child vocally expressed his pain.

Adenoidectomy↗