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Theo Dassen

Publications and source records attributed to Theo Dassen.

At least 19 recordsLinked to original sources
PubMed2007

[Pressure ulcer prevalence in Germany: results of a cross-sectional study in 2006].

In April 2006 the sixth study to survey the prevalence of nursing-related health problems in German hospitals and nursing homes was conducted. In total 7107 persons partcipated in this study. The pressure ulcer prevalence was calculated for the participants who were assessed to be at pressure ulcer risk. In nursing homes the prevalence was 8.3 percent, in hospitals 15.1 percent of patients at risk showed at least one pressure ulcer. Although the proportion of persons at risk did not alter during the last five years, the prevalence decreased within this time. Therefore one can assume that the quality of pressure ulcer prevention and therapy has been improved.

Cross-Sectional Studies↗
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

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↗
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↗
PubMed2006

Learning the meaning of care: a case study in a geriatric home in Upper Egypt.

Geriatric care is a new phenomenon in Egypt. This study investigates how Egyptian caregivers experience their work and how they conceive its meaning. A qualitative case study in a geriatric home in Upper Egypt was conducted using structured interviews with 10 staff members and content analysis according to Mayring. Performing care required learning to overcome initial experiences of fear, disgust, and sexual taboo. Care was perceived as a laborious repetition. Its ideal form was described as a reaction to a demand combined with kind patience and a family-like relationship. Christian and female values allowed coping with experienced problems and alleviated conflicts between traditional gender roles and care of male residents. Traditional values helped to adapt to the requirements of providing care. Sexual taboos may reduce willingness to provide care, but traditional values may encourage caregivers.

Adaptation, Psychological↗
PubMed2006

Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics.

In German healthcare facilities, research-based knowledge of pressure ulcers and their relation to patient characteristics is limited. To provide information for national and international comparison on pressure ulcers and related issues, two cross-sectional surveys were conducted among 21,574 German hospital patients and nursing home residents (147 institutions total) in 2002 and 2003. Prevalence and frequency rates of pressure ulcers in people at risk (Braden score of </=20) in different institution types were compared and descriptive data on severity, location, history, and origin of 3,857 wounds were analyzed to examine the relationship between age, body mass index, and Braden score and the frequency and severity of wounds. The studies found that among all persons at risk, pressure ulcer prevalence was 21.1% and that the number of pressure ulcers per person was higher in hospitals (1.91, 24.6%) than in nursing homes (1.42, 13.9%). In addition, in hospital patients and nursing home residents, 36.4% and 46.7% of wounds, respectively, were grade 2 severity and higher. In both types of institutions, the most common pressure ulcer locations were the lower back and the heels. In hospital patients, 51.4% of pressure ulcers were facility-acquired, compared to 60.2% in nursing homes. In hospital patients and nursing home residents, 7.4% and 29.7% of wounds, respectively, had existed for more than 3 months. The studies also found that persons with lower Braden scale scores had more ulcers and more severe pressure ulcers. Analysis of wounds in this large patient population provides more detailed information about the problem of pressure ulcers and should help improve prevention and treatment.

Age Distribution↗
PubMed2006

[Fall incident reports in theory and practice: recommendations for developing of practice-oriented fall incident reports in nursing homes].

Nursing home residents are known to be subject to a special risk for falls and fall-related injuries. The collection and analysis of root-causes and conditions of a fall in fall incident reports represent a vital instrument for secondary prevention and quality management. Preceding falls are proven to be one of the most important risk factors for repeated falls. Therefore it is recommended to report and evaluate the situation, in which the fall happened, in order to develop strategies for preventing repeated falls and for minimising the consequences of a fall. The question arises, how a fall incident report should look like, to meet both the scientific requirements and the expectations of the user in practice. To answer this question, six fall incident reports selected from theoretical and practical sources were described and analysed. After systematic analysis of the related German-language literature and conduction of some partly-structured interviews with different user groups the goals and requirements for fall incident reports were identified. Based on these targets and requirements as well as on the recommendations of national experts and scientific literature, criteria for evaluating fall incident reports were developed. None of the selected reports meets all the criteria. Finally, based on the theoretical and practical recommendations, components for fall incident reports were developed which meet both the criteria found. These components are guidelines for healthcare action based on the care process and, if followed properly, an important tool for fall prevention and for protecting nursing homes against liability claims.

Accidental Falls↗
PubMed2006

Treatment of pressure ulcers: results of a study comparing evidence and practice.

Pressure ulcers remain prevalent in hospitals and nursing homes despite the availability of evidence-based guidelines for prevention and care. To evaluate the level of evidence-based literature and its application in pressure ulcer treatment, a search was conducted of relevant English and German articles published between 1994 and 2002 using the key terms decubitus ulcer and its synonyms in different combinations with therapy, wound management, and specific wound treatment terms. Results were compared to wound dressing use data obtained from two pressure ulcer prevalence surveys conducted in 51 hospitals and 15 nursing homes in Germany in 2001 and 2002 (N = 11,584). Dressing usage evidence levels were reviewed and reported usage was classified as consistent or not consistent with existing guidelines or as evidence base unknown. Pressure ulcer prevalence rates ranged from 10.6% to 13.2% and the majority of pressure ulcers (60%) were Grade 1. In nursing homes, dressing selection was consistent with current evidence in 6.8% of Grade 1 and 27.8% of Grade 2 ulcers. In acute care facilities, dressing selection in 2001 and 2002 was consistent with current evidence in 21.6% and 38.5%, respectively, of Grade 1 ulcers and in 40.2% and 51.5%, respectively, of Grade 2 ulcers. Although strong evidence exists to support the use of dressings that facilitate moist wound healing, barely half of the grade 3 and grade 4 ulcers in all care settings received this treatment. While dressing classification limitations restricted the ability to analyze all treatment methods used, findings suggest that clinician knowledge deficits regarding evidence-based treatments remain. The literature review results also indicate the level of evidence for many practice recommendations remains low. Studies to increase evidence levels of pressure ulcer prevention and treatment as well as programs to improve awareness and implementation of current evidence-based guidelines are needed.

Bandages↗