2014, Article / Letter to editor (BMC Medical Education, vol. 14, iss. 117, (2014))Background: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers’ performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills) in a role-play that simulated physical therapy (PT) practice. Students alternately performed in the role of PT, assessor, and patient. Oral face-to-face feedback was provided as well as written feedback and scores.This study aims to explore the impact of PA on the improvement of clinical performance of undergraduate PT students. Methods: The PA task was analyzed and decomposed into task elements. A qualitative approach was used to explore students' perceptions of the task and the task elements. Semi-structured interviews with second year students were conducted to explore the perceived impact of these task elements on performance improvement. Students were asked to select the elements perceived valuable, to rank them from highest to lowest learning value, and to motivate their choices. Interviews were transcribed verbatim and analyzed, using a phenomenographical approach and following template analysis guidelines. A quantitative approach was used to describe the ranking results. Results: Quantitative analyses showed that the perceived impact on learning varied widely. Performing the clinical task in the PT role, was assigned to the first place (1), followed by receiving expert feedback (2), and observing peer performance (3). Receiving peer feedback was not perceived the most powerful task element. Qualitative analyses resulted in three emerging themes: pre-performance, true-performance, and post-performance triggers for improvement. Each theme contained three categories: learning activities, outcomes, and conditions for learning. Intended learning activities were reported, such as transferring prior learning to a new application context and unintended learning activities, such as modelling a peer’s performance. Outcomes related to increased self-confidence, insight in performance standards and awareness of improvement areas. Conditions for learning referred to the quality of peer feedback. Conclusions: PA may be a powerful tool to improve clinical performance, although peer feedback is not perceived the most powerful element. Peer assessors in undergraduate PT education use idiosyncratic strategies to assess their peers’ performance.
2015, Article / Letter to editor (International Journal of Nursing Studies, vol. 52, iss. 10, (2015), pp. 1617-1624)Background: Self-management support is essential to perform self-management behavior. To provide this support in an effective way, insight in the needs for self-management support is necessary. Objective: To give an overview of self-management support needs from the perspective of rheumatoid arthritis patients to help nurses to improve self-management. Design: We conducted a scoping review for the period of January 2002 to May 2013 using the following inclusion criteria: (1) studies on adult patients aged 18 years and older, (2) studies from the perspective of rheumatoid arthritis patients, (3) studies reporting results on support needs, and (4) empirical studies using any design. Data sources: We searched in PubMed, CINAHL, and PsycINFO. Review methods: Following the steps of a scoping review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, (4) charted the data, and (5) collated, summarized, and reported results. We incorporated the optional sixth step of consultation of a multidisciplinary panel of professionals and patients to validate our findings. Results: Seventeen articles were included. Our review shows that rheumatoid arthritis patients have informational, emotional, social and practical support needs. We found an information need for various topics, e.g. exercises and medication. Patients express a need for emotional support in daily life, given through other RA patients, colleagues and supervisors and nurses. For information needs, emotional and social support it is important that it is tailored to the individual needs of the patient. Conclusion: The most important support needs for self-management mentioned by rheumatoid arthritis patients are more informational, social and practical support and emotional support. Considering patients' perspective as a starting point for delivering support for self-management can lead to the development of nursing interventions tailored to the needs of rheumatoid arthritis patients. (C) 2015 Elsevier Ltd. All rights reserved.
2021, Article / Letter to editor (European Journal of Physiotherapy, (2021))Purpose: To translate and culturally adapt the Swedish version of the 'Blue flags' questionnaire into Dutch and to examine the validity and reliability aspects of the Dutch version. Methods: The 'Blue flags' questionnaire was translated and culturally adapted to the Dutch situation. A total of 58 participants filled in the first questionnaire at baseline and 51 participants filled in the second questionnaire sent two weeks later. The data of the participants who filled in the first questionnaire was used to determine internal consistency, structural validity and concurrent validity. The data of the participants who filled in both questionnaires was used to determine test-retest reliability. Results: The internal consistency was good with a Cronbach's alpha of 0.83. The structural validity was satisfactory with a Kaiser-Meyer-Olkin (KMO) test of 0.75 and a significance of p < .001 for the Bartlett's test. Four factors were extracted using principal component analysis (PCA) with varimax rotation with an explained total variance of 70.8%. Spearman's rho for concurrent validity was 0.68 (p < .001). The intraclass correlation coefficient (ICC) for test-retest was 0.80 (p < .001) for the total score. Conclusions: The Dutch version of the 'Blue flags' questionnaire showed good internal consistency, satisfactory structural validity, strong concurrent validity (with mixed item representation results) and strong reliability.
2011, Article / Letter to editor (International Journal of Nursing Studies, vol. 48, iss. 9, (2011), pp. 1049-1057)Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given. Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators.
2010, Article / Letter to editor (International Journal of Nursing Studies, vol. 47, iss. 9, (2010), pp. 1117-1125)Background: Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy. Objectives: The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses. Design: A cluster randomised trial was conducted between September 2006 and July 2008. Settings: Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward. Participants: All nurses from participating wards. Methods: A knowledge test measured nurses' knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately. Results: After correction for baseline, the mean difference between the intervention and the control group on hospital nurses' knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% Cl: -0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% Cl: 0.10-0.81). For the other two topics there was no statistically significant effect. Nursing home nurses' knowledge did neither improve (0 points, Cl: -0.35 to 0.35) overall, nor for the separate subjects. Conclusion: The educational intervention improved hospital nurses' knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed.
2009, Article / Letter to editor (BMC Health Services Research, vol. 2009, iss. 9, (2009), pp. 58)Patients in hospitals and nursing homes are at risk of the development of, often preventable, adverse events (AEs), which threaten patient safety. Guidelines for prevention of many types of AEs are available, however, compliance with these guidelines appears to be lacking. Besides general barriers that inhibit implementation, this non-compliance is associated with the large number of guidelines competing for attention. As implementation of a guideline is time-consuming, it is difficult for organisations to implement all available guidelines. Another problem is lack of feedback about performance using quality indicators of guideline based care and lack of a recognisable, unambiguous system for implementation. A program that allows organisations to implement multiple guidelines simultaneously may facilitate guideline use and thus improve patient safety. The aim of this study is to develop and test such an integral patient safety program that addresses several AEs simultaneously in hospitals and nursing homes. This paper reports the design of this study. The patient safety program addresses three AEs: pressure ulcers, falls and urinary tract infections. It consists of bundles and outcome and process indicators based on the existing evidence based guidelines. In addition it includes a multifaceted tailored implementation strategy: education, patient involvement, and a computerized registration and feedback system. The patient safety program was tested in a cluster randomised trial on ten hospital wards and ten nursing home wards. The baseline period was three months followed by the implementation of the patient safety program for fourteen months. Subsequently the follow-up period was nine months. Primary outcome measure was the incidence of AEs on every ward. Secondary outcome measures were the utilization of preventive interventions and the knowledge of nurses regarding the three topics. Randomisation took place on ward level. The results will be analysed separately for hospitals and nursing homes. Major challenges were the development of the patient safety program including a digital registration and feedback system and the implementation of the patient safety program.
2012, Article / Letter to editor (BMC Family Practice, vol. 13, (2012))Background: With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. Methods/design: The CareWell-primary care study includes a (cost-) effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver 'care as usual'. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients' and professionals' approval of the program, and the barriers and facilitators to implementation. Discussion: The CareWell-primary care study will provide new insights into the (cost-) effectiveness, feasibility, and barriers and facilitators for implementation of this complex intervention in primary care.
2012, Article / Letter to editor (Journal of Clinical Epidemiology, vol. 65, iss. 2, (2012), pp. 132-137)Objective: Balance of prognostic factors between treatment groups is desirable because it improves the accuracy, precision, and credibility of the results. In cluster-controlled trials, imbalance can easily occur by chance when the number of cluster is small. If all clusters are known at the start of the study, the "best balance" allocation method (BB) can be used to obtain optimal balance. This method will be compared with other allocation methods. Study Design and Setting: We carried out a simulation study to compare the balance obtained with BB, minimization, unrestricted randomization, and matching for four to 20 clusters and one to five categorical prognostic factors at cluster level. Results: BB resulted in a better balance than randomization in 13-100% of the situations, in 0-61% for minimization, and in 0-88% for matching. The superior performance of BB increased as the number of clusters and/or the number of factors increased. Conclusion: BB results in a better balance of prognostic factors than randomization, minimization, stratification, and matching in most situations. Furthermore, BB cannot result in a worse balance of prognostic factors than the other methods. (C) 2012 Elsevier Inc. All rights reserved.
2017, Article / Letter to editor (Journal of Advanced Nursing, vol. 73, iss. 4, (2017), pp. 775-793)AimTo assess the quality of evidence and determine the effect of patient-related and economic outcomes of self-management support interventions in chronically ill patients with a low socio-economic status. BackgroundIntegrated evidence on self-management support interventions in chronically ill people with low socio-economic status is lacking. DesignSystematic literature review. Data sourcesCochrane database of trials, PubMed, CINAHL, Web of Science, PsycINFO and Joanna Briggs Institute Library were searched (2000-2013). Randomized controlled trials addressing self-management support interventions for patients with cardiovascular disease, stroke, cancer, diabetes and/or chronic respiratory disease were included. Review methodsData extraction and quality assessment were performed by independent researchers using a data extraction form. ResultsStudies (n=27) focused mainly on diabetes. Fourteen studies cited an underlying theoretical basis. Most frequently used self-management support components were lifestyle advice, information provision and symptom management. Problem-solving and goal-setting strategies were frequently integrated. Eleven studies adapted interventions to the needs of patients with a low socio-economic status. No differences were found for interventions developed based on health behaviour theoretical models. ConclusionLimited evidence was found for self-management support interventions in chronically ill patients with low socio-economic status. Essential characteristics and component(s) of effective self-management support interventions for these patients could not be detected. Rigorous reporting on development and underlying theories in the intervention is recommended.
2020, Article / Letter to editor (SEXUALITY AND DISABILITY, vol. 38, iss. 2, (2020), pp. 191-216)Adolescent patients and healthcare professionals find it difficult to initiate the discussion on sexual health in consultations. The aim of this integrative review is to give an overview of determinants in the communication about sexual health between adolescents with chronic conditions, their parents, and their healthcare professionals. A systematic literature search for the period of January 2000 to October 2018 was conducted in four databases (Cinahl, Cochrane, PsycINFO, and Pubmed) and resulted in fifteen included studies. Four determinants were found in these studies: attitude, beliefs, knowledge, and self-efficacy. Patients, parents, and healthcare professionals experienced sexual health as a taboo topic and felt not comfortable talking about it. Both patients and professionals expressed a need to discuss sexual health, however personal and practical barriers withhold them from initiating the discussion. This in-depth overview suggests that all four determinants should be targeted to improve communication about sexual health in healthcare settings. Future research should be conducted to give more insight in the experiences and support needs of adolescent patients. On the long term, the discussion about sexual health should become normalized by improving knowledge, training, and support for healthcare professionals and integrating sexual health in education and hospital policies.
2017, Article / Letter to editor (JMIR Research Protocols, vol. 6, iss. 2, (2017))Background: In addition to medical intervention and counseling, patients with cardiovascular disease (CVD) need to manage their disease and its consequences by themselves in daily life. Objective: The aim of this paper is to describe the development of "Vascular View," a comprehensive, multi-component, tailored, Web-based, self-management support program for patients with CVD, and how this program will be tested in an early randomized controlled trial (RCT). Methods: The Vascular View program was systematically developed in collaboration with an expert group of 6 patients, and separately with a group of 6 health professionals (medical, nursing, and allied health care professionals), according to the following steps of the intervention mapping (IM) framework: (1) conducting a needs assessment; (2) creating matrices of change objectives; (3) selecting theory-based intervention methods and practical applications; (4) organizing methods and applications into an intervention program; (5) planning the adaption, implementation, and sustainability of the program, and (6) generating an evaluation plan. Results: The needs assessment (Step 1) identified 9 general health problems and 8 determinants (knowledge, awareness, attitude, self-efficacy, subjective norm, intention, risk perception, and habits) of self-managing CVD. By defining performance and change objectives (Step 2), 6 topics were distinguished and incorporated into the courses included in Vascular View (Steps 3 and 4): (1) Coping With CVD and its Consequences; (2) Setting Boundaries in Daily Life; (3) Lifestyle (general and tobacco and harmful alcohol use); (4) Healthy Nutrition; (5) Being Physically Active in a Healthy Way; and (6) Interaction With Health Professionals. These courses were based on behavioral change techniques (BCTs) (eg, self-monitoring of behavior, modeling, re-evaluation of outcomes), which were incorporated in the courses through general written information: quotes from and videos of patients with CVD as role models and personalized feedback, diaries, and exercises. The adoption and implementation plan (Step 5) was set up in collaboration with the members of the two expert groups and consisted of a written and digital instruction manual, a flyer, bimonthly newsletters, and reminders by email and telephone to (re-) visit the program. The potential effectiveness of Vascular View will be evaluated (Step 6) in an early RCT to gain insight into relevant outcome variables and related effect sizes, and a process evaluation to identify intervention fidelity, potential working mechanisms, user statistics, and/or satisfaction. Conclusion: A comprehensive, multi-component, tailored, Web-based, self-management support program and an early RCT were developed in order to empower patients to self-manage their CVD.
2012, External research report Deze handleiding is het product van een afstudeeropdracht van studenten Toegepaste Psychologie van de Hogeschool van Arnhem en Nijmegen. De handlediing is ontwikkeld i.s.m. de RIBW, NITransition, San Diego State University en het Lectoraat Levensloopbegeleiding bij Autisme (HAN). De handleiding beschrijft verschillende benaderingen van Person Centered Planning (PCP) en bevat een concreet plan voor de uitvoering van PCP. De handleiding is oorspronkelijk bedoeld voor professionals in de zorg voor mensen met autisme spectrum stoornissen (ASS), maar kan door iedereen gebruikt worden die aan de slag wil met een beproefde planningsmethodiek.
2011, Part of book or chapter of book (, pp. 107-116)Er is nog weinig onderzoek gedaan naar factoren die van invloed zijn op patiënttevredenheid binnen de ambulancezorg. Wij veronderstelden dat patiënten die vaker zijn vervoerd met de ambulance mogelijk kritischer zijn. Daarnaast leek het ons dat patiënten die ter plaatse behandeld worden minder tevreden zouden zijn over de zorg dan wanneer zij werden vervoerd. Ook veronderstelden we dat de vervoersurgentie gerelateerd zou kunnen zijn aan tevredenheid; bij spoed (A1 en A2-ritten) een hogere tevredenheid dan bij B-vervoer, omdat de patiënt meer in nood is. De onderzoeksvragen waren: hoe is de huidige patiënttevredenheid over de ambulancezorg in de RAV Gelderland-Zuid? Is de tevredenheid gerelateerd aan eerder vervoer, behandeling ter plaatse of riturgentie? Is er een trend waarneembaar in patiënttevredenheid in vergelijking met de resultaten van onderzoeken uit 2003 en 2006?
2016, Article / Letter to editor (Journal of Clinical Nursing, vol. 25, iss. 9-10, (2016), pp. 1253-1261)Aims and objectives. This study reports about the experiences of 11 patients in the Netherlands who use intermittent self-catheterisation to manage their symptoms. The aim of the study was to get insight in underlying barriers and facilitators for patients dealing with intermittent catheterisation in everyday life. Background. Studies show that intermittent catheterisation has an impact on everyday life. A positive effect does not guarantee that patients maintain catheterisation over a longer period of time. After the implementation of a guideline, a quantitative study was performed to determine successful intermittent catheterisation. The patients of this study had previously taken part in this quantitative study. Design. This is a qualitative multicentre study using semistructured in-depth interviews with 11 patients between March-May 2013. Methods. Inclusion criteria included patients of a quantitative study (n=124) with a variety of diagnoses referred to the outpatient clinic. Those who received instruction from the researcher and who at start of the study performed catheterisation <= 3 months were excluded. Of the total number that met the inclusion criteria, every fourth patient was invited to participate in an interview. Patients were asked about the introducing of intermittent catheterisation, the incorporation into everyday life, the progress after the instruction and guidance perceived, the cause of the bladder problem and the motivation to start intermittent catheterisation. Results. Eleven interviews were performed (six males/five females). All patients described the instruction and follow-up care as positive. Barriers were the preparation before the handling, which is more difficult than the catheterisation itself, and the fact that patients felt constrained by the need to plan convenient times to catheterise themselves. ConclusionThis study shows that patients who perform catheterisation are satisfied about the instruction and follow-up care. Important barriers in everyday life are the preparation and the need to plan convenient times. Relevance to clinical practice. Interviewing patients gave important additional information about dealing with intermittent catheterisation in everyday life. Prescribers and teachers of intermittent catheterisation must realise that they often have to high expectations of patients when it comes to being flexible in frequency of catheterisation. It is important to realise that patients experience barriers of which healthcare workers are not always aware of, such as the preparation before the handling and feeling constrained by the need to plan convenient times to catheterise. The outcome of this study can be used to improve the content of patient information brochures and guidelines for intermittent catheterisation.