Browsing Han Publications by Author "Gaal, B.G.I. van"

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Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study
Gaal, B.G.I. van ; Engelen, M.M. ; Adriaansen, M.J.M. ; Vermeulen, H. ; de Laat, E ; Dulmen, S. van
2022, Article / Letter to editor (Journal of Tissue Viability, (2022))
Effects on staff outcomes and process evaluation of the educating nursing staff effectively (TENSE) program for managing challenging behavior in nursing home residents with dementia: A cluster-randomized controlled trial
Bielderman, A. ; Nieuwenhuis, A.F.M. ; Hazelhof, TJGM ; Gaal, B.G.I. van ; Schoonhoven, Lisette ; Akkermans, R. ; Spijker, A ; Koopmans, R.T.C.M. ; Gerritsen, D.L.
2021, Article / Letter to editor (International Journal of Nursing Studies, vol. 120, (2021))Background: Challenging behavior is prevalent in people with dementia residing in nursing homes and places a high burden on the nursing staff of dementia special care units. This study evaluates an educational program for nursing staff for managing challenging behavior: The Educating Nursing Staff Effectively (TENSE) program. This program can be tailored to care organizations' wishes and needs and combines various learning styles. Objective: The aim of this cluster-randomized controlled trial was to examine the short-term (3 months) and long-term (9 months) effects of the TENSE training program on experienced stress, work contentment, and stress reactions at work in nursing staff working in dementia special care units. Design: Cluster-randomized controlled trial. Methods: Nursing staff members of 18 dementia special care units within nine nursing homes from different Netherlands regions were randomized into an intervention (n = 168) or control (n = 129) group. The TENSE program consisted of a three-day training course and two follow-up sessions after three and six months, respectively. The primary outcome was stress experienced by nursing staff measured with the Utrecht Burnout Scale - C. Secondary outcomes were work contentment and stress reactions at work. Furthermore, process evaluation data on the reach of and compliance with the program and the program's feasibility and relevance were collected. Data were collected between November 2012 and November 2014. Results: In general, the participants appreciated the quality and relevance of the TENSE training and evaluated the content of the training as beneficial. The TENSE training had no effect on the components of experienced stress, i.e., emotional exhaustion (p = 0.751), depersonalization (p = 0.701), and personal accomplishment (p = 0.182). Furthermore, no statistically significant effects of the intervention on work contentment and stress reactions at work were found. Conclusions: The TENSE training program did not have an effect on experienced stress, work contentment, nor stress reactions at work of nursing staff working in dementia special care units. In future studies, more focus on practicing new skills seems needed. (C) 2021 The Authors. Published by Elsevier Ltd.
De herziene richtlijn decubitus
Gaal, B.G.I. van ; de Laat, E ; Engelen, M.M.
2021, Article / Letter to editor (TVZ : verpleegkunde in praktijk en wetenschap, vol. 131(4), (2021), pp. 18-21)
Positive effects of the enhanced recovery after surgery (ERAS) protocol in DIEP flap breast reconstruction. The Breast
Gort, N. ; Gaal, B.G.I. van ; Tielemans, H.J.P. ; Ulrich, D.J.O. ; Hummelink, S.
2021, Article / Letter to editor (The Breast Journal, (2021))
The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: A systematic review
Engelen, M.M. ; Dulmen, S. van ; Vermeulen, H. ; de Laat, E ; Gaal, B.G.I. van
2021, Article / Letter to editor (International Journal of Nursing Studies, vol. 122, 10401, (2021))
Identifying the minimal important difference in patient-reported outcome measures in the field of people with severe mental illness: a pre-post-analysis of the Illness Management and Recovery Programme
Beentjes, T.A.A. ; Teerenstra, S. ; Vermeulen, H. ; Goossens, P. ; Nijhuis-van der Sanden, M.W.G. ; Gaal, B.G.I. van
2021, Article / Letter to editor (Quality of Life Research, (2021))Purpose Complementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR). Methods The effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change. Results All PROMs showed significant pre-post-effects. The QoL measure 'General Health Perception (Rand-GHP)' was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes. Conclusion Taking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.
A Blended Electronic Illness Management and Recovery Program for People With Severe Mental Illness: Qualitative Process Evaluation Alongside a Randomized Controlled Trial
Beentjes, T.A.A. ; Gaal, B.G.I. van ; Vermeulen, H. ; Nijhuis-van der Sanden, M.W.G. ; Goossens, P.
2021, Article / Letter to editor (JMIR Research Protocols, vol. 8(1), iss. e20860, (2021))
Nieuwe richtlijn Decubitus; van knelpunt tot implementatie
de Laat, E ; Gaal, B.G.I. van ; Engelen, M.M.
2021, Article / Letter to editor (Wcs Nieuws, vol. 37(2):p5, (2021))
Nieuwe richtlijn Decubitus; van knelpunt tot implementatie
de Laat, E ; Gaal, B.G.I. van ; Engelen, M.M.
2021, Article / Letter to editor (Wcs Nieuws, vol. 37(2), 5, (2021))
Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial
Engelen, M.M. ; Dulmen, S. van ; Gaal, B.G.I. van ; Nijhuis, R ; Vermeulen, H. ; Puijk-Hekman, S. ; Bredie, S.J.H.
2020, Article / Letter to editor (Journal of Medical Internet Research, (2020))
Self-Management Support Needs from the Perspectives of Persons with Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research
Beentjes, T.A.A. ; Gaal, B.G.I. van ; Achterberg, Theo van ; Goossens, P.
2020, Article / Letter to editor (Journal of the American Psychiatric Nurses Association, vol. 26, iss. 5, (2020))
Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder.
Mauritz, MW ; Gaal, B.G.I. van ; Goossens, P. ; Jongedijk, RA ; Vermeulen, H.
2020, Article / Letter to editor (British Journal of Psychiatry Open, vol. 7(1), e12, (2020))
Sexual Health Communication Between Healthcare Professionals and Adolescents with Chronic Conditions in Western Countries: An Integrative Review
Engelen, M.M. ; Knoll, J.L. ; Rabsztyn, PRI ; Maas-van Schaaijk, NM ; Gaal, B.G.I. van
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.
Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research
Beentjes, T.A.A. ; Gaal, B.G.I. van ; Achterberg, Theo van ; Goossens, P.
2019, Article / Letter to editor (Journal of the American Psychiatric Nurses Association, (2019))
Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: An observational study
Engelen, M.M. ; Dulmen, S. van ; Nijhuis-van der Sanden, M.W.G. ; Adriaansen, M.J.M. ; Vermeulen, H. ; Bredie, S.J.H. ; Gaal, B.G.I. van
2019, Article / Letter to editor (Patient Education and Counseling, vol. 103, iss. 1, (2019), pp. 159-164)
'Lessons learned from patients with access to an online self-management enhancing program for RA patients: Qualitative analysis of interviews alongside a randomized clinical trial'
Zuidema, S.U. ; Dulmen, S. van ; Nijhuis-van der Sanden, M.W.G. ; Fransen, G.A.J. ; Gaal, B.G.I. van
2019, Article / Letter to editor (Patient Education and Counseling, vol. 2019, iss. 102(6), (2019), pp. 1-16)
Efficacy of a Web-Based Self-Management Enhancing Program for Patients with Rheumatoid Arthritis: Explorative Randomized Controlled Trial
Zuidema, R ; Dulmen, S. van ; Nijhuis-van der Sanden, M.W.G. ; Meek, I ; Ende, C. van den ; Fransen, J ; Gaal, B.G.I. van
2019, Article / Letter to editor (Journal of Medical Internet Research, vol. 21, iss. 4, (2019))Background: Web-based self-management enhancing programs have the potential to support patients with rheumatoid arthritis (RA) in their self-management; for example, improve their health status by increasing their self-efficacy or taking their prescribed medication. We developed a Web-based self-management enhancing program in collaboration with RA patients and professionals as co-designers on the basis of the intervention mapping framework. Although self-management programs are complex interventions, it is informative to perform an explorative randomized controlled trial (RCT) before embarking on a larger trial. Objective: This study aimed to evaluate the efficacy of a Web based self-management enhancing program for patients with RA and identify outcome measures most likely to capture potential benefits. Methods: A multicenter exploratory RCT was performed with an intervention group and a control group. Both groups received care as usual. In addition, the intervention group received 12 months of access to a Web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included self-management behavior (Patient Activation Measurement, Self-Management Ability Scale), self-efficacy (Rheumatoid Arthritis task-specific Self-Efficacy, Perceived Efficacy in Patient-Physician Interaction), general health status (RAND-36), focus on fatigue (Modified Pain Coping Inventory for Fatigue), and perceived pain and fatigue (Numeric Rating Scales). A linear mixed model for repeated measures, using the intention-to-treat principle, was applied to study differences between the patients in the intervention (n=78) and control (n=79) groups. A sensitivity analysis was performed in the intervention group to study the influence of patients with high (N=30) and low (N=40) use of the intervention. Results: No positive effects were found regarding the outcome measurements. Effect sizes were low. Conclusions: Based on these results, it is not possible to conclude on the positive effects of the intervention or to select outcome measures to be regarded as the primary/main or secondary outcomes for a future trial. A process evaluation should be performed to provide more insight into the low compliance with and effectiveness of the intervention. This can determine for whom this sort of program will work and help to fine-tune the inclusion criteria.
E-IMR: e-health added to face-to-face delivery of Illness Management & Recovery programme for people with severe mental illness, an exploratory clustered randomized controlled trial.
Beentjes, T.A.A. ; Goossens, P. ; Vermeulen, H. ; Teerenstra, S. ; Gaal, B.G.I. van ; Nijhuis-van der Sanden, M.W.G.
2018, Article / Letter to editor (BMC Health Services Research, vol. 18, iss. 1, (2018))
Self-Management Support Program for Patients With Cardiovascular Diseases: User-Centered Development of the Tailored, Web-Based Program Vascular View
Puijk-Hekman, S. ; Gaal, B.G.I. van ; Bredie, S.J.H. ; Nijhuis-van der Sanden, M.W.G. ; Dulmen, S. van
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.
Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status
Hecke, A. van ; Heinen, M. ; Fernandez-Ortega, P ; Graue, M ; Hendriks, J.C.M. ; Hoy, B ; Kopke, S ; Lithner, M ; Gaal, B.G.I. van
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.
Online Support Program for Parents of Children With a Chronic Kidney Disease Using Intervention Mapping: A Development and Evaluation Protocol
Geense, W.W. ; Gaal, B.G.I. van ; Knoll, J.L. ; Cornelissen, E.A. ; Schoonhoven, Lisette ; Kok, G.
2016, Article / Letter to editor (JMIR Research Protocols, vol. 5, iss. 1, (2016))Background: The care for children with a chronic kidney disease (CKD) is complex. Parents of these children may experience high levels of stress in managing their child's disease, potentially leading to negative effects on their child's health outcomes. Although the experienced problems are well known, adequate (online) support for these parents is lacking. Objective: The objective of the study is to describe the systematic development of an online support program for parents of children with CKD, and how this program will be evaluated. Methods: Intervention Mapping (IM) was used for the development of the program. After conducting a needs assessment, defining program objectives, searching for theories, and selecting practical applications, the online program e-Powered Parents was developed. e-Powered Parents consist of three parts: (1) an informative part with information about CKD and treatments, (2) an interactive part where parents can communicate with other parents and health care professionals by chat, private messages, and a forum, and (3) a training platform consisting of four modules: Managing stress, Setting limits, Communication, and Coping with emotions. In a feasibility study, the potential effectiveness and effect size of e-Powered Parents will be evaluated using an explorative randomized controlled trial with parents of 120 families. The outcomes will be the child's quality of life, parental stress and fatigue, self-efficacy in the communication with health care professionals, and family management. A process evaluation will provide insight in parents' experiences, including their experienced level of support. Results: Study results are expected to be published in the summer of 2016. Conclusions: Although the development of e-Powered Parents using IM was time-consuming, IM has been a useful protocol. IM provided us with a systematic framework for structuring the development process. The participatory planning group was valuable as well; knowledge, experiences, and visions were shared, ensuring us that parents and health care professionals support the program.
Patients' experience with intermittent catheterisation in everyday life
Cobussen-Boekhorst, H ; Hermeling, E ; Heesakkers, J ; Gaal, B.G.I. van
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.
Testing an online self-management program for patients with CVR: an explorative RCT
Puijk-Hekman, S. ; Gaal, B.G.I. van ; Bredie, S.J.H. ; Nijhuis-van der Sanden, M.W.G. ; Dulmen, S. van
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 82)
Self-made & sound: e-health self-management support programs for patients with chronic conditions
Gaal, B.G.I. van ; Bredie, S.J.H. ; Goossens, P. ; Repping-Wuts, H ; Dulmen, S. van ; Nijhuis-van der Sanden, M.W.G.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 82)
The evaluation of an e-supported Illness Management and Recovery program for patients with SMI
Beentjes, T.A.A. ; Gaal, B.G.I. van ; Goossens, P. ; Nijhuis-van der Sanden, M.W.G.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 82-83)
Evaluating an online self-management program for patients with RA: an explorative RCT
Zuidema, R ; Gaal, B.G.I. van ; Dulmen, S. van ; Repping-Wuts, H ; Nijhuis-van der Sanden, M.W.G.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 82)
How the Illness Management and Recovery Program Enhanced Recovery of Persons With Schizophrenia and Other Psychotic Disorders: A Qualitative Study
Langen, W.J.M. van ; Beentjes, T.A.A. ; Gaal, B.G.I. van ; Nijhuis-van der Sanden, M.W.G. ; Goossens, P.
2016, Article / Letter to editor (Archives of Psychiatric Nursing, vol. 30, iss. 5, (2016), pp. 552-557)This study aims to describe how the Illness Management and Recovery program enhanced recovery of persons with schizophrenia and other psychotic disorders from their own perspective. Participants valued learning how to divide huge goals into attainable steps, how to recognize and prevent a relapse by managing symptoms, practicing skills, and talking openly about illness related experience. They learned from the exchange with peers and from the information in the IMR textbook. Nurses should have continuous attention and reinforcement for progress on goals, skills practice and exchange of peer information. A peer-support specialist can contribute to keep this focus. (C) 2016 Elsevier Inc. All rights reserved.
Narrative exposure therapy for posttraumatic stress disorder associated with repeated interpersonal trauma in patients with severe mental illness: a mixed methods design
Mauritz, MW ; Gaal, B.G.I. van ; Jongedijk, RA ; Schoonhoven, Lisette ; Nijhuis-van der Sanden, M.W.G. ; Goossens, P.
2016, Article / Letter to editor (European Journal of Psychotraumatology, vol. 7, (2016))Background: In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients' experiences with NET and to identify influencing factors on treatment results. Methods: This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n = 25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. Discussion: The results of this study will provide more insight into influencing factors for clinical changes in this population.
DEVELOPING AN ONLINE SELF-MANAGEMENT PROGRAM FOR RHEUMATOID ARTHRITIS PATIENTS, USING BEHAVIORAL CHANGE TECHNIQUES AND PATIENTS' INPUT
Zuidema, R ; Repping, H ; Nijhuis, R ; Dulmen, S. van ; Gaal, B.G.I. van
2016, Article / Letter to editor (Annals of the Rheumatic Diseases, vol. 75, (2016), pp. 1305)
Development of an e-supported illness management and recovery programme for consumers with severe mental illness using intervention mapping, and design of an early cluster randomized controlled trial
Beentjes, T.A.A. ; Gaal, B.G.I. van ; Goossens, P. ; Schoonhoven, Lisette
2016, Article / Letter to editor (BMC Health Services Research, vol. 16, (2016))Background: E-mental health is a promising medium to keep mental health affordable and accessible. For consumers with severe mental illness the evidence of the effectiveness of e-health is limited. A number of difficulties and barriers have to be addressed concerning e-health for consumers with severe mental illness. One possible solution might be to blend e-health with face-to-face delivery of a recovery-oriented treatment, like the Illness Management & Recovery (IMR) programme. This paper describes the development of an e-health application for the IMR programme and the design of an early clustered randomized controlled trial. Method/Design: We developed the e-IMR intervention according to the six-step protocol of Intervention Mapping. Consumers joined the development group to address important and relevant issues for the target group. Decisions during the six-step development process were based on qualitative evaluations of the Illness Management & Recovery programme, structured interviews, discussion in the development group, and literature reviews on qualitative papers concerning consumers with severe mental illness, theoretical models, behavioural change techniques, and telemedicine for consumers with severe mental illness. The aim of the e-IMR intervention is to help consumers with severe mental illness to involve others, manage achieving goals, and prevent relapse. The e-IMR intervention consists of face-to-face delivery of the Illness Management & Recovery programme and an e-health application containing peer-testimonials on videos, follow up on goals and coping strategies, monitoring symptoms, solving problems, and communication opportunities. We designed an early cluster randomized controlled trial that will evaluate the e-IMR intervention. In the control condition the Illness Management & Recovery programme is provided. The main effect-study parameters are: illness management, recovery, psychiatric symptoms severity, self-management, quality of life, and general health. The process of the IMR program will be evaluated on fidelity and feasibility in semi-structured interviews with participants and trainers. Discussion: Intervention Mapping provided a systematic procedure for the development of this e-health intervention for consumers with severe mental illness and the preparation of an early randomized controlled trial. Trial Registration: The trial is registered in the Dutch Trial Register: NTR4772
Nursing staff stress from challenging behaviour of residents with dementia: a concept analysis
Hazelhof, TJGM ; Schoonhoven, Lisette ; Gaal, B.G.I. van ; Koopmans, R.T.C.M. ; Gerritsen, D.L.
2016, Article / Letter to editor (International Nursing Review - Sci, vol. 63, iss. 3, (2016), pp. 507-516)Aim: Provide insight into the concept of stress in the context of challenging behaviour of nursing home residents with dementia and its causes and consequences. Background: Challenging behaviour is frequent in residents with dementia, but consequences for nursing staff are unclear. Introduction: Challenging behaviour of residents can be enervating for nurses and may lead to stress. Although stress in general is associated with negative outcomes, an overview of stress in this context would be a welcome addition to the field. Method: Concept analysis according to Walker and Avant. Results: Identified antecedents of stress: physical and verbal aggression, conflicts, excessive demands and being unresponsive (residents), age, experience, tenure, nursing level and training (nursing staff). Defining attributes: disturbed homoeostasis and the personal appraisal of the situation. Identified consequences regard health, psychological aspects and behaviour. Discussion: Intervening in the identified factors may contribute to prevention of stress in nursing staff. Limitations: Given a lack of strong empirical studies, our analysis is not based on a high level of evidence and needs to be tested. Papers from before 1990 might have been missed. Conclusion: The concept analysis revealed that nursing staff stress in the context of challenging behaviour may result from resident and nursing staff factors. Besides health and psychological consequences, behavioural consequences can enormously impact the well-being of residents. Implications: Application in daily care to support teams in influencing resident and nursing staff factors could prevent stress, for instance using behavioural management training or recruiting higher educated nursing staff. Given the increasing complexity of care, creating specialized units with specifically trained staff for different groups of people with dementia may be desirable.
An Online Tailored Self-Management Program for Patients With Rheumatoid Arthritis: A Developmental Study
Zuidema, R ; Gaal, B.G.I. van ; Dulmen, S. van ; Repping-Wuts, H ; Schoonhoven, Lisette
2015, Article / Letter to editor (JMIR Research Protocols, vol. 4, iss. 4, (2015))Background: Every day rheumatoid arthritis (RA) patients make many decisions about managing their disease. An online, computer-tailored, self-management program can support this decision making, but development of such a program requires the active participation of patients. Objective: To develop an online, computer-tailored, self-management program integrated with the nursing care, as nurses have an important role in supporting self-management behavior. Methods: The intervention mapping framework was used to develop the program. Development was a multistep process: (1) needs assessment; (2) developing program and change objectives in a matrix; (3) selecting theory-based intervention methods and practical application strategies; (4) producing program components; (5) planning and adoption, implementation, and sustainability; and (6) planning for evaluation. Results: After conducting the needs assessment (step 1), nine health-related problems were identified: (1) balancing rest and activity, (2) setting boundaries, (3) asking for help and support, (4) use of medicines, (5) communicating with health professionals, (6) use of assistive devices, (7) performing physical exercises, (8) coping with worries, and (9) coping with RA. After defining performance and change objectives (step 2), we identified a number of methods which could be used to achieve them (step 3), such as provision of general information about health-related behavior, self-monitoring of behavior, persuasive communication, modeling, and self-persuasion and tailoring. We described and operationalized these methods in texts, videos, exercises, and a medication intake schedule. The resulting program (step 4) consisted of an introduction module and nine modules dealing with health-related problems. The content of these modules is tailored to the user's self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed. After implementation (step 5), the program will be evaluated in a two-center pilot trial involving 200 RA patients. Log-in data and qualitative interviews will used for a process evaluation. Conclusions: The intervention mapping framework was used to guide development of an online computer-tailored self-management program via a process which could serve as a model for the development of other interventions. A pilot randomized controlled trial (RCT) will provide insight into the important outcome measures in preparation for a larger RCT. The process evaluation will provide insight into how RA patients use the program and the attrition rate.
Completeness of assisted bathing in nursing homes related to dementia and bathing method: results from a secondary analysis of cluster-randomised trial data
Achterberg, Theo van ; Gaal, B.G.I. van ; Geense, W.W. ; Verbeke, G ; Vleuten, Cees van der ; Schoonhoven, Lisette
2015, Article / Letter to editor (International Journal of Older People Nursing, vol. 11, iss. 2, (2015), pp. 121-129)Background. Bathing assistance is a core element of essential care in nursing homes, yet little is known for quality of assisted bathing or its determinants. Aim. To explore differences in completeness of assisted bathing in relation to bathing method and resident characteristics. Methods. Secondary analysis of a cluster randomised trial including 500 nursing home residents designed to compare traditional bathing methods for skin effects and cost-consequences; GlinicalTrials.gov ID [NCT01187732]. Logistic mixed modelling was used to relate resident characteristics and bathing method to bathing completeness. Results. Bathing completeness was highly variable over wards. Apart from a large effect for ward, logistic mixed modelling indicated bathing was more often complete in case of washing without water (using disposable skin cleaning and caring materials; estimate 2.55, SE 0.17, P < 0.0001) and less often complete in residents with dementia (estimate -0.22, SE 0.08, P = 0.0040). Conclusions. Introduction of washing without water is likely to lead to more bathing completeness in nursing homes. However, inequity in care was also identified with a view to highly variable bathing completeness over wards and more incomplete bathing by care staff in residents with dementia. Implications for practice. Monitoring the performance of assisted bathing in nursing homes is indicated for the identification of undesirable variation in essential care and poorly performing teams. The introduction of washing without water could serve the promotion of bathing completeness in nursing homes overall, but will not solve inequity issues for residents.
Cost-consequence analysis of "washing without water" for nursing home residents: A cluster randomized trial
Schoonhoven, Lisette ; Gaal, B.G.I. van ; Teerenstra, S. ; Adang, Eddy ; Vleuten, Cees van der ; Achterberg, Theo van
2015, Article / Letter to editor (International Journal of Nursing Studies, vol. 52, iss. 1, (2015), pp. 112-120)Background: No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. Objectives: To compare bed baths for effects on skin integrity and resistance against bathing and costs. Design: Cluster randomized trial. Setting: Fifty six nursing home wards in the Netherlands. Participants: Five hundred adult care-dependent residents and 275 nurses from nursing home wards. Methods: The experimental condition 'washing without water' consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs. Results: Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p= 0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at 218.30 (95%Cl 150.52-286.08) in the experimental group and 232.20 (95%Cl: 203.80-260.60) in the control group (difference 13.90 (95%Cl: 25.61-53.42). Conclusion: Washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative. (C) 2014 Elsevier Ltd. All rights reserved.
What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review
Zuidema, R ; Repping-Wuts, H ; Evers, A.W.M. ; Gaal, B.G.I. van ; Achterberg, Theo van
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.
Concurrent Incidence of Adverse Events in Hospitals and Nursing Homes
Gaal, B.G.I. van ; Schoonhoven, Lisette ; Mintjes-de Groot, JAJ ; Defloor, T. ; Habets, H ; Voss, Andreas ; Achterberg, Theo van ; Koopmans, R.T.C.M.
2014, Article / Letter to editor (Journal of Nursing Scholarship, vol. 46, iss. 3, (2014), pp. 187-198)Purpose To describe the concurrent incidence of pressure ulcers, urinary tract infections, and falls in hospitals and nursing homes, and the preventive care given. Additionally, the correlation between the occurrence of these adverse events and preventive care was explored. Design and Settings A prospective, 3-month, cohort study at 10 hospitals and 10 nursing homes in the Netherlands. Participants 687 hospital patients and 241 nursing home patients. Main Outcome Measures The incidence of three adverse events and preventive care given to patients at risk. During weekly visits, the patients and their files were assessed. Additionally, observations were performed. Results Seventy-seven hospital patients (11%) and 111 nursing home patients (46%) developed one or more adverse events. The incidence rate for both types of patients, and for the three adverse events combined, was 9% adverse events per patient week. In hospitals, 34% of the patients received adequate pressure ulcer preventive care, while 47% of the patients received adequate urinary tract infection preventive care, and none of the patients received adequate falls preventive care. In nursing homes, 18% of the patients received adequate pressure ulcer preventive care, 42% of the patients received adequate urinary tract infection preventive care, and less than 1% of the patients received adequate falls prevention care. Negative or no correlations were found between the incidence rates for the three adverse events. In nursing homes the incidence of pressure ulcers and preventive care were positively correlated. Conclusions There is a high incidence of adverse events in hospitals and nursing homes. Many patients at risk do not receive adequate preventive care.
The "best balance" allocation led to optimal balance in cluster-controlled trials
Hoop, E. de ; Teerenstra, S. ; Gaal, B.G.I. van ; Moerbeek, M ; Borm, George
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.
The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly
Ruikes, F.G.H. ; Meys, ARM ; Wetering, G. van de ; Akkermans, R.P. ; Gaal, B.G.I. van ; Zuidema, S.U. ; Schers, H.J. ; Achterberg, Theo van ; Koopmans, R.T.C.M.
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.
Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes : Part I: Primary outcome of a cluster randomised trial
Vloet, L.C.M. ; Habets, A. ; Koekkoek, B.W. ; Mintjes, Joke ; Schoonhoven, Lisette ; Gaal, B.G.I. van ; Hulscher, Marlies ; Borm, George ; Voss, Andreas ; Defloor, T. ; Koopmans, R.T. ; Achterberg, Theo van et al. sine al.
2011, Article / Letter to editor (International Journal of Nursing Studies, vol. 48, iss. 9, (2011), pp. 1040-1048)Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events. A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period. Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group.
The SAFE or SORRY? programme : Part II: Effect on preventive care
Mintjes, Joke ; Schoonhoven, Lisette ; Borm, George ; Achterberg, Theo van ; Gaal, B.G.I. van ; Koopmans, R.T.
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.
The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial
Gaal, B.G.I. van ; Schoonhoven, Lisette ; Vloet, L.C.M. ; Mintjes, Joke ; Borm, George ; Koopmans, R.T.C.M. ; Achterberg, Theo van
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.
The design of the SAFE or SORRY? study : A cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events
Gaal, B.G.I. van ; Achterberg, Theo van ; Hulscher, Marlies ; Borm, George ; Mintjes, Joke ; Koopmans, R.T. ; Schoonhoven, Lisette
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.

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