Browsing Han Publications by Author "Achterberg, Theo van"

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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))
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))
The effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review
Ebben, R.H.A. ; Siqeca, F. ; Riis Madsen, U. ; Vloet, L.C.M. ; Achterberg, Theo van
2018, Article / Letter to editor (BMJ Open, vol. 8, iss. 11, (2018))
Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial
Schoonhoven, Lisette ; Teerenstra, Steven ; Adang, Eddy ; Koekkoek, B.W. ; Veen, M. van ; Postulart, Debby ; Achterberg, Theo van ; Mulder, N.
2015, Article / Letter to editor (BMC Psychiatry, vol. 15, iss. 100, (2015))Background This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. Methods/Design Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18–65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. Discussion No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care.
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.
An exploration of factors influencing ambulance and emergency nurses protocol adherence in the Netherlands
Achterberg, Theo van ; Mintjes, Joke ; Ebben, R.H.A. ; Vloet, L.C.M.
2012, Article / Letter to editor (Journal of Emergency Nursing, (2012))Adherence to ambulance and ED protocols is often suboptimal. Insight into factors influencing adherence is a requisite for improvement of adherence. This study aims to gain an in-depth understanding of factors that influence ambulance and emergency nurses’ adherence to protocols.
Factors influencing a herence to an Emergency Department National Protocol
Ebben, R.H.A. ; Achterberg, Theo van ; Vloet, L.C.M. ; Mintjes, Joke
2012, Article / Letter to editor (European Journal of Emergency Medicine, vol. 19, iss. 1, (2012), pp. 53-56)The objective of this study was to identify factors that influence emergency nurses adherence to an emergency department national protocol (EDNP). A survey of emergency nurses (n=200) and physicians with medical end responsibility on an emergency department (n=103) was carried out. Emergency nurses self-reported adherence to the EDNP was 38%, 55% of the nurses and 44% of the physicians were aware of the protocol. Interference with professional autonomy, insufficient organizational support and the EDNPs applicability were indicated as barriers for adherence. The main influencing factor seems awareness. Other factors related to the individual, the organization and to protocol characteristics. Solely disseminating the EDNP is not enough to get the protocol used in clinical practice.
Van implementeren naar leren
Achterberg, Theo van ; Adriaansen, M.J.M.
2012, Article / Letter to editor (TVZ : verpleegkunde in praktijk en wetenschap, vol. 121, iss. 3, (2012), pp. 12-15)
Factors influencing the implementation of the guideline Triage in emergency departments : A qualitative study
Achterberg, Theo van ; Mintjes, Joke ; Schalk, René ; Kampshoff, C.S. ; Janssen, H.J.J. ; Adriaansen, M.J.M.
2012, Article / Letter to editor (Journal of Clinical Nursing, vol. 21, iss. 3-4, (2012), pp. 437-447)
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.
Facilitators and barriers in pain management for trauma patients in the chain of emergency care
Berben, S.A.A. ; Meijs, T. ; Schoonhoven, Lisette ; Achterberg, Theo van ; Grunsven, P.M. van
2011, Article / Letter to editor (Injury : International Journal of the Care of the Injured, vol. 43, iss. 9, (2011), pp. 1397-1402)The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA.
Adherence to national acute care protocol in the Netherlands: influencing factors explored : European federation of Critical Care Nursing associations (EfCCNa) - Copenhagen
Vloet, L.C.M. ; Schalk, René ; Achterberg, Theo van ; Ebben, R.H.A. ; Mintjes, Joke
2011, Article in monograph or in proceedings (European federation of Critical Care Nursing associations (EfCCNa))Which factors influence paramedics’ and emergency nurses’ adherence to the acute care national protocols?
Adherence to the guideline ‘Triage in emergency departments’ : A survey of Dutch emergency departments
Adriaansen, M.J.M. ; Mintjes, Joke ; Kampshoff, C.S. ; Janssen, H.J.J. ; Achterberg, Theo van
2011, Article / Letter to editor (Journal of Clinical Nursing, vol. 20, iss. 17-18, (2011), pp. 2458-2468)
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.
Implementatie van de richtlijn ‘Triage op de Spoedeisende Hulp’
Adriaansen, M.J.M. ; Tol, M. van ; Achterberg, Theo van ; Janssen, H.J.J. ; Mintjes, Joke ; Schalk, René
2010, Article / Letter to editor (Intensive Care Capita Selecta, (2010), pp. 59-63, 230)
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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