Browsing Han Publications by Author "Schoonhoven, Lisette"

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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.
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study
Lovink, M.H. ; Laurant, M.G.H. ; Vught, A.J.A.H. van ; Maassen, I.T.H.M ; Schoonhoven, Lisette ; Persoon, A. ; Koopmans, R.T.C.M.
2019, Article / Letter to editor (BMJ Open, vol. 9, iss. 5, (2019))
Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study
Lovink, M.H. ; Vught, A.J.A.H. van ; Persoon, A. ; Koopmans, R.T.C.M. ; Laurant, M.G.H. ; Schoonhoven, Lisette
2019, Article / Letter to editor (Nursing & Health Sciences, vol. 2019, iss. september, (2019), pp. 282-290)
Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study
Lovink, M.H. ; Vucht, A.J.A.H. van ; Persoon, A. ; Schoonhoven, Lisette ; Koopmans, R.T.C.M. ; Laurant, M.G.H.
2018, Article / Letter to editor (BMC Family Practice, vol. 19, iss. 1, (2018))
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.
Lovink, M.H. ; Vught, A.J.A.H. van ; Laurant, M.G.H. ; Schoonhoven, Lisette ; Koopmans, R.T.
2017, Article / Letter to editor (BMJ Open, (2017))
Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review
Lovink, M.H. ; Persoon, A. ; Koopmans, R.T.C.M. ; Vught, A.J.A.H. van ; Schoonhoven, Lisette ; Laurant, M.G.H.
2017, Article / Letter to editor (Journal of Advanced Nursing, (2017))
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.
Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study
Bloemhoff, A. ; Schoonhoven, Lisette ; Kreek, A.J.L. de ; van Grunsven, PM ; Laurant, M.G.H. ; Berben, S.A.A.
2016, Article / Letter to editor (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 24, (2016))Background: This study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medical services (EMS) in the Netherlands: the physician assistant (PA), educated in the medical domain, and the ambulance registered nurse (RN), educated in the nursing domain. The hypothesis of this study was that there is no difference in outcome of care between the patients of PAs and RNs. Methods: In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n = 493) and 23 RNs (n = 498). The inclusion period was October 2010-December 2012 for region 1 and January 2013-March 2014 for region 2. Emergency care data were drawn from predefined and free text fields in the electronic patient records. Data were analysed using descriptive statistics. We used chi(2) and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P < 0.05. Results: Patients treated by PAs and RNs were similar with respect to patient characteristics. In general, diagnostic measurements according to the national EMS standard were applied by RNs and by PAs. In line with the medical education, PAs used a medical diagnostic approach (16 %, n = 77) and a systematic physical exam of organ tract systems (31 %, n = 155). PAs and RNs provided similar interventions. Additionally, PAs consulted more often other medical specialists (33 %) than RNs (17 %) (chi(2) = 35.5, P < 0.0001). PAs referred less patients to the general practitioner or emergency department (50 %) compared to RNs (73 %) (chi(2) = 52.9, P < 0.0001). Patient follow up contact with the dispatch centre within 72 h after completion of the emergency care on scene showed no variation between PAs (5 %) and RNs (4 %). Conclusions: In line with their medical education, PAs seemed to operate from a more general medical perspective. They used a medical diagnostic approach, consulted more medical specialists, and referred significantly less patients to other health care professionals compared to RNs. While the patients of the PAs did not contact the dispatch centre more often afterwards.
Physician substitution by NPs, PAs and/or nurses in healthcare for older people
Lovink, M.H. ; Persoon, A. ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Vught, A.J.A.H. van ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 96)
Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study
Biezen, M van der ; Schoonhoven, Lisette ; Wijers, N. ; Burgt, R. van der ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, iss. 8, (2016), pp. 1813-1824)AimTo provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on: (1) the number of patients; and (2) general practitioners' caseload (patient characteristics, urgency levels, types of complaints). BackgroundGeneral practitioners' workload during out-of-hours care is high, and the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners. DesignQuasi-experimental study comparing differences between and within out-of-hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners. MethodsData of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012. ResultsThe number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 163% of the patients and each general practitioner on average 209% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners' caseload. ConclusionThe results show that nurse practitioners can make a valuable contribution to patient care during out-of-hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.
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
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.
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.
Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review
Lovink, M.H. ; Persoon, A. ; Vught, A.J.A.H. van ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Laurant, M.G.H.
2015, Article / Letter to editor (Journal of Advanced Nursing, vol. 71, iss. 12, (2015), pp. 2998-3005)Aim. This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. Background. Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking. Design. A quantitative systematic literature review using Cochrane methods. Methods. The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands. Discussion. This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people.
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.
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.
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.
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.
Prevalence and relief of pain in trauma patients in Emergency Medical Services
Schoonhoven, Lisette ; Meijs, T. ; Berben, S.A.A. ; Vugt, A. van ; Grunsven, P.M. van
2011, Article / Letter to editor (Clinical Journal of Pain, vol. 27, iss. 7, (2011), pp. 587-592)The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. The retrospective document study included adult and alert trauma patients. Data collection concerned patient characteristics, prevalence of pain, and the (effect of) pain management. Actual pain management was compared with the national emergency medical services analgesia protocol for paramedics. Pain relief was defined as a decrease on the Numeric Rating Scale. One thousand four hundred and seven trauma patients were included. A report on pain was missing in 28% of the patients (n=393), 2% of the patients (n=34) reported no pain, and the prevalence of pain was reported by 70% of the patients (n=980). Of the patients in pain, 31% (n=311) had a systematic pain assessment (Numeric Rating Scale) at the scene of accident and the median pain score was 6 (interquartile range=3 to 8). Pharmacological pain treatment was administered to 42% of the patients in pain (n=410), and consisted mainly of intravenous fentanyl. Nonpharmacological pain treatments were cleaning of wounds (n=189), and application of splints or immobilizing bandages (n=130). Pain relief on arrival in the emergency department could only be evaluated in 15% of the patients in pain (n=149).
Pijn bij trauma : Gids voor pijnbestrijding in de spoedzorg
Schoonhoven, Lisette ; Vloet, L.C.M. ; Berben, S.A.A.
2011, Book (monograph) Dit boek is een gids voor pijnbestrijding bij trauma patiënten. Verpleegkundigen in de ambulancezorg en op de spoedeisende hulp werken dagelijks met deze patiënten. De praktijkgids bundelt de wetenschappelijke kennis uit een richtlijn en promotieonderzoek op een toegankelijke manier. Helder geordend en compact geschreven behandelt deze gids alle aspecten van de zorg voor pijn bij trauma: wat is pijn, hoe kun je pijn meten en bestrijden en tot slot hoe kun je de pijnbestrijding in de spoedzorg goed organiseren? De informatie is geïllustreerd met casuïstiek en uitspraken van patiënten, verpleegkundigen en artsen. Ook is een stroomschema voor farmacologische pijnbehandeling toegevoegd. Aan het eind van de hoofdstukken zijn de aanbevelingen voor de praktijk in een kader samengevat.
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 impact of delirium in the prediction of In-Hospital Mortality in Intensive Care patients
Peters, M.J. ; Schoonhoven, Lisette ; Pickkers, Peter ; Leffers, Pieter ; Boogaard, Mark van den ; Hoeven, Hans van der ; Dagnelie, Pieter
2010, Article / Letter to editor (Critical Care, vol. 13, iss. 6, (2010), pp. 341)Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II model. The aim of the current study was to evaluate whether delirium, present within 24 hours after ICU admission, improves the predictive value of the APACHE-II score. Delirium in ICU patients present within 24 hours after ICU admission, is associated with increased in-hospital mortality. Adding delirium to the APACHE-II score does not improve its accuracy in predicting in-hospital mortality.
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.
Definition of Health 2.0 and Medicine 2.0 : A systematic review
Berben, S.A.A. ; Belt, T. van de ; Schoonhoven, Lisette ; Engelen, M.M.
2010, Article / Letter to editor (Journal of Medical Internet Research, vol. 12, iss. 2, (2010), pp. e18)During the last decade, the Internet has become increasingly popular and is now an important part of our daily life. When new "Web 2.0" technologies are used in health care, the terms "Health 2.0" or "Medicine 2.0" may be used. The objective was to identify unique definitions of Health 2.0/Medicine 2.0 and recurrent topics within the definitions. A systematic literature review of electronic databases (PubMed, Scopus, CINAHL) and gray literature on the Internet using the search engines Google, Bing, and Yahoo was performed to find unique definitions of Health 2.0/Medicine 2.0. We assessed all literature, extracted unique definitions, and selected recurrent topics by using the constant comparison method.
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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