A. Van Hecke

Pressure ulcer prevention: Development and psychometric validation of a knowledge assessment instrument

BACKGROUND Profound knowledge of pressure ulcers is important to enable good prevention. Validity and reliability of instruments assessing pressure ulcer knowledge are limited evaluated in previous research. AIMS AND OBJECTIVES To develop a valid and reliable instrument to assess knowledge of pressure ulcer prevention. DESIGN Prospective psychometric instrument validation study. METHODS An extensive literature review was performed to develop an instrument to assess knowledge of pressure ulcer prevention. Face and content validity were evaluated in a double Delphi procedure by an expert panel of nine trustees of the European Pressure Ulcer Advisory Panel (EPUAP) who each have extensive experience in pressure ulcer care and research (PhD level). A convenience sample of 608 nurses and nursing students from Belgium and The Netherlands participated to evaluate validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, internal consistency, and stability of the instrument. The data were collected between February and May 2008. RESULTS A 26-item instrument was developed, reflecting 6 themes expressing the most relevant aspects of pressure ulcer prevention. The content validity was excellent (CVI=0.78-1.00). Group scores of nurses with a (theoretically expected) high level of expertise were found to be statistically significantly higher than those of participants with (theoretically expected) less expertise (P<0.001). The item difficulty index of the questions ranged from 0.27 to 0.87, while values for item discrimination ranged from 0.29 to 0.65. The quality of the response alternatives was found to be good. The overall internal consistency reliability (Cronbachs alpha) was 0.77. The 1-week test-retest intraclass correlation coefficient (stability) was 0.88. CONCLUSION The instrument demonstrated acceptable psychometric properties and can be applied in both research and practice for evaluating knowledge about pressure ulcer prevention.

Pressure ulcers: Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP)

BACKGROUND Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking. AIMS AND OBJECTIVES Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP). DESIGN Prospective psychometric instrument validation study. METHODS A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008. RESULTS A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent pressure ulcers (three items); (2) attitude towards the priority of pressure ulcer prevention (three items); (3) attitude towards the impact of pressure ulcers (three items); (4) attitude towards personal responsibility in pressure ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards pressure ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC=0.88 (95% CI=0.84-0.91, P<0.001)]. For the total instrument, the internal consistency (Cronbachs alpha) was 0.79. CONCLUSION The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards pressure ulcer prevention in patient care, education, and research. In further research, the association between attitude, knowledge and clinical performance should be explored.

Towards an international language for incontinence-associated dermatitis (IAD): Design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries

Incontinence‐associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research.

Factors influencing the process of medication (non‐)adherence and (non‐)persistence in breast cancer patients with adjuvant antihormonal therapy: a qualitative study

Non-adherence and non-persistence in breast cancer patients taking antihormonal therapy (AHT) is common. However, the complex patterns and dynamics of adherence and persistence are still not fully understood. This study aims to give insight into the process of (non-)adherence and (non-)persistence by researching influencing factors and their interrelatedness in breast cancer patients taking AHT by means of a qualitative study with semi-structured interviews. The sample consisted of 31 breast cancer patients treated with AHT. Purposive and theoretical sampling and the constant comparison method based on a grounded theory approach were used. Expectations regarding the impact of AHT, social support from family and friends, and recognition from healthcare professionals were found to influence the process of non-adherence and non-persistence. The results of this study can help healthcare professionals understand why breast cancer patients taking AHT do not always adhere to or persist in taking the therapy and may facilitate patient-tailored interventions.

Development of a quality of meals and meal service set of indicators for residential facilities for elderly

ObjectivesTo develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents’ food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service.DesignThe indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group’s expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care.ResultsA preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals.ConclusionThe ‘quality of meals and meal service’ set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice are completed, the indicator set can be used to guide meal and meal service quality improvement projects in collaboration with kitchen staff and health care professionals. These improvement projects will help to improve food intake and reduce the risk of malnutrition among elders living in residential facilities.

The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study

BACKGROUND Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the wards culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare workers perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. OBJECTIVES The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare workers perspective in order to represent the patient participation culture on general and university hospital wards. DESIGN A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. SETTINGS The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. PARTICIPANTS Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. METHODS The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. RESULTS A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartletts test of sphericity was significant. An exploratory factor analysis identified eight components, explaining 49.88% of the variances. The eight original included components were retained. The PaCT-HCW also showed high internal consistency. CONCLUSION The PaCT-HCW offers an in-depth and differentiated perspective of the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation. The PaCT-HCW has been developed thoroughly, resulting in a strong, psychometric evaluated tool and is a valuable measure for both scientists and clinicians to measure these two aspects in general and university hospitals. By using the PaCT-HCW, the opportunity is created to develop specific actions to improve patient participation.

Compliance with a structured bedside handover protocol: An observational, multicentred study

BACKGROUND Bedside handover is the delivery of the nurse-to-nurse shift handover at the patients bedside. The method is increasingly used in nursing, but the evidence concerning the implementation process and compliance to the method is limited. OBJECTIVES To determine the compliance with a structured bedside handover protocol following ISBARR and if there were differences in compliance between wards. DESIGN A multicentred observational study with unannounced and non-participatory observations (n = 638) one month after the implementation of a structured bedside handover protocol. SETTINGS AND PARTICIPANTS Observations of individual patient handovers between nurses from the morning shift and the afternoon shift in 12 nursing wards in seven hospitals in Flanders, Belgium. METHODS A tailored and structured bedside handover protocol following ISBARR was developed, and nurses were trained accordingly. One month after implementation, a minimum of 50 observations were performed with a checklist, in each participating ward. To enhance reliability, 20% of the observations were conducted by two researchers, and inter-rater agreement was calculated. Data were analysed using descriptive statistics, one-way ANOVAs and multilevel analysis. RESULTS Average compliance rates to the structured content protocol during bedside handovers were high (83.63%; SD 11.44%), and length of stay, the type of ward and the nursing care model were influencing contextual factors. Items that were most often omitted included identification of the patient (46.27%), the introduction of nurses (36.51%), hand hygiene (35.89%), actively involving the patient (34.44%), and using the call light (21.37%). Items concerning the exchange of clinical information (e.g., test results, reason for admittance, diagnoses) were omitted less (8.09%-1.45%). Absence of the patients (27.29%) and staffing issues (26.70%) accounted for more than half of the non-executed bedside handovers. On average, a bedside handover took 146 s per patient. CONCLUSIONS When the bedside handover was delivered, compliance to the structured content was high, indicating that the execution of a bedside handover is a feasible step for nurses. The compliance rate was influenced by the patients length of stay, the nursing care model and the type of ward, but their influence was limited. Future implementation projects on bedside handover should focus sufficiently on standard hospital procedures and patient involvement. According to the nurses, there was however a high number of situations where bedside handovers could not be delivered, perhaps indicating a reluctance in practice to use bedside handovers.

Patient and public involvement in hospital policy-making: Identifying key elements for effective participation

The involvement of patients and the public in healthcare decisions becomes increasingly important. Although patient involvement on the level of the individual patient-healthcare worker relationship is well studied, insight in the process of patient and public involvement on a more strategic level is limited. This study examines the involvement of patient and public (PPI) in decision-making concerning policy in six Flemish hospitals. The hospitals organized a stakeholder committee which advised the hospital on strategic policy planning. A three-phased mixed- methods study design with individual questionnaires (n = 69), observations (n = 10) and focus groups (n = 4) was used to analyze, summarize and integrate the findings. The results of this study indicate that: (1) PPI on hospital level should include the possibility to choose topics, like operational issues; (2) PPI-stakeholders should be able to have proper preparation; (3) PPI-stakeholders should be externally supported by a patient organization; (4) more autonomy should be provided for the stakeholder committee. Additionally, the study indicates that the influence of national legislation on stakeholder initiatives in different countries is limited. In combination with the growing importance of PPI and the fact that the recommendations presented are not claimed to be exhaustive, more transnational and conceptual research is needed in the future.

建立失禁相关性皮炎(IAD)相关国际通用术语:在30个国家/地区进行根特全球(IAD)分类工具(GLOBIAD)心理测量特性的设计和评估

几十年来,婴儿尿布皮炎(尿布疹)的最佳预防和治疗方法一直都是研究热点。然而,这种皮肤问题也会出现在成人身上,这时被称作失禁相关性皮炎(IAD)。它是刺激性接触性皮炎(一种由接触刺激物而非致敏物导致的湿疹)的一种特殊类型,由皮肤与尿液或粪便长时间接触导致。很难确切知道IAD患者究竟有多少,因为目前尚无一套国际公认的诊断标准(例如,一份可用于鉴别疾病的特定症状和标准清单)将其与其他有类似症状的皮肤病(如压力性溃疡)区分开来。目前存在十种不同的量表/工具(即疾病诊断和严重程度排序方法),但有些十分复杂,因而需要有一种量表/工具来确保研究结果具有可比性。因此,来自13个国家/地区的34位专家携手合作,共同开发出了一款工具,取名为GLOBIAD,于2015年启用。该工具随后被翻译成14种不同的语言。30个国家/地区的823位专家使用GLOBIAD对34张IAD照片进行了分类,并检验结果是否匹配,从而测试了该工具的准确性。该研究发现,GLOBIAD的开发是一项重大进展,有助于在全球临床实践和研究中,对IAD进行更好的系统评估。但是,这种工具还有待进一步验证。