AnneLoes van Staa

Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study.

AIMS AND OBJECTIVESnTo describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions.nnnBACKGROUNDnNurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases.nnnDESIGNnAn ethnographic study.nnnMETHODSnEpisodic participant observations (in total 48xa0hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures.nnnRESULTSnThe nurse practitioners perceived the monitoring of patients treatment as their main professional responsibility. Four monitoring strategies could be distinguished: assessing health conditions, connecting with patients, prioritising treatment in daily living and educating patients.nnnCONCLUSIONnWhile nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients illness perceptions to the background was not conducive to self-management support.nnnRELEVANCE TO CLINICAL PRACTICEnBy their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients individual needs.

Driven by Ambitions: The Nurse Practitioner's Role Transition in Dutch Hospital Care

INTRODUCTIONnInsight into nurse practitioners (NPs) role transition can help NP students and new graduates in taking on new responsibilities in a changing and demanding healthcare context. The aim of the research was to explore the role transition from nurse to NP using the components of Meleiss Framework of Transitions.nnnMETHODnA qualitative descriptive design was used. Individual interviews (n = 9) and two focus group discussions (n = 12) were held with NPs. Data were analyzed with the directed content analysis method.nnnFINDINGSnThe Framework component transitions nature was characterized by changes in the healthcare system, combined with professional and educational role changes. Transition conditions showed that the respondents felt distressed after they became accountable for a patients care and well-being. Although the respondents were authorized to do medical procedures, they initially lacked nursing role models and NP protocols. Process indicators showed ongoing transition; the respondents were still developing clinical competencies and confidence in patient care while relying on earlier acquired nursing competencies. Outcome indicators showed that the respondents found themselves successful in the medical extension of two different nursing roles: continuity of medical care for hospitalized patients in acute and intensive care settings, and being responsible for continuity of care for chronic patients in outpatient clinics.nnnCONCLUSIONSnRole transition was characterized by coping with feelings of distress at the cost of time and effort. The respondents strategies to adapt to new expectations, combined with organizational support, determined the outcomes as well as the start of new transitions.nnnCLINICAL RELEVANCEnNPs role transition in hospital care implies a dynamic ongoing process that needs to be supported, with the ultimate goal to improve patient outcomes.

Perspectives of Dutch Physiotherapists on Self-Management Support : A Q-Methodology Study

ABSTRACT Self-management support programs are reported to have positive effects on the health and care of people with physical disabilities. It is unclear how physiotherapists (PTs) view self-management support. A cross-sectional study with mixed-methods design using Q-methodology was conducted to determine the perspectives of Dutch PTs on self-management support. PTs (n = 39) rank-ordered 37 validated statements about self-management support from “most disagree (−3)” to “most agree (+3).” Differences in perspectives on self-management support were explored in a by-person centroid factor analysis on the basis of the explained variance (R2). After having sorted the statements, PTs explained their ranking of −3 and +3 statements in semi-structured interviews. All PTs recognized self-management support as intrinsic part of physiotherapy practice. Nevertheless, four particular perspectives could be identified: (1) the “externally driven educator” (R2 = 14%), (2) “internally driven educator” (R2 = 9%), (3) “client-centered coach” (R2 = 13%), and (4) “client-initiated coach” perspective (R2 = 15%). Each perspective reflects particular goals and perceptions of self-management support. Differences were identified with respect to the PTs’ role perception (educating or coaching), drive (external or internal), and collaboration with the patient (as partner or not). The identified perspectives can be used in the physiotherapy education curriculum to create awareness about the various ways of practicing self-management support and the skills needed to be able to tailor support to patient needs and to switch between perspectives.

Self-management challenges and support needs among kidney transplantation recipients : A qualitative study

AIMSnThis study investigated self-management challenges and support needs experienced by kidney transplant recipients.nnnBACKGROUNDnAfter kidney transplantation, recipients are expected to take an active role in self-management. However, evidence suggests that nurses experience difficulties operationalizing self-management support. Greater insight into the recipients perspective could help to improve the adequacy and efficacy of nurse-led self-management support.nnnDESIGNnA cross-sectional qualitative study.nnnMETHODSnFocus groups and individual interviews were carried out with kidney transplant recipients treated in a Dutch university hospital. Directed content analysis (DCA) was used.nnnRESULTSnForty-one kidney transplant recipients participated. Challenges after transplantation included becoming an expert patient, adjusting daily life activities, dealing with medical regimen, forming relationships with nurses, dealing with social consequences, dealing with emotions related to transplantation and the donor and improving self-image. To be able to deal with these challenges, participants wished to receive disease specific knowledge and instruction, share personal experiences with fellow patients, share and discuss not only medical but also emotional and social issues with nurses and wanted to be encouraged through positive feedback. One-size fits all education was considered insufficient in meeting their needs.nnnCONCLUSIONSnAfter kidney transplantation, recipients experienced various challenges in dealing with the medical, emotional and social tasks. Current support from nurses overlooked recipients emotional and social support needs. Nurses need adequate tools and training to be able to meet recipients self-management support needs.

‘ISeeYou’: A woman-centred care education and research project in Dutch bachelor midwifery education:

Objective: To examine how student midwives in higher education learn to become competent and confident woman-centred practitioners. Design: Participant observation study using a ‘buddy’ approach. Setting: Bachelor of Midwifery students in one higher education institution in the Netherlands Methods: First-year student midwives followed one woman throughout the continuum of childbirth. The students attended a minimum of five of the woman’s antenatal care encounters and a minimum of one postnatal care encounter. In addition, students explored the woman’s professional care network. Student midwives used participant observation, structured interview techniques and reflective practice to focus on (1) the woman and to gain insight into her wishes and experiences of care throughout the continuum of pregnancy, birth and postpartum period; (2) the impact of the caregiver on the woman; and (3) the woman’s experience of the partnership. Lectures, peer-debriefing, competency assessments, research activities and a logbook supported students’ learning. Results: Learning was achieved through the student’s relational continuity and active engagement with the individual woman. Students gained insight into the experiences of individual pregnant and postpartum women, the individual practice of healthcare practitioners and the interaction between the woman and the healthcare practitioner. Students’ development of critical thinking and reflective practice was enhanced to begin to form a vision of woman-centred care. Conclusion: The project was successful in equipping Bachelor of Midwifery students with competencies to support them in their learning of providing woman-centred care and offered them unique and in-depth experiences supporting and augmenting their personal, professional and academic development.

Skills for Growing Up-Epilepsy: An exploratory mixed methods study into a communication tool to promote autonomy and empowerment of youth with epilepsy

INTRODUCTIONnThe consequences of having epilepsy seriously hamper the development of autonomy for youth with epilepsy (YWE) and limit their social participation. This study was designed to provide insight into the impact of epilepsy on autonomy and empowerment and to evaluate the use of the Skills for Growing Up (SGU-Epilepsy) communication tool in pediatric epileptic care.nnnMETHODSnA mixed methods design was used to examine the impact of epilepsy on autonomy and empowerment and to evaluate the feasibility and use of the SGU-Epilepsy. Six focus groups with YWE and their parents were organized (Nu202f=u202f27), and the benefits of the SGU-Epilepsy were evaluated (Nu202f=u202f72).nnnRESULTSnYouth with epilepsy struggled with social participation. Beliefs of YWE and their parents on managing daily life and taking medication were not always similar. Parents worried about the passive attitude of YWE, but autonomy of YWE seemed to be constrained by parents. The SGU-Epilepsy seemed to be feasible. It facilitated the communication on development and empowerment although it was sometimes confronting for parents. Not all YWE were motivated to use and discuss the tool. In the evaluation, no differences in perceived autonomy and empowerment between YWE who used SGU-Epilepsy and received usual care appeared.nnnCONCLUSIONnOn the short-term, a beneficial effect of using the SGU-Epilepsy on autonomy and empowerment for YWE and their parents was not shown. The SGU-Epilepsy seemed to be a feasible instrument, however, to address nonmedical issues during pediatric consultations.

Worries and needs of adults and parents of adults with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder associated with lifelong tumor growth propensity and neurocognitive impairments. Although follow‐up of adults with NF1 often focuses on tumor growth, follow‐up of cognitive or social problems and other NF1‐related comorbidity is often not a part of standardized care. In order to provide optimal care services for these patients, we explored the care needs of adults with NF1. A qualitative study was performed using semi‐structured group interviews, exploring worries and care needs in medical, psychological, and socioeconomic domains, also focusing on the transition from pediatric to adult care. Four focus groups were conducted, including young adult patients, patients over age 30, and parents of young adult patients. In total, 30 patients and 12 parents participated. Data were transcribed verbatim and analyzed by computerized thematic analysis. Themes were organized using the World Health Organization International classification of functioning, disability, and health (ICF). Results indicated many and diverse worries and care needs both during the transitional period and in adulthood in medical, mental health, and socioeconomic domains. Worries could be categorized into 13 themes. Parents reported high stress levels and difficulties with their parental role. Participants expressed the need for more information, access to NF1 experts, daily living support, care for mental health and socioeconomic participation, and closer communication between health‐care providers. In conclusion, worries and needs of patients and parents underline the importance of multidisciplinary follow‐up and continuity of care during and after the transitional period. Additionally, parental stress requires more attention from care providers.