Boukje Dijkstra

The role of HIV nursing consultants in the care of HIV-infected patients in Dutch hospital outpatient clinics

OBJECTIVE In the Netherlands HIV nursing consultants have participated in HIV-care since 1985; their profession has changed with developments in HIV-treatment over time. The study goal was to gather information about their role in HIV-care and to provide an useful example to other (HIV-)care settings over the world. METHODS Interviews were held with HIV nursing consultants from all AIDS treatment centres. Descriptive analyses and statistical tests to detect differences between centres categorized by care model (parallel/unstructured/alternating), were performed. RESULTS 58% centres perform substitution of care. HIV nursing consultants see almost all patients at least once a year and see all patients when treatment is started/altered. The frequency of consultations for HIV-patients in stable condition varies, 2-4 times a year. Substitution leads to a slight, non-significant decrease in number of consultations. Adherence support is provided at the start of and during treatment. Regular patient discussions are common. All respondents are acquainted with the guidelines. Detailed knowledge of the adherence issues is limited: 58.3% had read the adherence chapter. CONCLUSION Substitution of care model is an appropriate and effective method for the management of HIV-infected patients. PRACTICE IMPLICATIONS Further development of and research into this new role of HIV nurse consultants is appropriate.

Exploring family experiences of nursing aspects of end-of-life care in the ICU: A qualitative study

OBJECTIVES The aim of this study was to examine the experience(s) of family with the nursing aspects of End-of-life care in the intensive care unit after a decision to end life-sustaining treatment, and to describe what nursing care was most appreciated and what was lacking. METHOD A phenomenological approach including inductive thematic analysis was used. Twenty-six family members of deceased critically ill-patients were interviewed within two months after the patients death about their experiences with nursing aspects of end-of-life care in the intensive care unit. FINDINGS Most family members experienced nursing contribution to end-of-life care of the patient and themselves, especially supportive care. Families mentioned the following topics: Communication between intensive care nurses, critically ill patients and family; Nursing care for critically ill patients; Nursing care for families of critically ill patients; Pre-conditions. Families appreciated that intensive care nurses were available at any time and willing to answer questions. But care was lacking because families had for example, a sense of responsibility for obtaining information, they had problems to understand their role in the decision-making process, and were not invited by nurses to participate in the care. CONCLUSIONS Most family appreciated the nursing EOLC they received, specifically the nursing care given to the patient and themselves. Some topics needed more attention, like information and support for the family.

Good Psychometric Properties of the Addiction Version of the Revised Illness Perception Questionnaire for Health Care Professionals

Background Addiction, or substance dependence, is nowadays considered a chronic relapsing condition. However, perceptions of addiction vary widely, also among healthcare professionals. Perceptions of addiction are thought to contribute to attitude and stigma towards patients with addiction. However, studies into perceptions of addiction among healthcare professionals are limited and instruments for reliable assessment of their perceptions are lacking. The Illness Perception Questionnaire (IPQ) is widely used to evaluate perceptions of illness. The aim of this study was to evaluate the psychometric properties of the IPQ: factor structure, internal consistency, and discriminant validity, when applied to evaluate healthcare professionals’ perceptions of addiction. Methods Participants were 1072 healthcare professionals in training and master students from the Netherlands and Indonesia, recruited from various addiction-training programs. The revised version of the IPQ was adapted to measure perceptions of addiction (IPQ-A). Maximum likelihood method was used to explore the best-fit IPQ factor structure. Internal consistency was evaluated for the final factors. The final factor structure was used to assess discriminant validity of the IPQ, by comparing illness perceptions of addiction between 1) medical students from the Netherlands and Indonesia, 2) medical students psychology students and educational science students from the Netherlands, and 3) participants with different training levels: medical students versus medical doctors. Results Factor analysis revealed an eight-factor structure for the perception subscale (demoralization, timeline chronic, consequences, personal control, treatment control, illness coherence, timeline cyclical emotional representations) and a four-factor structure for the attribution subscale (psychological attributions, risk factors, smoking/alcohol, overwork). Internal reliability was acceptable to good. The IPQ-A was able to detect differences in perceptions between healthcare professionals from different cultural and educational background and level of training. Conclusions The IPQ-A is a valid and reliable instrument to assess healthcare professionals’ perceptions of addiction.

The perspectives of intensive care unit nurses about the current and ideal nursing end-of-life care

The role of intensive care unit (ICU) nurses during end-of-life care (EOLC) is not always clear. Therefore, insight into their experiences and perspectives is warranted. The aim of this study was to determine how EOLC could be improved, by knowing the differences in the current EOLC according to ICU nurses and the way ICU nurses would like to provide EOLC. A qualitative study of 20 ICU nurses was performed. They were interviewed about their experiences with and perspectives on EOLC. Intensive care unit nurses were quite satisfied with the care they provided, but their description of the ideal situation differed from the current situation. The interviews resulted in 5 themes: (1) collaboration with other professionals; (2) communication between ICU nurses, ICU patients, and relatives; (3) nursing care for ICU patients; (4) nursing care for relatives of ICU patients; and (5) organizational aspects of EOLC. According to ICU nurses, EOLC is performed reasonably well, but some aspects are lacking that hinder optimal EOLC. The following issues for ICU nurses were identified: (1) need for an active role in multidisciplinary decision making, (2) sufficient knowledge of EOLC, (3) a checklist for nursing activities in EOLC, and (4) more time for caring for the patient and family. If those issues can be resolved, EOLC would improve according to the ICU nursing professionals.

Strategies to Promote Adherence to Antiretroviral Therapy Applied by Dutch HIV Nurse Consultants: A Descriptive Qualitative Study

&NA; This study describes strategies used by Dutch HIV nurse consultants to promote adherence to antiretroviral therapy (ART) and the assumptions on which these strategies were based. The study used a descriptive qualitative design with individual and focus group interviews. Individual semi‐structured interviews (n = 23) focusing on adherence‐supporting procedures and case‐based focus groups (3 groups with 5‐7 participants each) focusing on adherence strategies were held with HIV nurse consultants (n = 19). The strategies described were mainly based on experience. Theoretical principles were rarely discussed and participants seldom referred to the literature. Adherence‐promoting strategies were identified for two phases: (a) before beginning ART and (b) during follow‐up care while on ART. Strategies that were not used in one specific phase were categorized under “all phases.” Data yielded useful ideas for the care of HIV‐infected patients, and findings can be applied to the development and use of adherence‐promoting strategies.

The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review

AIM The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD Three electronic databases, PubMed, CINAHL and EMBASE, and reference lists of included studies were searched for studies in English, Dutch or German between January 2002 and August 2015. Studies were included if they presented data about EOLC in the adult ICU, and the role of ICU nurses around EOLC. Quantitative and qualitative studies and opinion articles were extracted. Inductive content analysis was carried out to analyse and categorise the data. RESULTS Twenty studies were included. Four categories emerged: care for the ICU patient, care for the family, environmental aspects of EOLC and organisational aspects of EOLC. Regarding the care triad, a gap exists between theoretical models and the actual care provided by ICU nurses during EOLC. The relational aspect of care, like aimed with care triad, is absent. CONCLUSION The literature clearly indicates that the role of ICU nurses concerns care for the patient, family and environment. It described which care should be given, but it remains unclear how care should be given (attitude). Therefore, it is difficult for ICU nurses to provide this care. Further, it seems that care provided to family mainly consists of giving advice on how to care for the patient; care for family members themselves was only mentioned in a few studies. Therefore, it seems that family does not always receive adequate care yet, which may be helpful in preventing problems like depression, anxiety or post-traumatic stress disorder. It can be concluded that it is important for ICU nurses to be aware of the existing relationships; however, comparing the literature, care triad does not appear to be reached.

Epidemiology of gamma-hydroxybutyrate (GHB) use and misuse and characteristics of GHB-dependent inpatients

Gamma-hydroxybutyrate (GHB) has been used as a recreational drug in the nightlife setting since the 1990s in many Western countries. Problematic GHB use and addiction has been observed in certain countries recently. In this chapter, the epidemiology of GHB addiction is described as well as characteristics of recreational GHB use as GHB-dependent clients. GHB often is combined with other substances of abuse and problematic groups more often use at home or at nonsocial settings. GHB-dependent clients are older than recreational users and have achieved a lower level of education. They show a high unemployment rate and co-use of stimulants, which is associated with higher dependence severity. They also show a high co-morbidity with psychiatric mood disorders. In summary, GHB seems to be used by users of lower social economic status, in comparison with other typical nightlife drugs. This should be taken into account in prevention and addiction care.

End-of-life care op de ic

SamenvattingRegelmatig wordt onderzoek gedaan naar palliatieve zorg binnen de niet-acute zorgsetting, bijvoorbeeld bij oncologische patiënten of patiënten in de thuiszorg. Onderzoek naar zorg rond het levenseinde in de acute setting, zoals de intensive care (ic), is beperkt.