Louis Paquay

Quality of life in older Belgian people: comparison between people with dementia, mild cognitive impairment, and controls

To assess the sensitivity of the ‘Alzheimers Disease Related Quality of Life’ instrument (ADRQL) applied to Belgian people with dementia (n = 357), mild cognitive impairment (MCI) (n = 36), and controls (n = 72). We also determined the clinical parameters that influence the quality of life (QOL) of people with dementia.

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.

Adherence to pressure ulcer prevention guidelines in home care: a survey of current practice

AIMS AND OBJECTIVES To investigate the pressure ulcer prevalence in home nursing patients and to evaluate guideline adherence of measures for the prevention of pressure ulcers and the participation of informal carers in pressure ulcer prevention. BACKGROUND Since 2002, the Belgian Guideline for the Prevention of Pressure Ulcers was published on the Internet, but no information was available on guideline adherence in home care. METHODS A cross-sectional survey of pressure ulcer prevalence and guideline adherence was performed in a cluster randomized sample of 2779 clients of nine regional nursing departments in Flanders, Belgium. The Belgian Guideline for the Prevention of Pressure Ulcers was the reference standard for the evaluation of the guideline adherence. RESULTS There were 744 subjects at risk for developing pressure ulcers. The overall prevalence of pressure ulcers for the total sample population was 6.8%. The age-, sex- and risk-standardized prevalence per regional department varied between 4.9% and 9.1%. Of the 744 subjects at risk, 33 (4.4%) received preventive measures, which were in adherence to the Belgian Guideline for Prevention of Pressure Ulcers, 482 persons (64.8%) were administered measures, which did not adhere to the Belgian Guideline for Prevention of Pressure Ulcers and in 229 subjects (30.8%) at risk for developing pressure ulcers, prevention was lacking. For subjects with at least one pressure ulcer, the proportions were: 4.8% adherence, 76.6% no adherence and 18.6% no prevention. A proportion of 22.2% of the patients at risk and their informal carers were informed and motivated by the home care nurse to participate in the pressure ulcer prevention and their actual participation in the prevention was 21.4% of all risk cases. CONCLUSIONS The adherence of nurses and clients to the guideline for pressure ulcer prevention was low. RELEVANCE TO THE CLINICAL PRACTICE: The study demonstrates a detailed evaluation of guideline adherence to pressure ulcer prevention in an individual patient situation, with special attention for materials and measures, which are not adequate and not recommended by the Belgian Guideline for the Prevention of Pressure Ulcers.

Relationship between quality of life and cognitive decline in dementia

Aims: We aimed to examine the association of cognitive decline with quality of life (QoL) in dementia compared to controls and to determine variables associated with QoL. Methods: Every subject was placed within a specific group depending on their designation by the Mini Mental State Examination and evaluated by the Alzheimer’s Disease Related Quality of Life (ADRQL) and clinical assessments. Results: QoL for the mild dementia group was lower (p = 0.08) than that of controls. The very severe dementia group had a significantly lower QoL than the other dementia groups, which all had similar ADRQL scores. The only predictor of ADRQL scores was found to be the behavioral and psychological symptoms of dementia. Conclusion: There is no direct relationship between cognitive decline and QoL.

Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by nurses

Context Previous studies report that pressure ulcer classification and differentiation from incontinence associated dermatitis are difficult. Incorrect classification and differentiation result in incorrect prevention and treatment. Education is important to spread evidence-based insights about this topic and to improve classification skills. Aim To assess the effectiveness of the Pressure Ulcer Classification (PUCLAS) education tool. PUCLAS was developed by the PUCLAS Workgroup of the European Pressure Ulcer Advisory Panel. Design Randomised controlled trial. Setting and participants A convenience sample of 1217 Belgian, Dutch, British and Portuguese nurses. Outcome measure Correct classification of pressure ulcer photographs and differentiation from photographs of incontinence-associated dermatitis. Results Baseline, 44.5% of the photographs were classified correctly. In the post-test, the results in the intervention group were significantly higher (63.2%) compared with the control group (53.1%; p<0.001). The percentage of correct assessments of incontinence associated dermatitis (IAD) was 70.7% in the intervention group and 35.6% in the control group (p<0.001). The skill to differentiate IAD from pressure ulcers was significantly associated with the experimental intervention (OR 4.07, 95% CI 3.21 to 5.15, p<0.001). Conclusion The PUCLAS tool improved pressure ulcer classification and IAD differentiation significantly.

The professional self-image of registered home nurses in Flanders (Belgium): a cross-sectional questionnaire survey.

Despite their necessity and relevance, studies examining the professional self-image of nurses and instruments to measure this professional self-image in the homecare setting are scarce. This study highlights both the positive self-image of home nurses and the existence of a delicate balance between the large degree of autonomy that home nurses have and the need to feel supported in their professional role and responsibility. The practice environment, including time pressure, workload, and insufficient support, needs to be addressed to keep it from having a negative impact on the professional self-image of home nurses in the long-term.

Diagnosing dementia: No easy job

BackgroundFrom both clinical experience and research we learned that in complex progressive disorders such as dementia, diagnosis includes multiple steps, each with their own clinical and research characteristics.DiscussionDiagnosing starts with a trigger phase in which the GP gradually realizes that dementia may be emerging. This is followed by a disease-oriented diagnosis and subsequently a care -oriented diagnosis. In parallel the GP should consider the consequences of this process for the caregiver and the interaction between both. As soon as a comprehensive diagnosis and care plan are available, monitoring follows.SummaryWe propose to split the diagnostic process into four diagnostic steps, followed by a monitoring phase. We recommend to include these steps when designing studies on screening, diagnosis and monitoring of patients with dementia and their families.

Impact of place of residence on relationship between quality of life and cognitive decline in dementia.

The aim of this descriptive study was to estimate and compare the association between cognitive decline and quality of life (QOL) for 2 groups of dementia patients differing by place of residence: home or institution. Each subject was placed within a specific subgroup according to their Mini-Mental State Examination (MMSE) score and was evaluated by a QOL proxy-assessment [Alzheimer Disease Related Quality of Life (ADRQL)] and a dependency assessment (Katz Activities of Daily Living classification). For the “at home” and “institution” groups, global and subscale ADRQL scores showed significant differences between the 5 MMSE subgroups. Place of residence and MMSE subgroups significantly affected global and subscale ADRQL scores. The MMSE 4 to 8, 9 to 13, and 14 to 18 subgroups had ADRQL global scores significantly better in the institution group than the at home group. In contrast, the MMSE 19 to 23 and 0 to 3 subgroups had similar ADRQL global scores in both places of residence. In conclusion, there is no direct relationship between cognitive decline and QOL, and QOL does not seem to be better at home compared with the institution.

Restraint use in home care: a qualitative study from a nursing perspective.

BackgroundDespite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce.MethodsTo gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven.ResultsOur findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient’s family played a dominant role in the decision to use restraints. Reasons for using restraints included “providing relief to the family” and “keeping the patient at home as long as possible to avoid admission to a nursing home.” The nurses stated that general practitioners had no clear role in deciding whether to use restraints.ConclusionsThese findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers.

Restraint Use in Older Adults Receiving Home Care

To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision‐making process for restraint use and application.