Micheline Gobert

Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-centre study.

BACKGROUND & AIMS In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence. METHODS A cross-sectional, multi-centre study in elderly wards of Belgian hospitals. The nutritional status was assessed using the Mini Nutritional Assessment. A standardised questionnaire was used to record demographic data and data on potential factors associated with malnutrition. RESULTS Out of 2329 elderly patients, 33% suffered from malnutrition. Almost 43% of the patients were at risk of malnutrition and 24% were well-nourished. Having swallowing difficulties, taste difficulties, and being transferred from a nursing home were strongly associated with being malnourished. CONCLUSION The malnutrition prevalence in Belgian elderly hospitals wards is similar to international figures. Elderly who have swallowing difficulties, taste difficulties, or coming from a nursing home may need adequate nutritional care. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy.

Assessing the adequacy of pressure ulcer prevention in hospitals: a nationwide prevalence survey

Introduction The development of a pressure ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the pressure ulcer preventive interventions used in hospitals. Purpose The aim of this study was to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals. Methods A cross-sectional, multi-centre pressure ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure pressure ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention. Results The total sample consisted of 19 968 patients. The overall prevalence of pressure ulcers Category I–IV was 12.1%. Only 10.8% of the patients at risk received fully adequate prevention in bed and while sitting. More than 70% of the patients not at risk received some pressure ulcer prevention while lying or sitting. Concusion Generally, there is a limited use of adequate preventive interventions for pressure ulcers in hospitals, which reflects a rather low quality of preventive care. The implementation of pressure ulcer guidelines requires more attention. The pressure ulcer prevention used in practice should be re-evaluated on a regular basis.

Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: A cross-sectional study

BACKGROUND While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload. OBJECTIVES The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload. DESIGN A cross-sectional design. SETTINGS Hospitals within the acute hospital care setting. PARTICIPANTS Persons with a nursing educational background, working in Belgian acute care hospitals. METHODS A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed. RESULTS The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload. CONCLUSIONS It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool.

Malnutrition and nutritional care practices in hospital wards for older people

AIMS This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. BACKGROUND In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. METHODS In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. RESULTS The overall prevalence rate of malnutrition in wards for older people was 31.9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9.1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patients individual risk. CONCLUSION Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality.

Non-direct patient care factors influencing nursing workload: a review of the literature

AIMS The aim of this paper was to detect which non-direct patient care factors are related to nursing workload in acute hospital nursing care and to develop a conceptual model to describe the relationship between the non-direct patient care factors and nursing workload. BACKGROUND Since the 1930s, efforts to measure nursing workload have been undertaken. Still, it remains unclear which of the non-direct patient care elements are essential to the nursing workload. DATA SOURCES PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Engineering Village 2, Elin and the British Nursing Index were searched from 1970 up to July 2009. REVIEW METHODS Studies were included in this integrative review if they described factors that are related to nursing workload or if they presented models that explored the association between potential factors, excluding the factors related to direct patient care. RESULTS Thirty publications were included. The influencing variables were classified in five categories based on their level of impact: the hospital and ward, nursing team, individual nurse, patient and family and meta-characteristics. The variables were also classified, based on their cause-effect relationship. Some factors have a direct impact on the patient-nurse relationship, while others have an effect on the work fluency or on the subjective perception of the nursing workload. A conceptual model was built, based on the interaction between both classifications and derived from the systems theory. CONCLUSIONS Nursing workload has a multi-causal aetiology. The influencing factors from this review can be integrated in a workload measurement tool.

Determination of standard times of nursing activities based on a Nursing Minimum Dataset

AIM This paper is a report of a study conducted to determine the standard time per nursing activity and the proportion of nursing time covered by the nursing activities of the Belgian Nursing Minimum Dataset compared to the total time of a nurse shift, and to evaluate the correlation between hospital size and standard times of nursing activities. BACKGROUND Because of a shrinking workforce and rising workload, nursing managers need tools that help them to allocate their staff to the wards. Such tools should be based on objective time measurements. METHODS The study was performed in surgical, internal medicine and elder care wards in an acute hospital care setting. In the first phase, a two-round Delphi-procedure was used to operationalize the definitions of nursing activities. In the second phase, the standard time for each nursing activity was determined, based on data collected over a 6-month period during 2006-2007. A combination of 13,292 work sampling observations by external observers, 3000 recordings of direct time measurement by self-recording and subjective time assessments yielded times that were used to analyse the duration of the nursing activities. RESULTS A standard time for 102 nursing activities was established. The coverage of the Belgian Nursing Minimum Dataset in the surgical, internal medicine and elder care wards was 47.5%, 46.4% and 51.0% respectively. The Belgian Nursing Minimum Dataset was found to cover almost 70% of direct and indirect nursing care. CONCLUSION Further research is needed to assess the impact on the standard times of nursing activities of inefficient organizational structures and different cultural interpretations of the way an activity is conducted.

Organization of the medication management process in Belgian nursing homes

BACKGROUND With the increase of the proportion of old (>80 years), frail people living in long-term care settings, concern about the quality of medication management processes in nursing homes is growing. OBJECTIVES To characterize the organization of medication management processes in Belgian nursing homes. METHOD This cross-sectional, observational study of a representative sample of 76 Belgian nursing homes was performed in November and December 2005. The results are based on structured interviews that were conducted with 76 facility directors and 112 head nurses, using 2 questionnaires. RESULTS A self-reporting medication error system was set up in 69.7% of the nursing homes. Almost all nursing homes had a therapeutic drug formulary, but its use was not compulsory. Medications were mainly delivered from a community pharmacy (82.9%). The role of the pharmacist was often restricted to mere delivery of medications. Medications were not always administered by nurses, but also by care aides (67%) or nursing students (12.5%). The practice of postscription (i.e., prescribing medication after it has been dispensed by the pharmacist) was also found to be quite common (69.9%). CONCLUSION This study provides a detailed description of the organization of medication management processes in Belgian nursing homes. Based on these results, problem areas can be identified and, consequently, targeted improvement actions can be investigated and implemented.

Geneesmiddelengebruik in rust- en verzorgingstehuizen in België: verslag van het PHEBE-onderzoek

SamenvattingIn een representatieve steekproef van Belgische rusthuizen werd eind 2005 een uitvoerige transversale gegevensinzameling uitgevoerd om het medicatiebeleid en de kwaliteit van het geneesmiddelengebruik te beschrijven. De onderzoekers gingen na of buitenlandse methoden om de kwaliteit te evalueren (de criteria van Beers, ACOVE en BEDNURS) toepasbaar waren in de Belgische context. Het medicatiebeleid bleek vooral op het vermijden van distributiefouten gericht.Het geneesmiddelengebruik was overwegend chronisch en lag hoog (gemiddeld zeven verschillende geneesmiddelen per patiënt), met hoge uitgaven (ook voor de patiënt) en per patiënt gemiddeld twee meldingen van mogelijke kwaliteitsproblemen.

The implementation of evidence-based nutrition guidelines in an acute geriatric setting

Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff shortages and recruitment problems in different countries. Methods and Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of human resources. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Results: In many countries numbers of those working in private organisations are not available. Furthermore financial incentives and working conditions will be compared, as well as the task division between home care workers and to what extent educational requirements are explicitly formalised. Mechanisms of quality control of human resources differ strongly (e.g. recertification of nurses; rules for the education of home care nurses). An interesting phenomenon, related to pressures to increase efficiency, is the transfer of tasks or substitution which is taking place between home care workers of different qualification levels. In contrast to the provision of technical nursing, the provision of personal care and domestic aid is less strictly related to specific qualifications. Conclusion: Shortages in human resources are a common problem in many countries, but expectedly most in countries just having developed home care. There is a strong variation in mechanisms of quality control of home care professionals; in the level of education required; and in the strength of the position of home care workers. (aut. ref.)Introduction: Besides the ageing of populations there are many more factors that have an influence on home care demand or supply; such as increased mobility; changing character of family structures; intergeneration solidarity; labour participation of women and the labour market for home care. This presentation will sketch the current trends, problems and how they can be tackled. The year 2025 is still far away but we will try to look ahead without losing the sense of reality. Methods and Materials: This presentation is drawn upon the EC financed EURHOMAP project, which included an inventory of contextual factors, problems related to policy, financing and delivery of home care and future challenges in each country. The study has collected a wealth of data in each of 31 countries on a large set of indicators. Results: Trends influencing home care will be presented. We will notice that different trends may apply to groups of countries. The possible effects of more or less general problems will be explored, such as scarcity of financial and human resources. Besides less general, but still burning problems in some countries, will be examined; for instance the lack of integration and coordination between types of home care services; inequalities resulting from decentralisation of authority; limited access to home care services for middle income groups; and absent or poor control of the quality of services. Examples will be presented of how countries respond to the earlier mentioned challenges. Conclusion: Some problems, such as those related to financial and human resources apply to most countries and are expected to be persistent. Private models of provision may also be considered to be of growing importance. However, cross-country differences in trends and problems will continue to exist, especially between countries with a long tradition of home care and those where it was recently developed. (aut. ref.)