In response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a... Show moreIn response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a project for nursing education, orientation and internships. Between 2015 and 2018, a group of ten immigrants started working in a Dutch residential home and a group of seventeen immigrants in the German home. This dissertation investigates the social processes when these newcomers start working with the established staff, as well as the extent to which their mutual interactions and values of good care influence the enactment of geriatric care. Using ethnographic observations (305 hours), in-depth interviews (44) and six focus groups (24), the established care workers and immigrants were followed in both homes. The empirical data shows that institutional constraints, such as staff shortage, the imposition of professional norms, gossip used as a ‘weapon of the weak’, mutual suspicions of indifference, and collective images of ‘us’ versus ‘them’ affected the enactment of geriatric care. Their habitus stimulated them to tinker among each other as well as with different, sometimes conflicting, values of good care. However, both groups shared the feeling of ignorance by management, a pain of not mattering. Show less
Aim: To evaluate the inter-and intraindividual variation of predicted nasogastric tube insertion lengths by nurses working in two neonatal intensive care units in the Netherlands, using a mannequin... Show moreAim: To evaluate the inter-and intraindividual variation of predicted nasogastric tube insertion lengths by nurses working in two neonatal intensive care units in the Netherlands, using a mannequin model. Methods: A total of 110 nurses (55 nurses from Center A and 55 from Center B) were asked to predict the nasogastric tube insertion length on a neonatal mannequin. We evaluated the length and prediction method used by the nurses. We also estimated the number of tubes that would have correctly been placed in the stomach of a neonate according to the seize of the mannequin.Results: The mean predicted insertion length of the nasogastric tube was 30.0 cm with an inter -individual variation of 12 cm (range 24-36 cm). The mean intraindividual variation was 0.75 cm. The two centers used two different prediction methods in their local guidelines, but overall at least 6 different methods were used by the nurses. We estimated that 77% (85/110) of the tubes would have ended in the body of the mannequins stomach, while 10% (11/110) would have ended in the esophagus and 13% (14/110) would have ended against the stomach lining or in the duodenum.Conclusion: Nurses in two neonatal intensive care units used many different methods which lead to a large interindividual variation in predicted insertion lengths of the nasogastric tubes. Regular evaluations using this mannequin model could lead to more uniformity and reduce the risk of tube misplacement in neonates. Show less
The current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall... Show moreThe current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall effectiveness and effective elements of an intervention implementation project conducted in multiple EDs in the Netherlands. Findings show a high prevalence of stress-related outcomes in ED nurses, but also high levels of work engagement and job satisfaction. Worktime demands and aggression/conflict situations have the strongest relationship with exhaustion, whilst work engagement is mostly related to developmental opportunities. Recovery during and outside of work can buffer the impact of patient-related stressful situations. According to a literature review, interventions can effectively prevent/reduce stress-related outcomes in nurses, with person-directed interventions reaching greater short-term effects. Little is known about their longevity and only a limited number of organization-directed studies exist. The current 2,5-year (mostly organization-directed) intervention project, led to improved working conditions but not (yet) to better well-being. Greater effects were found in hospitals with more fitting interventions and were employees felt more informed about and involved in the project. Psychosocial safety climate was positively related to communication, participation and the fit of actions to the risk factors, and as such provides a good starting point for a successful intervention project. Show less
Vluggen, S.; Metzelthin, S.; Passos, V.L.; Zwakhalen, S.; Huisman-de Waal, G.; Man-van Ginkel, J. de 2022
Background: Nurses are in a key position to stimulate older people to maximize their functional activity and independence. However, nurses still often work in a task-oriented manner and tend to... Show moreBackground: Nurses are in a key position to stimulate older people to maximize their functional activity and independence. However, nurses still often work in a task-oriented manner and tend to take over tasks unnecessarily. It is evident to support nurses to focus on the capabilities of older people and provide care assistance only when required. Function-Focused Care (FFC) is a holistic care-philosophy aiming to support nurses to deliver care in which functioning and independence of older people is optimized. Dutch and internationally developed FFC-based interventions often lack effectiveness in changing nurses' and client's behavior. Process-evaluations have yielded lessons and implications resulting in the development of an advanced generic FFC-program: the'SELF-program's The SELF-program aims to improve activity stimulation behavior of nurses in long-term care services, and with that optimize levels of self-reliance in activities of daily living (ADL) in geriatric clients. The innovative character of the SELF-program lies for example in the application of extended behavior change theory, its interactive nature, and tailoring its components to setting-specific elements and needs of its participants. This paper describes the outline, content and theoretical background of the SELF-program. Subsequently, this paper describes a protocol for the assessment of the program's effect, economic and process-evaluation in a two-arm (SELF-program vs care as usual) multicenter cluster-randomized trial (CRT). Method: The proposed CRT has three objectives, including getting insight into the program's: (1) effectiveness regarding activity stimulation behavior of nurses and self-reliance in ADL of geriatric clients, and (2) cost-effectiveness from a societal perspective including assessments of quality of life and health-care use. Measurements will take place prior to program implementation (baseline), directly after (T1), and in long-term (T2). Parallel to the CRT, a process evaluation will be conducted to provide insight into the program's: (3) feasibility regarding implementation, mechanisms of impact and contextual factors. Discussion: The SELF-program was developed following the Medical Research Council framework, which addresses the systematic development, feasibility testing, evaluation and implementation of complex interventions. The program has been subjected to a feasibility study before and results of studies described in this protocol are expected to be available from end 2022 onwards. Show less
This study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the... Show moreThis study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the psychosocial risk management approach “PRIMA” which includes cycles of risk assessment, designing and implementing changes, evaluating changes and adapting the approach if necessary. In addition, principles of participative action research were used to empower the departments in designing and implementing their own actions during the project. Next to determining overall effects, the study aims to assess potential moderators including the level of intervening (organization-directed or multilevel), process variables (the number and fit of actions to risk factors, communication and employee participation) and partaking in a Psychosocial Safety Climate intervention offered during the second half of the project. The results of linear mixed-model analyses showed that all job factors improved with the exception of autonomy, which did increase halfway the project but not when considering the entire timeframe. In addition, work engagement decreased and symptoms of burnout remained stable. Emergency departments that implemented more fitting actions, communicated better and involved their employees more in the process, had more favorable changes in job factors and more stable well-being. More activity (based on the number of actions implemented) and a multilevel approach regarding stress management did not lead to greater improvements. The Psychosocial Safety Climate intervention was effective in improving Psychosocial Safety Climate, but a longer follow-up period seems required to evaluate its effect on job factors and well-being. Overall, the project resulted in positive changes in most job factors, and its findings emphasize the importance of process variables in stress management interventions. Longer follow-up and higher quality multilevel interventions (including professional support for employees with stress-related complaints) seem essential to also improve well-being. Show less
Koppel, M. ten; Onwuteaka-Philipsen, B.D.; Steen, J.T. van der; Kylanen, M.; Block, L. van den; Smets, T.; ... ; Alzheimer 2019
The central issue in this thesis is the work related causes and consequences of job stress among nurses. The relationships between a wide range of work characteristics and characteristics of the... Show moreThe central issue in this thesis is the work related causes and consequences of job stress among nurses. The relationships between a wide range of work characteristics and characteristics of the organization and environment on the one hand, and different outcomes (such as job satisfaction and emotional exhaustion) on the other hand are explored in three studies. The influence of goal orientation on the outcomes is studied in a fourth study. Data were gathered by means of questionnaires that were spread among all nurses of the Leiden University Medical Centre in 2000 and in 2003. Nurses’ job satisfaction is influenced by their possibilities to develop nursing skills and by having good working relationships with supervisors. Nurses’ ill health is largely determined by their workload. However, it seems not (necessarily) to be the emotional demand of patient contact that burdens nurses. More likely, ill-health is the effect of the fact that nurses cannot give each patient the attention they want to give, due to too many tasks. The thesis deals with methodological issues such as causality. Moreover, it deals with theoretical issues such as the influence of person and environmental factors on the stress reaction. Finally, practical considerations are outlined. Show less
