Nu even niet…! Of toch wel…?

Take a break…! Or better not…?

A daily-survey study on detachment and creativity

Ellen Spoor, Jan de Jonge & Jan P.H. Hamers, Gedrag & Organisatie, volume 23, December 2010, nr. 4, pp. 296-315.

This study investigated the influence of job demands, job resources, and off-job detachment on creativity, by testing the principles of the Demand-Induced-Strain Compensation (DISC) model with an 8-days daily survey study. Detachment is defined as the extent to which one is able to detach oneself completely from one’s work (recovery experience). Results of multilevel analysis among 71 health care workers showed that, in case of high emotional job demands, not completely detaching oneself emotionally from the job after working hours is beneficial for creativity. In addition it appeared that a combination of high physical demands and low physical resources is conducive to creativity. Contrary to expectations, cognitive job demands, cognitive resources, and cognitive detachment did not have any influence of creativity. Finally, study implications for theory and practice were discussed.

Reliability study in five languages of the translation of the pain behavioural scale Doloplus

Non-verbal pain assessment scales are useful tools for pain evaluation in persons with communication disorders and moderate-severe dementia. The Doloplus was one of the first scales to be developed and validated as a pain assessment tool in older adults with dementia. This study aims at evaluating the translation of the Doloplus scale in five languages, as regards test-retest and inter-rater reliability. Results show that both tests are good or excellent for the English, Italian, Portuguese and Spanish versions and moderate for the Dutch version. These results bring a unique opportunity to include the translated Doloplus scale in daily assessment of elderly persons with communication disorders, and future studies should focus on enriching the validation of the scale in each language.

Relatives of stroke patients--their experiences and needs in hospital

This study explores the experiences and needs of relatives of hospitalized stroke patients. In semi-structured interviews, 17 relatives of stroke patients were asked about their experiences during the hospitalization period. The interviews were analysed by thematic content analysis. The findings indicate that the experiences of the relatives change during the hospitalization period, and that they are influenced by four factors: the individual character of the relatives, the position of the patient, the people in the relatives' social environment and the hospital situation. Four categories of needs were also found: the need for information, communication, support and accessibility.

Different effort constructs and effort-reward imbalance: effects on employee well-being in ancillary health care workers

AIMS OF THE STUDY

The present study investigates the relationship between Effort-Reward Imbalance (ERI) and employee well-being, using three different concepts of efforts (i.e. psychological demands, physical demands and emotional demands).

BACKGROUND

The ERI model had been used as a theoretical framework, indicating that work stress is related to high efforts (i.e. job demands) and low occupational rewards (e.g. money, esteem and security/career opportunities). The ERI model also predicts that, in overcommitted workers, effects of ERI on employee well-being are stronger compared with their less committed counterparts.

METHODS

A cross-sectional survey among 167 ancillary health care workers of two nursing homes was conducted. Multiple univariate logistic regression analyses were used to test the relationship between ERI and employee well-being.

RESULTS

Results of the logistic regression analyses showed that employees with both high (psychological, physical and emotional) efforts and low rewards had higher risks of psychosomatic health complaints, physical health symptoms and job dissatisfaction (odds ratios (ORs) ranged from 5.09 to 18.55). Moreover, employees who reported both high efforts and high rewards had elevated risks of physical symptoms and exhaustion (ORs ranged from 6.17 to 9.39). No support was found for the hypothesis on the moderating effect of overcommitment.

CONCLUSION

Results show some support for the ERI model; ancillary health care workers with high effort/low reward imbalance had elevated risks of poor employee well-being. In addition, results show that the combination of high efforts and high rewards is important for employee well-being. Finally, some practical implications are discussed to combat work stress in health care work.

Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility

AIM OF THE STUDY

The purpose of this study is to explore the needs of stroke patients' relatives during the hospitalization period.

BACKGROUND

In the Netherlands, the consequences of a stroke, and the needs of stroke patients and their relatives are becoming increasingly important. In hospital, however, nursing care is still focused on the patients. A previous qualitative study on the needs of relatives of stroke patients identified four categories of needs. This present study aims to test the results of the previous study in a larger setting and to identify the factors that influence the needs of the relatives.

DESIGN/METHODS

This study uses a cross-sectional design. A questionnaire was designed for the purpose of data collection. This questionnaire was completed by 106 relatives of stroke patients admitted to the neurology wards of 19 Dutch hospitals (response rate 64%). The data were analysed using descriptive and multivariate analyses.

RESULTS/FINDINGS

The findings of the study indicate that the needs of the relatives of stroke patients are best divided into three categories. These are the need for information, counselling (a combination of communication and support) and accessibility. In all cases, the most important need of the relatives of stroke patients is that their questions are answered honestly. The findings show a discrepancy between the importance of the needs and the degree to which these needs are met. Multivariate data analyses show that female relatives requested most information, whereas highly educated relatives needed less counselling. Satisfaction about the care provided is positively influenced by the period of hospitalization and negatively influenced by prior experiences of hospitalization.

The effect of paracetamol, fentanyl, and systematic assessments on children's pain after tonsillectomy and adenoidectomy

Various clinical protocols are used to manage early postoperative tonsillectomy and/or adenoidectomy (T&A) pain in children. Although believed to be effective, these protocols are not evidenced-based. Therefore, a double-blind, randomized, placebo controlled (2 x 2) factorial design was used (1) to evaluate the effectiveness of 2 pain protocols used interchangeably to manage early postoperative T&A pain and (2) to investigate whether nurses' systematic pain assessments improve pain management. In the first protocol children receive a loading dose (30 to 50 mg/kg) of paracetamol (acetaminophen) Formularium der Nederlandse Apothekers (Formulary of the Dutch Royal Society for the Advancement of Pharmacy) intraoperatively, followed by regular doses (70 to 100 mg/kg/24 hours) of paracetamol. In the second protocol children receive the first protocol, plus intramuscular fentanyl citrate (1 microgram/kg) intraoperatively. Subjects were 83 healthy children between the ages of 3 and 12 years, admitted for T&A as an outpatient procedure. The child's pain was measured using observation scales (Children's Hospital of Eastern Ontario Pain Scale and Face Legs Activity Cry Consolability Scale), a visual analogue scale, and self-report measures (Faces Pain Scale and Oucher). Neither pain protocol sufficiently relieved early postoperative T&A pain, and systemic pain assessments did not improve the effectiveness of analgesics. Further research evaluating the effectiveness of pain management protocols is needed.

Assessment of pain in the neonate

This article critically reviews the measures developed for assessing pain in the human neonate. Information was gathered with a computerized literature search of published articles and abstracts, a manual review of relevant conference proceedings, recently published journals, unpublished reports and manuscripts, and personal files. This identified 16 measures that were critically examined for their psychometric properties (reliability and validity) and clinical use. Special emphasis was placed on the feasibility of using neonatal pain assessment measures for clinical practice to address the research-practice gap. Although considerable progress has been made in the field of neonatal pain assessment, few measures have adequately established psychometric properties and clinical utility. Furthermore, most measures have been developed for research and not for the clinical setting. Issues regarding sensitivity, specificity, and the ability to detect clinically important changes have not been addressed. A sufficient number of infant pain measures have now been developed to assess acute pain. There is a paucity of measures to assess chronic pain in infants, and measures for infants who are low birth weight, critically ill, or ventilated. Future research should be aimed at strengthening the properties of existing measures, and at the development of measures for those infants with chronic pain or special needs.

Are children given insufficient pain-relieving medication postoperatively?

The literature often suggests and assumes that children are under-medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children's pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under-medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under-estimate the child's pain, while in others, nurses' attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted.

Decision-making and paediatric pain: a review

The aim of this paper is to present an overview of the literature on the factors influencing decision-making in the nursing care of children in pain. To that effect published and unpublished references were reviewed. The most frequently cited factors influencing the assessment and management of pain in children are summarized and discussed. Finally recommendations are made where further research is warranted.

Differences in pain assessment and decisions regarding the administration of analgesics between novices, intermediates and experts in pediatric nursing

This article describes a study examining the influence of expertise on nurses' pain assessments and decisions regarding pharmacological interventions in children. In an experimental design, novices (n = 271), intermediates (n = 222), and experts (n = 202) in pediatric nursing, various cases were presented. Each case consisted of a combination of a vignette and a video. Subjects were asked (1) to assess the child's pain intensity, (2) to specify their confidence in the assessment, and (3) to state whether or not they would administer a non-narcotic analgesic. The results indicated that expertise did not influence assessments of pain intensity. However, expertise did have a distinct impact on both the subjects' confidence in their decisions, and the decision to administer analgesics. Experienced nurses were most confident and were most inclined to administer analgesics. The findings of this study are placed in the context of a general theory on the development of expertise, which assumes that experts' decision-making is based on cognitive structures that describe features of prototypical or even actual patients, so called "illness scripts". From this theory it can be deduced that mainly practical experience is responsible for the (lack of) differences in decision-making between novices, intermediates and experts.

[Development and assessment of questionnaires]

This article describes the development and psychometric evaluation of self-report measurement instruments in (nursing) research. The aim of this study is to gain more insight into, and understanding of the use of such instruments. To be more specific, this paper deals with: (1) What is a self-report measurement instrument?; (2) How to develop such an instrument?; (3) What is its psychometric quality in terms of validity and reliability?; (4) How to analyze an instrument statistically?; (5) Which are the pros en cons of a self-report measurement instrument in general?; and (6) Where do we find examples of good measurement instruments? These six questions will be answered with the help of several practical research examples. The article concludes with a few suggestions for literature concerning existing measurement instruments and their psychometric qualities.

Factors influencing nurses' pain assessment and interventions in children

Research is lacking on factors influencing nurses' decision-making directed at the diagnosis of pain in children and its related interventions. This paper reports on two studies, namely a qualitative study and its replication, in which we explored factors influencing nurses' pain assessments and interventions in children. Those factors found to influence nurses' decisions were: medical diagnosis, child's expressions, age, and parents, and the nurses' knowledge, experience, attitude and workload. Some of these factors seem to have more influence than others. For example, the presence of a medical diagnosis seems to legitimate being in pain. Furthermore, it is suggested that mainly vocal expressions, especially crying, influence nurses' decisions to administer analgesics. Finally, nurses' negative views on non-narcotic analgesics were striking. In this paper, the results of both studies and their relationship to information reported in the literature are further elaborated and discussed, and hypotheses on strength and direction of influence of factors on pain assessment and intervention are generated.

The volume effect in radiation-related late small bowel complications: results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma

PURPOSE

The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications.

METHODS

Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study.

RESULTS

The 5-year estimate of late pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm3 to 42% in patients with volumes over 328 cm3. This correlation was significant in the univariate and multivariate analysis (p = 0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p = 0.04).

CONCLUSIONS

This study demonstrated that there is a volume-effect in radiation-induced diarrhea at a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm3) after intra-abdominal surgery.

Diagnostic process and decision making in nursing: a literature review

In clinical practice professional nurses appear to make different judgments regarding particular nursing situations. The purpose of this literature review is to gain insight into the way nurses make decisions related to nursing diagnoses and interventions. Literature on decision making can be divided into literature that focuses on how decisions are made, ie, information-processing model, and information that focuses on how decisions ought to be made, ie, mathematical models. Most of the literature about decision making in nursing in particular appears to focus on the former, specifically on the stages and strategies in the decision-making process and on factors influencing this process. These factors include the problem task (cues), the decision maker (his or her knowledge, experience, personal variability), and discipline. However, to date, most of the research that has been done with regard to these factors has been restricted to the performance between novice and expert. We conclude that further validation of nursing diagnoses is necessary to ensure accuracy in decision making in nursing.

[Factors influencing nurses' pain assessment in children and the choice of pain-relieving interventions]

This article reports on a qualitative study, that explored factors influencing nurses' pain assessment and interventions with children. Although many factors appear to influence decision-making processes, nurses seem to attach more weight to some factors than to others. For example, medical diagnosis and the intensity with which the child expresses its pain are used as determining factors for the decision to administer analgesics. In this article the results of the study, their relationship to information reported in the literature as well as their implications for practice and research are further elaborated and discussed.

[Decision making in nursing. A literature review of the manner in which nurses make a diagnosis]

In clinical practice professional nurses appear to make different judgments regarding particular nursing situations. Assuming that it is desirable that nurses, confronted with the same situation, make the same decisions, it is important to gain insight into the way decisions are made. The purpose of this literature review is to summarize what is already known about decision-making in nursing. It appears that most of the texts on decision-making in nursing are based on a general model on decision-making: the information-processing model. Factors influencing decision-making processes are discussed. Finally, an overview is given of research on decision-making in nursing.