Verpleegkunde Nummer 3 , pp. 13-21
sep 2020, jaargang 35
Verpleegkunde Nr. 3 , pp. 13-21
sep 2020, jr. 35
Onderzoeksartikel

Behoeften in het verlenen van palliatieve zorg aan mensen met dementie, thuis of in het verpleeghuis

Een vragenlijstonderzoek onder verplegend en verzorgend personeel

DOEL
Deze studie onderzocht welk type en welke vormen van ondersteuning verplegend en verzorgend personeel nodig hebben bij het verlenen van palliatieve zorg aan mensen met dementie. Een ander doel was om een vergelijking te maken tussen de behoeften van personeel met verschillende opleidingsniveaus en werkend in de thuiszorg of in het verpleeghuis.

DESIGN
Een cross-sectioneel, beschrijvend vragenlijstonderzoek werd uitgevoerd.

METHODEN
Er is een vragenlijst uitgezet onder Nederlands verplegend en verzorgend personeel, werkend in de thuiszorg of in het verpleeghuis. Dataverzameling vond plaats tussen juli en oktober 2018. Kwantitatieve vragenlijstgegevens werden geanalyseerd met behulp van beschrijvende statistiek en de gegevens van de twee open vragen werden onderzocht door middel van een inhoudsanalyse.

RESULTATEN
De steekproef bestond uit 416 respondenten. Verplegend personeel met verschillende opleidingsniveaus en werkend in verschillende settings gaven grotendeels dezelfde behoeften aan. De meest onderschreven behoeften betroffen ondersteuning bij conflicten tussen naasten bij de besluitvorming over het levenseinde (58%), het omgaan met onbegrepen gedrag, zoals onrust of agressie (41%) en het herkennen van en omgaan met pijn (38%). De gewenste vorm van ondersteuning die het meest werd onderschreven, was intervisie (51%). Wanneer respondenten meer tijd zouden hebben om hun werk te doen, dan heeft het geven van persoonlijke aandacht de prioriteit.

CONCLUSIE 
Verplegend en verzorgend personeel met verschillende opleidingsniveaus en werkend in de thuiszorg of het verpleeghuis, geven vergelijkbare ondersteuningsbehoeften aan bij het verlenen van palliatieve zorg aan mensen met dementie en hun naasten.

Literatuur

  1. Smythe A, Jenkins C, Galant-Miecznikowska M, et al. A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes. Nurse Educ Today 2017;50:119-23.
  2. World Health Organization. WHO definition of palliative care. Beschikbaar op: https://www.who.int/cancer/palliative/definition/en/.
  3. Backhaus R. Thinking beyond numbers: nursing staff and quality of care in nursing homes. Maastricht: Maastricht University; 2017.
  4. Albers G, Francke AL, de Veer AJ, et al. Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study. Patient Educ Couns 2014;94:4-9.
  5. Toles M, Song MK, Lin FC, et al. Perceptions of family decision-makers of nursing home residents with advanced dementia regarding the quality of communication around end-of-life care. J Am Med Dir Assoc 2018;19:879-83.
  6. Van der Steen JT, Radbruch L, Hertogh CM, et al. White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliat Med 2014;28:197-209.
  7. Bolt SR, van der Steen JT, Schols JM, et al. Nursing staff needs in providing palliative care for people with dementia at home or in long-term care facilities: a scoping review. Int J Nurs Stud 2019;96:143-152.
  8. Perrar KM, Schmidt H, Eisenmann Y, et al. Needs of people with severe dementia at the end-of-life: a systematic review. J Alzheimers Dis 2015;43:397-413.
  9. Hendriks SA, Smalbrugge M, Galindo-Garre F, et al. From admission to death: Prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia. J Am Med Dir Assoc 2015;16:475-81.
  10. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med
    2009;361:1529-38.
  11. Erel M, Marcus EL, Dekeyser-Ganz F. Barriers to palliative care for advanced dementia: a scoping review. Ann Palliat Med 2017;6:365-79.
  12. Robinson A, Eccleston C, Annear M, et al. Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia. J Palliat Care 2014;30:158-65
  13. Maarse JAM, Jeurissen PP. The policy and politics of the 2015 long-term care reform in the Netherlands. Health Policy 2016;120:241-5.
  14. Saks K, Tiit EM, Verbeek H, et al. Most appropriate placement for people with dementia: individual experts’ vs. expert groups’ decisions in eight European countries. J Adv Nurs 2015;71:1363-77.
  15. Surr CA, Gates C, Irving D, et al. Effective dementia education and training for the health and social care workforce: A systematic review of the literature. Rev Educ Res 2017;87:966-1002.
  16. Whittaker E, George Kernohan W, Hasson F, et al. The palliative care education needs of nursing home staff. Nurse Educ Today 2006;26:501-10.
  17. D’Astous V, Abrams R, Vandrevala T, et al. Gaps in understanding the experiences of homecare workers providing care for people with dementia up to the end of life: A systematic review. Dementia 2017:1471301217699354.
  18. Verbeek H, Zwakhalen SM, Schols JM, et al. Keys to successfully embedding scientific research in nursing homes: A win-win perspective. J Am Med Dir Assoc 2013;14:855-7.
  19. Bolt SR, van der Steen JT, Schols JM, et al. What do relatives value most in end-of-life care for people with dementia? Int J Palliat Nurs 2019;25:432-42.
  20. Bolt SR, Verbeek L, Meijers JM, et al. Families’ experiences with end-of-life care in nursing homes and associations with dying peacefully with dementia. J Am Med Dir Assoc 2019;20:268-272.
  21. Lazenby M, Ercolano E, Schulman-Green D, et al. Validity of the end-of-life professional caregiver survey to assess for multidisciplinary educational needs. J Palliat Med 2012;15:427-31.
  22. Abdi H. Holm’s sequential Bonferroni procedure. Encyclopedia of research design. 2010;1(8):1-8.
  23. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open 2016;2:8-14.
  24. Nuffic. Grading systems in the Netherlands, the United States and the United Kingdom. The Netherlands organisation for international cooperation in higher education; 2013.
  25. Malara A, De Biase GA, Bettarini F, et al. Pain assessment in elderly with behavioral and psychological symptoms of dementia. J Alzheimers Dis 2016;50:1217-25.
  26. Pieper MJ, van Dalen-Kok AH, Francke AL, et al. Interventions targeting pain or behaviour in dementia: a systematic review. Ageing Res Rev 2013;12:1042-55.
  27. Midtbust MH, Alnes RE, Gjengedal E, et al. A painful experience of limited understanding: healthcare professionals’ experiences with palliative care of people with severe dementia in Norwegian nursing homes. BMC Palliat Care 2018;17:25.
  28. Monroe TB, Parish A, Mion LC. Decision factors nurses use to assess pain in nursing home residents with dementia. Arch Psychiatr Nurs 2015;29:316-20.
  29. Kitwood T, Bredin K. Towards a theory of dementia care: personhood and well-being. Ageing Soc 1992;12:269-87.
  30. Midtbust MH, Alnes RE, Gjengedal E, et al. Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals’ experiences. BMC Health Serv Res 2018;18:709.
  31. Kaplan HC, Brady PW, Dritz MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010;88:500-59.
  32. Sommerbakk R, Haugen DF, Tjora A, et al. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway. BMC Palliat Care 2016;15:61.
  33. Hill E, Savundranayagam MY, Zecevic A, et al. Staff perspectives of barriers to access and delivery of palliative care for persons with dementia in long-term care. Am J Alzheimers Dis Other Demen 2018;33:284-91.
  34. Ten Koppel M, Pasman HR, van der Steen JT, et al. 10th World Research Congress of the European Association for Palliative Care (EAPC). Palliat Med 2018;32(1_suppl):15.
  35. Lopez RP. Suffering and dying nursing home residents: Nurses’ perceptions of the role of family members. J Hosp Palliat Nurs 2007;9:141-9.
  36. Hasson H, Arnetz JE. Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes. J Clin Nurs 2008;17:468-81.
  37. Grönroos E, Perälä ML. Self-reported competence of home nursing staff in Finland. J Adv Nurs 2008;64:27-37.
  38. Fereday J, Muir-Cochrane E. The role of performance feedback in the self-assessment of competence: a research study with nursing clinicians. Collegian 2006;13:10-5.
  39. Cowan DT, Norman I, Coopamah VP. Competence in nursing practice: a controversial concept- a focused review of literature. Nurse Educ Today 2005;25:355-62.
  40. Irvine S, Williams B, McKenna L. Near-peer teaching in undergraduate nurse education: An integrative review. Nurse Educ Today 2018;70:60-8.
  41. Nelwati, Abdullah KL, Chan CM. A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students. Nurse Educ Today 2018;71:185-92.
  42. AZW. Arbeid in Zorg en Welzijn 2016 Eindrapport. Den Haag; 2016.
  43. Backhaus R, van Rossum E, Verbeek H, et al. Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities. BMC Health Serv Res 2017;17:53.
Onderzoeksartikel

Behoeften in het verlenen van palliatieve zorg aan mensen met dementie, thuis of in het verpleeghuis

Een vragenlijstonderzoek onder verplegend en verzorgend personeel

DOEL
Deze studie onderzocht welk type en welke vormen van ondersteuning verplegend en verzorgend personeel nodig hebben bij het verlenen van palliatieve zorg aan mensen met dementie. Een ander doel was om een vergelijking te maken tussen de behoeften van personeel met verschillende opleidingsniveaus en werkend in de thuiszorg of in het verpleeghuis.

DESIGN
Een cross-sectioneel, beschrijvend vragenlijstonderzoek werd uitgevoerd.

METHODEN
Er is een vragenlijst uitgezet onder Nederlands verplegend en verzorgend personeel, werkend in de thuiszorg of in het verpleeghuis. Dataverzameling vond plaats tussen juli en oktober 2018. Kwantitatieve vragenlijstgegevens werden geanalyseerd met behulp van beschrijvende statistiek en de gegevens van de twee open vragen werden onderzocht door middel van een inhoudsanalyse.

RESULTATEN
De steekproef bestond uit 416 respondenten. Verplegend personeel met verschillende opleidingsniveaus en werkend in verschillende settings gaven grotendeels dezelfde behoeften aan. De meest onderschreven behoeften betroffen ondersteuning bij conflicten tussen naasten bij de besluitvorming over het levenseinde (58%), het omgaan met onbegrepen gedrag, zoals onrust of agressie (41%) en het herkennen van en omgaan met pijn (38%). De gewenste vorm van ondersteuning die het meest werd onderschreven, was intervisie (51%). Wanneer respondenten meer tijd zouden hebben om hun werk te doen, dan heeft het geven van persoonlijke aandacht de prioriteit.

CONCLUSIE 
Verplegend en verzorgend personeel met verschillende opleidingsniveaus en werkend in de thuiszorg of het verpleeghuis, geven vergelijkbare ondersteuningsbehoeften aan bij het verlenen van palliatieve zorg aan mensen met dementie en hun naasten.

Literatuur

  1. Smythe A, Jenkins C, Galant-Miecznikowska M, et al. A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes. Nurse Educ Today 2017;50:119-23.
  2. World Health Organization. WHO definition of palliative care. Beschikbaar op: https://www.who.int/cancer/palliative/definition/en/.
  3. Backhaus R. Thinking beyond numbers: nursing staff and quality of care in nursing homes. Maastricht: Maastricht University; 2017.
  4. Albers G, Francke AL, de Veer AJ, et al. Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study. Patient Educ Couns 2014;94:4-9.
  5. Toles M, Song MK, Lin FC, et al. Perceptions of family decision-makers of nursing home residents with advanced dementia regarding the quality of communication around end-of-life care. J Am Med Dir Assoc 2018;19:879-83.
  6. Van der Steen JT, Radbruch L, Hertogh CM, et al. White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliat Med 2014;28:197-209.
  7. Bolt SR, van der Steen JT, Schols JM, et al. Nursing staff needs in providing palliative care for people with dementia at home or in long-term care facilities: a scoping review. Int J Nurs Stud 2019;96:143-152.
  8. Perrar KM, Schmidt H, Eisenmann Y, et al. Needs of people with severe dementia at the end-of-life: a systematic review. J Alzheimers Dis 2015;43:397-413.
  9. Hendriks SA, Smalbrugge M, Galindo-Garre F, et al. From admission to death: Prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia. J Am Med Dir Assoc 2015;16:475-81.
  10. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med
    2009;361:1529-38.
  11. Erel M, Marcus EL, Dekeyser-Ganz F. Barriers to palliative care for advanced dementia: a scoping review. Ann Palliat Med 2017;6:365-79.
  12. Robinson A, Eccleston C, Annear M, et al. Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia. J Palliat Care 2014;30:158-65
  13. Maarse JAM, Jeurissen PP. The policy and politics of the 2015 long-term care reform in the Netherlands. Health Policy 2016;120:241-5.
  14. Saks K, Tiit EM, Verbeek H, et al. Most appropriate placement for people with dementia: individual experts’ vs. expert groups’ decisions in eight European countries. J Adv Nurs 2015;71:1363-77.
  15. Surr CA, Gates C, Irving D, et al. Effective dementia education and training for the health and social care workforce: A systematic review of the literature. Rev Educ Res 2017;87:966-1002.
  16. Whittaker E, George Kernohan W, Hasson F, et al. The palliative care education needs of nursing home staff. Nurse Educ Today 2006;26:501-10.
  17. D’Astous V, Abrams R, Vandrevala T, et al. Gaps in understanding the experiences of homecare workers providing care for people with dementia up to the end of life: A systematic review. Dementia 2017:1471301217699354.
  18. Verbeek H, Zwakhalen SM, Schols JM, et al. Keys to successfully embedding scientific research in nursing homes: A win-win perspective. J Am Med Dir Assoc 2013;14:855-7.
  19. Bolt SR, van der Steen JT, Schols JM, et al. What do relatives value most in end-of-life care for people with dementia? Int J Palliat Nurs 2019;25:432-42.
  20. Bolt SR, Verbeek L, Meijers JM, et al. Families’ experiences with end-of-life care in nursing homes and associations with dying peacefully with dementia. J Am Med Dir Assoc 2019;20:268-272.
  21. Lazenby M, Ercolano E, Schulman-Green D, et al. Validity of the end-of-life professional caregiver survey to assess for multidisciplinary educational needs. J Palliat Med 2012;15:427-31.
  22. Abdi H. Holm’s sequential Bonferroni procedure. Encyclopedia of research design. 2010;1(8):1-8.
  23. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open 2016;2:8-14.
  24. Nuffic. Grading systems in the Netherlands, the United States and the United Kingdom. The Netherlands organisation for international cooperation in higher education; 2013.
  25. Malara A, De Biase GA, Bettarini F, et al. Pain assessment in elderly with behavioral and psychological symptoms of dementia. J Alzheimers Dis 2016;50:1217-25.
  26. Pieper MJ, van Dalen-Kok AH, Francke AL, et al. Interventions targeting pain or behaviour in dementia: a systematic review. Ageing Res Rev 2013;12:1042-55.
  27. Midtbust MH, Alnes RE, Gjengedal E, et al. A painful experience of limited understanding: healthcare professionals’ experiences with palliative care of people with severe dementia in Norwegian nursing homes. BMC Palliat Care 2018;17:25.
  28. Monroe TB, Parish A, Mion LC. Decision factors nurses use to assess pain in nursing home residents with dementia. Arch Psychiatr Nurs 2015;29:316-20.
  29. Kitwood T, Bredin K. Towards a theory of dementia care: personhood and well-being. Ageing Soc 1992;12:269-87.
  30. Midtbust MH, Alnes RE, Gjengedal E, et al. Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals’ experiences. BMC Health Serv Res 2018;18:709.
  31. Kaplan HC, Brady PW, Dritz MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010;88:500-59.
  32. Sommerbakk R, Haugen DF, Tjora A, et al. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway. BMC Palliat Care 2016;15:61.
  33. Hill E, Savundranayagam MY, Zecevic A, et al. Staff perspectives of barriers to access and delivery of palliative care for persons with dementia in long-term care. Am J Alzheimers Dis Other Demen 2018;33:284-91.
  34. Ten Koppel M, Pasman HR, van der Steen JT, et al. 10th World Research Congress of the European Association for Palliative Care (EAPC). Palliat Med 2018;32(1_suppl):15.
  35. Lopez RP. Suffering and dying nursing home residents: Nurses’ perceptions of the role of family members. J Hosp Palliat Nurs 2007;9:141-9.
  36. Hasson H, Arnetz JE. Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes. J Clin Nurs 2008;17:468-81.
  37. Grönroos E, Perälä ML. Self-reported competence of home nursing staff in Finland. J Adv Nurs 2008;64:27-37.
  38. Fereday J, Muir-Cochrane E. The role of performance feedback in the self-assessment of competence: a research study with nursing clinicians. Collegian 2006;13:10-5.
  39. Cowan DT, Norman I, Coopamah VP. Competence in nursing practice: a controversial concept- a focused review of literature. Nurse Educ Today 2005;25:355-62.
  40. Irvine S, Williams B, McKenna L. Near-peer teaching in undergraduate nurse education: An integrative review. Nurse Educ Today 2018;70:60-8.
  41. Nelwati, Abdullah KL, Chan CM. A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students. Nurse Educ Today 2018;71:185-92.
  42. AZW. Arbeid in Zorg en Welzijn 2016 Eindrapport. Den Haag; 2016.
  43. Backhaus R, van Rossum E, Verbeek H, et al. Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities. BMC Health Serv Res 2017;17:53.
Over dit artikel
Auteurs
Sascha Bolt, Judith Meijers, Jenny van der Steen, Jos Schols, Sandra Zwakhalen
Over de auteurs

Sascha R. Bolt, MSc, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University;
Dr. Judith M.M. Meijers, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University, en Zuyderland, Sittard-Geleen;
Dr. ir. Jenny T. van der Steen, epidemioloog, afdeling Public Health en Eerstelijnsgeneeskunde, Leids Universitair Medisch Centrum, en afdeling Eerstelijnsgeneeskunde, Radboudumc, Nijmegen;
Prof. dr. Jos M.G.A. Schols, hoogleraar Ouderengeneeskunde, afdeling Health Services Research en afdeling Family Medicine, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University;
Prof. dr. Sandra M.G. Zwakhalen, hoogleraar Verplegingswetenschap, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University.

Correspondentieadres: s.bolt@maastrichtuniversity.nl

Printdatum
18 september 2020
E-pubdatum
21 september 2020
ISSN print
0920-3273
ISSN online
2468-2225
DOI
https://doi.org/10.24078/vpg.2020.9.125799


Over dit artikel
Auteurs
Sascha Bolt, Judith Meijers, Jenny van der Steen, Jos Schols, Sandra Zwakhalen
Over de auteurs

Sascha R. Bolt, MSc, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University;
Dr. Judith M.M. Meijers, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University, en Zuyderland, Sittard-Geleen;
Dr. ir. Jenny T. van der Steen, epidemioloog, afdeling Public Health en Eerstelijnsgeneeskunde, Leids Universitair Medisch Centrum, en afdeling Eerstelijnsgeneeskunde, Radboudumc, Nijmegen;
Prof. dr. Jos M.G.A. Schols, hoogleraar Ouderengeneeskunde, afdeling Health Services Research en afdeling Family Medicine, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Lifesciences, Maastricht University;
Prof. dr. Sandra M.G. Zwakhalen, hoogleraar Verplegingswetenschap, afdeling Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University.

Correspondentieadres: s.bolt@maastrichtuniversity.nl

Printdatum
18 september 2020
E-pubdatum
21 september 2020
ISSN print
0920-3273
ISSN online
2468-2225
DOI
https://doi.org/10.24078/vpg.2020.9.125799