Nursing home residents and professional caregivers may engage in behaviors that, although not considered formal treatments for depression, can improve residents’ mood. To support future studies aiming to explore ways to complement formal depression care in nursing homes, reliable and valid instruments for measuring these informal mood-improving behaviors are needed. This project developed and evaluated inventories to measure mood-improving behaviors in Dutch and Belgian nursing homes. Study 1 followed an iterative mixed-methods approach to develop two inventories: the Actions to Improve Mood by Residents (AIM-R) and the Actions to Improve Mood by Caregivers (AIM-C), and to assess their content validity (N = 31 residents; N = 35 caregivers, respectively). Study 2 evaluated test-retest agreement (N = 206; N = 125) and inter-rater agreement (AIM-C: N = 81) using a test-retest design. Study 3 explored the inventories’ practical application through semi-structured interviews (N = 12; N = 6). Data were analyzed through thematic analysis, content validity indices, and Gwet’s AC2 agreement coefficients. Both inventories demonstrated acceptable content validity, with moderate to very good test-retest agreement. Inter-rater agreement for most AIM-C items was classified as “fair,” and appeared lower when caregivers completed the inventories for residents with moderate to severe cognitive decline compared to residents with no to mild cognitive decline. Thematic analysis suggested that using the inventories increased awareness of mood-improving behaviors and contributed to better knowledge about residents. Challenges regarding usability and interpretability were identified, along with suggestions for refinement. The inventories appear to adequately capture mood-improving behaviors and show consistency over time. Nevertheless, their usability and interpretability could benefit from further refinement. Pending additional research, these inventories hold promise for assessing mood-improving behaviors in nursing homes, aiding future efforts to explore new ways to enhance depression care alongside traditional treatments.

Background and aim Challenging behaviour (CB) occurs frequently in nursing home residents with dementia. Up to now, little attention has been given to how to document CB in nurses’ daily progress reports in a standardised way. The aim of the study was to gain deeper insight into the factors influencing nursing staff members in their reporting CB. Methods We conducted fourteen semi-structured interviews in Dutch nursing homes with nursing staff members (EQF level 2-6) working in (highly specialised) geriatric units. Participant used a standardised method for reporting in the Electronic Patient Record. Thematic data analysis was conducted, based on the framework by Braun and Clarke. Quality criteria for conducting and reporting qualitative research were applied. Results Four themes influencing nurses reporting emerged from the data:1 Sense of Ownership, with varying perceptions of responsibilities, and resistance towards CB;2 Involvement of psychologists, with concerns about quality of plan of approach and, uncertainties in reading progress reports;3 Complexity of defining CB, including differences in interpretation and the normalisation of CB; and4 Complexity of reporting CB, affected by reporting skills, present-day challenges, and digital access to reports by relatives. Conclusion This study highlights that reporting CB in dementia is complex, and its complexity appears underestimated. The results display several issues including the integration of CB as part of the nursing process, the ambiguous nature of the CB concept, the occurrence of ethical dilemmas, the perceived ownership of CB, and the need for interprofessional collaboration. Recommendations for each issue have been derived from this.

Background Distress behaviour of people living with dementia is associated with negative effects for the person concerned, their family, and care staff. Video feedback interventions seem promising to use in nursing homes in cases of distress behaviour. In the Netherlands, a video feedback intervention “VIO” (Video Interventie Ouderenzorg) – in which the care team reflectively watches video footage, is asked stimulating questions by the VIO counsellor, and practises with assignments – can be used. This study aims to explain how VIO works, for whom, and under which circumstances. Methods A purposive sample of eight VIO counsellors and three care team members was interviewed in this realist interview study conducted in the Netherlands in 2022. The data was analysed by building Context-Mechanism-Outcome configurations. Results Participants reported that VIO can improve verbal and nonverbal communication with the person living with dementia and can work because team members become aware of their contribution to the interaction with that person and change their behaviour accordingly. According to the participants the impact of VIO can be determined by different factors, such as safety and trust within the care team, having a team member with an exemplary role, trust between the VIO counsellor and the care team, as well as by organisational conditions, such as the lack of staff, high sick leave, and managerial support. The role of family was rarely mentioned. Conclusions The design of VIO aligns with the way in which the care team learns. The intended outcomes of improved verbal and nonverbal communication and a decrease in distress behaviour are more likely to be achieved when team’s and organisational conditions, and the VIO counsellor’s approach are satisfactory. Future research should focus on testing and refining the discovered Context-Mechanism-Outcome configurations in practice. For daily practice, it is recommended to explore how to overcome incorrect expectations, and how to increase the role of family.

To achieve international consensus on three key eHealth-related topics in geriatric rehabilitation: the use, domains and scientific evaluation of eHealth. Eighty healthcare professionals participated in an two-round Delphi study. consensus was obtained on 26 statements: three related to the use of eHealth, five to the domains of eHealth and 18 related to the scientific evaluation of eHealth. International consensus on eHealth in geriatric rehabilitation is achievable and essential for promoting a more consistent approach to the development, implementation, scientific and safety evaluation of eHealth. Current evidence on the use of eHealth in geriatric rehabilitation is limited. This aim of this study was to achieve international consensus on three key eHealth-related topics in geriatric rehabilitation: the use, domains, and scientific evaluation of eHealth. Additionally, we developed a model that provides insight into the use of eHealth in geriatric rehabilitation. An international, two-round Delphi study was conducted. Two models served as a framework for the initial statement draft, with a total of 28 statements based on our systematic review results, an international survey, and expert opinion. Eligible healthcare professionals working in geriatric rehabilitation facilities were recruited across 10 countries. Eighty healthcare professionals participated in round one and 47 in round two. In the first round, consensus was obtained for 20 of the 28 statements (71

Interprofessional collaboration became more firmly positioned after the WHO highlighted its importance for better healthcare outcomes. In nursing homes, interprofessional collaboration refers to collaboration between teams of physicians/allied health professionals and care teams. Collaboration within care teams is known as intraprofessional collaboration. Determinants of interprofessional and intraprofessional collaboration have yet to be explored within the nursing-home context. Our exploratory qualitative study focused on the determinants considered important by professionals in seven nursing homes. We conducted 14 one-on-one, semistructured interviews with nurses and collaborating physicians/allied health professionals from seven teams of one care organisation. Data were analysed on thematic analysis, proceeding from an inductive approach. Five interacting determinants were identified. The core determinant was ‘investing in each other’, followed by ‘roles, functions and responsibilities within care teams’; ‘written policies for individual residents’; ‘verbal coordination meetings’; and ‘organisational influences’. One notable finding is the influence of intraprofessional collaboration within the care team on all determinants of interprofessional collaboration, including the role of the coordinating nurse. Future ethnographic and action research on intraprofessional collaboration is needed, including the perspective of nurse assistants, as well as on interventions aimed at improving interprofessional collaboration. We recommend training professionals to invest in each other as a skill that encourages relationships.

In Dutch nursing homes, the number of older adults with complex care needs increases, while at the same time there is a shortage of professionals. This requires changes in the organisation of care in order to provide appropriate care. The aims of this study were to generate knowledge about: 1) how team composition and interprofessional collaboration influence each other and 2) the development and implementation of optimal skill mix in nursing homes. In this participatory action research study five nursing homes organisations participated with seven teams. The focus in this study was on the nursing, psychological and medical disciplines. The teams worked on optimizing their skill mix based on general rules formulated on organisation level and a situation analysis assessed by the action researcher. Data were collected by logbooks of the action researchers and focus groups with participants. Thematic analysis revealed that teams started with creating clarity about everyone's function and qualities optimising everyone's contribution and improving interprofessional collaboration. Therefrom they gained more insight into optimal team composition in order to provide appropriate care. Preconditions for experimenting with skill mix were support, coaching, time and (financial) space.

ABSTRACT Background Implementation of evidence‐based practice (EBP) in nursing homes is important to improve quality of care and reduce costs. These facilities primarily employ certified nurse assistants (CNAs) and vocationally‐trained registered nurses (VTRNs). Although EBP is scarcely addressed in their education, these caregivers have an important role in EBP. Insight into their affinity with EBP could provide a good starting point for working according to EBP. Aims To develop a questionnaire that measures affinity with EBP amongst CNAs and VTRNs in nursing homes. To assess the reliability and validity of the questionnaire. Design Mixed‐method design according to the COSMIN‐checklist. Methods Phase 1: the questionnaire was developed in three steps: (1) gathering items from existing questionnaires, occupational profiles and interviews; (2) compression through consensus rounds and (3) a pilot study. Phase 2: psychometric properties were assessed amongst CNAs and VTRNs in nine nursing homes. The factors extracted through principal component analysis were tested for measurement invariance using the one‐parameter Rasch model. Results Phase 1: all experts interviewed (N = 5) indicated CNAs and VTRNs can play specific and significant roles in EBP. A 26‐item questionnaire was created through two consensus rounds with experts (N = 7) and a pilot study (N = 7). Phase 2: Principal component analysis revealed a two‐factor structure with good internal reliability (N = 428 questionnaires). All items exhibited good fit with the Rasch model and measurement invariance for CNAs and VTRNs. Conclusion CNAs and VTRNs can fulfil important roles in EBP in nursing homes. The ‘Evidence‐Based Practice‐Affinity Questionnaire’ is reliable and valid for assessing affinity with EBP amongst CNAs and VTRNs to improve practice and research, and can guide tailored training programs for CNAs and VTRNs, enhancing evidence‐based practices in nursing homes. Impact The research provides insight into the roles CNAs and VTRNs can play in EBP and how to measure their affinity with EBP, which contributes to implementation of EBP in nursing homes. Patient or Public Contribution No patient or public contribution in the study.

Moving to a nursing home has a major existential impact on the lives of residents and their relatives. Healthcare professionals who have daily contact with residents have many opportunities to pay attention to existential and spiritual issues. To support them, the Dutch multidisciplinary guideline on existential and spiritual aspects of palliative care was developed. However, many healthcare professionals report a perceived lack of competence in this domain and it remains unclear what they need to effectively translate the theory and tools from the guideline into daily practice. The multicomponent intervention ‘Insight into meaning’ (Zicht op zingeving) was developed, to facilitate the integration of the spiritual dimension into the daily practice of healthcare professionals. It consisted of structured training sessions, individualized on-the-job coaching and team intervision meetings. This study aimed to examine the effects of the intervention by exploring how healthcare professionals assess their spiritual competencies before and after the intervention, the focus of their coaching questions and learning outcomes during individual on-the-job coaching, and how they apply spiritual skills in daily practice. A mixed method experimental design was used to examine the effects of a multicomponent intervention on two wards of a Dutch nursing home. The study included 44 healthcare professionals: primarily certified nurse assistants and client support workers. Participants were recruited via non-probability volunteer sampling and completed the Spiritual Care Competency Scale (SCCS) before and after the intervention. Quantitative data were analyzed using paired samples t-tests. Qualitative data were collected via coach registration forms and analyzed using thematic and deductive content analysis to explore participants’ coaching questions, learning outcomes, and observed spiritual competencies. SCCS total and subscale scores showed statically significant improvements for pre- to post intervention (n=19; Δ0.50). Participants foremost frequently sought coaching to strengthen their role in addressing the spiritual dimension in interactions with residents. An increased awareness of their personal role in such encounters was commonly reported. Moreover, participants who did not articulate specific coaching questions appreciated the individual feedback. The observations provided valuable insight into the practical application of spiritual competency: particularly in the areas of aligning, connecting and deepening. A variety of responsive actions were noted, when healthcare professionals pay attention to what matters most to residents The multicomponent intervention led to improvements in self-reported spiritual competencies among healthcare professionals. Both the training sessions and individualized on-the-job coaching contributed to heightened awareness of the spiritual dimension in daily practice. The study provided valuable insight into how theoretical frameworks and practical tools related to the spiritual dimension can be effectively integrated into the daily practice of healthcare professionals working in a nursing home setting.

AIM:This study is intended to generate insight into the knowledge possessed by formal caregivers in the Netherlands about care for people living with dementia. More specifically, it explores the association between the knowledge and characteristics of caregivers in nursing homes and home care. The formal caregivers included in this study served a variety of functions, primarily as nursing staff. DESIGN:A quantitative retrospective cohort study. METHODS:We analysed two datasets based on two Dementia Knowledge Monitors (DKMs): one for the nursing-home setting (DKM-NH; n = 5807) and one for the home-care setting (DKM-HC; n = 532). Total scores and subscale scores ranged from 0 to 100. Analyses were conducted at both the total level and the subscale level. RESULTS:On average, nursing-home caregivers scored 68.3 out of 100, as compared to 62.9 for home caregivers. Scores for nursing-home caregivers were associated with age, function, educational training, region and experience (working in a specialised dementia department, private experience and years of working in a nursing home). Scores for home caregivers were associated with function, age and the number of PwD for whom they had provided care. CONCLUSION:Knowledge of dementia care leaves room for improvement for formal caregivers in all functions, in both nursing-home and home-care settings. Professional function, experience with dementia and previous extra training have a significant impact on a caregiver's level of knowledge concerning dementia care. PUBLIC CONTRIBUTION:Offering educational programmes to caregivers could increase dementia-care knowledge. Additionally, caregiver experience in caring for PwD could potentially be optimised through short internships, shadowing and staff retention. Future research should explore valid, effective and attractive educational programmes for the various functional groups, in addition to identifying strategies for accelerating the process of acquiring experience in care for people with dementia.

Moving to a nursing home has a major impact on the lives of residents and their relatives. The relationship with healthcare workers is often intensive and offers plenty of opportunities to pay attention to the spiritual dimension. Until now, it is unclear whether healthcare professionals pay attention to the spiritual dimension and how they apply it in daily contact. To provide insight into how residents and relatives experience attention for spirituality in the nursing home, semi-structured interviews were conducted with four residents and four relatives. Transcripts were analyzed according to the principles of reflexive, inductive thematic analysis. We identified three themes and seven sub-themes that contribute to attention for meaning in life and which we have named 'spiritual skills/meaning in life skills': Alignment (being present with attention and acknowledging individuality), connecting (aligning approach, aligning communication and building a care relationship) and deepening (deepening contact and acknowledging life-questions). Our study shows that healthcare professionals apply skills in their daily contact with residents that help them align and connect. However, it was not apparent from the interviews if they also deepened their contact. A combination of training, intervision-meetings and on-the-job coaching, as was also part of the broader study, is in line with the way care workers learn and what they need to further deepen their spiritual skills in practice.

De verhuizing naar een verpleeghuis heeft een grote existentiële impact op het leven van bewoners en hun naasten. De relatie met zorgmedewerkers is vaak intensief en biedt volop kansen om aandacht voor de zingevingsdimensie te hebben. Tot nu toe is onduidelijk in welke mate zorgmedewerkers daadwerkelijk die aandacht hebben en toepassen in hun dagelijkse contacten. Om inzichtelijk te maken hoe bewoners en naasten aandacht voor zingeving ervaren in de dagelijkse praktijk van een verpleeghuis zijn bij vier bewoners en vier naasten semigestructureerde interviews afgenomen. De transcripten werden geanalyseerd volgens de principes van reflexieve, inductieve thematische analyse. Er werden drie thema's en zeven categorieën geïdentificeerd: afstemmen (met aandacht aanwezig zijn en eigenheid bewoner erkennen), verbinden (benadering afstemmen, communicatie afstemmen en zorgrelatie opbouwen) en verdiepen (contact verdiepen en levensvragen erkennen). Uit ons onderzoek blijkt dat zorgmedewerkers vaardigheden toepassen in hun dagelijkse contact met bewoners die hen helpen af te stemmen en te verbinden. Wat echter niet duidelijk uit de interviews naar voren komt is het tot verdieping komen in het contact. Een combinatie van training, intervisiebijeenkomsten en coaching-on-the-job sluit aan op de wijze waarop zorgmedewerkers leren en wat zij nodig hebben om hun zingevingsvaardigheden verder te verdiepen in de praktijk.

Het aantal ouderen met een complexe zorgvraag neemt toe in Nederlandse verpleeghuizen en tegelijkertijd is er sprake van krapte op de arbeidsmarkt. Dit vraagt om een andere organisatie van zorg. De doelen van dit onderzoek waren kennis te genereren over: 1) de samenhang tussen teamsamenstelling en interprofessionele samenwerking in een passende functiemix en 2) het ontwikkelen en implementeren van een passende functiemix in verpleeghuizen. In dit participatief actieonderzoek namen vijf zorgorganisaties met zeven teams deel. De focus in dit onderzoek lag op de verzorgende/verpleegkundige, psychologische en medische en disciplines. De teams gingen aan de slag met het optimaliseren van hun functiemix aan de hand van op organisatieniveau geformuleerde vuistregels en een door de actieonderzoeker gemaakte situatieanalyse. Data werden verzameld door logboeken van de actieonderzoekers en focusgroepen met de deelnemers. Uit de thematische analyse bleek dat teams startten met het creëren van helderheid over ieders functie, het optimaliseren van de overlegstructuur en andere samenwerkingsaspecten. Van daaruit ontstond er meer inzicht in de vraag of de teamsamenstelling optimaal en toekomstbestendig was. Randvoorwaardelijk in het experimenteren met de functiemix bleken aanmoediging, begeleiding, tijd en (financiële) ruimte.

The greatest shortages in the nursing discipline are expected in nursing homes. Although job satisfaction is an important factor in the retention of Bachelor’s-level nurses (BNs), little is known about the relationship between the BN roles that are performed on a daily basis and job satisfaction. A cross-sectional, descriptive, questionnaire study was conducted which was based on a convenience sample. The extent of performing seven BN roles was assessed by a self-developed questionnaire. Satisfaction was investigated at three levels: satisfaction with the BN role performance, satisfaction with the work packet (the combination of all roles performed) and satisfaction with job function (all things considered). Respondents (N = 78) were satisfied with the performance of all BN roles (range 3.71–4.42), generally satisfied with the work packet (M = 3.96; SD = 0.96) and neutral about the job function (M = 3.15; SD = 1.12). Not one single BN role correlated with job satisfaction, and the work packet (as a combination of all roles) was significantly related to job satisfaction (r = 0.551; p = 0.000). Four BN roles correlated significantly with satisfaction with the work packet, of which one was meaningful, the role of reflective Evidence-Based Practice professional (r = 0.476; p = 0.000), and three roles related less strongly: the roles of Organiser (r = 0.364; p = 0.001), Communicator (r = 0.224; p = 0.049), and Professional and Quality Enhancer (r = 0.261; p = 0.021). It is important for nurses to create interesting packets of BN roles for themselves. For nurses and care managers, it is essential to create interesting BN descriptions, with highly recognisable BN roles in the work packet, and to stimulate a work environment in order to enhance job satisfaction.

BACKGROUND:People with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior. METHODS:Three data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places. RESULTS:Patients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one's own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient's biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low. CONCLUSION:Highly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.

Background: Moving to a nursing home has a major existential impact on the lives of residents and their relatives. In particular, healthcare professionals who have daily contact with residents have many opportunities to pay attention to existential and spiritual issues. We aimed to increase awareness of the spiritual dimension to understand how healthcare professionals evaluate their spiritual competencies, which coaching questions they have and which spiritual skills can be observed in daily practice after a multicomponent intervention, comprising training, team intervision and individual coaching on the job. Methods: To implement the intervention in two nursing home teams, we performed action research. The participants were mainly certified nurse assistants and client support workers. The training was evaluated with the Spiritual Care Competency Scale (SCCS). Paired-samples t-tests were used to compare the sum scores of the scales of the pre- and posttests of the SCCS (n=24 participants). Thematic analysis was used to analyse the different coaching questions. Observations during individual coaching-on-the-job were analysed via deductive content analysis. Results: The sum scores of the scales and subscales significantly increased between the pre- and posttests. The awareness of participants’ own role in contact with residents was mentioned frequently in the coaching questions. Increased awareness of one’s role in contacts was also reported. Additionally, participants without specific coaching questions appreciated the feedback. [NF1] These observations provide valuable insight into the application of different spiritual skills: aligning, connecting and deepening. Many different actions in response to residents’ needs are observed when healthcare professionals pay attention to what is particularly important. Conclusions: Increasing SCCS scores indicate that the intervention improved spiritual competencies. Trainingand individual coaching were helpful for increasingawareness and translating theories and tools during the daily work of healthcare professionals in a nursing home. [NF1]Even iets over toevoegen in discussie en conclusie

Aims and objectives: This study aimed to gain insight into the experiences and needs of certified nursing assistants regarding their coaching by bachelor-educated registered nurses in nursing homes.Background: Certified nursing assistants are key in providing day-to-day nursing home care. They are, however, not trained to meet the increasingly complex needs of nursing home residents. For certified nursing assistants to respond to high-complexity care, coaching by bachelor-educated registered nurses may be appropriate. Yet, knowledge of how bachelor-educated registered nurses can provide valid coaching is lacking.Design: An explorative qualitative design was adopted.Methods: Certified nursing assistants (n = 13) were purposively selected from 10 Dutch nursing homes. Semi-structured interviews were conducted in 2020 and 2021, and thematic analysis was applied.Results: Two main themes emerged: connecting with certified nursing assistants, and the coaching activities themselves. Certified nursing assistants deemed several aspects important for bachelor-educated registered nurses to connect with them: respecting the autonomy of certified nursing assistants, being visible and reachable, adapting communication, clarifying own job description, and participating in care. Certified nursing assistants perceived coaching by bachelor-educated registered nurses as valuable when they fulfil their needs through activities such as empowering, teaching, and mediating between management and certified nursing assistants.Conclusions: Valid coaching of certified nursing assistants appears possible and requires specific competencies of bachelor-educated registered nurses.Relevance to clinical practice: Coaching certified nursing assistants is one way of addressing complex care needs in nursing homes, and coaching can contribute to both professional and team development. As coaching requires specific competencies of bachelor-educated registered nurses, nursing education profiles should be enriched with this most important role. Management can facilitate coaching by providing bachelor-educated registered nurses with a clear job description.Patient or public contribution: Experts on coaching in nursing home settings informed the topic list. Furthermore, member check was performed.

ObjectiveConceptualize successful treatment of persons with dementia and severe challenging behavior as perceived by professionals.MethodsIn this concept mapping study 82 experts in dementia care participated. The study followed two phases of data collection: (1) an online brainstorm where participants completed the focus prompt: 'I consider the treatment of people with severe challenging behavior in dementia successful if.'; (2) individual sorting and rating of the collected statements followed by data analysis using multidimensional scaling and hierarchical cluster analysis, resulting in a concept map.ResultsThree clusters were identified, the first addressing treatment outcomes and the latter two addressing treatment processes, each divided into sub-clusters: (1) well-being, comprising well-being of the person with dementia and all people directly involved; (2) multidisciplinary analysis and treatment, comprising multidisciplinary analysis, process conditions, reduction in psychotropic drugs, and person-centered treatment; and (3) attitudes and skills of those involved, comprising consistent approach by the team, understanding behavior, knowing how to respond to behavior, and open attitudes.ConclusionsSuccessful treatment in people with dementia and severe challenging behavior focuses on well-being of all people involved wherein attention to treatment processes including process conditions is essential to achieve this.