Nienke Bleijenberg

• PhD, RN
• Professor (Assistant) at University Medical Center Utrecht

Introduction The rising global demand for district nursing care necessitates effective strategies to support evidence-based decision-making. Despite the extensive development of nursing guidelines, adherence by district nursing teams remains suboptimal, revealing a gap between guideline development and daily practice. The Learning And Reflection fo...

Background: The demand for homecare is increasing, and reducing low-value care is essential for achieving sustainable healthcare. Low-value care refers to practices that are ineffective, inefficient, unwanted, or potentially harmful to the client. This study aimed to evaluate the effects of a tailored, multifaceted de­implementation strategy in red...

The increasing complexity of healthcare needs driven by an ageing population places pressure on district nursing care. Many vulnerable older adults prefer to remain at home, requiring care coordinated with general practitioners and other professionals. This demand for integrated care is further challenged by a shortage of nursing professionals and...

Background The aging population presents challenges for healthcare, particularly in maintaining the functional independence of older adults. The Decision Support Tool for Functional Independence was developed to identify declines in functional independence and promote collaboration between healthcare professionals. This study examines the barriers...

Needs assessment is the starting point of good home care as it determines which care is necessary, based on the needs of patients, their personal situation, and social context. There are indications that practice variation in needs assessment exists among home care nurses. However, little is known about potential explanations for this variation. Th...

In this study we explore the change in behaviour in terms of capability, opportunity and motivation of all healthcare professionals involved in the implementation of the complex nursing intervention PREDOCS in twelve cardiac surgery centres in the Netherlands. A multicentre survey in twelve Dutch cardiac surgery centres, implementing a complex nurs...

VOORUITGANG IN DE WIJKVERPLEGING Een samenvatting van de belangrijkste bevindingen uit het proefschrift Advancing District Nursing Care: enriching evidence, embracing outcomes, and evolving through continuous learning door Jessica Veldhuizen.

Background Research on what matters to people with dementia in their everyday lives is crucial to develop tailored interventions and programs. However, they are rarely asked. A scoping review of studies with the perspective of people with dementia revealed that no study has explicitly examined everyday life as a whole (Huizenga et al., 2022). A con...

Introduction Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, ang...

The objective of this rapid scoping review is to provide an overview of studies from northwest Europe that describe and evaluate community care delivered by a nurse practitioner (NP) in a team of healthcare professionals. In particular, we explore the roles of NPs within community care, the perceived impact at the patient and informal caregivers le...

Objectives: Research on what matters most to people with dementia is crucial for developing tailored interventions and support. This study explored how people with dementia experience their everyday lives, providing insight into what is important to them to live the best they can at home. Methods: Inspired by a phenomenological approach, open in...

Aim To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment. Design A Delphi study was conducted with the participation of home care representatives. Method A Delphi questionnaire was...

Background: There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs...

Background The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowermen...

Increasing attention has been paid to the ‘voice’ of people living with MCI or dementia, but there is a lack of clarity about how everyday life is exercised, lived, and understood from this insider’s perspective. The current study aimed to explore and identify the everyday life experiences, challenges and facilitators, of home living individuals wi...

Aim: Worldwide, long-term care tends to shift from institutional care towards home care. In order to deliver high-quality and adequate care, the type, amount and cost of care is determined by a patient needs assessment. However, there are indications that this patient needs assessment varies between comparable patients. In the Netherlands, some ho...

There is a lack of evidence to guide district nurses in using nurse‐sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse‐sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes...

Increasing attention has been paid to the ‘voice’ of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider’s perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living a...

BACKGROUND In homecare, eHealth implementation requires healthcare professionals and homecare clients to change their behavior as they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in homecare is needed to optimize implementation strategies. However, a comprehensive overview...

Background: In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensi...

Background The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care profes...

Implementing complex nursing interventions can be challenging. The degree of fit between context and the intervention is essential in explaining whether the implementation succeeds or fails, how and to what extent the intervention achieves impact and whether interventions can be sustained or successfully translated from one context to another. We p...

Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19′s impact on patients receiving district nursing care, district nursing teams, and their organisations during the...

Background : Measuring nursing interventions and nurse-sensitive outcomes in a standardized manner is essential because it provides insight into the quality of delivered care. However, there is currently no systematic overview of the interventions conducted by district nurses, the evidence for the effects of these interventions, or what nurse-sensi...

District nurses have a crucial position in healthcare provision and are expected to use leadership practices to ensure optimal quality patient care. To better equip them, a leadership program named the ambassador project was developed to support the development of a liaison role between policy and district nursing practice. This research aims to ev...

Abstract Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Met...

Het ministerie van VWS stelt geld beschikbaar om landelijke richtlijnen te ontwikkelen voor verpleegkundigen en verzorgenden in de wijkverpleging. Aan welke richtlijnen hebben deze zorgverleners eigenlijk behoefte op korte en lange termijn?

Purpose To describe nurses’ support interventions for medication adherence, and patients’ experiences and desired improvements with this care. Patients and Methods A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The question...

Objective To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important. Setting District nursing care as a part of primary care. Participants I...

Background : During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidence-based intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally partic...

Background • The quality of care at home is under pressure. • Dutch policymakers aim to monitor the quality of district nursing care in terms of nurse-sensitive outcomes (i.e. patient outcomes relevant based on nurses' scope and that are influenced by nursing interventions). • It is currently unknown what outcomes are needed to measure for distr...

Objectives To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses’ scope and domain of practice and that are influenced by nursing inputs and interventions. Design A Delphi study following the RAND/UCLA Appropriaten...

Background Due to multimorbidity and geriatric problems, older people often require both psychosocial and medical care. Collaboration between medical and social professionals is a prerequisite to deliver high-quality care for community-living older people. Effective, safe, and person-centered care relies on skilled interprofessional collaboration a...

Objective To explore how to build and maintain the resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions. Design Scoping review supplemented with expert interviews to validate the findings. Setting Hospitals. Methods We searched PubMed, Embase, PsycINFO, CINAHL, bioRxiv and medRxiv systematically and gr...

Background: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. Objective: This...

Background The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice. Aim The aim of this study was to identify the needs...

Ageing potentially poses a threat to independent functioning of older adults. Although clinicians commonly focus on physical factors limiting Functional Independence (FI), it is likely that personal and environmental interactions also seem important to maintain FI. Herewith, FI exceeds several professional borders and calls for a uniform, multidisc...

Objectives Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing...

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education...

Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. This article describes the methodolog...

Als verpleegkundige verleen je zorg op basis van een continu, cyclisch proces van klinisch redeneren. Dit omvat risico-inschatting, vroegsignalering, probleemherkenning, evidence based-interventies, monitoring en evaluatie. Door de zorgbehoefte of een gezondheidsrisico van de patiënt tijdig te signaleren en op basis van klinisch redeneren de juiste...

Background: Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the meas...

Aging in place is an important goal for both older adults as well as many health policies worldwide, as it is in the Netherlands. Within an aging society, the number of frail older people with complex care needs living at home is increasing. Despite the various definitions of frailty, it is important to early identify who is at risk in clinical pra...

This study explores associations between frailty and oral health in cross-sectional data of 1,202 community-dwelling older people. Two dichotomous outcomes were used: 1. Potential frailty, using routine primary care data; 2. Self-reported frailty, using a questionnaire. Oral health concerned dental record data and self-reported oral problems. Follo...

Effective, safe, person-centred care relies on skilled interprofessional collaboration (IPC) and practice. Little is known about interprofessional education (IPE) to increase IPC in the context of care for frail older people in the community. This study evaluates the effectiveness of IPE on IPC of primary health and social care providers providing...

This study presents the long-term evaluation and impact of a proactive primary care program that aims to reduce acute healthcare consumption and preservation of daily functioning of frail older people living at home. For nine years the program has been adapted and evaluated. We present the results of our implementation study with two-year follow-up...

Background: The aim of the current study is to perform a multi-criteria decision analysis (MCDA) of the proactive, person-centred integrated primary care programme U-PROFIT for frail elderly in the Netherlands. Although, the cost-effectiveness of U-PROFIT has been assessed in a large trial, this MCDA includes a more comprehensive set of outcomes th...

Background To investigate trends over age by comorbidity-status for the risk of limitations in individual activities of daily living for community-living older persons. Methods A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported MCC and nine IADLs were assessed in fifte...

Sociale netwerkanalyse (SNA) wordt veelvuldig gebruikt in de sociale wetenschappen met als doel netwerken te ontrafelen. Sinds twintig jaar wordt SNA ook binnen het vakgebied educatie ingezet, maar het is nog niet eerder toegepast om interprofessionele educatie te evalueren. Deze studie evalueert een interprofessioneel educatie-programma voor profe...

Background There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability...

Purpose to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design individual p...

Background: The present study investigated the trajectories of decline in individual instrumental activities of daily living (IADL) with aging and the effect of hearing (HL) , vision (VL), or dual sensory loss (DSL) on these trajectories in community-living frail older persons. Method: This longitudinal population-based study was conducted in 9,...

Background: In recent years there has been much emphasis on 'research waste' caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full cli...

Objective: Complex interventions are criticized for being a 'black box', which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary care programmes aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare and synthesize the d...

Background: A proactive integrated approach has shown to preserve daily functioning among older people in the community. The aim is to determine the cost-effectiveness of a proactive integrated primary care program. Methods: Economic evaluation embedded in a single-blind, 3-armed, cluster-randomized controlled trial with 12 months' follow-up in...

Maintaining independence is the most important goal of the majority of older people. The onset of disability in activities of daily living is one of the greatest threats to the ability of older people to live independently. Older people with a low socioeconomic status (SES) are at high risk of functional decline. It is unclear what predicts functio...

Background: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), o...

Background: Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs. Objectives: To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in...

Background As populations age, chronic geriatric conditions linked to progressive organ failure jeopardize health-related quality of life (HRQoL). Thus, this research assessed the validity and applicability of the EQ-5D (a common HRQoL instrument) across four major chronic geriatric conditions: hearing issues, joint damage, urinary incontinence, or...

Objectives To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability. Design & SettingA prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands. MeasurementsDisa...

BACKGROUND Multimorbidity, functional impairment and frailty among community-dwelling older people are causing increasing complexity in primary care. A proactive integrated primary care approach is therefore essential. Between October 2014-2015, an evidence-based proactive care program for frail older people was implemented in the region Noord-West...

Objectives Decline in the performance of instrumental activities of daily living (IADL) and mobility may be preceded by symptoms the patient experiences, such as fatigue. The aim of this study is to investigate whether self-reported non-task-specific fatigue is a long-term risk factor for IADL-limitations and/or mobility performance in older adults...

Het evalueren van de effectiviteit van een complexe interventie in een gerandomiseerde klinische trial is niet eenvoudig.1,2) In de literatuur wordt een interventie als effectief beschouwd wanneer er een positief resultaat op de primaire uitkomst is gevonden. Echter, om de validiteit en betrouwbaarheid van een interventie te beoordelen is kennis no...

Background: Research waste is often related to inadequate reporting, design or poor intervention description. However, less attention has been given to a poorly developed intervention, and how to optimize the development process of a complex intervention before pro- ceeding to a full clinical trial. Although the Medical Research Council (MRC) Frame...

Objectives: To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. Design: Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. Setting: Primary care setting, 39 general practices in the Netherlands. Participants: Community-dwelling people ag...

Objective: This study investigated whether visual function is associated with cognitive activity engagement and mild cognitive impairment in middle-aged and elderly individuals. Method: This cross-sectional study was conducted on 120 individuals aged 50-89. The Florida Cognitive Activity Scale (FCAS) was used to assess cognitive activity engagem...

Background: In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fide...

How to Obtain Contact Hours by Reading This Article Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College...

Objective: To internally validate a 15-item dichotomous Activities of Daily Living and Instrumental Activities of Daily Living (ADL/IADL) Index. Methods: Data were extracted from The Older Persons and Informal Caregivers Survey Minimal DataSet (TOPICS-MDS). Using Rasch modelling, six aspects of the ADL/IADL scale were assessed: (1) overall fit;...

Developed as part of the National Care for the Elderly Programme (NPO), TOPICS-MDS is a uniform, national database on the health and wellbeing of the older persons and caregivers who participated in NPO-funded projects. TOPICS-MDS Consortium has gained extensive experience in constructing a standardized questionnaire to collect relevant health care...

Objectives: To predict the risk of future unfavourable health outcomes in older people it is common to assess the level of both basic and instrumental activities of daily living. To accomplish this, the commonly used Katz-6 and the Lawton IADL questionnaires can be combined to form the 'Modified Katz ADL' scale, also known as the Katz-15 scale. So...

Objectives To predict the risk of future unfavourable health outcomes in older people it is common to assess the level of both basic and instrumental activities of daily living. To accomplish this, the commonly used Katz-6 and the Lawton IADL questionnaires can be combined to form the ‘Modified Katz ADL’ scale, also known as the Katz-15 scale. So f...

To better accommodate for the complex care needs of frail, older people, general practitioners must be capable of easily identifying frailty in daily clinical practice, for example, by using the frailty index (FI). To explore whether the FI is a valid and adequate screening instrument for primary care, we conducted a systematic review of its psycho...

Background:Little is known regarding the complex care needs, level of frailty or quality of life ofmulti-morbid older patients. Objectives:The objective of this study was to determine the relationship betweenfrailty, complexity of care and quality of life in multi-morbid older people. Design:Cross-sectional study.Setting: Thirteen primary care prac...