
Roelof G A EttemaUniversity of Applied Sciences Utrecht
Roelof G A Ettema
PhD
About
101
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Introduction
Skills and Expertise
Publications
Publications (101)
Background
In older patients undergoing elective cardiac surgery, the timely identification and preparation of patients at risk for frequent postoperative hospital complications provide opportunities to reduce the risk of these complications.
Aims
We developed an evidence-based, multi-component nursing intervention (Prevention of Decline in Older...
Introduction
Families with multiple and complex problems often deal with multiple professionals and organizations for support. Integrated social care supposedly prevents the fragmentation of care that often occurs.We identified facilitators and barriers experienced by families receiving integrated social care and by the professionals who provide it...
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...
Introduction/Background: An ongoing realist evaluation of the implementation of the program [Amsterdam Customization method] in social welfare in Amsterdam (NL), focussing on multi-problem families, revealed among others, that participating organisations within the program tend to focus on their own tasks, without shared decision making. This becom...
Introduction/Background: PhD research is one of the directions to contribute to the development of integrated care and contribute to international conferences such as ICIC in. Contributions are made towards the nine pillars of integrated care. Results are added, mostly as part of an individual PhD study, in a wide array of subjects which fits the n...
Introduction/Background: Do you also see citizens’ complex needs are nowadays often poorly met by the current services from single organizations which are mainly focused on providing single component care? Citizens’ complex needs are characterized by support questions in several interrelated domains of daily life. A need for support consists theref...
Short summary: Are you curious about how accountability in integrated care is developed and applied? How to organize accountability that suit these integrate care services is still work in progress and far from an end conclusion. Would you like to join this progress? Then come to our workshop. Why a workshop? There is still a way to go of developin...
Nurses play a pivotal role in the care of older people with malnutrition or who are at risk. However, research shows that they lack the motivation to give adequate nutritional care. To change this motivation, an educational intervention targeted at nurses would be desirable. To optimize learning efficacy, we developed a microlearning intervention a...
Nurses have a key role in providing nutritional care to older adults to prevent and treat malnutrition, and stimulate health and well-being. However, evidence for nursing activities regarding nutritional care is often lacking. Therefore, intervention development is necessary. From earlier studies, an evidence-based nutritional intervention carried...
For better serving people's complex needs the subsequent movement to person‐centred integrated care, requires inter‐organisational cooperation and service provision by domain‐overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter‐organisatio...
For better serving people’s complex needs the subsequent movement to person-centered integrated care, requires inter-organizational cooperation and service provision by domain-overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter-organizati...
Background
To improve nutritional care for community-dwelling older adults before, during, and after hospitalization, factors influencing nurses' current behavior should be targeted. The aim of this study was to obtain expert consensus on which factors influencing the behavior of hospital and home care nurses are most relevant, modifiable, and feas...
Background
Nutritional care for older adults provided by hospital and home care nurses and nursing assistants is suboptimal. This is due to several factors including professionals' lack of knowledge and low prioritisation. Affecting these factors may promote nurses' and nursing assistants' behavioral change and eventually improve nutritional care....
Background and objective: Hospital and home care nurses and nursing assistants do not provide optimal nutritional care to older adults, which is due to several factors that influence their current behaviour. To successfully target these factors, we developed a microlearning intervention. The next step is to assess its feasibility to achieve the bes...
Background
Most asylum seekers experience stress, not only due to the reason for fleeing and their travel but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes lower self-esteem and lower quality of life. Adverse life events, forc...
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...
Accountability in health services is necessary for legitimacy, transparency, financial and managerial justification. To achieve the best possible outcomes for people at an affordable cost, healthcare services are continuously evolving. One development is the movement to person-centred integrated care to better serve people’s individual needs. This...
DOI: doi.org/10.5334/ijic.ICIC21027
To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults’ and informal caregivers’ perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregive...
Aims and objectives
To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition.
Background
In‐depth knowledge about hospital and home care nurses’ experiences and perceptions can contribute to optimise nutritional care for older adults across t...
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:
Undernutrition in surgical patients leads to a higher risk of postoperative complications like infections and delayed recovery of gastrointestinal functions, often resulting in a longer hospital stay and lower quality of life. Nurses at outpatient clinics can deliver nutritional care during outpatient preoperative evaluation of health...
Aims and objectives
To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition.
Background
Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses h...
Nurses play an important role in the prevention and treatment of malnutrition in older adults. However, research shows that nurses lack the motivation to give adequate nutritional care. In order to change this motivation a learning intervention about nutrition in older adults targeted at nurses would be desirable. The aim of this study was to asses...
Malnutrition in older adults is a frequent and major problem. Despite the fact that nurses have an essential role in nutritional care, they fail to ensure appropriate delivery in preventing and treating malnutrition. For improvement, it is necessary to understand the perspective of nurses about malnutrition. The aim of this study was to gain insigh...
Background
Care recipients in care and welfare are increasingly presenting themselves with complex needs (Huber et al., 2016). An answer to this is the integrated organization of care and welfare in a way that personalized care is the measure (Topol, 2016). The reality, however, is that care and welfare are still mainly offered in a standardized, s...
Introduction: Both in literature and in practice there is debate about defining Integrated Care. The WHO for example, defines Integrated Care as a process, not covering the perspective of (cost-) effectiveness. From the perspective of research into evidence in Integrated Care this is rather awkward. Triple aim focusses on 1) quality of life of citi...
Background: In the Netherlands, elderly people live longer and longer at home. Estimates show that the number of elderly people living at home will increase from 3 million (17%) in 2017 to 4,5 million (25%) in 2040. Estimates show that 15 to 25% of the elderly who receive care at home is malnourished. Causes are a reduced thirst-tingling and appeti...
A shared culture for change can be achieved if there is a shared set of values which requires a shared paradigm for the exchange of research findings, assessment tools, design principles and a shared language. Systems theory, often referred to as complex adaptive system theory, may provide the framework for increased cooperation and collaboration f...
Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. The NSW Government’s Integrated Care Strategy funding enabled the establishment of an integrated care initiative called Healthy Homes and Neighbourhoods (HHAN). The Initiative was designed as a population-based, family-centered,...
To assess the integrated care interventions, a study needs to be designed to review the pre-existing system performance. Hospital Length of Stay (LOS) is one of the single most important indicators of hospital performance and health care delivery. LOS not only evaluates bed management and the efficiency of internal hospital systems but also the per...
Background: The integration of system-wide health and social care policies and services has long been seen as the answer to improved efficiency and outcomes for consumers of health and social care services. Recent Government reviews[1] , however, have failed to find substantial evidence that integration lead to better outcomes for patients or finan...
Background: Realist philosophy and methodology is increasingly being explicitly used in the field of integrated care to research the extant context, structure and mechanisms at play, and to design and evaluation interventions. Philosophic realism is the view that entities exist independently of our perception or our theories about them. While the r...
Introduction: Malnutrition is an increasing problem among community-dwelling elderly (1) and reported prevalence data are up to 50% (2). Malnutrition is associated with depression, lower cognitive and functional status, infections, comorbidities, a higher use of home care facilities and mortality (3, 4). In older community-dwelling people malnutrit...
Introduction: Quality, accessibility and affordability in Dutch healthcare are system-goals in which the secretaries of the ministry of Healthcare, Welfare and Sports are accountable. These system-goals serve a public interest and they have to be accounted for. This only happens if the allied institutes, professionals and citizens take responsibili...
Introduction: In the Netherlands, skin cancer is the most common type of cancer (KWF, 2016). More than 51.000 new cases of skin cancer are diagnosed every year and over 900 fatalities are reported (RIVM, 2017). Skin cancer incidence rates increase dramatically: since 1990 the number of new patients with skin cancer quadrupled (RIVM, 2017). This inc...
Introduction:
In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist tr...
Background:
The diffusion of telehealth into hospital care is still low, partially because of a lack of telehealth competence among nurses. In an earlier study, we reported on the knowledge, skills, and attitudes (KSAs) nurses require for the use of telehealth. The current study describes hospital nurses' confidence in possessing these telehealth...
This preliminary workshop will support evaluators and researchers to use realist methods in integrated care and other complex evaluations. Because realist evaluation was initially developed using smaller-scale programs, methods need to be modified for large scale programs,
while remaining consistent with underlying methodological principles.
The w...
Objective: Delirium is an impactful, frequently occurring complication in older hospital patients. Consequently, risk stratification of delirium was included in a set of mandatory safety measures in general hospitals in the Netherlands. This risk stratification contains three consensus-based questions that have not been validated. Therefore, we eva...
Aims and objectives
To evaluate the effects of preoperative nutritional support using a regular diet for undernourished surgical patients at the outpatient clinic.
Background
Undernutrition (or malnutrition) in surgical patients has severe consequences i.e. more complications, longer hospital stay, and decreased quality of life. While systematic r...
Background:
The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this populat...
Aims:
The aim of this paper is to describe and discuss the 'Basic Care Revisited' (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities.
Background:
While basic nursing care serves nearly all people at some point in the...
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...
Background:
Today's nursing school applicants are considered "digital natives." This study investigated students' views of new health care technologies.
Method:
In a cross-sectional survey among first-year nursing students, 23 common nursing activities and five telehealth nursing activities were presented along with three statements: "I consider...
Rationale: Undernutrition among patients planned for surgery influences outcomes, e.g. higher complication rates, longer length of hospital stay (LoS) and increased mortality. The aim of this study was to evaluate the feasibility and effectiveness of an early nursing nutrition intervention (NNI) in outpatients planned for surgery.
Methods: The NNI...
Routine care data were used to examin the predictive value of three Dutch health care inspection mandatory questions for screening on delirium. Delirium diagnosis was established on three proxy measures.
The three health care inspection mandatory questions for screening on delirium combined with relevant routine collected patient characteristics we...
Background and aim: In older patients undergoing elective cardiac surgery, timely identification and preparation of patients at risk for frequent postoperative hospital complications provides for the opportunity reducing their risk. We developed an evidence based multi component nursing intervention (PREDOCS-Program) to improve patients’ physical a...
BackgroundA pragmatic, stepped wedge trial design can be an appealing design to evaluate complex interventions in real-life settings. However, there are certain pitfalls that need to be considered. This paper reports on the experiences and lessons learned from the conduct of a cluster randomized, stepped wedge trial evaluating the effect of the Hos...
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...
Op hartoperatieafdelingen groeit het aantal postoperatieve complicaties continu, vooral bij oudere operatiepatiënten. Het lectoraat Chronisch Zieken en Ouderenzorg van de Hogeschool Utrecht startte in 2008 een onderzoekslijn om zulke complicaties te voorkomen. Heeft het geholpen?
Background:
Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nurs...
Het aantal artsen dat parttime gaat werken neemt toe. Meer vrouwelijke artsen voeren het beroep uit. Wat betekent de feminisering van het beroep voor de samenwerking in de zorg? Waar vroeger de zorg van de huisarts eenduidig was en de huisarts bijna onbeperkt tot de beschikking van zijn of haar patiënten stond, is de zorg- en behandelvraag niet all...
Background:Given the growing number of vulnerable, older cardiac surgery patients, the preadmission PREvention Decline in Older Cardiac Surgery patients (PREDOCS) programme was developed to reduce the incidence of postoperative complications. Before the clinical effects of such a complex multicomponent intervention can be evaluated, the feasibility...
The timely detection of post-stroke depression is complicated by a decreasing length of hospital stay. Therefore, the Post-stroke Depression Prediction Scale was developed and validated. The Post-stroke Depression Prediction Scale is a clinical prediction model for the early identification of stroke patients at increased risk for post-stroke depres...
ABSTRACT
Background: After a cardiopulmonary bypass procedure, as a result of the use of the heart-lung machine, patients frequently have an overfilling of the blood circularly system, resulting in an increased weight. Existing malnutrition screening instruments have ‘weight’ included, which can result in underestimations, in the period after sur...
In cardiac surgery prediction models identifying patients at risk of prolonged stay at the Intensive Care Unit (ICU) are used to optimize treatment and use of ICU resources. A recent systematic validation study of 14 of these models identified three models with a good predictive performance across patients of all ages. It is however unclear how the...
Several models have been developed to predict prolonged stay in the intensive care unit (ICU) after cardiac surgery. However, no extensive quantitative validation of these models has yet been conducted. This study sought to identify and validate existing prediction models for prolonged ICU length of stay after cardiac surgery.
After a systematic re...
Veranderingen zet men meestal in door het veranderen van ‘oud gedrag’ naar ‘nieuw gedrag’, waarbij men de overtuiging heeft dat het nieuwe gedrag meer oplevert. Dit implementeren van nieuw gedrag is een proces dat succesvol is verlopen wanneer het gedrag dat van mensen in een organisatie wordt verwacht, ook daadwerkelijk is terug te zien in de over...
Wanneer men de eigen organisatie aan een buitenstaander toelicht, dan zal dat veelal gaan aan de hand van het organigram; de verticale organisatie. Zelden wordt een organisatie beschreven in termen van processtromen, de horizontale organisatie (Dorr, 2007). In gezondheidszorg- en welzijnsorganisaties wordt bij processtromen de cliënt gevolgd. Om to...
Materiële en immateriële producten zoals diensten probeert men zo veel mogelijk tegen vooraf afgesproken voorwaarden steeds weer met dezelfde kwaliteit te leveren. Bij een immaterieel product, zoals zorg, behandeling of begeleiding, is voorraadvorming niet mogelijk. In de meeste gevallen is zonder medewerking van de cliënt of patiënt geen dienstver...
Wellicht de meest basale vragen die de leiding van een organisatie, een organisatieonderdeel of een afdeling zich kan stellen zijn: ‘Waartoe zijn wij op aarde?’, ‘Wat voegen wij aan wie in onze omgeving toe?’, ‘Waarin onderscheiden wij ons van anderen met een soortgelijke dienstverlening?’ en ‘Waartoe willen wij in de toekomst op aarde zijn?’ Enkel...
Routinematig handelen, zoals daar binnen processen van dienstverlening naar wordt gestreefd, biedt de zekerheid van een standaardoutput van een redelijk zeker niveau. Het biedt de medewerkers die in het proces werken veiligheid. Medewerkers en cliënten kunnen ervan op aan dat de activiteiten die men uitvoert zullen leiden tot het verwachte resultaa...
Subcutaneous administration of heparin is becoming the standard treatment for patients with unstable angina. However the actual injection technique appears to vary greatly between individuals. This study was designed to investigate the optimum technique for subcutaneous heparin injection and produce nursing guidelines derived from evidence based pr...