Evidence based nursing:

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Evidence based nursing research on symptom
control and adverse events Rianne de
Wit Nursing Science, Maastricht University
Dept Nursing care, University Hospital
Maastricht The Netherlands
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• The Netherlands 16 milj. inhibitants
• 425.000 (associate) nurses
• 220.000 Nurses
• 1650 Master degree
• 50 PhD degree
• 4 prof. dept. of Nursing Science

Maastricht
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Research programme

• Nursing Science, Maastricht University
• Disease management programming of care for
  chronically ill
• Innovations in health care for the elderly
• NEW Evidence based practice research on symptom
  control and adverse events

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Research programme

• Dept of patient care, University hospital
  Maastricht
• Implementation of research
• Quality improvement
• NEW conducting research

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Evidence-Based Symptom control

• Symptoms are the most common reason people seek
  health care.
• The patient is the gold standard for
  understanding the symptom experience.
• Greater frequency and intensity of symptoms leads
  to lower quality of life.
• Nonadherence to treatment regiments is associated
  with greater frequency and intensity of symptoms.

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Evidence-Based Symptom control

• Symptoms may or may not correspond with
  physiologic markers.
• Nurses are not necessarily good judges of
  patients symptoms.
• Patients report using limited self-care symptom
  management strategies other than medications.
• There is a paucity of data from randomized
  controlled trials that have attempted to test
  symptom management interventions.

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Mission

• Conduct research across health science
  disciplines and settings in the area of symptom
  control and adverse events to realize evidence
  based practice
• Improve patients quality of life by conducting
  research regarding the effectiveness of
  prevention, assessment, treatment, and
  implementation of symptom control and adverse
  events

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Organization

• Establish an organizational unit of research
  development on symptom control and adverse events
  at the university hospital Maastricht,
• in collaboration with the university hospital
  Maastricht

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Performance indicators

• Prevalence/incidence of pressure ulcer
• Medication safety
• Wound infection and complication registration
• Post-operative pain
• Presence of integrated diabetes care service
• Presence of outpatient heart failure clinic).

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nursing care is essential in assessing,
monitoring and applying interventions regarding
symptoms and adverse events
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Symptoms
Person demographic,
psychological, sociological, physiological,
developmental
Symptom Experience
Components of Symptom Management Strategies
Perception of symptoms
Evaluation of symptoms
Who? (delivers)
What? How much?
When? To whom?
Response to symptoms
Where? How?
Outcomes
Why?
Functional status
Emotional status
Self-care
Adherence
Health Illness
Symptom status
Costs
Environment
Mortality
Quality of life
Risk factors
Physical
Morbidity Co-morbidity
Health status
Social
Disease Injury
Cultural
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What do we know about symptoms and adverse
events?

• Intensity
• Management

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Measurement Issue Validity

• Subjective vs. objective?
• Response frame (today, one week, etc.)
• Response format (yes/no, 1-10 scale)
• Sensitivity of change over time
• Clusters of symptoms
• Symptoms as moderators between two other
  variables
• Effects on quality of life

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Measurement Issue Reliability

• Internal consistency (Cronbachs alpha)
• Test-retest

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Measurement Issue Utility

• Feasibility
• Length (time to completion)
• Scoring

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Research programme

• Rianne de Wit
• Ruud Halfens

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Symptoms and adverse events

• Pain
• Prevalence of pain in hospitals patients
• Implementing pain monitoring in hospital
  patients
• Implementing pain monitoring in nursing homes
• Pain in cognitively impaired residents in
  nursing homes
• Effects of pain medication prescription and
  analgesic adherence monitoring in cancer pain
  patients
• Effects of a Pain Education Program in cancer
  pain patients
• Influence of psychological and psychiatric
  factors in Complex Regional Pain Syndrome (CRPS)
• The effect of a Sternum support harness in open
  hart surgery patients (sternotomy) on pain

• Fatigue
• Fatigue in patients with breast cancer
• Fatigue in cildren (7-11y )wth cancer

• Other symptoms
• Dysphagia in CVA patients
• Monitoring delier in intensive care patients
• Chronic hart failure

Nausea and vomiting - Assessment and treatment
of nausea and vomiting in patients in the
palliative phase
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Symptoms and adverse events

• Pressure ulcers
• Prevalence of pressure ulcers
• Evaluation of massage on pressure ulcers
• Implementation of B-learning on pressure ulcers
• Comparing prevalence of pressure ulcers between
  Germany and The Netherlands

• Incontinence
• - Prevalence of incontinence in hospital patients
• Prevalence of incontinence in primary care

Malnutrition Prevalence of malnutrition in health
care settings
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Evidence-Based Symptom control

• Conduct research and develop symptom management
  across
• health science disciplines
• health care settings
• across countries
• Dissemination of research
• Implement successful relief strategies

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Prevalence of Chronic Pain
Overall Prevalence 19
(n46,394)Moderate 13 Severe 6
30 27 26 23 21 19 18 18
17 17 16 16 15 13 13 11
Norway (n2,018)
Germany (n3,832)
Poland (n3,812)
Israel (n2,244)
Italy (n3,849)
Denmark (n2,169)
Belgium (n2,451)
Switzerland (n2,083)
Austria (n2,004)
France (n3,846)
Finland (n2,004)
Ireland (n2,722)
Sweden (n2,563)
UK (n3,800)
Netherlands (n3,197)
Spain (n3,801)
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