Herlinde Wynendaele

Background and Purpose: Nurse practitioners (NPs) are increasingly integrated to meet workforce demands. Measuring patient satisfaction across provider types requires validated tools. This pilot study adapted the Nurse Practitioner Satisfaction Survey into Dutch (NPSS-NL) and examined its psychometric properties. Methods: In two outpatient clinics (gastroenterology and pediatrics), 190 participants (321 observations) completed the NPSS-NL after physician- and NP-led visits. Analyses included exploratory and confirmatory factor analyses, internal consistency, measurement invariance, and mixed-effects modeling. Results: A refined, 20-item, one-factor model showed excellent reliability (α and ω > .95). Multigroup confirmatory factor analysis supported metric and tentative scalar invariance. Satisfaction was high, with a minor decline at the second NP follow-up. Conclusions: The NPSS-NL demonstrated strong reliability and initial evidence of cross-provider comparability. Further validation in larger samples is warranted.

Background: Growing demand for resident care has made it increasingly challenging for care workers (registered nurses and nursing assistants) to provide person‐centered and high‐quality care in nursing homes. Demanding working conditions, high workloads, and job‐related stress increase burnout risk among care workers. Positive work environments have been associated with reduced risk of emotional exhaustion and improved quality of care. Objectives: This study assessed the nursing home work environment, risk of burnout in care workers, and explored their association. Additionally, the study examined whether professional role moderates this association. Methods: A cross‐sectional, multicenter study included survey data from 819 care workers across 54 Belgian nursing homes. Linear mixed models examined associations between the work environment and burnout risk in care workers, with additional analyses exploring the moderating role of profession. Results: A substantial proportion of care workers reported positive collegial relationships (86.3%) and foundations for quality care (86.8%), while 65.5% reported insufficient staffing and resources. Additionally, 23.4% were at high risk of emotional exhaustion, 19.9% of depersonalization, and 32.2% of reduced personal accomplishment. All work environment measures were negatively associated with emotional exhaustion and depersonalization and positively associated with reduced personal accomplishment. Significant findings were obtained regarding the moderating role of profession. Conclusion: This study underscores the importance of improving the nursing home work environment. Implementing targeted interventions to enhance these elements could reduce burnout risk among care workers. While achieving adequate staffing levels is essential, the impact on care worker well‐being may be limited without additional improvements in the work environment. Granting care workers decision latitude and involving them in nursing home affairs could foster a more supportive and participative nursing management.

Aim: To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses. Design: A cross‐sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well‐established. Methods: A self‐administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce‐related factors. Descriptive statistics, chi‐squared tests and correspondence analysis were employed to identify patterns and country‐specific differences across these domains of implementation factors. Results: A total of 491 advanced practice nurses participated in the study. While almost three‐quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions. Conclusion: The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce. Implications for the Profession: Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well‐being and long‐term role sustainability in Europe is recommended. Impact: What problem did the study address? What were the main findings? Where and on whom will the research have an impact? This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.

This umbrella review aims to systematically synthesize the current evidence on the factors associated with personnel turnover in the healthcare and welfare sectors, the methodologies used to measure turnover, and the effectiveness of interventions designed to reduce turnover. Following PRISMA-P guidelines, we analyzed data from January 2013 to July 2023 across multiple databases, including PubMed, Web of Science, CINAHL, Cochrane Database of Systematic Reviews, and Embase. Two reviewers independently screened titles and abstracts for predefined eligibility criteria. They also collaboratively examined 10% of the full texts to ensure compliance with these criteria. Study quality was evaluated using AMSTAR 2, and a Corrected Covered Area analysis was conducted. The analysis included 37 studies with a total of 511 primary studies. Turnover factors were grouped into three categories: socio-demographics and health status, work environment characteristics, and personal attitude and functioning, highlighting a wide range of factors that influence both turnover intention and actual turnover. Various measurement methodologies were identified, with a notable lack of standardization. Interventions targeting work-related factors showed mixed effectiveness, underscoring the importance of context-specific strategies. The findings show the complexity and context-specific nature of turnover in healthcare and welfare sectors, requiring targeted, context-specific interventions to address the diverse factors involved. Standardization of measurement methodologies is necessary for comparing turnover rates and the effectiveness of interventions. Future research should focus on filling existing gaps, particularly in non-hospital settings, and on developing and evaluating multifaceted interventions.

Aim: Our study aims to explore nurses' shift preferences in relation to their personal characteristics and examine how these preferences align with the rosters imposed in Belgian healthcare settings. Additionally, the study seeks to identify patterns in shift preferences across different days of the week and investigate the existence of distinct groups of nurses with similar preferences, further examining the link between these groups and their personal characteristics.Design: Cross‐sectional.Methods: Questionnaires were distributed to 778 nurses across 11 general hospitals in Belgium, collecting data on demographics, chronotype, shift preferences, and roster alignment. Statistical analyses included logistic regression, principal component analysis, and k‐means clustering.Results: Age and chronotype significantly influence nurses' shift preferences. Preferences were consistent across the days within the week. The study revealed two groups of preferences: ‘early birds’ (preferring morning/day shifts) and ‘night owls’ (preferring evening/night shifts). Night owls were often neutral or evening‐type chronotypes and had a higher alignment between imposed and ideal rosters.Conclusions: This study reinforces the importance of considering individual differences in nurses' shift preferences, linked to age and chronotype, and advocates for the adoption of flexible, personalized rostering systems.Implications: Personalized scheduling has the potential to improve workforce management, suggesting that healthcare administrators should consider individual preferences in rostering to mitigate the challenges of nurse understaffing.Impact: Tackles the pressing problem of nurse understaffing. Proposes that tailored rosters based on individual preferences could improve work conditions for nurses. Relevant to policymakers aiming to enhance nursing workforce management.Reporting method: STROBE Statement (for cross‐sectional studies).Patient or public contribution: None.

Purpose The transition towards adult-focused healthcare comprises a complex process requiring careful, individualized guidance of adolescents with congenital heart disease (CHD). Detailed data on their preferences regarding disease-related information and acquirable transitional skills are mostly lacking. We examined the preferences of CHD adolescents in the early transition stage. Methods A cross-sectional descriptive study was performed with adolescents recruited from a transition program. Two questionnaires assessing needs for information and transitional skills were used. Only questionnaires completed in the early transition stage were included. Results Forty-nine adolescents participated (mean age 15.9 ± 1.2 years, 43% girls). 59% requested information about their heart and previous and/or future surgeries/interventions, 45% about sports and medication, and a maximum of 27% about psychosocial topics. More girls than boys requested surgical information (76% versus 46%; p = 0.04). Adolescents with severely complex CHD more often requested information about medication than those with moderately complex CHD (63% versus 28%; p = 0.02). Older adolescents were less likely to request surgical information (OR = 0.53; 95%CI [0.26–0.88]; p = 0.03). Up to 83% of the adolescents perceived their skills as insufficient, but less than 14% was interested in acquiring skills. Conclusion: Adolescents were mainly interested in medical topics, followed by lifestyle information. The informational needs tended to decrease with age. Timely gauging individual needs and delivering information, ideally in the early teens, appear important when providing person-tailored transitional care in CHD. Paradoxically, although the transitional skills were low-perceived, there was limited motivation to improve them. This paradox requires further investigation to better tailor transition interventions. Clinical trial registration: Not applicable. What is Known: • Transition towards adult life and care requires careful patient guidance. A person-tailored approach is strongly encouraged. However, details on preferences regarding disease-related information and transitional skills are scarce in adolescents with CHD. What is New: • This study showed that adolescents with CHD in early transition mainly need medical-related information. Their informational needs tend to decrease with age necessitating timely gauging for interest and delivering information. Adolescents report a low need to acquire transitional skills despite low self-esteemed skills levels.

Aims: To describe the monthly self‐scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization‐related outcomes. Design: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. Methods: Data collection was performed in four Belgian NH during Spring 2019 using semi‐structured interviews ( n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within‐case and cross‐case analysis was performed. The COREQ checklist was used for reporting the findings. Results: One group (two NH) used self‐scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self‐scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. Conclusion: Self‐scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. Impact: This study contributes to the rare literature on self‐scheduling in NHs by focusing on the monthly self‐scheduling process and by including an organizational design perspective. NH management can become informed of different self‐scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. Patient or Public Contribution: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self‐scheduling process.

Introduction and aims: The transition towards adult-focused healthcare comprises a complex process through which adolescents with congenital heart disease (CHD) should be carefully guided. Various task forces encourage implementing person-tailored transition programs, but detailed data on adolescents' preferences regarding disease-related information and acquirable transitional skills are mostly lacking. This study examined these preferences towards adolescents with moderately and severely complex CHD. Material and methods: A cross-sectional descriptive study including logistic regression analysis was performed in a Belgian tertiary CHD center with adolescents recruited from “Transition With a Heart” (TWAH). For this 4-year transition program, adolescents were invited to complete a communication paper (focused on the need for information) and an individualized transition plan (focused on the evaluation of transitional skills) prior to an outpatient visit. Only questionnaires completed in the early transition stage, from January 2016 to August 2021, were used for data analysis. Results: Forty-nine adolescents completed both questionnaires at an average age of 15.9±1.2 years. Of all adolescents, 59% indicated the need for information about the heart defect and surgical treatment, followed by 45% that expressed the need for information about sports and medication; and ≤27% regarding psychosocially-related topics. The proportion of girls needing information was larger than boys. Significantly more girls than boys requested information about surgeries (76% versus 46%; p=0.04). Younger adolescents were more likely to express a need for information about most topics and significantly more likely regarding surgeries (odds ratio=0.53; 95% CI [0.26 to 0.88]; p=0.03). A maximum of 14% of adolescents were interested in acquiring transitional skills. Larger proportions of adolescents perceived the relevant transitional skills as insufficient, from 21% to 83%. Conclusion: The preferences for disease-related information of adolescents with CHD are mainly related to medical topics and tend to decrease with increasing age. This motivates timely gauging of individual information needs and delivering disease-related information, ideally in the early teens. Furthermore, preferences varied according to gender, with more information requested by girls. Adolescents expressed minimal needs to acquire transitional skills despite the low self-perceived skills levels. This paradox requires further research to enable the adaptation of transition interventions. Funding Acknowledgement: Type of funding sources: None.

Background: Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods: The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results: The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion: Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.