Assessment of complex geriatric health problems by nurses is important for diagnosis, especially ... more Assessment of complex geriatric health problems by nurses is important for diagnosis, especially assessment of cognitive functioning through daily observations. However, it is unclear which Dutch observation scales are available to assess cognitive abilities. In this study, we present an overview of these scales. A systematic review was performed. Beforehand we determined criteria for inclusion of scales and we searched through Dutch and English databases up till May 2005. Thirteen behavioural observation scales were found. The number of dimensions of cognitive functioning assessed in the scales varied greatly, from two to eight in number. Memory and psychomotor behaviour were always included; consciousness and thinking were frequently included, while alertness, perception, executive functions and language were least included. Extensive assessment of cognitive functioning is highly relevant for a geriatric hospital ward in which patients are admitted for diagnosis. Of all scales tha...
Keywords cognitie Á observatieschaal Á review Á geriatrie Á verpleegkundige Inleiding Geriatrisch... more Keywords cognitie Á observatieschaal Á review Á geriatrie Á verpleegkundige Inleiding Geriatrische patie¨nten worden in het ziekenhuis opgenomen vanwege hun multipele problematiek. De diagnostiek richt zich op het ontrafelen van de verscheidenheid aan somatische, psychische en sociale gezondheidsproblemen. Observaties door verpleegkundigen van patie¨nten tijdens A. Persoon (*) verpleegkundig expert klinische geriatrie, UMC St. Radboud, Nijmegen
Background. Daily observation by nurses of the cognitive function of patients is of high ecologic... more Background. Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock. Aim. To evaluate why and how geriatric nurses observe the cognitive functioning of their patients. Design. Survey. Methods. A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis. Results. The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%). Conclusions. Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect. Relevance to clinical practice. This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarrily to develop a validated observation scale.
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
Background. To assess a patient's cognitive functioning is an important issue because nurses tail... more Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested.
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
Background. Daily observation by nurses of the cognitive function of patients is of high ecologic... more Background. Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock. Aim. To evaluate why and how geriatric nurses observe the cognitive functioning of their patients. Design. Survey. Methods. A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis. Results. The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%). Conclusions. Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect. Relevance to clinical practice. This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarrily to develop a validated observation scale.
Background. To assess a patient's cognitive functioning is an important issue because nurses tail... more Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested.
Assessment of complex geriatric health problems by nurses is important for diagnosis, especially ... more Assessment of complex geriatric health problems by nurses is important for diagnosis, especially assessment of cognitive functioning through daily observations. However, it is unclear which Dutch observation scales are available to assess cognitive abilities. In this study, we present an overview of these scales. A systematic review was performed. Beforehand we determined criteria for inclusion of scales and we searched through Dutch and English databases up till May 2005. Thirteen behavioural observation scales were found. The number of dimensions of cognitive functioning assessed in the scales varied greatly, from two to eight in number. Memory and psychomotor behaviour were always included; consciousness and thinking were frequently included, while alertness, perception, executive functions and language were least included. Extensive assessment of cognitive functioning is highly relevant for a geriatric hospital ward in which patients are admitted for diagnosis. Of all scales tha...
Keywords cognitie Á observatieschaal Á review Á geriatrie Á verpleegkundige Inleiding Geriatrisch... more Keywords cognitie Á observatieschaal Á review Á geriatrie Á verpleegkundige Inleiding Geriatrische patie¨nten worden in het ziekenhuis opgenomen vanwege hun multipele problematiek. De diagnostiek richt zich op het ontrafelen van de verscheidenheid aan somatische, psychische en sociale gezondheidsproblemen. Observaties door verpleegkundigen van patie¨nten tijdens A. Persoon (*) verpleegkundig expert klinische geriatrie, UMC St. Radboud, Nijmegen
Background. Daily observation by nurses of the cognitive function of patients is of high ecologic... more Background. Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock. Aim. To evaluate why and how geriatric nurses observe the cognitive functioning of their patients. Design. Survey. Methods. A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis. Results. The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%). Conclusions. Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect. Relevance to clinical practice. This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarrily to develop a validated observation scale.
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
Background. To assess a patient's cognitive functioning is an important issue because nurses tail... more Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested.
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitat... more the bathtub, and 572 were in a state of cardiopulmonary arrest, only four of whom were resuscitated. The mortality was higher in women than in men (58% vs 49%, Po.01), although incidence was higher in men than in women (14 vs 9 per 100,000, Po.001). Fatal cases were older than nonfatal ones (77 vs 65, Po .001) and were found more often in colder months than in warmer months (January, 60%, October, 46%, Po.02).
Background. Daily observation by nurses of the cognitive function of patients is of high ecologic... more Background. Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock. Aim. To evaluate why and how geriatric nurses observe the cognitive functioning of their patients. Design. Survey. Methods. A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis. Results. The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%). Conclusions. Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect. Relevance to clinical practice. This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarrily to develop a validated observation scale.
Background. To assess a patient's cognitive functioning is an important issue because nurses tail... more Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested.
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