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Papers by Astrid Onderwater
Nederlands Tijdschrift voor Geneeskunde, 2018
Nederlandsch tijdschrift voor geneeskunde, Aug 10, 2018
To explore motives and experiences of patients with incurable cancer who are looking across the b... more To explore motives and experiences of patients with incurable cancer who are looking across the border for second opinions or treatments or are considering to do so. Qualitative, semi-structured interview study. A total of 24 patients with incurable cancer from two Dutch hospitals were interviewed by phone. All interviews were coded independently by two researchers and then analysed inductively, without any pre-specified theoretical framework. Patients were looking for second opinions or treatments because they found it very difficult to accept a sudden diagnosis of incurable disease. They experienced little guidance during this transition. Patients felt they were not offered any treatment options because of imperative protocols. Many patients were in great need of some form of hope. There were often high expectations - unrealistic or not - of the possibilities abroad. Oncologists' reactions to patients' choices were very diverse. While disapproving reactions were unable to ...
Nederlands Tijdschrift voor Geneeskunde, 2018
CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of... more CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of incurable disease. Dutch oncologists might be able to offer alternative forms of hope to these patients, who have a great need for this. If physicians speak with patients about what a treatment abroad may or may not be able to provide, this might benefit patients.
Journal of gerontological nursing, 2015
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarde... more 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 of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Frail Older Adults' Experiences With a Proactive, Nurse-Led Primary Care Program: A Qualitative Study" found on pages 20-29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article...
Psycho-Oncology, 2012
Patients' trust in their physician is crucial for optimal treatment. Yet, among oncology patients... more Patients' trust in their physician is crucial for optimal treatment. Yet, among oncology patients, for whom trust might be especially important, research into trust is limited. A qualitative interview study was carried out to investigate 1) to what extent aspects of trust important to cancer patients reflect the aspects described in other patient populations, and 2) which additional themes emerge. Methods In-depth, semi-structured interviews were performed with a purposefully selected heterogeneous sample of 29 cancer patients. Transcribed interviews were analyzed using MAXqda. Data were clustered across interviews to derive common themes related to trust. Results Three commonly described aspects, i.e., Fidelity, Competence, and Honesty, were strongly reflected in patients' accounts of trust in their oncologist. Confidentiality was irrelevant to many. An additional aspect, labeled Caring, was distinguished. Central to the accounts of these patients was their need to trust the oncologist, arising from the severe and life-threatening nature of their disease. This necessity to trust led to the quick establishment of a competence-based trust alliance. A deeper, more emotional sense of trust was developed only after repeated interaction, and seemed primarily based on the oncologist's interpersonal skills. Conclusions The need for trust encountered in this study underscores the power imbalance between cancer patients and their oncologist. Additionally, these results imply that, when aiming to measure cancer patients' trust, what we might actually be assessing is patients' intention and determination to trust their oncologist. personal relevance. Interviews took approximately one hour. Interviews were conducted between February and September 2009 by two of the authors (M.H. and A.O.), both with a background in psychology and trained in qualitative interviewing. The hospital's Medical Ethics Committee provided an exemption for the study to seek formal approval.
Journal of Nursing Management, 2014
Nursing Management Nurses' experiences and perspectives on medication safety practices: an explor... more Nursing Management Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study Aim To explore nurses' experiences with and perspectives on preventing medication administration errors. Background Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. Methods A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Results Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Conclusions Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Implications for nursing management Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge.
European Journal of Human Genetics, 2014
Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potenti... more Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at risk and allow preventive measures to be taken. However, at present, the number of families attending a cardiogenetics clinic after the SCD of a young relative is low in the Netherlands. We performed a qualitative study and report on the experiences and attitudes of first-degree relatives who attended a cardiogenetics clinic for evaluation. In total, we interviewed nine first-degree relatives and one spouse of seven SCD victims about their experiences, considerations and emotions before attendance and at the first stage of the cardiogenetic evaluation before DNA results were available. Interviews were transcribed verbatim and analysed. Medical professionals did not have an important role in informing or referring relatives to a cardiogenetics clinic. Importantly, all participants indicated that they would have appreciated a more directive approach from medical professionals, because their mourning process hampered their own search for information and decision-making. A need to understand the cause of death and wanting to prevent another SCD event occurring in the family were the most important reasons for attending a clinic. There are possibilities to improve the information process and better support their decision-making. The multidisciplinary cardiogenetic evaluation was appreciated, but could be improved by minor changes in the way it is implemented.
Nederlands Tijdschrift voor Geneeskunde, 2018
Nederlandsch tijdschrift voor geneeskunde, Aug 10, 2018
To explore motives and experiences of patients with incurable cancer who are looking across the b... more To explore motives and experiences of patients with incurable cancer who are looking across the border for second opinions or treatments or are considering to do so. Qualitative, semi-structured interview study. A total of 24 patients with incurable cancer from two Dutch hospitals were interviewed by phone. All interviews were coded independently by two researchers and then analysed inductively, without any pre-specified theoretical framework. Patients were looking for second opinions or treatments because they found it very difficult to accept a sudden diagnosis of incurable disease. They experienced little guidance during this transition. Patients felt they were not offered any treatment options because of imperative protocols. Many patients were in great need of some form of hope. There were often high expectations - unrealistic or not - of the possibilities abroad. Oncologists' reactions to patients' choices were very diverse. While disapproving reactions were unable to ...
Nederlands Tijdschrift voor Geneeskunde, 2018
CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of... more CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of incurable disease. Dutch oncologists might be able to offer alternative forms of hope to these patients, who have a great need for this. If physicians speak with patients about what a treatment abroad may or may not be able to provide, this might benefit patients.
Journal of gerontological nursing, 2015
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarde... more 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 of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Frail Older Adults' Experiences With a Proactive, Nurse-Led Primary Care Program: A Qualitative Study" found on pages 20-29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article...
Psycho-Oncology, 2012
Patients' trust in their physician is crucial for optimal treatment. Yet, among oncology patients... more Patients' trust in their physician is crucial for optimal treatment. Yet, among oncology patients, for whom trust might be especially important, research into trust is limited. A qualitative interview study was carried out to investigate 1) to what extent aspects of trust important to cancer patients reflect the aspects described in other patient populations, and 2) which additional themes emerge. Methods In-depth, semi-structured interviews were performed with a purposefully selected heterogeneous sample of 29 cancer patients. Transcribed interviews were analyzed using MAXqda. Data were clustered across interviews to derive common themes related to trust. Results Three commonly described aspects, i.e., Fidelity, Competence, and Honesty, were strongly reflected in patients' accounts of trust in their oncologist. Confidentiality was irrelevant to many. An additional aspect, labeled Caring, was distinguished. Central to the accounts of these patients was their need to trust the oncologist, arising from the severe and life-threatening nature of their disease. This necessity to trust led to the quick establishment of a competence-based trust alliance. A deeper, more emotional sense of trust was developed only after repeated interaction, and seemed primarily based on the oncologist's interpersonal skills. Conclusions The need for trust encountered in this study underscores the power imbalance between cancer patients and their oncologist. Additionally, these results imply that, when aiming to measure cancer patients' trust, what we might actually be assessing is patients' intention and determination to trust their oncologist. personal relevance. Interviews took approximately one hour. Interviews were conducted between February and September 2009 by two of the authors (M.H. and A.O.), both with a background in psychology and trained in qualitative interviewing. The hospital's Medical Ethics Committee provided an exemption for the study to seek formal approval.
Journal of Nursing Management, 2014
Nursing Management Nurses' experiences and perspectives on medication safety practices: an explor... more Nursing Management Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study Aim To explore nurses' experiences with and perspectives on preventing medication administration errors. Background Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. Methods A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Results Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Conclusions Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Implications for nursing management Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge.
European Journal of Human Genetics, 2014
Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potenti... more Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at risk and allow preventive measures to be taken. However, at present, the number of families attending a cardiogenetics clinic after the SCD of a young relative is low in the Netherlands. We performed a qualitative study and report on the experiences and attitudes of first-degree relatives who attended a cardiogenetics clinic for evaluation. In total, we interviewed nine first-degree relatives and one spouse of seven SCD victims about their experiences, considerations and emotions before attendance and at the first stage of the cardiogenetic evaluation before DNA results were available. Interviews were transcribed verbatim and analysed. Medical professionals did not have an important role in informing or referring relatives to a cardiogenetics clinic. Importantly, all participants indicated that they would have appreciated a more directive approach from medical professionals, because their mourning process hampered their own search for information and decision-making. A need to understand the cause of death and wanting to prevent another SCD event occurring in the family were the most important reasons for attending a clinic. There are possibilities to improve the information process and better support their decision-making. The multidisciplinary cardiogenetic evaluation was appreciated, but could be improved by minor changes in the way it is implemented.