Hans-Peter de Ruiter - Academia.edu (original) (raw)
Papers by Hans-Peter de Ruiter
Creative Nursing, 2015
An oncology nurse talks about her 42-year career at Stanford Medical Center. The technological an... more An oncology nurse talks about her 42-year career at Stanford Medical Center. The technological and pharmacological advances she has seen in that time have changed the face of oncology nursing practice and transformed many previously fatal cancers into curable diseases or chronic illnesses compatible with well-being. The increasing complexity of care requires multidisciplinary collaboration and brings with it new ethical dilemmas. She cautions nurses to make the best use of technology without losing their critical thinking skills, basic assessment skills, and common sense.
Creative Nursing
1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter... more 1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter, PhD, RN; Deborah Freeman, BSN, RN; Ronda Hughes, PhD, RN, MHS, FAAN; and Richard Sellers, MDiv, MA. de Ruiter HP, Freeman D, Hughes R, Sellers R. ...
Creative nursing, 2011
1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter... more 1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter, PhD, RN; Deborah Freeman, BSN, RN; Ronda Hughes, PhD, RN, MHS, FAAN; and Richard Sellers, MDiv, MA. de Ruiter HP, Freeman D, Hughes R, Sellers R. ...
Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses, 2002
A medical unit developed a subspecialty in diabetes care by increasing the expertise of its staff... more A medical unit developed a subspecialty in diabetes care by increasing the expertise of its staff nurses. A task force was formed to set goals and create an action plan. An educational curriculum was developed, implemented, and evaluated. Medical staff nurses were integrated as diabetes educators and now provide 24-hour diabetes specialty care coverage for the hospital.
Creative nursing, 2007
de Ruiter RN, MS "It's fine to celebrate suecess hut it is more important to heed the lessons of ... more de Ruiter RN, MS "It's fine to celebrate suecess hut it is more important to heed the lessons of failure. BUI Gates Hans-Peter de Ruiter Nurses are try in a to fit their observatio^is and interventions into the structure offered them.
Creative nursing, 2006
Creating an environment that is truly safe for both nurses and patients requires the elimination ... more Creating an environment that is truly safe for both nurses and patients requires the elimination of disparities in approaches to staff safety and patient safety. Patient safety approaches based on transparency and blamelessness are effective tools in developing an environment that is constantly improving itself. In addition to creating a safe and blame-free environment, creating a new model that nurses can use in real time would allow for rapid decision-making that maintains the safety and integrity of nurses as well as patients.
The American journal of nursing, 2006
Journal of Pediatric Oncology Nursing, 2007
Creative Nursing, 2011
Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting instituti... more Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting institutional goals in the form of documentation have led to a culture of action-based practice, which interferes with nurses' ability to simply be with patients. In order for nurses to be fully present with their patients, the cultural norm of multitasking and the emphasis on doing must be reexamined within the context of patient care.
AAOHN Journal, 2011
Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In re... more Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In response to musculoskeletal injuries, safe patient-handling programs are being instituted to decrease the risk of injuries and resulting impaired function. This study was designed to identify patient-handling practices in clinical practice. This qualitative study used 128 hours of observations of patient-handling practices and interviews of 32 nursing staff who discussed these practices. Findings demonstrated five factors impact nurses' judgment regarding the best way to move patients: complexity of everyday care, patient treatment goals, time, knowledge, and equipment issues.
AJN, American Journal of Nursing, 2006
The development of a transcultural Web site created by a multidiscplinary committee in a large me... more The development of a transcultural Web site created by a multidiscplinary committee in a large medical center is described. The purpose of this Web site is to give direct patient caregivers immediate, around-the-clock access to various types of transcultural information that can serve as an aid in the provision of culturally competent care. This article outlines the steps to developing the Web site and provides a description of the types of informational resources available on it.
& Abstract One of the most significant changes in modern healthcare delivery has been the evoluti... more & Abstract One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk man-agement/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care deliv-ery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). Like all technological developments, the EHR has changed healthcare practices and relationships. In this study, we argue that the primary change has been a shift in focus of documentation from monitoring individual patient progress to recording data pertinent to institutional priorities. We focus on the consequences that this change has for patients and providers. We argue that the organization of work and the patient–clinician relationship are subtly but powerfully shifting in response to changes in healthcare
Journal of Nursing Administration, 2001
Bulletin of The History of Medicine, 2004
... in a medical manner. Medicine is not merely a background to Plath or any of the other autho... more ... in a medical manner. Medicine is not merely a background to Plath or any of the other authors: their writing could not exist without it. ... Hans-Peter de Ruiter University of Minnesota and Fairview University Hospital Minneapolis Konrad Maurer and Ulrike Maurer. ...
Nursing Management (springhouse), 2001
Creative Nursing, 2008
A nurse who has practiced in different countries reflects on the words used in various languages ... more A nurse who has practiced in different countries reflects on the words used in various languages to name our profession, and what those words have to say about the deeper meaning of nursing.
Books by Hans-Peter de Ruiter
The handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in... more The handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in health-care institutions. For obvious reasons, this puts healthcare providers at risk for musculoskeletal injuries (MSIs); furthermore the risk of such injuries has been considered an inherent risk of care work. In the last decade a concerted effort has been made to decrease (with the goal of eliminating) caregiver injuries by implementing safe patient handling programs (SPHP). These programs are presented as evidence-based algorithms that require the use of mechanical lifting devices. Institutions implement SPHPs as policies and procedural guidelines to which caregivers must conform. SPHPs represent a change in institutional thinking from the earlier belief that MSIs were inherent to care work, to the contemporary idea that injuries are preventable. Despite these efforts, healthcare providers continue to be exposed to the risk of injury.
The assumptions underlying the SPHP are open to questions, none of which are addressed in the literature. Most importantly the literature does not take into consideration that healthcare providers are handling individual patients with subjective and unique needs. For the purpose of understanding why healthcare providers continue to be exposed to the risk of MSIs, the purpose of this study is to explore how the generic policies and guidelines meant to apply to all patient-caregiver interactions impact patients and caregivers in everyday care work. In particular, this study examines the complexity of
care delivery on inpatient care units that have implemented the latest research recommendations regarding safe patient handling. This study starts with the assumption that care workers are positioned at the intersection between the patient and the hospital policies and guidelines that govern their care. In order to understand the caregivers’ continued exposure to injury, this study examines the work of caregivers during their shift and the policies and guidelines they encounter that impact their decisions.
This study is an Institutional Ethnography (IE), a unique research approach that makes visible how complex actions in everyday care work are coordinated by institutional texts such as policies and guidelines. This research approach permits the researcher to make visible the connection between the actual day-to-day experiences of people and the organizational priorities as reflected in institutional texts.
This study was conducted in two healthcare facilities on neurology and rehabilitation units which had instituted SPHPs and had state-of-the-art lifting equipment.
Two sources of data were collected for this study, the first were observations of every day lifting. It describes caregiver practice beginning with 1. A description of how caregivers obtain the knowledge they need to handle the patients encountered during their shift. 2. What occurs once the caregiver encounters the patient. 3. Their decision-making process
used to determine how to transfer a patient. 4. How the transfers are brought into action, and 5. How this care is then documented and reflected in the patient's record. The second
source of data were the institutional texts that impacted the handling of patients. These were identified by interviewing caregivers and managers and performing searches in
institutional data base
Creative Nursing, 2015
An oncology nurse talks about her 42-year career at Stanford Medical Center. The technological an... more An oncology nurse talks about her 42-year career at Stanford Medical Center. The technological and pharmacological advances she has seen in that time have changed the face of oncology nursing practice and transformed many previously fatal cancers into curable diseases or chronic illnesses compatible with well-being. The increasing complexity of care requires multidisciplinary collaboration and brings with it new ethical dilemmas. She cautions nurses to make the best use of technology without losing their critical thinking skills, basic assessment skills, and common sense.
Creative Nursing
1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter... more 1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter, PhD, RN; Deborah Freeman, BSN, RN; Ronda Hughes, PhD, RN, MHS, FAAN; and Richard Sellers, MDiv, MA. de Ruiter HP, Freeman D, Hughes R, Sellers R. ...
Creative nursing, 2011
1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter... more 1. Creat Nurs. 2011;17(2):96-103. Ethics at the bedside: A conversation with Hans-Peter de Ruiter, PhD, RN; Deborah Freeman, BSN, RN; Ronda Hughes, PhD, RN, MHS, FAAN; and Richard Sellers, MDiv, MA. de Ruiter HP, Freeman D, Hughes R, Sellers R. ...
Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses, 2002
A medical unit developed a subspecialty in diabetes care by increasing the expertise of its staff... more A medical unit developed a subspecialty in diabetes care by increasing the expertise of its staff nurses. A task force was formed to set goals and create an action plan. An educational curriculum was developed, implemented, and evaluated. Medical staff nurses were integrated as diabetes educators and now provide 24-hour diabetes specialty care coverage for the hospital.
Creative nursing, 2007
de Ruiter RN, MS "It's fine to celebrate suecess hut it is more important to heed the lessons of ... more de Ruiter RN, MS "It's fine to celebrate suecess hut it is more important to heed the lessons of failure. BUI Gates Hans-Peter de Ruiter Nurses are try in a to fit their observatio^is and interventions into the structure offered them.
Creative nursing, 2006
Creating an environment that is truly safe for both nurses and patients requires the elimination ... more Creating an environment that is truly safe for both nurses and patients requires the elimination of disparities in approaches to staff safety and patient safety. Patient safety approaches based on transparency and blamelessness are effective tools in developing an environment that is constantly improving itself. In addition to creating a safe and blame-free environment, creating a new model that nurses can use in real time would allow for rapid decision-making that maintains the safety and integrity of nurses as well as patients.
The American journal of nursing, 2006
Journal of Pediatric Oncology Nursing, 2007
Creative Nursing, 2011
Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting instituti... more Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting institutional goals in the form of documentation have led to a culture of action-based practice, which interferes with nurses' ability to simply be with patients. In order for nurses to be fully present with their patients, the cultural norm of multitasking and the emphasis on doing must be reexamined within the context of patient care.
AAOHN Journal, 2011
Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In re... more Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In response to musculoskeletal injuries, safe patient-handling programs are being instituted to decrease the risk of injuries and resulting impaired function. This study was designed to identify patient-handling practices in clinical practice. This qualitative study used 128 hours of observations of patient-handling practices and interviews of 32 nursing staff who discussed these practices. Findings demonstrated five factors impact nurses' judgment regarding the best way to move patients: complexity of everyday care, patient treatment goals, time, knowledge, and equipment issues.
AJN, American Journal of Nursing, 2006
The development of a transcultural Web site created by a multidiscplinary committee in a large me... more The development of a transcultural Web site created by a multidiscplinary committee in a large medical center is described. The purpose of this Web site is to give direct patient caregivers immediate, around-the-clock access to various types of transcultural information that can serve as an aid in the provision of culturally competent care. This article outlines the steps to developing the Web site and provides a description of the types of informational resources available on it.
& Abstract One of the most significant changes in modern healthcare delivery has been the evoluti... more & Abstract One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk man-agement/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care deliv-ery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). Like all technological developments, the EHR has changed healthcare practices and relationships. In this study, we argue that the primary change has been a shift in focus of documentation from monitoring individual patient progress to recording data pertinent to institutional priorities. We focus on the consequences that this change has for patients and providers. We argue that the organization of work and the patient–clinician relationship are subtly but powerfully shifting in response to changes in healthcare
Journal of Nursing Administration, 2001
Bulletin of The History of Medicine, 2004
... in a medical manner. Medicine is not merely a background to Plath or any of the other autho... more ... in a medical manner. Medicine is not merely a background to Plath or any of the other authors: their writing could not exist without it. ... Hans-Peter de Ruiter University of Minnesota and Fairview University Hospital Minneapolis Konrad Maurer and Ulrike Maurer. ...
Nursing Management (springhouse), 2001
Creative Nursing, 2008
A nurse who has practiced in different countries reflects on the words used in various languages ... more A nurse who has practiced in different countries reflects on the words used in various languages to name our profession, and what those words have to say about the deeper meaning of nursing.
The handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in... more The handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in health-care institutions. For obvious reasons, this puts healthcare providers at risk for musculoskeletal injuries (MSIs); furthermore the risk of such injuries has been considered an inherent risk of care work. In the last decade a concerted effort has been made to decrease (with the goal of eliminating) caregiver injuries by implementing safe patient handling programs (SPHP). These programs are presented as evidence-based algorithms that require the use of mechanical lifting devices. Institutions implement SPHPs as policies and procedural guidelines to which caregivers must conform. SPHPs represent a change in institutional thinking from the earlier belief that MSIs were inherent to care work, to the contemporary idea that injuries are preventable. Despite these efforts, healthcare providers continue to be exposed to the risk of injury.
The assumptions underlying the SPHP are open to questions, none of which are addressed in the literature. Most importantly the literature does not take into consideration that healthcare providers are handling individual patients with subjective and unique needs. For the purpose of understanding why healthcare providers continue to be exposed to the risk of MSIs, the purpose of this study is to explore how the generic policies and guidelines meant to apply to all patient-caregiver interactions impact patients and caregivers in everyday care work. In particular, this study examines the complexity of
care delivery on inpatient care units that have implemented the latest research recommendations regarding safe patient handling. This study starts with the assumption that care workers are positioned at the intersection between the patient and the hospital policies and guidelines that govern their care. In order to understand the caregivers’ continued exposure to injury, this study examines the work of caregivers during their shift and the policies and guidelines they encounter that impact their decisions.
This study is an Institutional Ethnography (IE), a unique research approach that makes visible how complex actions in everyday care work are coordinated by institutional texts such as policies and guidelines. This research approach permits the researcher to make visible the connection between the actual day-to-day experiences of people and the organizational priorities as reflected in institutional texts.
This study was conducted in two healthcare facilities on neurology and rehabilitation units which had instituted SPHPs and had state-of-the-art lifting equipment.
Two sources of data were collected for this study, the first were observations of every day lifting. It describes caregiver practice beginning with 1. A description of how caregivers obtain the knowledge they need to handle the patients encountered during their shift. 2. What occurs once the caregiver encounters the patient. 3. Their decision-making process
used to determine how to transfer a patient. 4. How the transfers are brought into action, and 5. How this care is then documented and reflected in the patient's record. The second
source of data were the institutional texts that impacted the handling of patients. These were identified by interviewing caregivers and managers and performing searches in
institutional data base