National Representative The Netherlands:

Myriam Crijns RN, MSc., Steering Group Member

Work address: Netherlands Centre for Excellence in Nursing (LEVV) P.O. Box 3135 3135 GC Utrecht, The Netherlands
Tel. at work: +31 30 291 9005  
Fax: +31 30 291 9049
E-mail: m.crijns@levv.nl

Download Annual Reports Below:

Netherlands Scoping Report 2005

Annual Report 2003


Nursing Research in the Netherlands 1997

Background:

The Netherlands has about 15.5 million inhabitants. On average they enjoy good health, a high life expectancy and low infant mortality. By 2010, the Central Bureau for Statistics (CBS) expects life expectancy to increase to 75.0 year for men and 81.5 years for women. However, the growing percentage of elderly people is one of the reasons why the demand for health care has been growing for some time. Other reasons for the growing demand for health care are for example advanced treatment, improved medical appliances, modern standard of comfort, as well as the increasing lack of safety (1). The number of inhabitants is growing by about 3.6% since 1990 and the total growth of the population is on average 0.5% per year (2). The health care is a large branch of economic activity. In 1997, expenditure mounted to about 65 billion guilders and is of the same order as that spent on housing (1). Only about 10% of the health care is paid for directly from public funds, 80% is covered by compulsory and private medical health insurance premiums, and some 10% by patients' own contributions (13).

Only sufficient personnel of sufficient quality will be able to supply health care that meets the demands of society. That is why labour market policy is of great importance, as within some years a shortage of personnel is being predicted again. The number of working nurses and second-level nurses/caring personnel increased during the period 1990-1995 with almost 17%, since then it is stabilizing. To cover health care there are about 370,000 nursing and caring personnel working actively in all kinds of intra-, semi-, and extra-mural care settings (2).

The government is beginning to acknowledge the key position of these professions in the care process and therefore, in 1993 the National Centre for Nursing and Care (LCVV) was established to improve the position of nurses and care providers in all sectors and subsectors of health care. The Centre is being funded by the government. In 1996 the General Assembly of Nursing and Allied Health Professional Groups (AVVV), a cluster of 43 professional organizations in nursing and care, including the National Nurses Association of the Netherlands, NU'91, and the Society of Nursing Scientists (VERVE) became an important coalition partner. Together the AVVV, LCVV and NU'91 bring out viewpoints concerning developments in care that influence matters of professional content. However, a nationally coordinated nursing research strategy has not yet been established by this consortium (5). For the quality assurance of care the Nursing Scientific Council (VWR) plays a marginal role by providing directives and standards for nursing care since 1988. They published in 1997 the directive for subcutaneous injection of heparin (15). Since the successful second European Nursing Congress on "Empowerment of the chronically ill: A challenge for nursing" at Amsterdam, October 1997, the LCVV is in process to become a WHO Collaborating Centre for the (nursing) care of the chronically ill.

Historical summary regarding nursing research education

Since the University of Maastricht opened in 1980 its faculty for the course in Nursing Science more than 1,000 nursing scientists have graduated. Number 1,000, Paul Baartsmans, graduated on 2 April, 1997, which was striking as Paul did the part-time study and travelled for 3.5 years 1,400 kilometres up and down from Switzerland. Since 1990 the University of Maastricht started also collaborating with the Universities of Utrecht and Groningen in providing courses in Nursing Science.

From 1988 there is also the possibility to follow a master's programme in nursing science at The Hogeschool van Utrecht (Polytechnic) in collaboration with the University of Wales (UK), where almost 100 students have graduated since then. Since 1990, there is also the Amsterdam Medical Centre (AMC) internal educational course for "Clinical Epidemiology for Nurses" which lasts 2 years and is an internal training but open for non-AMC nurses. Participants are trained in clinical epidemiology and biostatistics in order to be able to either execute or participate in clinical scientific research.

Annual Report for 1997 - the Netherlands

Education for and in nursing research

General basic education

With regard to the basic nursing education the vocational and professional training courses for nurses and care providers have been subject to review and grouped together in a transparent and coherent new system since the implementation of it in August 1997. The new structure had to meet the demands made upon professional practitioners by the Individual Health Care Professions Act (Wet BIG) (3) and the Decree on Educational Requirements in Nursing, which springs from it. These educational requirements are in line with the current European directive 77/453/EEG. The new system also falls now only under various education laws (and therefore the portfolio of the Ministry of Education, Culture and Science), namely the Adult and Vocational Education Act (WEB) and the Higher Education and Research Act (WHW). The new qualification structure for nursing and care providing is now made up of five so-called 'qualification levels'. Each qualification level details the competence (skills and knowledge) of a professional practitioner, based upon three criteria: responsibility, complexity, and transfer. The competence of the professional practitioner increases per level.

The course leading to qualification as a (generic) nurse lasts at least four years at both level 4 (Middle Vocational Training) and level 5 (Higher Professional Training), both leading to the official title of Registered Nurse (4).

Education in nursing research

In the Netherlands nurses with such a basic level of education are able to understand and apply nursing research results and graduates from level 5 are able to carry out minor research. For research on a more advanced level, the nurses with a basic education can apply for a course leading to a university degree for nurse scientists or master in nursing science at one of the Universities of Maastricht, Utrecht or Groningen, or the Hoogeschool van Utrecht. Which resulted in about 78 new full-time and part-time students for the year 1997-1998 (25 for Maastricht, 13 for Groningen, and 38 for Utrecht), and about 25 for the master of nursing course at Utrecht.

 

  • Prof. Dr. Carla M.A. Frederiks was officially inaugurated as professor in nursing at the medical faculty of the University of Nijmegen. (January 1997).
  • Prof. Dr. Rob de Haan was officially inaugurated as professor in clinical epidemiology in nursing at the medical faculty of the University of Asterdam. (May 1997).
  • Prof. Dr. Theo Dassen was officially appointed professor in nursing science at the highest level professorship at the Humboldt University in Berlin, Germany. (October 1997).
  • Prof. Dr. George Evers was also officially appointed professor in nursing at the Institute for Nursing Science of the University of Witten/Hedecke, Germany (November 1997).

Completed and ongoing research

Since the beginning of the nursing science programmes in 1980 there is, especially during the last years, an increasing number of nursing research being carried out. For example, the information centre of the National Centre for Nursing and Care has published in 1997 a floppy disk: The O + O databank. On this disk about 1,400 research and development projects in the field of nursing and caring from 1985 onwards in the Netherlands are mentioned. Nurses are doing more and more research in all kinds of settings and multi- and monodisciplinary teams in universities, academic hospitals, and health care research institutes.

To gain insight in the number and nature of nursing research in academic medical hospitals, Marieke Schuurmans has in 1997 started an investigation into this unknown phenomenon. So, maybe next year it will be possible to inform you about her findings.

The following can be stated about completed and ongoing research:

With regard to the department of nursing science at the University of Maastricht the research activities fall mainly within four research projects: quality of care; continuity of care; occupational health care interventions; and experimental psychopathology. The research itself can be categorized into two main research themes: care process and nursing and the working environment. Examples of completed research were given in the report of last year. In 1997 70 nurses graduate from the Nursing Science Programme at the University of Maastricht. The department of health ethics and philosophy of the University of Maastricht carried out a national survey on moral problems among Dutch nurses and a nurse ethical perspective on euthanasia in the Netherlands by the main researcher Dr. Arie van der Arend. Ongoing research is on the professional codes in nursing; nursing errors and quality assurance in Dutch health care; and an ethics of care approach in a nursing oncology department. The research lines are moral aspects of professionalization in nursing and care, technology and culture (6).
In September 1998 there will also start a course for Master of Science in Epidemiology at the faculty of Health Sciences of the University of Maastricht. It will last one year. On 10 January, 1997, Maike Groen received the student prize during the celebration of Dies Natalis of the University of Maastricht. She got this prize for her doctoral study and report "Towards a univocal definition and classification of patient outcome; interim report of a Delphi survey".

The Hogeschool van Utrecht (Polytechnic) and the faculty of health care, department of nursing science, of the university of Utrecht are collaborating with the Universitiy of Wales on university nursing education and research. The research programme is carried out by the department responsible for the Master of Science in Nursing, and parts of this programme are carried out within different collaborating connections like the Collaborative Nursing Research Programme (CNRP) at Utrecht and the Nursing Research Programme of the School of Nursing Studies at Cardiff. The main theme of the programme is the research into the implementation and effectivity of the use of research results in practice, with the following projects: nursing education and health care information; nursing practice; and nursing management and health care information; nursing practice; and nursing management and innovation. The main researcher and coordinator is Dr. R. van Linge (7).

The Department of Nursing Science in the faculty of Medicine of the Utrecht University is offering a part-time Master of Nursing Science Degree programme in collaboration with the Universities of Maastricht and Groningen. This MUG programme started in 1990. Prof. Dr. Grypdonck is chair of the department. The other professors are prof. Dr. M. Duijnstee, prof. Dr. L.M. Shortridge, and prof. Dr. J. Winnubst. The Collaborative Nursing Research Programme (CNRP) is mainly focusing on two headlines: Line 1: Nursing care of the chronically ill, and Line 2: The implementation of research based nursing practice. Nineteen PhD candidates are working on several projects in both lines, supervised by their professors.

At present a total number of 156 students are enrolled in the part-time Master of Nursing Science Degree Programme at the Utrecht University. The number of students who enrolled the first year of the programme in September 1997 in Utrecht was 42. In 1997, 26 students were awarded with a Master of Science Degree in Nursing. Two of these students were certified with a 'cum laude'. Michel Kappen was one of them. He was awarded with the Johanne Diepeveen-Speekenbrink prize for his Master of Science in Nursing research thesis. The title of hist study: 'The development of an instrument measuring 'self-efficacy beliefs' of children (8-12 years), with insulin dependent diabetic mellitus'.

At the University of Groningen,faculty of health sciences, section nursing science, research is partly carried out at the Northern Centre for Health Studies. An example of a completed research is the study into continuity of care in the home care for chronically ill and mentally handicapped people. Which was aiming at the development of a measurement instrument to measure the continuity of care. The main researchers were P. Moorer and R.H. Bakker. In 1997, 16 students started on the nursing science programme at the University of Groningen and there were 12 students who graduated from the nursing science programme in Groningen. Each of them completed a research thesis. Ongoing research is carried out into the nursing diagnosis of aggression; nursing care - dependency scale (VZA scale); the development of a methodology for psychiatric home care; and fatigue, the development of an instrument. And they are preparing research into con-compliance and self-management. The main research theme of the department of Nursing Science at the University of Groningen is mental health care and the care of the chronically ill people (including the mentally handicapped) with an emphasis on diagnoses, interventions, and outcomes (8).

At the Academic Hospital and University of Nijmegen a lot of nursing research is conducted as well, certainly since the appointment of Prof. Dr. Frederiks as professor in nursing. For example, the research into nursing diagnoses and interventions in relation to nausea and vomiting by chemo-therapy by M. de Hullu and the research into the validity and reliability of the Braden instrument by R. Bal. And there are many ongoing research projects now by nurse researchers., students of nursing science, and external nurse researchers. The main research theme will be the effectivity of nursing interventions and nursing diagnostics (9).

The Netherlands Institute for Primary Health Care (NIVEL),WHO Collaborating Centre for Primary Health Care also carried out a lot of nursing research in 1997 under the leadership of Dr. A. Kerkstra and Dr. A. Francke. The research programme encompasses four major items:

  • Factors influencing job satisfaction, burn-out and pressure of work in nursing and home-help services.
  • Effects of collaboration: 'transmural nursing' and integration of community nursing and home-help services. Policy is aimed at cohesion between nursing facilities in primary care and in hospital in order to increase the quality and continuity of care for (chronically ill) patients. Therefore, nursing care at the interface between hospitals and home care ('transmural nursing') is becoming more important.
  • Quality of nursing care. These studies focus on the quality of nurse/patient communication in home care, homes for the elderly, nursing homes, and hospitals. Also, the patient perspective on quality of care or quality of life is being measured in most of the studies.
  • International comparison of home care. With the Unification of Europe, it is important to have the information about the organisation and funding of home care in the member states, in order to improve communication and co-operation among home care organisations as well as among policy makers at European Union level.

Next to NIVEL there is also the Dutch Institute for Care and Welfare (NIZW) which is carrying out nursing research and is having a specific nursing programme under the leadership of Dr. A. Pool. From a study into the future scenarios for nursing in the Netherlands, which was completed in 1997, it was not clear in what direction the nursing profession will develop. The scenarios are termed needs assessment, insurance, catchment area, and service scenario. Scenarios are an aid for the nursing profession to find out in which direction they are heading and whether this is consistent with their wishes. Among other things, nurses can take steps to either prevent or promote a specific situation. The nursing programme of the NIZW is directed towards mainly home care nursing. The main target of the programme is to improve home care nursing. The main target of the programme is to improve home care nursing and is deepened by four research lines: quality and policy; perception directed care; psychosocial care; and specialization/differentiation. With regard to the perception directed care the main research question will be if the classification of problems according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH) can be used in the rendering of home care from that perspective (11).

Almost for 30 years the National Hospital Institute (NZI) is active as well in the field of research for the health care sector in the Netherlands. In the beginning mainly to support the management of intramural health care institutions. However, at present the NZI has developed itself to a broad knowledge, research, and practice supporting centre for the total health care sector (14).

Dissemination and utilization

The National Centre for Nursing and Care (LCVV) is beginning to be one of the main institutions for disseminating research results among fellow professionals by means of having an information centre with for example the presentation of a floppy disk informing about 1,400 research and development projects in the field of nursing and caring from 1985 onwards in the Netherlands. But also by having a nursing and health care library, publishing brochures and organizing congresses. The LCVV funds research projects aiming at the practice of nursing and care and it implements results of practice-based research.

In 1997 the Society for Nursing Scientists, VERVE, changed their policy and is no longer just a aluminum society but also aiming now at the dissemination and promotion of nursing research. In that way it will adopt and follow the nursing research report and recommendations by the European Health Committee (CDSP) (12). NU'91 has asked VERVE to appoint a member of VERVE to represent them here at the WENR.

The Department of Nursing Science, University of Utrecht, organized the fifth Mebius Kramer lecture on April 11, 1997. The lecture was held by Ann Gardulf, PhD, Director of the Nursing Care Development and Research Unit, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. The title of her lecture: "Patients with Primary Antibody Deficiency Aspects of Treatment, Nursing Care, Quality of Life and Costs".

The Utrecht Nursing Research Interest Group has met four times during the past academic year. Several PhD projects were presented at these meetings.

Also at international and national conferences research results were being presented and discussed.

Involvement of the National Nurses Association

By asking VERVE (Society for Nursing Scientists) to represent them at this WENR Meeting it might be concluded that in connection with the coming into existence of the AVVV (General Assembly of Nursing and Allied Health Professional Groups) NU'91 is acknowledging their responsibility as the official National Nursing Organisation for the development and promotion of nursing research in the Netherlands. NU'91 and VERVE are going to organize reference meetings before and after the Annual WENR Meetings with all the relevant parties, in order to help the Dutch representative to prepare for those meetings and to discuss the main matters with them afterwards.

Funding

There are several semi-governmental and private funds available to support nursing research. However, a national policy for this matter is lacking and it is hoped that out of the abovementioned collaboration between VERVE, NU'91, AVVV, and the National Centre for Nursing and Care something will come up in the future. In that way it can adopt and follow the nursing research report and recommendations by the European Health Committee (CDSP) (12).

For designing, monitoring, and management of research programmes, a new intermediary organisation is currently being set up, the socalled PEO Fund (Fund for projects, experiments and research) with money from the Ministry of Health (VWS) and spent via the new intermediary research-organization Zorgonderzoek Nederland (ZON) (Care Research Holland). The basic and/or targeted grants are limited to several non-academic institutes such as the Netherlands Institute for research into Primary Health Care (NIVEL). The sum concerned amounts to more than 80 million NLG Dutch Guilders, which can flexibly be employed on a programme basis.

Future developments

Probably the research into home care and the care of the chronically ill and handicapped will be of importance in the future and one of the main research lines for the Netherlands. Certainly when the LCVV will gain the status of WHO collaborating centre for that matter. Another issue will be the testing, developing, and measuring the results of nursing diagnoses, interventions, and outcomes.

Summary of key issues

The growth of number of nursing scientists carrying out nursing research.

The collaboration between the NNA of the Netherlands, NU'91, and VERVE with regard to the promotion of nursing research and discussion with the relevant parties in the Netherlands.

The role of the LCVV for this matter and especially for the possible development of setting up a national databank and information centre for nursing research and implementation of the European Health Committee's Nursing Research Report and Recommendations.

References

  1. Health and Sound, Framework for Health Policy in the Netherlands 1995-1998, Ministry of Health, Welfare and Sport, Rijswijk, August 1996.
  2. LCVV (1997): Feiten over verpleging en verzorging in Nederland (Facts about nursing and caring in the Netherlands). Utrecht: De Tijdstroom/LCVV.
  3. Ministry of Health, Welfare and Sport (1997): Fact sheet: The Individual Health Care Professions Act. Rijswijk: VWS.
  4. Ministry of Education Culture and Science (1997): Qualified for the Future, a summary. Zoetermeer: OC&W.
  5. National Centre for Nursing & Care (LCVV) (1997) (brochure): Influence of nursing care: better care. Utrecht: LCVV.
  6. Annual report 1996, Faculty of Health Sciences, Department of Nursing Science of the Maastricht University.
  7. Information given by F. Mensink, leader of the Master of Nursing Science Programme at the University of Utrecht.
  8. Information given by M. Kastermans of the department for Nursing Science of the University of Groningen.
  9. Information given by Prof. Dr. C. Frederiks of the Faculty of Medical Sciences of the University of Nijmegen.
  10. Information given by Dr. A. Francke of NIVEL.
  11. NIZW (1998): Werkprogramma. Utrecht: NIZW.
  12. European Health Committee (CDSP) (1966): Nursing research report and recommendations. Strasbourg: Council of Europe.
  13. Ministry of Welfare, Health and Cultural Affairs (1993): Health care in the Netherlands, Facst sheet, Rijswijk: WVC.
  14. From "Zorgtelematica Transparant", February 1998, 3, 1.
  15. Information given by Aart Eliëns, President of the Nursing Scientific Council (VWR).

W. Bakker
Executive Director of NU'91

N.E. Oud
Representative of NU'91

WENR c/o LEVV, P.O. Box 3135, 3502 GC Utrecht, The Netherlands,
Tel: +31 30 291 9005 Fax: +31 30 291 9049 E-mail:   wenr@levv.nl