Background: There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission. Method: A qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed. Results: The analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences. Conclusion: Frail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.
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Abstract from the authors: "In this paper we discuss our experiences of facilitating collaborative creative activities within healthcare. The study consists of a larger case study on innovation scouting with the staff at the emergency room backed up by a series of seven retrospective mini-case studies. By means of discussing our experiences we identify some insights and challenges. Challenges for design facilitators working in this domain relate to: 1) dealing with the clash of professional eco-systems, the informal designers’ way of working with the formal and procedural healthcare operations; 2) Positioning yourself ‘at the right table’ in order to find backing for concepts; and, 3) steering the intertwined processes of developing strategic direction and concrete products and services on the floor." Tanja van der Laan is spatial designer, lecturer and researcher, creative research group HKU Design (Hogeschool voor de Kunsten Utrecht).
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Emergency care (from ambulance to emergency room) is focused on somatic care: fixing the body. When a patient with mental dysregulation who experiences ‘disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours’ (Van de Glind et al. 2023) does not get appropriate attention, this can result in the disruption of treatment and even psychological trauma upon trauma. To improve the emergency care process, the authors of this paper - health researchers and design researchers engaged in a project based on the experience-based co-design (EBCD) approach (Donetto et al. 2015; Bate and Robert 2007). EBCD is a method used to design better experiences in healthcare settings, in cooperation with (former) patients and healthcare professionals. The process of EBCD involves partnerships between stakeholders and the discovery and sensemaking of experiences through specialized methods to gain an understanding of the interface between user and service, to design new experiences (Bate and Robert 2007, 31). There is, however, an interesting challenge in bringing patients and care professionals together. In emergency care, patients depend greatly on their healthcare providers. The patients in this study had existing mental vulnerabilities and may have been traumatized by previous visits. We needed to enable these stakeholders to be equal partners with ownership and power, one of the characteristics of co-design in EBCD (Donetto et al. 2015). In this paper, we describe how we adapted and applied the EBCD method, with a focus on creating equal partnerships. We also reflect on the extent of our success and the diBiculties we encountered in attaining this objective.
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BackgroundSpecialist palliative care teams are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist palliative care teams may help improve the outcomes of palliative care.MethodsIn this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period (2017 or 2018) in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records.ResultsWe extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). The estimated life expectancy was less than three months for 52.3% of all patients. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life.ConclusionThis study provides detailed insight into consultations of palliative care teams and shows that even though most palliative care consultations were requested for advance care planning, consultations focus on end-of-life care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate advance care planning would promote a more prevention-oriented approach. Defining factors that indicate the need for timely palliative care team consultation and advance care planning could help timely identification and consultation.
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In het winternummer van 2005, met het thema: Social Emergency and Crisis Intervention in Large European Cities, beschrijft Lia van Doorn de onderzoeksresultaten van een follow-up studie onder (voormalige) daklozen in Utrecht. Het betreft een kwalitatief onderzoek. In dit artikel worden drie fasen in het ontwikkelingsproces van de daklozen beschreven: Recente, langdurige en voormalige dakloosheid. De omstandigheden in deze fasen verschillen en daardoor ook de zorgbehoefte.
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Background: Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing. Methods: Trauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night). Results: All thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members). Conclusion: We found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.
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Ambient intelligence technologies are a means to support ageing-in-place by monitoring clients in the home. In this study, monitoring is applied for the purpose of raising an alarm in an emergency situation, and thereby, providing an increased sense of safety and security. Apart from these technological solutions, there are numerous environmental interventions in the home environment that can support people to age-in-place. The aim of this study was to investigate the needs and motives, related to ageing-in-place, of the respondents receiving ambient intelligence technologies, and to investigate whether, and how, these technologies contributed to aspects of ageing-in-place. This paper presents the results of a qualitative study comprised of interviews and observations of technology and environmental interventions in the home environment among 18 community-dwelling older adults with a complex demand for care.
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Om eerste beelden te verzamelen van het belang van een ontlokkende en vriendelijke inrichting, zijn er in het najaar van 2019 twee spreekkamers van de Jeugdgezondheidszorg opnieuw ingericht. Het team van Social Design Studio Joes + Manon heeft de inrichting ter hand genomen op de locaties De Gravin en F.C. Donderstraat. Het lectoraat schulden & Incasso van de Hogeschool Utrecht heeft vanuit haar ontwerpende rol in de aanpak van het stress-sensitief werken een vragenlijst voor een voor- en nameting ontwikkeld en de ingevulde vragenlijsten geanalyseerd. In het totaal zijn er 58 ouders bevraagd over de oude en 52 ouders over de nieuwe spreekkamer. Het resultaat van het onderzoek is dat de uitstraling van de spreekkamers op beide locaties significant positiever wordt beoordeeld na de herinrichting van de spreekkamers. De uitstraling is de optelsom van hoe vriendelijk, veilig en verwelkomend de spreekkamer op mensen overkomt. Daarbij voelen mensen zich ook significant vrijer om te praten over hetgeen zij belangrijk vinden. Het effect op het vrij voelen is kleiner dan het effect van de ervaren uitstraling. Dat verschil kan wellicht verklaard worden uit het gegeven dat uitstraling alleen over de spreekkamers gaat en hoe vrij je je voelt met meer zaken in het contact samenhangt. Denk bijvoorbeeld aan het gevoel dat de medewerker je geeft in het gesprek of de mate waarin je je schaamt voor wat er speelt. De opzet van het onderzoek was een cross-sectioneel pre-post design. Dit houdt in dat de ouders die bevraagd zijn over de aanvankelijke spreekkamers niet dezelfde mensen zijn als de ouders die bevraagd zijn over de aangepaste spreekkamers. Daarbij is het aantal ouders dat een vragenlijst heeft ingevuld beperkt. De optelsom van deze twee zaken maakt dat de gevonden resultaten beschouwd mogen worden als belangrijke en interessante positieve aanwijzingen. In wetenschappelijke termen is de herinrichting niet onomstotelijk aan te wijzen als de causale veroorzaker van de gevonden positieve verschillen. Daarvoor zou op termijn nog een effectonderzoek uitgevoerd moeten worden. Mocht de gemeente dat voornemens zijn dan laat de in het kader van dit project uitgevoerde powerberekening zien dat er tussen de 46 en 94 ouders moeten worden bevraagd.
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In the last years we have observed a growing interest in the use of gamification approaches for climate change education. While most practices are related to digital gaming, there is a new trend which is still academically unexplored: escape rooms. The main objective of this paper is to serve as an initial exploratory study in this field by identifying and analysing climate change-related escape rooms. For that purpose we carried out a web search and a qualitative content analysis. A total of 17 initiatives are described and compared, unravelling their main audience, country of origin, topics, scenarios and objectives covered. The paper also highlights what escape rooms can offer to climate change education: experiential and immersive learning, problem solving and critical thinking skills, and a sense of collaboration and urgency.
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In maart 2011 dreigde Muammer Gaddafi van Libya duizenden onschuldige burgers van de stad Benghazi uit hun huizen te halen om hen te vermoorden. De Veiligheidsraad van de Verenigde Naties verwees de situatie door naar het Internationaal Strafhof in Den Haag, dwong een no-flyzone af en gaf de NAVO een mandaat om burgers te beschermen with all necessary means, met de uitzondering van grondtroepen. Deze operatie was snel, robuust en effectief. Het principe van The Responsibility to Protect (R2P) -de verantwoordelijkheid van de internationale gemeenschap om genocide, misdaden tegen de menselijkheid, etnische zuivering en oorlogsmisdaden te voorkomen en te stoppen- werd voor het eerst volledig toegepast. Is R2P daarmee een norm geworden? Dit onderzoek plaatst de casus Libië in het model van de "Norm Life Cycle" (de levenscyclus van een norm) van de Constructivistische theoretici Finnemore en Sikkink (1998). Libië toont aan dat R2P nu een tipping point (omslagpunt) heeft bereikt, en zich van de fase norm emergence (opkomende norm) naar de fase norm cascade heeft verplaatst. Er is echter een spanning ontstaan: de terughoudendheid van de Veiligheidsraad om R2P toe te passen in Syrië (2012) wijst de andere kant uit. Er is dus nog een lange weg te gaan, voordat R2P als een internalised norm (vanzelfsprekende norm) kan worden beschouwd. ABSTRACT In March 2011, Muammar Gaddafi of Libya threatened to pull thousands of civilian protesters in the city of Benghazi out of their homes and kill them. The Security Council of the United Nations referred the crisis to the International Criminal Court, imposed a no-fly zone and provided NATO with a mandate to protect civilians by all necessary means, with the exception of ground troops. This operation was fast, robust and effective. It also marked the first time that the Responsibility to Protect (R2P) principle was fully implemented, being the responsibility of the international community to prevent and respond to genocide, crimes against humanity and war crimes if the state in question is not able or not willing to protect its citizens itself. Has R2P become a new norm? This study situates the case of Libya in the 'Norm Life Cycle' model of Constructivist theorists Finnemore and Sikkink (1998). It suggests that R2P has reached a tipping point and has moved from the stage of norm emergence to the stage of norm cascade. However, a certain tension still exists: the reluctance of the Security Council to implement R2P again in the crisis in Syria (2012)points in the opposite direction. This suggests there is still a long way to go before R2P becomes an internalised norm in the international community.
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