Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians and identify drivers for and barriers to reallocation. Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
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Because physical fitness and health are related to physical activity, it is important to gain an insight into the physical activity levels of persons with profound intellectual and multiple disabilities (PIMD). The purpose of this study was to examine heart rate patterns to measure the activity levels of persons with PIMD and to analyze these heart rate patterns according to participant characteristics, observed level of activity, days, and time of day. The heart rate patterns of 24 participants with PIMD were measured continuously using a heart rate monitor for 8 h·d for a period of 6 days. Physical activity levels were measured with questionnaires. Data were analyzed using multilevel analysis. The results indicate that the participants use only 32% of their heart rate reserve over 6 days. The intensity of heart rate reserve ranged from 1 to 62%. On a given day, wide ranges in heart rates between participants and within persons were observed. Between days, only small ranges in the heart rate were found. The participants could be grouped into 4 classes according to their heart rate. In addition, factors such as time of day, physical activity, and age are significantly related to heart rate patterns. In conclusion, this study is an important first step in exploring activity patterns based on heart rate patterns in persons with PIMD. The participants used relatively small fractions of their heart rate reserves. Time of day and age appear to have a considerable influence on heart rate patterns. The observed classes in heart rate patterns suggest that other probably more personal and psychosocial factors have significant influences on heart rate patterns, as well
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The road to science for the arts therapies requires research on the full breadths of the spectrum, from systematic case studies to RCTs. It is important that arts therapists and arts therapeutic researchers reflect on the typical characteristics of each research paradigm, research type and research method and select what is appropriate with regard to the particular research question. Questions rather differ. Finding out whether a certain intervention has a particular effect with a large group of clients differs from wanting to know which change occurs at which moment by which interventions in the treatment of an individual client. Research in practice remains close to questions encountered by arts therapists in their daily practice. It concerns questions arts therapists have about their lived experience of acting due to the complexity and variability of practice. By carrying out research in practice that links up with those questions, evidence evolves; evidence that enables the professional to proceed and that makes explicit what often remains implicit and unsaid. What is explicit can be communicated, can be criticised and tested. The professional himself does the road to science of the profession. The investment in professionals’ research in practice is the motor of knowledge-productivity that bridges the theory-practice gap. Research in the arts therapies should lead to ‘knowledge’ in which the ‘art’, nor the ‘subject’ of therapist and client have been lost.
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Clinical decision support systems (CDSSs) have gained prominence in health care, aiding professionals in decision-making and improving patient outcomes. While physicians often use CDSSs for diagnosis and treatment optimization, nurses rely on these systems for tasks such as patient monitoring, prioritization, and care planning. In nursing practice, CDSSs can assist with timely detection of clinical deterioration, support infection control, and streamline care documentation. Despite their potential, the adoption and use of CDSSs by nurses face diverse challenges. Barriers such as alarm fatigue, limited usability, lack of integration with workflows, and insufficient training continue to undermine effective implementation. In contrast to the relatively extensive body of research on CDSS use by physicians, studies focusing on nurses remain limited, leaving a gap in understanding the unique facilitators and barriers they encounter. This study aimed to explore the facilitators and barriers influencing the adoption and use of CDSSs by nurses in hospitals, using an extended Fit Between Individuals, Tasks, and Technology (FITT) framework.
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This study addresses the burgeoning global shortage of healthcare workers and the consequential overburdening of medical professionals, a challenge that is anticipated to intensify by 2030 [1]. It explores the adoption and perceptions of AI-powered mobile medical applications (MMAs) by physicians in the Netherlands, investigating whether doctors discuss or recommend these applications to patients and the frequency of their use in clinical practice. The research reveals a cautious but growing acceptance of MMAs among healthcare providers. Medical mobile applications, with a substantial part of IA-driven applications, are being recognized for their potential to alleviate workload. The findings suggest an emergent trust in AI-driven health technologies, underscored by recommendations from peers, yet tempered by concerns over data security and patient mental health, indicating a need for ongoing assessment and validation of these applications
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Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐ interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk— as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.
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Background. One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. Objective. Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients’ overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. Methods. This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, vanWoerkumCMJ, Fieren CJ, vantHofMA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29–36.) demonstrated that ‘noticing patients’ overweight and guidance of treatment’ was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). Results. This analysis shows both similarity and differences inworking mechanism of determinants of noticing patients’ overweight and guidance of treatment between 1997 and 2007. The backbone of themechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. Conclusions. The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients’ overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients’ overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.
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Background: Inequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to ‘promote well-being for all’. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration. Method: We conducted a Concept Analysis (CA) of twinning in healthcare using Morse’s method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field. Results: We found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals. Conclusions: Based on these four attributes we developed the following operational definition: Twinning is a crosscultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare.
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BACKGROUND: Although enhancing physical activity (PA) is important to improve physical and/or cognitive recovery, little is known about PA of patients admitted to an inpatient rehabilitation setting. Therefore, this study assessed the quantity, nature and context of inpatients PA admitted to a rehabilitation center. METHODOLOGY/PRINICIPAL FINDINGS: Prospective observational study using accelerometry & behavioral mapping. PA of patients admitted to inpatient rehabilitation was measured during one day between 7.00-22.00 by means of 3d-accelerometery (Activ8; percentage of sedentary/active time, number of sedentary/active bouts (continuous period of ≥1 minute), and active/sedentary bout lengths and behavioral mapping. Behavioral mapping consisted of observations (every 20 minutes) to assess: type of activity, body position, social context and physical location. Descriptive statistics were used to describe PA on group and individual level. At median the 15 patients spent 81% (IQR 74%-85%) being sedentary. Patients were most sedentary in the evening (maximum sedentary bout length minutes of 69 (IQR 54-95)). During 54% (IQR 50%-61%) of the observations patients were alone) and in their room (median 50% (IQR 45%-59%)), but individual patterns varied widely. CONCLUSION/SIGNIFICANCE: The results of this study enable a deeper understanding of the daily PA patterns of patients admitted for inpatient rehabilitation treatment. PA patterns of patients differ in both quantity, day structure, social and environmental contexts. This supports the need for individualized strategies to support PA behavior during inpatient rehabilitation treatment.
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Nursing Leadership is an important competence to develop for providing quality of care and preventing attrition of nurses. This study looked into the perceptions and experiences of nurses on practising leadership related to performing bachelor nursing competencies. Next to that awareness of the development of nursing leadership was addressed.
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