Background: Quality Improvement (QI) is the key for every healthcare organization. QI programs may help healthcare professionals to develop the needed skills for interprofessional collaboration through interprofessional education. Furthermore, the role of diversity in QI teams is not yet fully understood. This evaluation study aimed to obtain in-depth insights into the expectations and experiences of different stakeholders of a hospital-wide interprofessional QI program. Methods: This qualitative study builds upon 20 semi-structured interviews with participants and two focus groups with the coaches and program advisory board members of this QI program. Data were coded and analyzed using thematic analysis. Results: Three themes emerged from the analysis: “interprofessional education”, “networking” and “motivation: presence with pitfalls”. Working within interprofessional project groups was valuable, because participants with different experiences and skills helped to move the QI project forward. It was simultaneously challenging because IPE was new and revealed problems with hierarchy, communication and planning. Networking was also deemed valuable, but a shared space to keep in contact after finalizing the program was missing. The participants were highly motivated to finish their QI project, but they underestimated the challenges. Conclusions: A hospital-wide QI program must explicitly pay attention to interprofessional collaboration and networking. Leaders of the QI program must cherish the motivation of the participants and make sure that the QI projects are realistic.
Abstract Background: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
We developed an application which allows learners to construct qualitative representations of dynamic systems to aid them in learning subject content knowledge and system thinking skills simultaneously. Within this application, we implemented a lightweight support function which automatically generates help from a norm-representation to aid learners as they construct these qualitative representations. This support can be expected to improve learning. Using this function it is not necessary to define in advance possible errors that learners may make and the subsequent feedback. Also, no data from (previous) learners is required. Such a lightweight support function is ideal for situations where lessons are designed for a wide variety of topics for small groups of learners. Here, we report on the use and impact of this support function in two lessons: Star Formation and Neolithic Age. A total of 63 ninth-grade learners from secondary school participated. The study used a pretest/intervention/post-test design with two conditions (no support vs. support) for both lessons. Learners with access to the support create better representations, learn more subject content knowledge, and improve their system thinking skills. Learners use the support throughout the lessons, more often than they would use support from the teacher. We also found no evidence for misuse, i.e., 'gaming the system', of the support function.
