Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
Challenging behaviour, such as aggression towards oneself, others, or objects, arises in interaction with the environment and may prevent individuals from participating in society and compromise their quality of life (QoL). Literature suggests that architects can contribute to prevention, by influencing challenging behaviour before rather than after its occurrence. By conducting a case study at a very-intensive-care facility, we explore how architecture can contribute to the QoL of intellectually impaired (and autistic) individuals showing challenging behaviour. The case study is based on interviews with residents and care providers, and direct observations of their daily life. Preliminary findings confirm the relevance of architecture in influencing challenging behaviour. They suggest that the residents are dependent on the (visual and auditory) connection with the care provider. Also, care providers confirm the importance of this connection for the quality of the care they provide. At the same time, residents may experience anxiety triggered by fellow residents and their challenging behaviour. Residents may also feel stress when faced with unexpected situations and this may lead to an onset of challenging behaviour. Sensory sensitivity, specifically to noise and heat is also relevant for their QoL.The findings will be further substantiated through multiple triangulation with available data (personal files, incident reports, photographs). Future research, specifically focused on intellectually impaired individuals showing challenging behaviour, is needed to better understand the similarities and differences between their needs and the needs of autistic people.
MULTIFILE
Playful Mapping is the result of many years of joint enterprise in which we, as authors, devel-oped a close intellectual collaboration. As a book, it emerged towards the end of the ERC project Charting the Digital that ran from 2011-2016, and during a still-ongoing Erasmus+ project; Go Go Gozo. Over this five year period, members of the Playful Mapping Collective got to know each other as colleagues and friends, participating regularly in diverse academic and social activities, such as conference panels and workshops.1 The authorship of this book therefore reflects an interesting collaborative experiment, enrolling researchers who have been working together in an active way over the past half-decade. This preface explains the genealogy of the emerging and open collaboration through which we developed ideas
