Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.
Aim: In-hospital prescribing errors (PEs) may result in patient harm, prolonged hospitalization and hospital (re)admission. These events are associated with pressure on healthcare services and significant healthcare costs. To develop targeted interventions to prevent or reduce in-hospital PEs, identification and understanding of facilitating and protective factors influencing in-hospital PEs in current daily practice is necessary, adopting a Safety-II perspective. The aim of this systematic review was to create an overview of all factors reported in the literature, both protective and facilitating, as influencing in-hospital PEs. Methods: PubMed, EMBASE.com and the Cochrane Library (via Wiley) were searched, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, for studies that identified factors influencing in-hospital PEs. Both qualitative and quantitative study designs were included. Results: Overall, 19 articles (6 qualitative and 13 quantitative studies) were included and 40 unique factors influencing in-hospital PEs were identified. These factors were categorized into five domains according to the Eindhoven classification (‘organization-related’, ‘prescriber-related’, ‘prescription-related’, ‘technologyrelated’ and ‘unclassified’) and visualized in an Ishikawa (Fishbone) diagram. Most of the identified factors (87.5%; n = 40) facilitated in-hospital PEs. The most frequently identified facilitating factor (39.6%; n = 19) was ‘insufficient (drug) knowledge, prescribing skills and/or experience of prescribers’. Conclusion: The findings of this review could be used to identify points of engagement for future intervention studies and help hospitals determine how to optimize prescribing. A multifaceted intervention, targeting multiple factors might help to circumvent the complex challenge of in-hospital PEs.
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The study of human factors in forensic science informs our understanding of the interaction between humans and the systems they use. The Expert Working Group (EWG) on Human Factors in Forensic DNA Interpretation used a systems approach to conduct a scientific assessment of the effects of human factors on forensic DNA interpretation with the goal of recommending approaches to improve practice and reduce the likelihood and consequence of errors. This effort resulted in 44 recommendations. The EWG designed many of these recommendations to improve the production, interpretation, evaluation, documentation, and communication of DNA comparison results.
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The pace of technology advancements continues to accelerate, and impacts the nature of systems solutions along with significant effects on involved stakeholders and society. Design and engineering practices with tools and perspectives, need therefore to evolve in accordance to the developments that complex, sociotechnical innovation challenges pose. There is a need for engineers and designers that can utilize fitting methods and tools to fulfill the role of a changemaker. Recognized successful practices include interdisciplinary methods that allow for effective and better contextualized participatory design approaches. However, preliminary research identified challenges in understanding what makes a specific method effective and successfully contextualized in practice, and what key competences are needed for involved designers and engineers to understand and adopt these interdisciplinary methods. In this proposal, case study research is proposed with practitioners to gain insight into what are the key enabling factors for effective interdisciplinary participatory design methods and tools in the specific context of sociotechnical innovation. The involved companies are operating at the intersection between design, technology and societal impact, employing experts who can be considered changemakers, since they are in the lead of creative processes that bring together diverse groups of stakeholders in the process of sociotechnical innovation. A methodology will be developed to capture best practices and understand what makes the deployed methods effective. This methodology and a set of design guidelines for effective interdisciplinary participatory design will be delivered. In turn this will serve as a starting point for a larger design science research project, in which an educational toolkit for effective participatory design for socio-technical innovation will be designed.
Client: Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW) Funder: RAAK (Regional Attention and Action for Knowledge circulation) The RAAK scheme is managed by the Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW). Early 2013 the Centre for Sustainable Tourism and Transport started work on the RAAK-MKB project ‘Carbon management for tour operators’ (CARMATOP). Besides NHTV, eleven Dutch SME tour operators, ANVR, HZ University of Applied Sciences, Climate Neutral Group and ECEAT initially joined this 2-year project. The consortium was later extended with IT-partner iBuildings and five more tour operators. The project goal of CARMATOP was to develop and test new knowledge about the measurement of tour package carbon footprints and translate this into a simple application which allows tour operators to integrate carbon management into their daily operations. By doing this Dutch tour operators are international frontrunners.Why address the carbon footprint of tour packages?Global tourism contribution to man-made CO2 emissions is around 5%, and all scenarios point towards rapid growth of tourism emissions, whereas a reverse development is required in order to prevent climate change exceeding ‘acceptable’ boundaries. Tour packages have a high long-haul and aviation content, and the increase of this type of travel is a major factor in tourism emission growth. Dutch tour operators recognise their responsibility, and feel the need to engage in carbon management.What is Carbon management?Carbon management is the strategic management of emissions in one’s business. This is becoming more important for businesses, also in tourism, because of several economical, societal and political developments. For tour operators some of the most important factors asking for action are increasing energy costs, international aviation policy, pressure from society to become greener, increasing demand for green trips, and the wish to obtain a green image and become a frontrunner among consumers and colleagues in doing so.NetworkProject management was in the hands of the Centre for Sustainable Tourism and Transport (CSTT) of NHTV Breda University of Applied Sciences. CSTT has 10 years’ experience in measuring tourism emissions and developing strategies to mitigate emissions, and enjoys an international reputation in this field. The ICT Associate Professorship of HZ University of Applied Sciences has longstanding expertise in linking varying databases of different organisations. Its key role in CARMATOP was to create the semantic wiki for the carbon calculator, which links touroperator input with all necessary databases on carbon emissions. Web developer ibuildings created the Graphical User Interface; the front end of the semantic wiki. ANVR, the Dutch Association of Travel Agents and Tour operators, represents 180 tour operators and 1500 retail agencies in the Netherlands, and requires all its members to meet a minimum of sustainable practices through a number of criteria. ANVR’s role was in dissemination, networking and ensuring CARMATOP products will last. Climate Neutral Group’s experience with sustainable entrepreneurship and knowledge about carbon footprint (mitigation), and ECEAT’s broad sustainable tourism network, provided further essential inputs for CARMATOP. Finally, most of the eleven tour operators are sustainable tourism frontrunners in the Netherlands, and are the driving forces behind this project.
In order to stay competitive and respond to the increasing demand for steady and predictable aircraft turnaround times, process optimization has been identified by Maintenance, Repair and Overhaul (MRO) SMEs in the aviation industry as their key element for innovation. Indeed, MRO SMEs have always been looking for options to organize their work as efficient as possible, which often resulted in applying lean business organization solutions. However, their aircraft maintenance processes stay characterized by unpredictable process times and material requirements. Lean business methodologies are unable to change this fact. This problem is often compensated by large buffers in terms of time, personnel and parts, leading to a relatively expensive and inefficient process. To tackle this problem of unpredictability, MRO SMEs want to explore the possibilities of data mining: the exploration and analysis of large quantities of their own historical maintenance data, with the meaning of discovering useful knowledge from seemingly unrelated data. Ideally, it will help predict failures in the maintenance process and thus better anticipate repair times and material requirements. With this, MRO SMEs face two challenges. First, the data they have available is often fragmented and non-transparent, while standardized data availability is a basic requirement for successful data analysis. Second, it is difficult to find meaningful patterns within these data sets because no operative system for data mining exists in the industry. This RAAK MKB project is initiated by the Aviation Academy of the Amsterdam University of Applied Sciences (Hogeschool van Amsterdan, hereinafter: HvA), in direct cooperation with the industry, to help MRO SMEs improve their maintenance process. Its main aim is to develop new knowledge of - and a method for - data mining. To do so, the current state of data presence within MRO SMEs is explored, mapped, categorized, cleaned and prepared. This will result in readable data sets that have predictive value for key elements of the maintenance process. Secondly, analysis principles are developed to interpret this data. These principles are translated into an easy-to-use data mining (IT)tool, helping MRO SMEs to predict their maintenance requirements in terms of costs and time, allowing them to adapt their maintenance process accordingly. In several case studies these products are tested and further improved. This is a resubmission of an earlier proposal dated October 2015 (3rd round) entitled ‘Data mining for MRO process optimization’ (number 2015-03-23M). We believe the merits of the proposal are substantial, and sufficient to be awarded a grant. The text of this submission is essentially unchanged from the previous proposal. Where text has been added – for clarification – this has been marked in yellow. Almost all of these new text parts are taken from our rebuttal (hoor en wederhoor), submitted in January 2016.
