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.
DOCUMENT
Objectives To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses’ scope and domain of practice and that are influenced by nursing inputs and interventions. Design A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. Setting District nursing care in the community care setting in the Netherlands. Participants Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Main outcome measures Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. Results In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient’s autonomy, the patient’s ability to make decisions regarding the provision of care, the patient’s satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. Conclusions This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.
DOCUMENT
The rising global demand for district nursing care necessitates effective strategies to support evidence-based decision-making. Despite the extensive development of nursing guidelines, adherence by district nursing teams remains suboptimal, revealing a gap between guideline development and daily practice. The Learning And Reflection for Nurses (LEARN) programme aims to bridge this gap by enhancing guideline use and fostering a learning attitude among district nursing teams. This protocol outlines the programme’s development, components and evaluation approach.
LINK
The goal of this research is to develop an instrument for working with justice in urban development projects for urban professionals such as policy makers, urban planners and designers. The instrument will provide them with the tools to set up participatory processes for the development of urban areas where conflicting interests and perspective on justice form a challenge in working towards a just solution for a shared ambition. The plans for the future of de Wallen, Amsterdam’s Red Light District, will function as a case study for this research. There, conflicting interests have formed a challenge in creating a shared vision for the future of the neighborhood, mainly regarding the presence of sex work. The instrument will be developed in co-creation with the stakeholders of the neighborhood, with a focus on the involved policy makers and designers as the changemakers.
The key societal problem addressed by the EmPowerED consortium is the urgent need to accelerate and scale up the development of Positive Energy Districts (PEDs). Carbon neutral heating and cooling is a core element of the design of Positive Energy Districts (PEDS). However, many Dutch heat transition projects run behind schedule and are not compatible with this future vision of PEDs, making the heat transition a key factor in PED realization and upscaling. In this heat transition and the transition to PEDs, citizen engagement and support is a key societal factor and citizens need to be an integral part of the decision-making process on the realization of PEDs. Furthermore, technical, regulatory and financial uncertainties hamper the ability of decision makers to create PED system designs that have citizen support. Such system designs require a deep understanding of the relevant social, spatial, governance, legal, financial, and technical factors, and their interactions in PED system designs.
Family Dairy Tech Sustainable and affordable stable management systems for family dairy farms in India. An example of Dutch technology that is useful to an ?emerging economy?. Summary Problem The demand for dairy products in India is increasing. Small and medium-sized family farmers want to capitalize on this development and the Indian government wants to support them. Dutch companies offer knowledge and a wide range of products and services to improve dairy housing systems and better milk quality, in which India is interested. However, the Dutch technology is sophisticated and expensive. For a successful entry into this market, entrepreneurs have to develop affordable and robust (?frugal?) systems and products adapted to the Indian climate and market conditions. The external question is therefore: ?How can Dutch companies specialised on dairy housing systems adapt their products and offer these on the Indian market to contribute to sustainable and profitable local dairy farming??. Goal Since 2011, VHL University of Applied Sciences (VHL) is collaborating with a college and an agricultural information center Krishi Vigyan Kendra (KVK), Baramati, Pune district, Maharashtra State India. In this region many small-scale dairy farmers are active. Within this project, KVK wants to support farmers to scale up their farm form one or a few cows up to 15 to 100 cows, with a better milk quality. In this innovative project, VHL and Saxion Universities of Applied Sciences, in collaboration with KVK and several Dutch companies want to develop integrated solutions for the growing number of dairy farms in the State of Maharashtra, India. The research questions are: 1. "How can, by smart combinations of existing and new technologies, the cow-varieties and milk- and stable-management systems in Baramati, India, for family farmers be optimized in an affordable and sustainable way?" 2. "What are potential markets in India for Dutch companies in the field of stable management and which innovative business models can support entering this market?" Results The intended results are: 1. A design of an integral stable management system for small and medium-sized dairy farms in India, composed of modified Dutch technologies. 2. A cattle improvement programme for robust cows that are adapted to the conditions of Maharashtra. 3. An advice to Dutch entrepreneurs how to develop their market position in India for their technologies. 4. An advice to Indian family farmers how they can increase their margins in a sustainable way by employing innovative technologies.
