OBJECTIVE: 'Better By Moving' is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why 'Better By Moving' resulted in higher levels of physical activity by evaluating both outcomes and implementation process.DESIGN: Mixed-methods study informed by the Medical Research Council guidance.SETTING: Tertiary hospital.PARTICIPANTS: Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals.MEASURES: Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews.RESULTS: There was no significant difference observed in physical activity (median [IQR] 23 [12-51] vs 27 [17-55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components' reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes.CONCLUSION: Although implementing 'Better By Moving' did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.
DOCUMENT
To support physiotherapists in their role of health promotor and to support physical activity (PA), the Keep Moving Support Tool (KMST) was developed. It is unknown how to align the KMST with everyday practice in a wider variety of primary care physiotherapy clinics in the Netherlands.
DOCUMENT
Surgery aims to improve a patient’s medical condition. However, surgery is a major life event with the risk of negative consequences, like peri- and postoperative complications, prolonged hospitalization and delayed recovery of physical functioning. One of the major common side effects, functional decline, before (in the “waiting” period), during and after hospitalization is impressive, especially in frail people. Preoperative screening aims to identify frail, highrisk patients at an early stage, and advice these high-risk patients to start supervised preoperative home-based exercise training (prehabilitation) as soon as possible. Depending on the health status of the patient and his/her outcomes during the screening and the type of surgery, prehabilitation should focus on respiratory, cardiovascular and/or musculoskeletal parameters to prepare the patient for surgery. By improving preoperative physical fitness, a patient is able to better with stand the impact of major surgery and this will lead to a both reduced risk of negative side effects and better short term outcomes as a result. Besides prehabilitation hospital culture and infrastructure should be inherently activating so that patients stay as active as can be, socially, mentally and physically. In the first part of this chapter the concept of prehabilitation and different parameters that should be trained will be described. The second part focuses on the “Better in, Better out” (BiBo™) strategy, which aims to optimize patient’s pre-, peri- and postoperative physical fitness. Prehabilitation should comprise “shared decisions” between patient and physical therapist regarding experience and evidence based best options for rehabilitation goals, needs, and potential of the individual patient and his/her (in) formal support-system. Next, a case will describe the preoperative care pathway. This chapter will close with conclusions about how moving people before and after surgery will improve their outcomes.
DOCUMENT
This chapter examines some of the challenges of unlearning anthropocentrism - i.e. the deep-seated cultural, psychological and enacted prejudices of human specialness - in nature-based early childhood education programs. We begin with a critical exploration of recent trends in environmental philosophy and the conservation sciences that seek to move beyond the so-called archaic notions of “wilderness” and “nature” towards more managerial models of human dominion over planetary “ecosystem services.” We suggest the trouble with these discursive moves is that they shirk from the courageous conversations required from environmental education in a time of ecological emergency. We conclude by drawing on research at nature-based schools in the Netherlands and Canada to illustrate the tenacity of anthropocentric “common-sense” and suggest the beginnings of pedagogy of childhoodnatures guided by notions of rewilding and ecological humility. https://doi.org/10.1007/978-3-319-51949-4_40-1 LinkedIn: https://www.linkedin.com/in/helenkopnina/
MULTIFILE
That expressive writing can be a beneficial response to trauma or grief is well-established in the literature. Grief research also shows that the majority of people are resilient in the face of the death of loved ones. That said, traditional rituals around loss are no longer ubiquitous, well-known phase models of bereavement are contested, and ‘unfinished business’ can create difficulties in the face of loss. Increasingly, bereavement scholars speak of a need for individuals in western society to make meaning of their own grief through narrative construction, though little is said about what constitutes a beneficial story. The author takes an autoethnographic approach to write and reflect on her spouse’s illness and death and explores through a multi-voiced expressive dialogue a personal issue around her bereavement. In an analysis of her writing, using Dialogical Self Theory, she identifies markers which may be indicative of the development of a beneficially constructed narrative. The model of writing-for-transformation is used to describe the overall intent of the process, while the dialogical markers show how progress may be identified. Reinekke Lengelle (2020) Writing the Self and Bereavement: Dialogical Means and Markers of Moving Through Grief, Life Writing, 17:1, 103-122, DOI: 10.1080/14484528.2020.1710796
DOCUMENT
MOOI in beweging WP2 reisWe gaan op reis met zijn allen, met als ultieme doel meer en beter bewegen voor alle jeugd van 0 tot 18 jaar. Goed en genoeg bewegen voor iedereen is wat we willen. Maar wat hebben we nodig ter voorbereiding? Allereerst kijken we waar we goed in zijn, wat we al hebben, op zoek naar nieuwe ideeën en vooral wat we nodig hebben om ons doel te bereiken. We kiezen ervoor om op basis van theorie drie benaderingen uit te stippelen. De levensloopbenadering, de contextbenadering en defactorenbenadering, elk met hun eigen kansen en uitdagingen. Elke benadering heeft zijn eigenstrategie die in de loop ter tijd bij elkaar komen, van elkaar leren en elkaar versterken. We beschrijvende strategie met de meeste kans van slagen wat niet wegneemt dat andere keuzes niet kansrijk kunnen zijn. Zoals altijd op reis kan je van benadering wisselen en kruisen de paden zich. Neem onderweg kennis mee, verzin en onderzoek ideeën, deel dit met medereizigers en leg het vast voor het nageslacht. Om de kansrijke routes te realiseren is natuurlijk geld nodig, zoek wat passend is perroute en stem je plan af op de omstandigheden. Daarnaast is een goede stabiele basisuitrusting onmisbaar, stop in je rugzak wat je altijd nodig zal hebben voor onderweg en vertrouw op de reis.Annemarie en Remo
DOCUMENT
Early mobilisation after abdominal surgery is necessary to avoid complications and increase recovery. However, due to a variety of factors, failure of early mobilisation is seen in clinical practice. The aim of this study is to investigate the perspectives of nurses and patients of the Haaglanden Medical Center (HMC) how to increase mobilisation frequency after colorectal surgery in the oncological surgery ward. This explorative study employed qualitative data collection and analysis by means of semi-structured interviews with patients and nurses. Patients were included when they had a colorectal resection, were older than 18 years and spoke Dutch. The interviews were audiotaped and verbatum transcribed. A thematic content analysis was performed. It was concluded that mobilisation can be increased when it is incorporated in daily care activities and family support during visiting hours. Appropriate information about mobilisation and physical activity is needed for nurses, patients and family and the hospital environment should stimulate mobilisation.
DOCUMENT
Provision of adequate protein is crucial for optimizing outcomes in hospitalized patients. However, the methodologies upon which current recommendations are based have limitations, and little is known about true requirements in any clinical population. In this tutorial, we aim to give clinicians an understanding of how current protein recommendations were developed, an appreciation for the limitations of these recommendations, and an overview of more sophisticated approaches that can be applied to better define protein requirements. A broader perspective of the challenges and opportunities in determining clinical protein requirements can help clinicians think critically about the individualized nutrition care they provide to their patients with the goal of administering adequate protein to optimize outcomes.
DOCUMENT
10 tips to improve study performance by gaining focus and getting less distracted. These tips have been compiled on the basis of scientific insights from cognitive psychology, neuropsychology and educational science and from our own research into stress, engagement and study performance.
DOCUMENT
During the past years a lot of research has been done on measuring and analyzing the stated and re-vealed preferences of house buyers, in order to develop so called new product market combinations for the housing market. It has become clear from these studies that the choice of a house buyer for a cer-tain type of dwelling is based on both quantitative and qualitative criteria, derived from the quantita-tive and qualitative attributes he observes and perceives when confronted with the choice for a dwell-ing. A dwelling as such, can be regarded as a complex ‘product’, consisting of a varied amount of quantitative and qualitative attributes. A dwelling not only offers a place to eat, sleep and live, but also a place of comfort and safety. For a growing group of house buyers their dwelling seems to be-come more and more even like ‘a statement of life style’, in the same way a dwelling was regarded as ‘a statement of richness’ in the earlier days. The focus of researchers is gradually moving towards the qualitative criteria that determine the choice behaviour of house buyers. Or, more specifically, towards the relationships between the preferences, perceptions, emotions and beliefs of the house buyer and the quantitative and qualitative criteria he has in mind. And, secondly, they want to understand how these aspects are related to the actual choice for a dwelling. An intriguing question is how these preferences, perceptions, emotions and beliefs (i.e. psychological factors) can be measured and analyzed in such a way that they can be described and communicated unambiguously to different parties that are involved in the housing market. The aim of this conceptual paper is to make a start with the exploration of the expected added value of Conjoint Analysis and Rule Developing Experiment as tools for measuring and analyzing the combi-nation of quantitative and qualitative criteria that direct the choice behaviour of house buyers. Conjoint Analysis, which has originally been developed for marketing applications, analyzes the joint subjective and psychological factors that influence the choice behavior of consumers. Applying Con-joint Analysis as a method of research, will not only add to the measurement and analysis of stated and revealed preferences of house buyers. It may be also of help to develop knowledge on unstated and even innovative preferences, which will eventually lead to innovative, yet unknown dwelling concepts and dwelling market combinations. These unknown combinations might be found by adding the method of Rule Developing Experiment.
DOCUMENT
