Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐ interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk— as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.
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We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT−COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4−14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41−2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87−1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation.
Ethnographic fieldwork is a balancing act between distancing and immersing. Fieldworkers need to come close to meaningfully grasp the sense-making efforts of the researched. In methodological textbooks on ethnography, immersion tends to be emphasized at the expense of its counterpart. In fact, ‘distancing’ is often ignored as a central tenet of good ethnographic conduct. In this article we redirect attention away from familiarization and towards ‘defamiliarization’ by suggesting six estrangement strategies (three theoretical and three methodological) that allow the researcher to develop a more detached viewpoint from which to interpret data. We demonstrate the workings of these strategies by giving illustrations from Machteld de Jong’s field- and text-work, conducted among Moroccan-Dutch students in an institution of higher vocational education.
In 2017, renowned Prof Kate Raworth from Oxford University and Amsterdam University introduced Doughnut Economics, an economic model to enable humans to thrive within the planetary boundaries and resources. Several private and public actors, including the city of Amsterdam, adopted the model in their circular economy development's strategies. Doughnut-Architecture aims to develop further the AREA (Atelier for Resilient Environmental Architecture) Framework, a tool designed by graduating students Charlotte Uiterwaal, Isabella van der Griend, Ryan McGaffney, Karolina Bäckman, at the faculty of Architecture, Delft University of Technology (TU-Delft), under the supervision of Henri van Bennekom. AREA-Framework support architects to intervene in the built environment taking as a reference the Doughnut Economics model. The AREA-Framework is at an initial stage, and its categories and subcategories are only qualitative. TU-Delft, the architectural practices Space&Matter and SuperuseStudios, in collaboration with the interdepartmental research group Circular Built Environment Hub (CBEH) and architectural practices from the network of 400 construction companies belonging to the Ex'tax project, the advice from Kate Raworth and the Amsterdam-Donut-Coalitie will further develop the AREA-Framework primarily quantitatively and also qualitatively. TU-Delft, Space&Matter, SuperuseStudios, other architectural practices from the Ex'tax-network will test the framework on different phases of real projects, interdepartmental research and education. The ultimate goal is to develop the framework further, to increase the number of architectural practices successfully implementing the Doughnut Economics in the built environment at a national level. The framework will contribute to positioning the architectural practices concerning Doughnut Economics and the Circular Economy. The project results are firstly an online open-access publication about the further developed Framework to be applied by architects; secondly, the preparation and submission of a follow-up research proposal about the extended development and implementation of the Framework applicable to the built environment by all the Ex'tax construction sector companies.
