Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients' needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, fo
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Aim and objectives: To provide an in-depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care. Background: As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation. Design: A multi-method qualitative study. Methods: Open-ended questions of a survey study (N = 132) were supplemented with in-depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis. Results: Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient-centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care. Conclusions: The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation. Relevance to clinical practice: This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient-centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.
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Abstract Aim: This study protocol aims to examine the effectiveness and preconditions of a self-management program—named REducing Delay through edUcation on eXacerbations (REDUX)—in China. Background: The high disease burden in people with chronic lung disease is mainly due to exacerbations. There is a need for effective exacerbation-management interventions. A nurse-led program, REDUX, helped patients self-manage exacerbations. Design: A single-arm pre-post study. Methods: Fifty-four patients and 24 healthcare professionals (HCPs) in Chinese primary care will be included. The core element of the program is a personalized action plan. HCPs will receive training in using the action plan to help patients manage exacerbations. The intervention will start when a patient is referred to the nurse for a post-exacerbation consultation and ends when the patient presents for the second post-exacerbation consultation. During the first post-exacerbation consultation, the patient and nurse will create the action plan. The primary outcomes in patients will include the delays between the onset of exacerbation and recognition, between exacerbation recognition and action, between exacerbation recognition and consultation with a doctor, and when the patients feel better after receiving medical help from HCPs. The secondary outcomes will include preconditions of the program. The ethics approval was obtained in September 2021. Discussion: This study will discuss a culturally adapted nurse-led self-management intervention for people with chronic lung disease in China. The intervention could help Chinese HCPs provide efficient care and reduce their workload. Furthermore, it will inform future research on tailoring nurse-led self-management interventions in different contexts. Impact: The study will contribute to the evidence on the effectiveness and preconditions of REDUX in China. If effective, the result will assist the nursing of people with chronic lung disease. Trial registration: Registered in the Chinese clinical trial registry (ID: 2100051782).
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More and more local bottom-up energy initiatives are emerging. Those involved encounter many barriers during the realization of their ideas. As the generation of renewable energy is mostly included, these local initiatives contribute to the targets set at regional, national & EU level. At the same time, they are an indication that end-users themselves want to be part of the energy transition. What are the reasons for citizens to organize themselves and start and initiative? What kind of barriers do they encounter? What does this mean for roles and responsibilities of professionals? And to what kind of opportunities does this lead for products and services? Answers to these questions provide a solid starting point to develop methods and instruments to stimulate,facilitate and upscale local energy initiatives. This paper bundles the outcomes of three workshops and three additional interviews in the Netherlands as part of the European E-hub project. Conclusions can be drawn on needs and drivers, barriers, risks and solutions (lessons learned), possible roles for professionals and opportunities for new products and services.
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This paper presents the results of an exercise to assess the effects of metaphors on knowledge management. Knowledge is an abstract phenomenon with no direct referent in the real world. To think and talk about knowledge we use conceptual metaphors. The exercise shows that these metaphors greatly influence the problems we identify related to knowledge in organizations and the type of knowledge management solutions we propose. The knowledge as water metaphor used in this exercise – which reflects the dominant way of thinking in Western knowledge management literature – leads to the thingification of knowledge, resulting in a discourse about ways to formalize, manage and control knowledge. This discourse primarily serves the interests of management. In contrast, the knowledge as love metaphor used in this exercise – which reflects more an Asian way of thinking about knowledge – shifts the discourse from the topic of knowledge as a thing to the underlying preconditions for good knowledge work. These conditions include the facilitation of knowledge professionals, the quality of the relationships in the organization, and the quality of the organizational culture. This discourse is aimed at humanizing the organization instead of formalizing it and is more in the interest of employees.
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Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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Abstract Objective This was to elucidate the experiences and perceptions of people with severe mental illness (SMI) and their health care professionals with the SMILE (Severe Mental Illness Lifestyle Evaluation) group-based lifestyle intervention. SMILE focuses primarily on promoting healthy diet, physical activity and weight loss. Method A qualitative study with semi-structured interviews was conducted using purposive sampling. Interviews were conducted with 15 clients and 13 health care professionals (HCPs). Data were analysed according to a thematic analysis. Results Four overall themes were identified: interest in a lifestyle programme; group-based setting; changes in lifestyle behaviour; and preconditions for changing health behaviour. The results showed that clients valued the programme and were interested in the subject of lifestyle. The group-based setting was seen as a positive and important aspect of the intervention. Making lifestyle changes was acknowledged as difficult, especially in combination with the presence of psychiatric symptoms. Clients acquired an improved awareness of different aspects related to lifestyle behaviour. Irrespective of weight loss achieved, clients found their efforts successful with relatively ‘small’ changes. Some needed more support during the intervention than others. The practical activities in group sessions were regarded as most useful. HCPs were enthusiastic about the programme and their interactions with lifestyle improvements. Conclusions The results of this study shed light on different aspects that were considered important when delivering a lifestyle intervention to people with SMI. We recommend considering these aspects when implementing a lifestyle intervention in a mental health care setting for clients with SMI.
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A presentation about a step wise behavioural change approach that is developed by Maastricht Bereikbaar. With this approach actions and campaigns to stimulate people to change their mobility behaviour will be effective and successfull. The presentation contains an introduction of Maastricht Bereikbaar, an explaination of the steps and preconditions, and the results we achieved so far with the program.
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Dissertatie met als onderwerp het ontwerp en evaluatie van de Hogere Beroepsopleidding Orthopedische Technologie in Nederland. In deze dissertatie wordt naast het ontwerp van de opleiding ingegaan op een vergelijking die is gemaakt met andere opleidingen op het gebied van hoger orthopedisch technologisch onderwijs in de wereld.
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Titel: The Exodus from the Netherlands or Brain Circulation: Push and Pull Factors of Remigration among Highly Educated Turkish Dutch Auteurs: Gürkan Çelik and Ton Notten In: European Review, 22 (3), 2014, pp. 403-413 The exodus from the Netherlands or brain circulation: Push and pull factors of remigration among highly educated Turkish-Dutch An increasing number of Turks, the Netherlands’ largest ethnic minority, are beginning to return to their country of origin, taking with them the education and skills they have acquired abroad, as the Netherlands faces challenges from economic difficulties, social tension and increasingly powerful right wing parties. At the same time Turkey’s political, social and economic conditions have been improving, making returning home even more appealing for Turkish migrants at large. This article gives explanations about the push and pull factors of return migration. The factors influencing return to one’s country of origin are “pulls”. It is assumed that remigration is more affected by positive developments in the country of origin than by negative developments in the country of residence. Civil society, business world and the Dutch government can develop policies to bind these capable people to the Netherlands, at least in the form of “brain circulation” so that they can serve as “bridge builders” between the two countries. Keywords Return migration, integration, Turkish-Dutch, Turkish migrants, brain circulation =============================================================================== SAMENVATTING De uittocht uit Nederland of breincirculatie: Push- en pull-factoren van remigratie onder hoogopgeleide Turkse Nederlanders. In Nederland zien we een lichte toename van het aantal Turken, de grootste etnische minderheidsgroep in Nederland, die terugkeren naar hun land van herkomst. Ze exporteren daarmee goede opleidingen en vaardigheden die ze in Nederland verwierven. De oorzaken: de economische neergang, sociale spanningen en de groeiende invloed van extreemrechtse partijen. Tegelijkertijd verbeteren in Turkije de politieke, sociale en economische omstandigheden die steeds meer aantrekkingskracht uitoefenen op immigranten in dat land. Dit artikel gaat in op de push- and pull-factoren voor remigranten. Pull-factoren beinvloeden iemands terugkeer naar zijn land van herkomst. Aangenomen wordt dat zo’n remigratie sterker wordt bevorderd door positieve ontwikkelingen in het land van herkomst dan door negatieve (push-factoren) in het land waar men op dat moment woont. De civil society, het bedrijfsleven en de Nederlandse overhead kunnen een beleid ontwikkelen dat verdienstelijke inwoners weet te behouden, hen op z’n minst kan inschakelen als bruggenbouwers en aldus kenniscirculatie mogelijk maakt tussen beide landen. Trefwoorden Retourmigratie, integratie, Turkse Nederlanders, Turkse migranten, kenniscirculatie, breincirculatie
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