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.
To evaluate the effect of the educational program "Guided Clinical Reasoning" (GCR) and the introduction of an intelligent electronic nursing documentation system (e-doc) on the quality of the nursing process.Evaluation was conducted at three measurement points and rated with the instrument "Quality of Nursing Diagnoses, Interventions and Outcomes" (Q-DIO).GCR showed the best Q-DIO-scores. No long-term effect was found after GCR cessation. The e-doc delivered the lowest scores, while showing adequate support in using nursing diagnoses.E-docs can support conducting the nursing process, but for meaningful e-doc use, clinical reasoning is essential.High-quality nursing documentation requires recognition of factors obstructing or supporting nurses in the use of e-docs while conducting the nursing process.
Students in Higher Music Education (HME) are not facilitated to develop both their artistic and academic musical competences. Conservatoires (professional education, or ‘HBO’) traditionally foster the development of musical craftsmanship, while university musicology departments (academic education, or ‘WO’) promote broader perspectives on music’s place in society. All the while, music professionals are increasingly required to combine musical and scholarly knowledge. Indeed, musicianship is more than performance, and musicology more than reflection—a robust musical practice requires people who are versed in both domains. It’s time our education mirrors this blended profession. This proposal entails collaborative projects between a conservatory and a university in two cities where musical performance and musicology equally thrive: Amsterdam (Conservatory and University of Amsterdam) and Utrecht (HKU Utrechts Conservatorium and Utrecht University). Each project will pilot a joint program of study, combining existing modules with newly developed ones. The feasibility of joint degrees will be explored: a combined bachelor’s degree in Amsterdam; and a combined master’s degree in Utrecht. The full innovation process will be translated to a transferable infrastructural model. For 125 students it will fuse praxis-based musical knowledge and skills, practice-led research and academic training. Beyond this, the partners will also use the Comenius funds as a springboard for collaboration between the two cities to enrich their respective BA and MA programs. In the end, the programme will diversify the educational possibilities for students of music in the Netherlands, and thereby increase their professional opportunities in today’s job market.
Om tegemoet te komen aan de eisen die gesteld worden aan werknemers in de huidig snel veranderende samenleving heeft de NHL Stenden Hogeschool gekozen voor een nieuw onderwijsconcept, namelijk Design Based Education (DBE). DBE is gebaseerd op het gedachtegoed van Design Thinking en stimuleert iteratieve en creatieve denkprocessen. DBE is een student-georiënteerde leeromgeving, gebaseerd op praktijk-, dialoog-, en vraaggestuurde onderwijsprincipes en op zelfsturend, constructief, contextueel en samenwerkend leren. Studenten construeren gezamenlijk kennis en ontwikkelen een prototype voor een praktijkvraagstuk. Student-georiënteerde leeromgevingen vragen andere begeleidingsstrategieën van docenten dan zij gewend zijn. Van docenten wordt verwacht dat zij studenten activeren gezamenlijk kennis te construeren en dat zij nauw samenwerken met werkveldprofessionals. Eerder onderzoek toont aan dat docenten, zelfs in een student-georiënteerde leeromgeving, geneigd zijn terug te vallen op conventionele strategieën. De overstap naar een ander onderwijsconcept gaat dus blijkbaar niet vanzelf. Collectief leren stimuleert docenten de dialoog aan te gaan met andere docenten en werkveldprofessionals met als doel gezamenlijk te experimenteren en collectief te handelen. De centrale vraag van het postdoc-onderzoek is het ontwerpen en ontwikkelen van (karakteristieken van) interventies die collectief leren van docenten en werkveldprofessionals stimuleren. Het doel van het postdoconderzoek is om de overstap naar DBE zo probleemloos mogelijk te laten verlopen door docenten te ondersteunen DBE leeromgevingen te ontwikkelen in samenwerking met werkveldprofessionals en DBE te integreren in hun docentactiviteiten. De onderzoeksmethode is Educational Design Research en bestaat uit vier fasen: preliminair onderzoek, ontwikkelen van prototypes, evaluatie en bijdrage aan de praktijk. Het onderzoek is verbonden aan het lectoraat Sustainable Educational Concepts in Higher Education en wordt hiërarchisch en inhoudelijk aangestuurd door de lector. Docenten, experts, werkveldprofessionals en studenten worden betrokken bij het onderzoek. Dit onderzoek kan zowel binnen als buiten de hogeschool een bijdrage leveren omdat steeds meer hogescholen kiezen voor een ander onderwijsconcept.
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.
