To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults’ and informal caregivers’ perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults’ and informal caregivers’ perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.
LINK
Background: Transmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. Objective: To examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. Design: A qualitative study design using semi-structured interviews. Setting(s): Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants: 19 community nurses. Methods: A topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. Results: Four themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. Conclusions: We highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstract: Community nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.
Challenges in keeping healthcare affordable make informal care increasingly important. It is essential to understand the context in which people provide informal care and gain insight into their wishes with regard to the division of care responsibilities. A total of 37 interviews and eight focus groups were conducted to investigate how Dutch carers’ care attitudes are shaped. Results show that carers’ intersecting social positions, such as gender, migration background, socio-economic status and stage of life, largely influence their care attitudes. Carers want to provide care but experience challenges in doing so. They request a government that takes the lead and facilitates cooperation with professionals.
Dutch society faces major future challenges putting populations’ health and wellbeing at risk. An ageing population, increase of chronic diseases, multimorbidity and loneliness lead to more complex healthcare demands and needs and costs are increasing rapidly. Urban areas like Amsterdam have to meet specific challenges of a growing and super divers population often with a migration background. The bachelor programs and the relating research groups of social work and occupational therapy at the Amsterdam University of Applied Sciences innovate their curricula and practice-oriented research by multidisciplinary and cross-domain approaches. Their Centres of Expertise foster interprofessional research and educational innovation on the topics of healthy ageing, participation, daily occupations, positive health, proximity, community connectedness and urban innovation in a social context. By focusing on senior citizens’ lives and by organizing care in peoples own living environment. Together with their networks, this project aims to develop an innovative health promotion program and contribute to the government missions to promote a healthy and inclusive society. Collaboration with stakeholders in practice based on their urgent needs has priority in the context of increasing responsibilities of local governments and communities. Moreover, the government has recently defined social base as being the combination of citizen initiatives, volunteer organizations , caregivers support, professional organizations and support of vulnerable groups. Kraktie Foundations is a community based ethno-cultural organization in south east Amsterdam that seeks to research and expand their informal services to connect with and build with professional care organizations. Their aim coincides with this project proposal: promoting health and wellbeing of senior citizens by combining intervention, participatory research and educational perspectives from social work, occupational therapy and hidden voluntary social work. With a boundary crossing innovation of participatory health research, education and Kraktie’s work in the community we co-create, change and innovate towards sustainable interventions with impact.
The modern economy is largely data-driven and relies on the processing and sharing of data across organizations as a key contributor to its success. At the same time, the value, amount, and sensitivity of processed data is steadily increasing, making it a major target of cyber-attacks. A large fraction of the many reported data breaches happened in the healthcare sector, mostly affecting privacy-sensitive data such as medical records and other patient data. This puts data security technologies as a priority item on the agenda of many healthcare organizations, such as of the Dutch health insurance company Centraal Ziekenfonds (CZ). In particular when it comes to sharing data securely, practical data protection technologies are lacking as they mostly focus on securing the link between two organizations while being completely oblivious of what is happening with the data after sharing. For CZ, searchable encryption (SE) technologies that allow to share data in encrypted form, while enabling the private search on this encrypted data without the need to decrypt, are of particular interest. Unfortunately, existing efficient SE schemes completely leak the access pattern (= pattern of encrypted search results, e.g. identifiers of retrieved items) and the search pattern (= pattern of search queries, e.g. frequency of same queries), making them susceptible to leakage-abuse attacks that exploit this leakage to recover what has been queried for and/or (parts of) the shared data itself. The SHARE project will investigate ways to reduce the leakage in searchable encryption in order to mitigate the impact of leakage-abuse attacks while keeping the performance-level high enough for practical use. Concretely, we propose the construction of SE schemes that allow the leakage to be modeled as a statistic released on the queries and shared dataset in terms of ε-differential privacy, a well-established notion that informally says that, after observing the statistic, you learn approximately (determined by the ε-parameter) the same amount of information about an individual data item or query as if the item was not present in the dataset or the query has not been performed. Naturally, such an approach will produce false positives and negatives in the querying process, affecting the scheme’s performance. By calibrating the ε-parameter, we can achieve various leakage-performance trade-offs tailored to the needs of specific applications. SHARE will explore the idea of differentially-private leakage on different parts of SE with different search capabilities, starting with exact-keyword-match SE schemes with differentially-private leakage on the access pattern only, up to schemes with differentially-private leakage on the access and search pattern as well as on the shared dataset itself, allowing for more expressive query types like fuzzy match, range, or substring queries. SHARE comes with an attack lab in which we investigate existing and new types of leakage-abuse attacks to assess the mitigation-potential of our proposed combination of differential privacy with cryptographic guarantees in searchable encryption. To stimulate commercial exploitation of SHARE-results, our consortium partners CZ and TNO will take the lead on applying and evaluating our envisioned technologies in various healthcare use-cases.
