Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
AimsKnowledge of patient preferences is vital for delivering optimal healthcare. This study uses utility measurement to assess the preferences of heart failure (HF) patients regarding quality of life or longevity. The utility approach represents the perspective of a patient; facilitates the combination of mortality, morbidity, and treatment regimen into a single score; and makes it possible to compare the effects of different interventions in healthcare.Methods and resultsPatient preferences of 100 patients with HF were assessed in interviews using the time trade-off (TTO) approach. Health-related quality of life (HR-QoL) was assessed with the EQ-5D and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients' own estimation of life expectancy was assessed with a visual analogue scale (VAS). Of the 100 patients (mean age 70 ± 9 years; 71% male), 61% attach more weight to quality of life over longevity; while 9% and 14% were willing to trade 6 and 12 months, respectively, for perfect health and attach more weight to quality of life. Patients willing to trade time had a significantly higher level of NT-proBNP and reported significantly more dyspnoea during exertion. Predictors of willingness to trade time were higher NT-proBNP and lower EQ VAS.ConclusionThe majority of HF patients attach more weight to quality of life over longevity. There was no difference between both groups with respect to life expectancy described by the patients. These insights enable open and personalized discussions of patients' preferences in treatment and care decisions, and could guide the future development of more patient-centred care. © 2013 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.
Perceptions of community care and placement preferences in first-year nursing students: A multicentre, cross-sectional studyMargriet VAN IERSEL MSc1, Corine H.M. LATOUR PhD1, Rien DE VOS PhD2, Paul A. KIRSCHNER PhD3,5, Wilma J.M. SCHOLTE OP REIMER PhD1,4.1 ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands2 Centre of Evidence Based Education, Academic Medical Centre, Amsterdam, The Netherlands3 Open University of the Netherlands, Heerlen, The Netherlands4 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands 5 University of Oulu, Oulu, FinlandBackground: Despite increasing shortages of well-educated community nurses, far too few nursing students choose community care for their future profession; a strong societal problem that urgently needs resolution. This study provides a solid understanding of causes for the fields’ low popularity by exploring first-year baccalaureate nursing students' perceptions of community care, and their placement preferences along with their underlying assumptions. Insights from this study can be used by educators to positively influence students’ perceptions with targeted curriculum redesign strategies.Summary of work: A cross-sectional multicentre survey study was performed. First-year nursing students from six universities of applied sciences in the Netherlands (n = 1058) participated in the study from September-December 2014. The students completed the ‘Scale on Community Care Perceptions’ (SCOPE), consisting of demographic data, current placement preferences, and three subscales measuring the affective component of community care perception, perceptions of a placement, and a profession in community care. Descriptive statistics were used. Summary of results: For placement, 71.2% of the students prefer the general hospital, 23.4% another area, and only 5.4% choose community care. Students consider opportunities for advancement and enjoyable relationships with patients as most important for their placement. Community care is perceived as a ‘low-status-field’ with many elderly patients, where students expect to find little care variety and few opportunities for advancement. Discussion and conclusions: This study shows why few students show an interest for a career in community care. Students’ perceptions of the field are at odds with aspects they regard as important for their placement. They also underestimate the complexity of community care, where specific traits are required to ensure appropriate nursing care in patients’ homes. Take-home messages: The results of this study allow for three recommendations. First, students and educators should be aware of misconceptions about career opportunities in the field of community care. Second, educators should provide students with experiences that foster an optimistic and realistic career outlook on community care. Third, growing shortages in the community care sector urgently require representatives from the field and educators to collaborate to make community nursing an attractive career alternative.Keywords: Career choice; Students
Due to societal developments, like the introduction of the ‘civil society’, policy stimulating longer living at home and the separation of housing and care, the housing situation of older citizens is a relevant and pressing issue for housing-, governance- and care organizations. The current situation of living with care already benefits from technological advancement. The wide application of technology especially in care homes brings the emergence of a new source of information that becomes invaluable in order to understand how the smart urban environment affects the health of older people. The goal of this proposal is to develop an approach for designing smart neighborhoods, in order to assist and engage older adults living there. This approach will be applied to a neighborhood in Aalst-Waalre which will be developed into a living lab. The research will involve: (1) Insight into social-spatial factors underlying a smart neighborhood; (2) Identifying governance and organizational context; (3) Identifying needs and preferences of the (future) inhabitant; (4) Matching needs & preferences to potential socio-techno-spatial solutions. A mixed methods approach fusing quantitative and qualitative methods towards understanding the impacts of smart environment will be investigated. After 12 months, employing several concepts of urban computing, such as pattern recognition and predictive modelling , using the focus groups from the different organizations as well as primary end-users, and exploring how physiological data can be embedded in data-driven strategies for the enhancement of active ageing in this neighborhood will result in design solutions and strategies for a more care-friendly neighborhood.
Everyone has the right to participate in society to the best of their ability. This right also applies to people with a visual impairment, in combination with a severe or profound intellectual and possibly motor disability (VISPIMD). However, due to their limitations, for their participation these people are often highly dependent on those around them, such as family members andhealthcare professionals. They determine how people with VISPIMD participate and to what extent. To optimize this support, they must have a good understanding of what people with disabilities can still do with their remaining vision.It is currently difficult to gain insight into the visual abilities of people with disabilities, especially those with VISPIMD. As a professional said, "Everything we can think of or develop to assess the functional vision of this vulnerable group will help improve our understanding and thus our ability to support them. Now, we are more or less guessing about what they can see.Moreover, what little we know about their vision is hard to communicate to other professionals”. Therefore, there is a need for methods that can provide insight into the functional vision of people with VISPIMD, in order to predict their options in daily life situations. This is crucial knowledge to ensure that these people can participate in society to their fullest extent.What makes it so difficult to get this insight at the moment? Visual impairments can be caused by a range of eye or brain disorders and can manifest in various ways. While we understand fairly well how low vision affects a person's abilities on relatively simple visual tasks, it is much more difficult to predict this in more complex dynamic everyday situations such asfinding your way or moving around during daily activities. This is because, among other things, conventional ophthalmic tests provide little information about what people can do with their remaining vision in everyday life (i.e., their functional vision).An additional problem in assessing vision in people with intellectual disabilities is that many conventional tests are difficult to perform or are too fatiguing, resulting in either no or the wrong information. In addition to their visual impairment, there is also a very serious intellectual disability (possibly combined with a motor impairment), which makes it even more complex to assesstheir functional vision. Due to the interplay between their visual, intellectual, and motor disabilities, it is almost impossible to determine whether persons are unable to perform an activity because they do not see it, do not notice it, do not understand it, cannot communicate about it, or are not able to move their head towards the stimulus due to motor disabilities.Although an expert professional can make a reasonable estimate of the functional possibilities through long-term and careful observation, the time and correct measurement data are usually lacking to find out the required information. So far, it is insufficiently clear what people with VZEVMB provoke to see and what they see exactly.Our goal with this project is to improve the understanding of the visual capabilities of people with VISPIMD. This then makes it possible to also improve the support for participation of the target group. We want to achieve this goal by developing and, in pilot form, testing a new combination of measurement and analysis methods - primarily based on eye movement registration -to determine the functional vision of people with VISPIMD. Our goal is to systematically determine what someone is responding to (“what”), where it may be (“where”), and how much time that response will take (“when”). When developing methods, we take the possibilities and preferences of the person in question as a starting point in relation to the technological possibilities.Because existing technological methods were originally developed for a different purpose, this partly requires adaptation to the possibilities of the target group.The concrete end product of our pilot will be a manual with an overview of available technological methods (as well as the methods themselves) for assessing functional vision, linked to the specific characteristics of the target group in the cognitive, motor area: 'Given that a client has this (estimated) combination of limitations (cognitive, motor and attention, time in whichsomeone can concentrate), the order of assessments is as follows:' followed by a description of the methods. We will also report on our findings in a workshop for professionals, a Dutch-language article and at least two scientific articles. This project is executed in the line: “I am seen; with all my strengths and limitations”. During the project, we closely collaborate with relevant stakeholders, i.e. the professionals with specific expertise working with the target group, family members of the persons with VISPIMD, and persons experiencing a visual impairment (‘experience experts’).
Mode heeft een cruciale functie in de samenleving: zij maakt diversiteit en inclusiviteit mogelijk en is een middel voor individuen om zich uit te drukken. Desalniettemin is mode ook een raadsel op het gebied van duurzaamheid, zowel aan de sociale als aan de milieukant. Er bestaan echter alternatieven voor de huidige praktijken in de mode. Dit project heeft tot doel de ontwikkeling van een van die initiatieven te ondersteunen. In samenwerking met twee Nederlandse MKB bedrijven in de mode-industrie, willen we een of meer business modellen co-designen voor het vermarkten van circulair ontworpen laser geprinte T-shirts. Door lasertechnologie te introduceren in plaats van traditionele inktopties, kunnen de T- shirts hun CO2 voetafdruk verder verkleinen en een verstandig alternatief zijn voor individuen, die op zoek zijn naar duurzame modekeuzes. Maar hoewel de technologische haalbaarheid vaststaat, vereist het vermarkten sterke, schaalbare, bedrijfsmodellen. Via een haalbaarheidsstudie willen we dergelijke businessmodellen ontwikkelen en de commercialisering van deze producten ondersteunen. Wij zijn van plan de reacties van de consument op een dergelijke innovatie te bestuderen, evenals de belemmeringen en stimulansen vanuit het oogpunt van de consument, en de inkoop-, toeleveringsketen- en financiële kwesties die kunnen voortvloeien uit de schaalbaarheid van een potentieel bedrijfsmodel. Om praktische relevantie voor de bredere industrie te verzekeren, streven we ernaar om de resultaten te presenteren op evenementen georganiseerd door een van de consortiumpartners (in 2023), als ook om een teaching case en een wetenschappelijk artikel te ontwikkelen op basis van de resultaten van het project.
