Abstract Background. Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations. Objective. To describe GPs’ experiences regarding management of childhood fever during out-ofhours care. Methods. A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding. Results. Main categories were: (i) Workload and general experience; (ii) GPs’ perceptions of determinants of consulting behaviour; (iii) Parents’ expectations from the GP’s point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time–pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging. Conclusion. Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking longterm relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.
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Purpose: To gain a rich understanding of the experiences and opinions of patients, healthcare professionals, and policymakers regarding the design of OGR with structure, process, environment, and outcome components. Methods: Qualitative research based on the constructive grounded theory approach is performed. Semi-structured interviews were conducted with patients who received OGR (n=13), two focus groups with healthcare professionals (n=13), and one focus group with policymakers (n=4). The Post-acute Care Rehabilitation quality framework was used as a theoretical background in all research steps. Results: The data analysis of all perspectives resulted in seven themes: the outcome of OGR focuses on the patient’s independence and regaining control over their functioning at home. Essential process elements are a patient-oriented network, a well-coordinated dedicated team at home, and blended eHealth applications. Additionally, closer cooperation in integrated care and refinement regarding financial, time-management, and technological challenges is needed with implementation into a permanent structure. All steps should be influenced by the stimulating aspect of the physical and social rehabilitation environment. Conclusion: The three perspectives generally complement each other to regain patients’ quality of life and autonomy. This study demonstrates an overview of the building blocks that can be used in developing and designing an OGR trajectory.
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Abstract Background: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
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Introduction: Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. Methods: This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Results: Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
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Smart glasses were perceived to be potentially revolutionary for healthcare, however, there is only limited research on the acceptance and social implications of smart glasses in healthcare. This study aims to get a better insight into the theoretical foundations and the purpose was to identify themes regarding adoption, mediation, and the use of smart glasses from the perspective of healthcare professionals. A qualitative research design with focus groups was used to collect data. Three focus groups with 22 participants were conducted. Data were analyzed using content analysis. Our analysis revealed six overarching themes related to the anticipated adoption of smart glasses: knowledge, innovativeness, use cases, ethical issues, persuasion, and attitude. Nine themes were found related to anticipated mediation and use of smart glasses: attention, emotions, social influences, design, context, camera use, risks, comparisons to known products, and expected reaction and might influence the acceptance of smart glasses.
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Smart glasses were perceived to be potentially revolutionary for healthcare, however, there is only limited research on the acceptance and social implications of smart glasses in healthcare. This study aims to get a better insight into the theoretical foundations and the purpose was to identify themes regarding adoption, mediation, and the use of smart glasses from the perspective of healthcare professionals. A qualitative research design with focus groups was used to collect data. Three focus groups with 22 participants were conducted. Data were analyzed using content analysis. Our analysis revealed six overarching themes related to the anticipated adoption of smart glasses: knowledge, innovativeness, use cases, ethical issues, persuasion, and attitude. Nine themes were found related to anticipated mediation and use of smart glasses: attention, emotions, social influences, design, context, camera use, risks, comparisons to known products, and expected reaction and might influence the acceptance of smart glasses.
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Introduction In 2016 a new form of integrated community treatment for patients with serious mental illnesses was implemented in two neighborhoods in the city of Utrecht (335000 inhabitants) in the Netherlands. Treatment is characterized by close collaboration of psychiatric care, somatic care (i.e. general practitioner, nurse practitioner), supported housing and other facilities, i.e. the police officer, and is provided in the direct neighborhood of the patients. This ‘neighborhood based integrated mental health care’ should not contribute solely to clinical recovery, but also specifically to social and personal recovery. Objectives The aim of this research was to investigate the experience of patients with serious mental illnesses themselves receiving this new form of neighborhood-based integrated mental health care. More specific the question is studied if and how neighborhood-based integrated mental health care supports personal and social recovery. Methods To assess the experience of patients in depth qualitative semi-structured interviews were conducted with 20 patients. Patients were asked to participate in interviews directly by the researchers, by their case managers and by experts by experience. Interview topics included personal and social recovery, resilience and self-efficacy related to the collective effort of caregivers. Qualitative data was analyzed by three independent researches with the qualitative computer program Tarzan. Strategies to enhance quality of data analysis (respondent validation) and validity (attention to negative cases) were used. Results The study will be finished in January 2019. Conclusions The results, a brief description of the collaborative care methodology offered and experiences of patients, and conclusions will be presented at the ENMESH conference.
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In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called Frequently Asked Questions. This journal series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By ‘novice’ we mean Master’s students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of papers reporting on qualitative research. This first article describes the key features of qualitative research, provides publications for further learning and reading, and gives an outline of the series.
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Background: The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice. Aim: The aim of this study was to identify the needs, barriers and facilitators amongst community-dwelling older adults (60þ) suffering from one or more chronic health conditions, in using online eHealth applications to support general practice services. Methods: A qualitative study, using semi-structured followed by think-aloud interviews, was conducted in the Netherlands. The semi-structured interviews, supported by an interview guide were conducted and analysed thematically. The think-aloud method was used to collect data about the cognitive process while the participant was completing a task within online eHealth applications. Verbal analysis according to the Chi approach was conducted to analyse the think-aloud interviews. Findings: A total of n = 19 older adults with a mean age of 73 years participated. The ability to have immediate contact with the GP on important health issues was identified as an important need. Identified barriers were non-familiarity with the online eHealth applications and a mismatch of user health needs. The low computer experience resulted in non-familiarity with the online eHealth applications. Faltering applications resulted in participants refusing to participate in the use of online eHealth applications. Convenience, efficiency and the instant availability of eHealth via applications were identified as important facilitators. Conclusion: To improve the use and acceptability of eHealth applications amongst older adults in the general practice, the applications should be tailored to meet individual needs. More attention should be given to improving the user-friendliness of these applications and to the promotion of the benefits such as facilitating older adults independent living for longer.
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In het middelbaar beroepsonderwijs worden hybride leeromgevingen, waarin de contexten van school en werk worden geïntegreerd, gezien als een veelbelovende manier om onderwijs en praktijk beter op elkaar aan te laten sluiten. Er is weinig bekend over het duurzaam ontwerpen van deze integratieve leeromgevingen binnen een mbo-instelling als geheel, waarbij het gaat om leeromgevingen van verschillende sectoren. In deze meervoudige, tweejarige case study zijn 45 integratieve leeromgevingen op de grens van school en werk, verspreid over zes sectoren binnen één onderwijsinstelling in kaart gebracht. Deze leeromgevingen zijn in focusgroepen geanalyseerd op 1) waar zij zich bevinden op de dimensie school-werk, 2) de ontwerpkenmerken inhoudelijk, sociaal, temporeel, instrumenteel en ruimtelijk, en 3) bevorderende en belemmerende factoren bij het ontwerpen en uitvoeren van integratieve leeromgevingen. Dit onderzoek geeft inzicht in hoe deze leeromgevingen zijn ontworpen en welke factoren daarbij van belang zijn. Integratief samenwerken met het werkveld blijkt in alle sectoren mogelijk. De ontwerpkenmerken inhoudelijk, sociaal en ruimtelijk worden vaker als integratief ervaren dan het ontwerpkenmerk temporeel. Vanuit het temporele perspectief blijken vooral kaders van school leidend en komen daarmee naar voren als een belangrijke factor in het succesvol opschalen en verduurzamen van leeromgevingen.
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