This thesis describes an Action Research (AR) project aimed at the implementation of Evidence Based Practice in a mental health nursing setting in the Netherlands. The main research question addressed in this thesis is: In what way is Action Research with an empowering appropriate to implement Evidence Based Practice in a mental health nursing setting in the Netherlands and what is the effect of this implementation on the care experienced by the client, the nursing interventions and the context in this setting compared to a comparative setting? To answer this main research question, the following questions derived from it were addressed: What is Evidence Based Practice? What is known about implementing evidence-based practice in nursing through Action Research? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be more successful? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be successful? How is EBP implemented through AR with an empowering intent and what are the outcomes for the use of evidence, the context and the facilitation in the setting? What is the effect of the implementation of EBP in mental health nursing using AR with an empowering intent on the care experienced by the client, the nursing interventions and the context compared to a comparison setting? The first two questions were answered by a search of the literature while the remaining questions were answered during the AR study conducted in two mental health organisations in the Netherlands.
The use of growth monitoring and promotion (GMP) has become widespread. It is a potential contributor towards achieving the Millennium Development Goals of halving hunger and reducing child mortality by two-thirds within 2015. Yet, GMP appears to be a prerequisite for good child health but several studies have shown that there is a discrepancy between the purpose and the practice of GMP. The high prevalence of malnutrition in many developing countries seems to confirm this fact. A descriptive qualitative study was carried out from April to September 2011. Focus group discussions and in-depth interviews were conducted amongst mothers and health workers. Data were analyzed using a qualitative content analysis technique, with the support of ATLAS.ti 5.0 software. The results suggest that most mothers were aware of the need for regular weight monitoring while health workers also seemed to be well-aware and to practise GMP according to the international guidelines. However, there was a deficit in maternal knowledge with regard to child-feeding and a lack of basic resources to keep and/or to buy healthful and nutritionally-rich food. Furthermore, the role of the husband was not always supportive of proper child-feeding. In general, GMP is unlikely to succeed if mothers lack awareness of proper child-feeding practices, and if they are not supported by their husbands.
In a home care setting, high-quality care is typically associated with continuity of care. In addition, the increasing pressure due to labor shortages calls for cost-efficient operations. This paper focuses on obtaining cost-efficient daily schedules over a longer time horizon, with balanced shift lengths, while ensuring continuity of care (using the continuity of care index). To address this challenge, we propose a novel method based on blueprint routes. This method generates daily schedules by constructing optimized shifts and routes with regard to travel time, (time window) waiting time, and shift costs based on hourly wages. To ensure continuity of care, the daily scheduling decisions are strategically guided using the concept named blueprint routes. The blueprint routes are pre-optimized (partial) routes that help to align the daily schedules to achieve continuity of care in the subsequent nurse-to-shift assignment. Model-based evolutionary algorithms are employed to overcome the NP-hardness of the routing problem and nurse-to-shift assignment. Real-life-based numerical experiments demonstrate that continuity of care does not have to compromise home care schedule costs significantly.
MULTIFILE
01-09-2024
