Abstract: This case study examines the use of an eHealth application for improving preoperative rehabilitation (prehabilitation). We have analysed healthcare professionals' motivators and drivers for adopting eHealth for a surgical procedure at academic medical facilities. The research focused on when and why healthcare professionals are inclined to adopt eHealth applications in their way of working? For this qualitative study, we selected 12 professionals involved in all levels of the organisation and stages of the medical process and conducted semi-structured interviews. Kotter’s transformational change model and the Technology Acceptance Model were used as analytical frameworks for the identification of the motivation of eHealth adoption. The findings suggest that contrary to Kotter’s change model, which argues that adoption of change is based on perceptions and feelings, the healthcare drivers are rational when it comes to deciding whether or not to adopt eHealth apps. This study further elaborates the observation made by the Dutch expertise centre on eHealth, Nictiz, that when the value of an eHealth pplication is clear for a stakeholder, the adoption process accelerates. Analysis of the motivations and drivers of the healthcare professionals show a strong relationship with an evidence-based grounding of usefulness and the responsibility these professionals have towards their patients. We found that healthcare professionals respond to the primary goal of improving healthcare. This is true if the eHealth application will innovate their work, but mainly when the application will improve the patient care they are responsible for. When eHealth applications are implemented, rational facts need to be collected in a study before deployment of eHealth applications on how these applications will improve the patient's health or wellbeing throughout their so-called medical journey for their treatment. Furthermore, the preference to learn about new eHealth applications from someone who speaks from authority through expertise on the subject matter, suggests adoption by healthcare professionals may be accelerated through peers. The result of this study may provide healthcare management with a different approach to their eHealth strategy. Future research is needed to validate the findings in different medical organisational settings such as regional healthcare facilities or for-profit centers which do not necessarily have an innovation focus but are driven by other strategic drivers.
When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
MULTIFILE
Nearly all waterborne products, such as food, beverages, pharmaceuticals, paints, biological (medical) samples, cosmetics and wood require preservation to prevent decomposition of the product due to microbial growth. Most non-food preservatives such as isothiazolinones, bronopol, and pyrithiones, are derived from oil and are increasingly more strictly regulated due to hazards such as ecotoxicity, sensibilization and development of allergies. The low legally permitted concentrations will not only become too low to realize preservation, they will also induce antimicrobial resistance. A chemical transition towards new, innovative, biobased, and eco-friendly preservatives is therefore required. Wydo NBD is dedicated to research towards sustainable ingredients for waterborne paints. For this, together with the Hanze University, non-hazardous, eco-friendly and biobased natural preservatives will be identified and further developed towards marketable products. The knowledge obtained in this project will contribute to the development of biological (paint) conservatives knowledge and improvement of current production methods of Wydo, with the potential for wider application in food and medical products. This project aims to identify natural antimicrobial additives and consists of three consecutive stages. First, an extensive, unbiased bioinformatics guided literature mining will be performed to find relationships between biological antimicrobial compounds and microbes found in paint. The most promising antimicrobials from this mining will be made available by chemical synthesis. Subsequently, the compounds will be assessed for their potential as novel natural preservatives for waterborne paints, by testing for their antimicrobial activity and stability.
