Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.
Over recent years aspects of sustainability have claimed a central role in many countries. As a result research for sustainability has become an important driver for innovation. This paper describes developing a model that supports SMEs in integrating sustainability in their business and innovation processes. In general innovation and entrepreneurship are important in the realm of national economies because they hold the key to the continuity and growth of companies and economic growth within a country. National governments are spending vast sums of money to enable and improve innovation management and entrepreneurial behaviour within organizations. This is also the case in The Netherlands. Partnerships involving universities (education), companies (preferably SMEs) and industrial associations (business) and representatives from governmental organizations (community) are stimulated and should be geared towards: the development of sustainable networks, a contribution to regional economic growth within sectors, the development of learning communities in which best practices are shared, knowledge circulates and knowledge is created through applied research and last but not least sustainable relations are developed between universities and the business community. Within the centre for innovation and entrepreneurship at our university we have taken the initiative to develop an innovation programme for entrepreneurs in the construction industry to help them integrate sustainability in their business processes, while simultaneously professionalizing students and teachers. Sustainability and concern for the environment are two of the main reasons for entrepreneurs to look for opportunities to innovate. Policy measures are aimed at reduction of CO2 emission, waste management and alternative use of energy sources and materials. In line with these measures companies are urged to integrate sustainability in their business processes and search for innovative sustainable solutions. This paper describes the experiences with a number of SMEs in the construction industry and the barriers entrepreneurs encounter on the road towards sustainability. We focus on the role of the entrepreneur in the process of sustainable innovation and development. We conducted exploratory research and through an organisational analysis and in-depth interviews with the owners/managers of the companies insight was gained in innovation processes towards sustainable development. Conclusions show that one of the main bottlenecks is the dilemma posed by the need for profit for the continuity of a company, while taking into account people and planet. The dilemmas of innovation are described as issues that need to be addressed and which influence the innovative capacity of companies and organizations. This paper deals with the underlying factors related to the dilemma between sustainability and growth/profit.
Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event.Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation.Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.
MULTIFILE
31-05-2021
Vragenlijsten die fysiotherapeuten gebruiken om behandeluitkomsten te meten zijn vaak lang en bevatten soms irrelevante vragen. Dit probleem kan opgelost worden door gebruik te maken van PROMIS-CAT (Computer Adaptief Testen). Door deze slimme manier van meten hoeven nog maar vier tot zeven vragen ingevuld te worden voor een betrouwbare score.Doel Het doel van dit project is het onderzoeken van de feasibility (haalbaarheid) van voor de fysiotherapie relevante PROMIS-CAT instrumenten. Resultaten Dit onderzoek loopt nog. We zullen de resultaten hier later publiceren. Het onderzoek is verdeeld in vijf werkpakketten: Wat is de meetfout en bij welke verschilscore is de verandering groter dan de meetfout van de PROMIS-CAT instrumenten (test-hertest betrouwbaarheid en Smallest Detectable Change)? Kunnen de PROMIS-CAT instrumenten verandering goed meten en met welke score is de verandering relevant voor patiënten (responsiviteit en Minimal Important Change)? Wat is de behoefte, aanvaardbaarheid, implementeerbaarheid en praktische toepasbaarheid van de PROMIS-CAT instrumenten? Welke scholing kunnen we ontwikkelen die nodig is voor implementatie van de PROMIS-CAT instrumenten in de eerstelijns fysiotherapie? Wat is het effect van deze scholing op het gebruik en de haalbaarheid van de PROMIS-CAT instrumenten? Looptijd 01 juni 2021 - 31 mei 2023 Aanpak In een pilotproject zijn de PROMIS-CAT instrumenten ingebouwd in het Elektronisch Patiënten Dossier “Fysiomanager”. Fysiotherapeuten nemen de PROMIS-CAT instrumenten gedurende een half jaar af, naast de huidige gebruikte vragenlijsten. Door middel van interviews worden ervaringen van fysiotherapeuten en patiënten in kaart gebracht en wordt een scholing ontwikkeld en geëvalueerd. Relevantie Indien de PROMIS-CAT instrumenten goede meeteigenschappen hebben en praktisch goed toepasbaar zijn, kan de belasting voor het invullen van vragenlijsten voor patiënten en fysiotherapeuten aanzienlijk afnemen. De verwachting is dat de PROMIS-CAT instrumenten de huidige lange vragenlijsten op termijn kunnen gaan vervangen en de nieuwe gouden standaard in uitkomstmetingen kunnen worden. Quote Met dit onderzoek brengen we uitkomstgerichte zorg een stukje dichter bij de patiënt en de fysiotherapeut” (Dr. Caroline Terwee, Dutch-Flemish PROMIS National Center).
