Background: Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs). Objectives: The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients. Methods: This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed. Findings: Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”. Conclusions: Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.
MULTIFILE
Background: During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidencebased intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) ‘Environmental and policy assessment’; (2) ‘Education’; (3) ‘Goal setting with the patient’ and (4) ‘Ongoing motivation and mentoring’. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Objective: Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Design: Mixed method design Setting(s): A Neurological and a Geriatric ward in a Dutch Hospital. Participants: 56 Nurses and nursing students working on these wards. Methods: The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. Results: A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0–10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components ‘Education’ and ‘Ongoing motivation and mentoring’. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. Conclusions: FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals.
Under what conditions is end-user training (EUT) as part of the implementation of a business process management (BPM) system successful? This question is addressed in this paper. Based on the literature on EUT and implementation success, we first argue that user involvement with, and attitude towards, a BPM system, both have a conditional effect on the relationship between EUT and the implementation success of the system. Secondly, we investigated this expectation empirically, by measuring the practice of EUT as perceived by end-users. Using a mixed method approach, survey data was collected from 143 end-users of a BPM system in a large Dutch social insurance organisation, and by 49 additional semi-structured interviews. Regression analysis of the survey data shows that attitude variables indeed have a significant moderating influence on implementation success. In addition, the interviews revealed that specific attention must be paid to the arrangements for EUT when deploying BPM systems in this type of organisations. Arguments are given for a more comprehensive way of measuring and optimising EUT during the implementation of information systems/information technology in organisations.
Adolescenten brengen steeds meer vrije tijd door met het spelen van games en bevinden zich mede daardoor in een hybride leefwereld. Deze relatief nieuwe wereld brengt nieuwe uitdagingen mee rondom identiteitsontwikkeling en psychosociaal welzijn; voor gamende adolescenten zelf, maar ook hun (professionele) opvoeders. Wij onderzoeken de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn en de rol die (professionele) opvoeders hierin hebben.Doel Op dit moment ontbreekt kennis over de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn van adolescenten en is het onder andere lastig om handvatten voor (professionele) opvoeders te ontwikkelen. Handvatten kunnen helpen om beter aan te sluiten bij de leefwereld en behoeftes van gamende adolescenten. De resultaten van dit onderzoek kunnen bijdragen aan een positieve (sociale) identiteitsontwikkeling van gamende adolescenten in een hybride wereld. Resultaten Het promotieonderzoek gaat verschillende wetenschappelijke publicaties opleveren. We vertalen onze resultaten samen met professionals, opvoeders en adolescenten naar praktische handvatten voor (professionele) opvoeders. De betrokken praktijkpartners en opleidingen geven deze wetenschappelijk onderbouwde inzichten en handvatten een passende plaats in hun curricula en werkwijzen. Looptijd 01 september 2022 - 01 september 2026 Aanpak Dit promotieonderzoek heeft een praktijkgericht, mixed-methods design. Voor de kwantitatieve analyse maken we gebruik van longitudinale data van het Digital Youth project van Universiteit Utrecht. De kwalitatieve data wordt verzameld door symbolic netnography (een digitale variant van etnografisch onderzoek), interviews en participerende observaties met adolescenten en (professionele) opvoeders. In samenspraak met adolescenten en (professionele) opvoeders worden deze inzichten vertaald naar praktische handvatten.
Adolescenten brengen steeds meer vrije tijd door met het spelen van games en bevinden zich mede daardoor in een hybride leefwereld. Deze relatief nieuwe wereld brengt nieuwe uitdagingen mee rondom identiteitsontwikkeling en psychosociaal welzijn; voor gamende adolescenten zelf, maar ook hun (professionele) opvoeders. Wij onderzoeken de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn en de rol die (professionele) opvoeders hierin hebben.
Denim Democracy from the Alliance for Responsible Denim (ARD) is an interactive exhibition that celebrates the journey and learning of ARD members, educates visitors about sustainable denim and highlights how companies collaborate together to achieve results. Through sight, sound and tactile sensations, the visitor experiences and fully engages sustainable denim production. The exhibition launches in October 2018 in Amsterdam and travels to key venues and locations in the Netherlands until April 2019. As consumers, we love denim but the denim industry, like other sub-sectors in the textile, apparel and footwear industries, faces many complex sustainability challenges and has been criticized for its polluting and hazardous production practices. The Alliance for Responsible Denim project brought leading denim brands, suppliers and stakeholders together to collectively address these issues and take initial steps towards improving the ecological sustainability impact of denim production. Sustainability challenges are considered very complex and economically undesirable for individual companies to address alone. In denim, small and medium sized denim firms face specific challenges, such as lower economies of scale and lower buying power to affect change in practices. There is great benefit in combining denim companies' resources and knowledge so that collective experimentation and learning can lift the sustainability standards of the industry and lead to the development of common standards and benchmarks on a scale that matters. If meaningful, transformative industrial change is to be made, then it calls for collaboration between denim industry stakeholders that goes beyond supplier-buyer relations and includes horizontal value chain collaboration of competing large and small denim brands. However collaboration between organizations, and especially between competitors, is highly complex and prone to failure. The research behind the Alliance for Responsible Denim project asked a central research question: how do competitors effectively collaborate together to create common, industry standards on resource use and benchmarks for improved ecological sustainability? To answer this question, we used a mixed-method, action research approach. The Alliance for Responsible Denim project mobilized and facilitated denim brands to collectively identify ways to reduce the use of water and chemicals in denim production and then aided them to implement these practices individually in their respective firms.
