Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
Full text beschikbaar met HU-account. Sinds de opkomst van sociale media spelen de toepassing en het bereik ervan in toenemende mate een rol, ook bij rampen en crises. De vraag rijst dan hoe daar in de crisiscommunicatie en het crisismanagement effectief mee om te gaan. Uit literatuuronderzoek en een analyse van een viertal Nederlandse casus blijkt dat, hoewel sommige officiële instanties nog steeds verrast kunnen worden door de snelle stroom van berichten en de effecten die dat met zich meebrengt, er al veel is geleerd over het omgaan met en benutten van sociale media in crisissituaties. Professionals dealing with crises are more or less forced to a next level of crisis communication and crisis management. This is because of the influence of social media. Messages on Twitter, Facebook and other social media can have a significant impact on the course of developments during a crisis. Sometimes in a positive way, when help is mobilized quickly and people can be informed almost instantly. On other occasions the impact is more negative, when for instance rumors lead to false accusations or threats. In the past several years, crisis management authorities have built up more experience with the use and application of social media and monitoring tools. There are still cases where officials and professionals are taken by surprise because of the shift stream of messages and their impact on public opinion and crisis control. But also lessons have been learned, e.g. in terms of online and offline reactions, cooperation with the public, and rumor control. This article gives an overview of research results in literature and summarizes the outcomes of a case study research project
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Surgery aims to improve a patient’s medical condition. However, surgery is a major life event with the risk of negative consequences, like peri- and postoperative complications, prolonged hospitalization and delayed recovery of physical functioning. One of the major common side effects, functional decline, before (in the “waiting” period), during and after hospitalization is impressive, especially in frail people. Preoperative screening aims to identify frail, highrisk patients at an early stage, and advice these high-risk patients to start supervised preoperative home-based exercise training (prehabilitation) as soon as possible. Depending on the health status of the patient and his/her outcomes during the screening and the type of surgery, prehabilitation should focus on respiratory, cardiovascular and/or musculoskeletal parameters to prepare the patient for surgery. By improving preoperative physical fitness, a patient is able to better with stand the impact of major surgery and this will lead to a both reduced risk of negative side effects and better short term outcomes as a result. Besides prehabilitation hospital culture and infrastructure should be inherently activating so that patients stay as active as can be, socially, mentally and physically. In the first part of this chapter the concept of prehabilitation and different parameters that should be trained will be described. The second part focuses on the “Better in, Better out” (BiBo™) strategy, which aims to optimize patient’s pre-, peri- and postoperative physical fitness. Prehabilitation should comprise “shared decisions” between patient and physical therapist regarding experience and evidence based best options for rehabilitation goals, needs, and potential of the individual patient and his/her (in) formal support-system. Next, a case will describe the preoperative care pathway. This chapter will close with conclusions about how moving people before and after surgery will improve their outcomes.
