BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
Abstract Background: To address the lack of social interaction and meaningful activities for persons with dementia (PWD) in nursing homes an artistic Photo-Activity was designed. The present study aims to develop a digital version of the Photo-Activity and to investigate its implementation and impact on nursing home residents with advanced dementia, and their (in)formal carers. Methods: First, within a user-participatory design, a digital-app version of the Photo-Activity will be developed and pilot-tested, in co-creation with (in)formal carers and PWD. Next, the feasibility and effectiveness of the Photo-Activity versus a control activity will be explored in a randomized controlled trial with nursing home residents (N=90), and their (in)formal carers. Residents will be offered the Photo- Activity or the control activity by (in)formal carers during one month. Measurements will be conducted by independent assessors at baseline (T0), after one month (T1) and at follow up, two weeks after T1 (T2). Qualitative and quantitative methods will be used to investigate the effects of the intervention on mood, social interaction and quality of life of the PWD, sense of competence of informal carers, empathy and personal attitude of the formal carers, and quality of the relationship between the PWD, and their (in)formal carers. In addition, a process evaluation will be carried out by means of semi-structured interviews with the participating residents and (in)formal carers. Finally, an implementation package based on the process evaluation will be developed, allowing the scaling up of the intervention to other care institutions. Discussion: Results of the trial will be available for dissemination by Spring 2023. The digital Photo-Activity is expected to promote meaningful connections between the resident with dementia, and their (in)formal carers through the facilitation of person-centered conversations. Trial registration: Netherlands Trial Register: NL9219; registered (21 January 2021); NTR (trialregister.nl)
Nature areas in North-West Europe (NWE) face an increasing number of visitors (intensified by COVID-19) resulting in an increased pressure on nature, negative environmental impacts, higher management costs, and nuisance for local residents and visitors. The high share of car use exaggerates these impacts, including peak pressures. Furthermore, the almost exclusive access by car excludes disadvantaged people, specifically those without access to a car. At the same time, the urbanised character of NWE, its dense public transport network, well-developed tourism & recreation sector, and presence of shared mobility providers offers ample opportunities for more sustainable tourism. Thus, MONA will stimulate sustainable tourism in and around nature areas in NWE which benefits nature, the environment, visitors, and the local economy. MONA will do so by encouraging a modal shift through facilitating sustainableThe pan-European Innovation Action, funded under the Horizon Europe Framework Programme, aims to promote innovative governance processes ,and help public authorities in shaping their climate mitigation and adaptation policies. To achieve this aim, the GREENGAGE project will leverage citizens’ participation and equip them with innovative digital solutions that will transform citizen’s engagement and cities’ effectiveness in delivering the European Green Deal objectives for carbon neutral cities.Focusing on mobility, air quality and healthy living, citizens will be inspired to observe and co-create their cities by sensing their urban environments. The aim to complement, validate, and enrich information in authoritative data held by the public administrations and public agencies. This will be facilitated by engaging with citizens to co-create green initiatives and to develop Citizen Observatories. In GREENGAGE, Citizen Observatories will be a place where pilot cities will co-examine environmental issues integrating novel bottom-up process with top-down perspectives. This will provide the basis to co-create and co-design innovative solutions to monitor environmental problems at ground level with the help of citizens.With two interrelated project dimensions, the project aims to enhance intelligence applied to city decision-making processes and governance by engaging with citizen observations integrated with Copernicus, GEOSS, in-situ, and socio-economic intelligence, and by delivering innovative governance models based on novel toolboxes of decision-making methodologies and technologies. The envisioned citizens observatory campaigns will be deployed and fully demonstrated in 5 pilot engagements in selected European cities and regions including: Bristol (the United Kingdom), Copenhagen (Denmark), Turano / Gerace (Italy) and the region of Noord Brabant (the Netherlands). These innovation pilots aim to highlight the need for smart city governance by promoting citizen engagement, co-creation, gathering new data which will complement existing datasets and evidence-based decision and policymaking.
Nature areas in North-West Europe (NWE) face an increasing number of visitors (intensified by COVID-19) resulting in an increased pressure on nature, negative environmental impacts, higher management costs, and nuisance for local residents and visitors. The high share of car use exaggerates these impacts, including peak pressures. Furthermore, the almost exclusive access by car excludes disadvantaged people, specifically those without access to a car. At the same time, the urbanised character of NWE, its dense public transport network, well-developed tourism & recreation sector, and presence of shared mobility providers offers ample opportunities for more sustainable tourism. Thus, MONA will stimulate sustainable tourism in and around nature areas in NWE which benefits nature, the environment, visitors, and the local economy. MONA will do so by encouraging a modal shift through facilitating sustainable transport modes, providing inclusive routing to and within nature areas, and nudging visitors and stakeholders towards more sustainable behaviour. These are the key solutions to manage visitor flows, reduce negative impacts, and stimulate inclusive access. 8 nature areas and 3 knowledge & dissemination partners work together to:> Assess the impact of visitors & mobility on nature areas and develop strategies to reduce this impact>Jointly pilot solutions on the modal shift, routing and nudging > Provide capacity building for stakeholders across NWENature areas, destination marketing organisations, tourism & mobility service providers, local and regional authorities and (potential) visitors of nature areas all benefit from the strategies and solutions for, and revenues of, sustainable tourism. MONA develops and promotes a mindset around sustainable tourism which is balanced, inclusive, and socially and environmentally sustainable. This is made possible by the projects’ multidisciplinary approach, for which the transnational partnership and expertise is essential.
The number of tourists in Zeeland is high, which influences the livability and quality of life in the region. There are also increasing concerns about health and well-being in this area. Zeeland aims to be a vital region, where a vital Leisure, Tourism, Hospitality (LTH) sector is in balance with society and the environment. The practical problem revolves around the realisation of the social legitimation of the impact of tourism on its environment. This PD-trajectory overall ambition is to contribute to the social legitimation of LTH by strengthening crossovers between the LTH sector and the health sector. The objective of this PD-trajectory is to support LTH entrepreneurs in a way that their initiatives contribute to the health of the local residents. To accomplish this task, entrepreneurs in the LTH industry have a need for practical tools and guidelines that assist them in contributing to these societal challenges. So far, there are no concrete tools or other support products available in the region for LTH entrepreneurs to base their actions (in quadruple helix context) on in order to achieve crossovers and positive impact on health. How this process works and what is required for this is important to gain insight into so that this co-creation process can serve as an example for other initiatives in the LTH sector. Therefore, this process will be monitored and evaluated so that lessons can be learned. Ultimately, a decision support tool will be developed from this effort which other entrepreneurs can use to develop and organize their initiatives in a quadruple helix context with the aim of health benefits for the resident. This will help to establish a cross-domain approach and work in co-creation on regional positive impact of LTH in line with the future vision for Zeeland.
