Presentatie gegeven over de review in Brussel Objectives: In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined.
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Abstract: Technological innovation in the healthcare sector is increasing, but integration of information technology (IT) in the care process is difficult. Healthcare workers are important agents in this IT integration. The purpose of this study is to explore factors that feed motivation to use IT. Self-determination theory (SDT) is applied to study how motivational factors impact effective IT use among frontline caregivers in residential care settings. As the team is very important to these caregivers, the team is our unit of analysis. In an embedded single case study design, interviews were conducted with all nine members of a team effectively using IT. All three basic psychological needs from SDT - autonomy, competence and relatedness - were found to have impact on effective IT use, though autonomy was primarily experienced at team level. Conversely, the effective use of an IT collaboration tool influences relatedness.
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The economic recession has hit especially hard the residential building sector in the EU region, e.g., the number of the housing completions has decreased -49% and the total residential output has been squeezed down by -24% between 2007 and 2014 (Euroconstruct, 2015). In turn, the aim of our paper is to suggest a set of radical, novel programmes for developing the national residential building sectors within EU member countries up to 2025. We have applied the framework of strategic niche management (SNM) to the diagnoses of the current portfolios of the innovation, R&D programs in our two member country contexts. In the case of the Northern Finland, the prime example is Hiukkavaara, the largest district to be built in the City of Oulu. Homes will be constructed for 20,000 new residents. Hiukkavaara is a model for climate- conscious design in the northern hemisphere. Energy and materials are conserved, nature is valued and human beings adapt to their environment. One sub-programme involves Future Buildings and Renewable Energy Project. In the case of the Netherlands, the prime example is Energiesprong (Energy Leap), i.e., the innovation programme commissioned by the Dutch Ministry of the Interior. The aim is to make buildings energy-neutral and boost large-scale initiatives. The sub-programmes are targeting homes owned by housing associations, privately owned homes, office buildings, shops and care institutions. This programme is about ensuring new supply by encouraging companies to package a variety of technical sub-solutions, full services and financing options as well as about asking clients to put out tenders and ask for quotes in novel ways, with the government making changes to the rules and the regulations. Experiences on which the Dutch case in this paper focuses are sub-programmes for residential buildings, which include de Stroomversnelling, LALOG and Ons Huis Verdient Het. Based on the emerging Finnish and Dutch evidence, we are suggesting key elements to be incorporated into future national residential programmes within EU member countries on: (1) radical direction with balanced stakeholder groups, trustworthy advocates, contextual goal-setting and barriers management, (2) radical networking with entrepreneurial roles and causal links, novel expertise, transparent choices and digital platforms and (3) radical learning processes to arrive at better informed markets on user preferences, co-innovating, new rules and regulations, higher performance/price ratios, higher quality, new roles and responsibilities assignments.
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Background The experiences of residents who have communication difficulties such as dysphasia are largely absent from the literature. Aim To illuminate the everyday experiences of four residents with severe communication difficulties living in a residential care setting in the Netherlands. Methodology & Methods A collective case study methodology was used. Seventy-five hours of observation, interview and documentary data was gathered over six weeks. Alternative strategies of communication were developed to enable the co-creation of dialogue between participants and researcher. For example, a participant who could not talk used intentionally created artwork to share her ideas with the researcher. Findings Participants' daily experiences were characterised by struggling against the constraints of the residential setting: having to wait, having unmet needs, experiencing vulnerability and uncertainty. Participants' communication difficulties exacerbated these constraints. Their experiences of struggling were sometimes ameliorated by significant social contact with family or particular staff members, and engaging in enjoyable activities. Occasionally the experiences of enjoying the here-and-now, and being 'seen' as a person by the other, would create beautiful moments in which truly person centred engagement would occur. These moments were neither articulated nor recorded, and were thus invisible after they had occurred. Similarly, the experiences of struggling against the constraints were neither acknowledged nor recorded. Significant experiences in the lives of these four residents were therefore invisible to others. The unifying theme representing the participants' daily experiences was: That which goes unsaid. Discussion It was necessary to develop communication strategies which would by-pass the researcher's assumptions and enable participants to introduce their own ideas and opinions. This ongoing process of co-creation of dialogue required work from, and trust between, participants and researcher. What is new? Expressly seeking the views of residents with communication difficulties Successfully using process consent with participants in this situation Using intentionally created artwork during data gathering in this context What has regional, national or international relevance? The findings indicate that people with communication difficulties may not receive optimal care in residential settings in the Netherlands. Methods are described which could be used by practitioners in their everyday work, and which show facilitators or practice developers how they can help carers to engage in more effective communication with this kind of resident. Additionally, this research contributes to the international discussion about ethical participation of vulnerable people in research.
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To adequately deal with the challenges faced within residential care for older people, such as the increasing complexity of care and a call for more person-centred practices, it is important that health care providers learn from their work. This study investigates both the nature of learning, among staff and students working within care for older people, and how workplace learning can be promoted and researched. During a longitudinal study within a nursing home, participatory and democratic research methods were used to collaborate with stakeholders to improve the quality of care and to promote learning in the workplace. The rich descriptions of these processes show that workplace learning is a complex phenomenon. It arises continuously in reciprocal relationship with all those present through which both individuals and environment change and co-evolve enabling enlargement of the space for possible action. This complexity perspective on learning refines and expands conventional beliefs about workplace learning and has implications for advancing and researching learning. It explains that research on workplace learning is itself a form of learning that is aimed at promoting and accelerating learning. Such research requires dialogic and creative methods. This study illustrates that workplace learning has the potential to develop new shared values and ways of working, but that such processes and outcomes are difficult to control. It offers inspiration for educators, supervisors, managers and researchers as to promoting conditions that embrace complexity and provides insight into the role and position of self in such processes.
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In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. Methods: A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results: Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). Conclusions: This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.
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Background: As the world population ages, the number of people with diminished performance on the Activities of Daily Living (ADL) increases. A reliable and valid measure needs to be developed to determine the effects of interventions focused at increasing self-care abilities. We developed the Performance ADL Test (PAT) for this purpose. Objective: The aim of this study was to investigate the reliability and validity of the PAT in older people living in residential homes. Methods: The PAT contains 16 test items, covering the entire range of Basic ADL and Instrumental ADL performance in elderly people. For this assessment, 40 older people (mean age of 85 ± 7.5 years) participated. All 40 subjects lived in residential institutions in the Netherlands, were able to walk at least 10 m, could understand instructions spoken in Dutch, and had no cognitive impairment. During the first test session, subjects completed the PAT, the Groningen Activity Restriction Scale (GARS), and performance-based physical fitness tests. Two weeks later, subjects were retested on the PAT. Results: Factor analysis revealed three subscales: Organization of Performance, Gross Motor Function, and Fine Motor Function. Internal consistency (Cronbach's α) of all scales and subscales ranged from 0.731 to 0.881. Test-retest reliability (intraclass correlation) ranged from 0.316 to 0.950. Paired sample t-tests revealed no significant differences between subject performance obtained during the two test periods. Pearson's correlations between the PAT and the GARS ranged from 0.490 to 0.831, and between the PAT and the fitness tests from 0.317 to 0.781. Conclusion: Although the number of participants was limited (n = 40), the PAT seems to be a useful instrument for assessing ADL performance in older people living in residential homes. In general, internal consistency, test-retest reliability, and validity were satisfactory. Copyright © 2010 S. Karger AG, Basel.
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Abstract Background: Although there is little evidence on their efficacy regarding challenging behaviour, antipsychotics are the most used psychotropic drugs in residential intellectually disabled people. Discontinuation is possible for some residential clients with intellectual disabilities. This study aimed to gain insight into support staff's perceptions of discontinuing antipsychotics in residential clients with intellectual disabilities. Method: Four focus groups were conducted in this mixed‐methods study, followed by a survey. Results: A large majority of support staff perceive antipsychotics to be effective in controlling challenging behaviour. Support staff regarded themselves as willing to contribute to the discontinuation of antipsychotics, but were more confident about achieving reductions. Conclusions: The attitude of the majority of support staff towards discontinuation provides a good basis for regularly reviewing antipsychotics use. A reduction plan should include preliminary steps, methods of monitoring and evaluating the process, and establishing measures for dealing with possible crises.
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Background Little is known about the nature and reactions to sexual abuse of children with intellectual disability (ID). The aim was to fill this gap. Method Official reports of sexual abuse of children with ID in state care were examined (N = 128) and compared with children without ID (N = 48). Results Clear signs of penetration or genital touching by male (adolescent) peers or (step/foster) fathers were found in most ID reports. Victims often received residential care and disclosed themselves. Type of perpetrator seemed to affect the nature and reaction to the abuse. Cases of children with and without ID seemed to differ in location and reports to police. Conclusions Screening of (foster)homes seems crucial. Residential facilities should find a balance between independence of children and protection. Care providers should be trained in addressing sexual issues and sexual education, accounting for different types of perpetrators (peers/adults). Uniform reporting guidelines are needed.
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Offering physical activities matching with the preferences of residents in long-term care facilities could increase compliance and contribute to client-centered care. A measure to investigate meaningful activities by using a photo-interview has been developed (“MIBBO”). In two pilot studies including 133 residents living on different wards in long-term care facilities, feasibility, most chosen activities, and consistency of preferences were investigated. It was possible to conduct the MIBBO on average in 30 min with the majority (86.4%) of residents. The most frequently chosen activities were: gymnastics and orchestra (each 28%), preparing a meal (31%), walking (outside, 33%), watering plants (38%), and feeding pets (40%). In a retest one week after the initial interview 69.4% agreement of chosen activities was seen. The MIBBO seems a promising measure to help health care professionals in identifying residents’ preferred activities. Future research should focus on the implementation of the tailored activity plan, incorporating it into the daily routine.
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