Background: Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods: To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman’s rank correlation. Results: The mean screening performances ranged from 63 % to 93 % across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (r S = 0.943, p = 0.005). Conclusions: Our findings showed that there is a significant positive association between objectively measured nurse sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses’ perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.
BACKGROUND: One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used.OBJECTIVES: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.METHODS: MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form.RESULTS: The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights.CONCLUSION: Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.
MULTIFILE
Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness.
In the last decade, the automotive industry has seen significant advancements in technology (Advanced Driver Assistance Systems (ADAS) and autonomous vehicles) that presents the opportunity to improve traffic safety, efficiency, and comfort. However, the lack of drivers’ knowledge (such as risks, benefits, capabilities, limitations, and components) and confusion (i.e., multiple systems that have similar but not identical functions with different names) concerning the vehicle technology still prevails and thus, limiting the safety potential. The usual sources (such as the owner’s manual, instructions from a sales representative, online forums, and post-purchase training) do not provide adequate and sustainable knowledge to drivers concerning ADAS. Additionally, existing driving training and examinations focus mainly on unassisted driving and are practically unchanged for 30 years. Therefore, where and how drivers should obtain the necessary skills and knowledge for safely and effectively using ADAS? The proposed KIEM project AMIGO aims to create a training framework for learner drivers by combining classroom, online/virtual, and on-the-road training modules for imparting adequate knowledge and skills (such as risk assessment, handling in safety-critical and take-over transitions, and self-evaluation). AMIGO will also develop an assessment procedure to evaluate the impact of ADAS training on drivers’ skills and knowledge by defining key performance indicators (KPIs) using in-vehicle data, eye-tracking data, and subjective measures. For practical reasons, AMIGO will focus on either lane-keeping assistance (LKA) or adaptive cruise control (ACC) for framework development and testing, depending on the system availability. The insights obtained from this project will serve as a foundation for a subsequent research project, which will expand the AMIGO framework to other ADAS systems (e.g., mandatory ADAS systems in new cars from 2020 onwards) and specific driver target groups, such as the elderly and novice.
One of the mission-driven innovation policies of the Netherlands is energy transition which sets, among others, the challenge for a carbon-neutral built environment in 2050. Around 41% of Dutch houses do not yet have a registered energy label, and approximately 31% of the registered houses have label C or lower. This calls for action within the housing renovation industry. Bound to the 70 percent rule, a renovation plan requires full (or at least 70 percent) agreement on the renovation between relevant parties, including residents. In practice, agreement indicators focus mostly on economic and energy aspects. When indicators include people’s needs and preferences, it is expected to speed participation and agreement, increasing residents’ satisfaction and enhances the trust in public institutions. Tsavo was founded in 2015 to organise the sustainability of buildings for ambitious clients. Its sustainability process aims to accelerate renovation by keeping at their core value the social needs and preferences of residents. In this project Tsavo and TU Delft work together to optimise the sustainability process so, it includes everyone’s input and results in a sustainability plan that represents everyone. Tsavo’s role will be key in keeping the balance between both a sustainable renovation service that is cheaper and fast yet also attractive and with an impact on the quality of living. In this project, Tsavo’s sustainable renovation projects will be used to implement methods that focus on increasing participation and residents’ satisfaction. TU Delft will explore principles of attractive, accessible and representative activities to stimulate residents to decide on a renovation plan that is essential and meaningful to all.
Wereldwijd zorgen riffen, gebouwd door biobouwers zoals koralen en schelpdieren, voor belangrijke ecosysteemdiensten waaronder kustveiligheid, visserij en recreatie. Deze riffen staan echter onder toenemende druk en door het verlies van natuurlijke harde substraten gaat ook de biodiversiteit en productiviteit van het mariene ecosysteem achteruit. Tegelijkertijd is er juist een toename van kunstmatig hard substraat voor mariene infrastructuur, zoals dijken, havens en golfbrekers. Vanwege de goede verwerkbaarheid en grote toepasbaarheid, is het meest gebruikte materiaal voor mariene infrastructuur beton. Beton heeft echter grote nadelen: 1) De cementindustrie is verantwoordelijk voor 5-7% van de wereldwijde CO2 uitstoot en 2) op beton groeien door de suboptimale chemische samenstelling andere ecologische gemeenschappen dan op natuurlijke riffen. De komende jaren zal er, door klimaatverandering en economische ontwikkeling, nog meer op zee gebouwd worden. Er is daarom een wereldwijde noodzaak voor materialen die een lagere CO2 footprint hebben dan beton en ecologisch beter functioneren. In het RAAK-publiek ECODAMI (Ecologisch Optimale en Duurzame Alternatieve materialen voor Mariene Infrastructuur) project werkt hogeschool VHL samen met publieke partijen Waterschap Noorderzijlvest, Rijkswaterstaat, Public Entity Saba en partners uit zowel de bouwkundige als ecologische hoek aan de interdisciplinaire vraag “Welke alternatieve materialen kunnen gebruikt worden om mariene infrastructuur te verduurzamen en tegelijk de onderwaternatuur te verrijken?” Om deze vraag te beantwoorden worden alternatieve materialen voor beton geproduceerd en getest op conventionele eigenschappen zoals verwerkbaarheid en sterkte. De meest kansrijke materialen worden in experimenteel labonderzoek getest op de vestiging van indicatorsoorten, waarna de best functionerende materialen worden gecombineerd. Via experimenteel veldonderzoek in de Waddenzee, de Zeeuwse delta en bij Saba (Caribisch Nederland) wordt de ontwikkeling van ecologische gemeenschappen op de proefblokken onderzocht en wordt een laatste selectie gemaakt. Op deze manier resulteert het ECODAMI project in duurzame en ecologisch optimale bouwmaterialen die direct toepasbaar zijn in mariene infrastructuur.
