Aim. This study aims to identify ways that allow studying how intellectually impaired persons showing challenging behaviour interact with space, without impacting their daily lives. Back-ground. Research about space that better suits these persons’ needs is challenging to conduct, since they may have difficulties expressing themselves verbally and are extremely sensitive to-wards sensory stimuli. Therefore, researchers collecting data may be disturbing and intrusive, and requires great caution. Tapping into existing data may be a promising alternative. Residential care organisations routinely collect data about residents during their regular work processes, such as personal information and incident registration. Also useful may be routinely collected spatial data, such as drawings and repair reports. This study explores how routinely collected data (RCD) can provide insight into how residents interact with space, without impacting their daily lives. Methods. We reflect on the possibilities of using RCD (related to resident or space) based on explorations in the context of a case study at a Dutch very-intensive-care facility. The data were analysed to identify general patterns, such as locations with a high density of incidents/repairs and verified initial findings by member checking with staff. Results. The RCD analysed provide a basic and relevant insight into incidents and repairs connected to challenging behaviour. However, most data were neither complete or relevant for analysis. Therefore, we dis-cussed the RCD were with staff and only then it was possible to draw conclusions regarding relevance of RCD and the residents-space interactions. Conclusions. Only in conjunction with an ex-tended approach on member checking the use of RCD seems relevant. RCD have little meaning of their own. But the combination of RCD with member checking seems to provide insight into the interaction between residents and space, without interfering with the residents’ daily lives.
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Background: A pragmatic, stepped wedge trial design can be an appealing design to evaluate complex interventions in real-life settings. However, there are certain pitfalls that need to be considered. This paper reports on the experiences and lessons learned from the conduct of a cluster randomized, stepped wedge trial evaluating the effect of the Hospital Elder Life Program (HELP) in a Dutch hospital setting to prevent older patients from developing delirium. Methods: We evaluated our trial which was conducted in eight departments in two hospitals in hospitalized patients aged 70 years or older who were at risk for delirium by reflecting on the assumptions that we had and on what we intended to accomplish when we started, as compared to what we actually realized in the different phases of our study. Lessons learned on the design, the timeline, the enrollment of eligible patients and the use of routinely collected data are provided accompanied by recommendations to address challenges. Results: The start of the trial was delayed which caused subsequent time schedule problems. The requirement for individual informed consent for a quality improvement project made the inclusion more prone to selection bias. Most units experienced major difficulties in including patients, leading to excluding two of the eight units from participation. This resulted in failing to include a similar number of patients in the control condition versus the intervention condition. Data on outcomes routinely collected in the electronic patient records were not accessible during the study, and appeared to be often missing during analyses. Conclusions: The stepped wedge, cluster randomized trial poses specific risks in the design and execution of research in real-life settings of which researchers should be aware to prevent negative consequences impacting the validity of their results. Valid conclusions on the effectiveness of the HELP in the Dutch hospital setting are hampered by the limited quantity and quality of routine clinical data in our pragmatic trial. Executing a stepped wedge design in a daily practice setting using routinely collected data requires specific attention to ethical review, flexibility, a spacious time schedule, the availability of substantial capacity in the research team and early checks on the data availability and quality.
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Current research on data in policy has primarily focused on street-level bureaucrats, neglecting the changes in the work of policy advisors. This research fills this gap by presenting an explorative theoretical understanding of the integration of data, local knowledge and professional expertise in the work of policy advisors. The theoretical perspective we develop builds upon Vickers’s (1995, The Art of Judgment: A Study of Policy Making, Centenary Edition, SAGE) judgments in policymaking. Empirically, we present a case study of a Dutch law enforcement network for preventing and reducing organized crime. Based on interviews, observations, and documents collected in a 13-month ethnographic fieldwork period, we study how policy advisors within this network make their judgments. In contrast with the idea of data as a rationalizing force, our study reveals that how data sources are selected and analyzed for judgments is very much shaped by the existing local and expert knowledge of policy advisors. The weight given to data is highly situational: we found that policy advisors welcome data in scoping the policy issue, but for judgments more closely connected to actual policy interventions, data are given limited value.
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