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.
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.
BackgroundThe challenge of combining professional work and breastfeeding is a key reason why women choose not to breastfeed or to stop breastfeeding early. We posited that having access to a high-quality lactation room at the workplace could influence working mothers’ satisfaction and perceptions related to expressing breast milk at work, which could have important longer term consequences for the duration of breastfeeding. Specifically, we aimed to (1) develop a checklist for assessing the quality of lactation rooms and (2) explore how lactation room quality affects lactating mothers’ satisfaction and perceptions. Drawing on social ecological insights, we hypothesized that the quality of lactation rooms (operationalized as any space used for expressing milk at work) would be positively related to mothers’ satisfaction with the room, perceived ease of, and perceived support for milk expression at work.MethodsWe conducted two studies. In Study 1 we developed a lactation room quality checklist (LRQC) and assessed its reliability twice, using samples of 33 lactation rooms (Study 1a) and 31 lactation rooms (Study 1b). Data were collected in the Northern part of the Netherlands (between December 2016 and April 2017). Study 2 comprised a cross-sectional survey of 511 lactating mothers, working in a variety of Dutch organizations. The mothers were recruited through the Facebook page of a popular Dutch breastfeeding website. They completed online questionnaires containing the LRQC and measures aimed at assessing their satisfaction and perceptions related to milk expression at work (in June and July 2017).ResultsThe LRQC was deemed reliable and easy to apply in practice. As predicted, we found that objectively assessed higher-quality lactation rooms were associated with increased levels of satisfaction with the lactation rooms, perceived ease of milk expression at work, and perceived support from supervisors and co-workers for expressing milk in the workplace.ConclusionsThe availability of a high-quality lactation room could influence mothers’ decisions regarding breast milk expression at work and the commencement and/or continuation of breastfeeding. Future studies should explore whether and how lactation room quality affects breastfeeding choices, and which aspects are most important to include in lactation rooms.
