Aim: To develop an understanding of how nurses obtain and take account of patient preferences in shared decision-making processes in evidence-based practice to provide personalized nursing care. Design: Qualitative grounded theory. Methods: This research was part of a PhD study successfully completed in December 2015. Semi-structured interviews were conducted with 27 nurses in four medium-sized hospitals in the Netherlands. Additionally, seven nurses were observed during their shift on the ward. Constant comparative analysis underpinned by Strauss and Corbin’s framework was used. Results: Three communication tools of nurses were identified to discern and attend to patient preferences to provide individual tailored nursing care: 1) A click-making tool that enables to build rapport instantly; 2) The use of antennae to carefully monitor the individual patient’s needs; 3) Asking empathic questions so that the care is fine-tuned to the individual patient’s preferences. This way, the nurses attempt to provide optimal nursing care to enhance the patient's perceived quality of life. Conclusion: The excellent nurses have a set of three implicit and intuitive tools to continuously attune their professional care to individual patient preferences in the evidence-based practice to provide personalized care. The nurses consciously spend time to discover patient preferences. The use of the implicit communication tools appears to be part of the nurses’ professional knowledge, and deserves further research as a follow up to this study. Considering the importance of taking account of patient preferences in the evidence-based practice, these findings have international relevance to nursing professionals across the world. Dit artikel is later verschenen in de Journal of Advanced Nursing onder de titel 'The role of patient preferences in nursing decision‐making in evidence based practice: excellent nurses’ communication tools' (2019).
Aims and objectives: To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalized care. Background: In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice, and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making. Design: Qualitative grounded theory. Methods: Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data-analysis was conducted using three level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed. Results: A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: “Teach me to provide the best care for you in this situation”. During the observations it was confirmed that the excellent nurses behaved as they had described before. Conclusion: Excellent nurses actively turn towards patients’ expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalized nursing care. Relevance to clinical practice: Patient preferences become a fully-fledged part of nursing decision-making in EBP when in education and practice the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalized care is more valued and taught.
Background Clients facing decision-making for long-term care are in need of support and accessible information. Construction of preferences, including context and calculations, for clients in long-term care is challenging because of the variability in supply and demand. This study considers clients in four different sectors of long-term care: the nursing and care of the elderly, mental health care, care of people with disabilities, and social care. The aim is to understand the construction of preferences in real-life situations. Method Client choices were investigated by qualitative descriptive research. Data were collected from 16 in-depth interviews and 79 client records. Interviews were conducted with clients and relatives or informal caregivers from different care sectors. The original client records were explored, containing texts, letters, and comments of clients and caregivers. All data were analyzed using thematic analysis. Results Four cases showed how preferences were constructed during the decision-making process. Clients discussed a wide range of challenging aspects that have an impact on the construction of preferences, e.g. previous experiences, current treatment or family situation. This study describes two main characteristics of the construction of preferences: context and calculation. Conclusion Clients face diverse challenges during the decision-making process on long-term care and their construction of preferences is variable. A well-designed tool to support the elicitation of preferences seems beneficial.
Due to societal developments, like the introduction of the ‘civil society’, policy stimulating longer living at home and the separation of housing and care, the housing situation of older citizens is a relevant and pressing issue for housing-, governance- and care organizations. The current situation of living with care already benefits from technological advancement. The wide application of technology especially in care homes brings the emergence of a new source of information that becomes invaluable in order to understand how the smart urban environment affects the health of older people. The goal of this proposal is to develop an approach for designing smart neighborhoods, in order to assist and engage older adults living there. This approach will be applied to a neighborhood in Aalst-Waalre which will be developed into a living lab. The research will involve: (1) Insight into social-spatial factors underlying a smart neighborhood; (2) Identifying governance and organizational context; (3) Identifying needs and preferences of the (future) inhabitant; (4) Matching needs & preferences to potential socio-techno-spatial solutions. A mixed methods approach fusing quantitative and qualitative methods towards understanding the impacts of smart environment will be investigated. After 12 months, employing several concepts of urban computing, such as pattern recognition and predictive modelling , using the focus groups from the different organizations as well as primary end-users, and exploring how physiological data can be embedded in data-driven strategies for the enhancement of active ageing in this neighborhood will result in design solutions and strategies for a more care-friendly neighborhood.
Everyone has the right to participate in society to the best of their ability. This right also applies to people with a visual impairment, in combination with a severe or profound intellectual and possibly motor disability (VISPIMD). However, due to their limitations, for their participation these people are often highly dependent on those around them, such as family members andhealthcare professionals. They determine how people with VISPIMD participate and to what extent. To optimize this support, they must have a good understanding of what people with disabilities can still do with their remaining vision.It is currently difficult to gain insight into the visual abilities of people with disabilities, especially those with VISPIMD. As a professional said, "Everything we can think of or develop to assess the functional vision of this vulnerable group will help improve our understanding and thus our ability to support them. Now, we are more or less guessing about what they can see.Moreover, what little we know about their vision is hard to communicate to other professionals”. Therefore, there is a need for methods that can provide insight into the functional vision of people with VISPIMD, in order to predict their options in daily life situations. This is crucial knowledge to ensure that these people can participate in society to their fullest extent.What makes it so difficult to get this insight at the moment? Visual impairments can be caused by a range of eye or brain disorders and can manifest in various ways. While we understand fairly well how low vision affects a person's abilities on relatively simple visual tasks, it is much more difficult to predict this in more complex dynamic everyday situations such asfinding your way or moving around during daily activities. This is because, among other things, conventional ophthalmic tests provide little information about what people can do with their remaining vision in everyday life (i.e., their functional vision).An additional problem in assessing vision in people with intellectual disabilities is that many conventional tests are difficult to perform or are too fatiguing, resulting in either no or the wrong information. In addition to their visual impairment, there is also a very serious intellectual disability (possibly combined with a motor impairment), which makes it even more complex to assesstheir functional vision. Due to the interplay between their visual, intellectual, and motor disabilities, it is almost impossible to determine whether persons are unable to perform an activity because they do not see it, do not notice it, do not understand it, cannot communicate about it, or are not able to move their head towards the stimulus due to motor disabilities.Although an expert professional can make a reasonable estimate of the functional possibilities through long-term and careful observation, the time and correct measurement data are usually lacking to find out the required information. So far, it is insufficiently clear what people with VZEVMB provoke to see and what they see exactly.Our goal with this project is to improve the understanding of the visual capabilities of people with VISPIMD. This then makes it possible to also improve the support for participation of the target group. We want to achieve this goal by developing and, in pilot form, testing a new combination of measurement and analysis methods - primarily based on eye movement registration -to determine the functional vision of people with VISPIMD. Our goal is to systematically determine what someone is responding to (“what”), where it may be (“where”), and how much time that response will take (“when”). When developing methods, we take the possibilities and preferences of the person in question as a starting point in relation to the technological possibilities.Because existing technological methods were originally developed for a different purpose, this partly requires adaptation to the possibilities of the target group.The concrete end product of our pilot will be a manual with an overview of available technological methods (as well as the methods themselves) for assessing functional vision, linked to the specific characteristics of the target group in the cognitive, motor area: 'Given that a client has this (estimated) combination of limitations (cognitive, motor and attention, time in whichsomeone can concentrate), the order of assessments is as follows:' followed by a description of the methods. We will also report on our findings in a workshop for professionals, a Dutch-language article and at least two scientific articles. This project is executed in the line: “I am seen; with all my strengths and limitations”. During the project, we closely collaborate with relevant stakeholders, i.e. the professionals with specific expertise working with the target group, family members of the persons with VISPIMD, and persons experiencing a visual impairment (‘experience experts’).
Mode heeft een cruciale functie in de samenleving: zij maakt diversiteit en inclusiviteit mogelijk en is een middel voor individuen om zich uit te drukken. Desalniettemin is mode ook een raadsel op het gebied van duurzaamheid, zowel aan de sociale als aan de milieukant. Er bestaan echter alternatieven voor de huidige praktijken in de mode. Dit project heeft tot doel de ontwikkeling van een van die initiatieven te ondersteunen. In samenwerking met twee Nederlandse MKB bedrijven in de mode-industrie, willen we een of meer business modellen co-designen voor het vermarkten van circulair ontworpen laser geprinte T-shirts. Door lasertechnologie te introduceren in plaats van traditionele inktopties, kunnen de T- shirts hun CO2 voetafdruk verder verkleinen en een verstandig alternatief zijn voor individuen, die op zoek zijn naar duurzame modekeuzes. Maar hoewel de technologische haalbaarheid vaststaat, vereist het vermarkten sterke, schaalbare, bedrijfsmodellen. Via een haalbaarheidsstudie willen we dergelijke businessmodellen ontwikkelen en de commercialisering van deze producten ondersteunen. Wij zijn van plan de reacties van de consument op een dergelijke innovatie te bestuderen, evenals de belemmeringen en stimulansen vanuit het oogpunt van de consument, en de inkoop-, toeleveringsketen- en financiële kwesties die kunnen voortvloeien uit de schaalbaarheid van een potentieel bedrijfsmodel. Om praktische relevantie voor de bredere industrie te verzekeren, streven we ernaar om de resultaten te presenteren op evenementen georganiseerd door een van de consortiumpartners (in 2023), als ook om een teaching case en een wetenschappelijk artikel te ontwikkelen op basis van de resultaten van het project.
