Vilans

AimThe aim of this study is to further develop a preliminary framework into a model that can translate mechanisms into output and impact, based on the views of those working in practice and the relations between the mechanisms: a model that can inform practitioners and organizations on what has to be in place to shape a learning and innovating environment in nursing. BackgroundA Learning and Innovation Network (LIN) is a network of healthcare professionals, students and education representatives who come together to be part of a nursing community to integrate education, research and practice to contribute to quality of care. In a previous study a preliminary framework was developed through a concept analysis based on publications. The preliminary framework describes input, throughput and output factors in a linear model that does not explain what the components entail in practice and how the components work together. DesignFocus groups. MethodsWe designed a Theory of Change (ToC) in four phases. This was based on a focus group interview with lecturer practitioners (Phase 1); a first concept ToC based on thematic analysis of the focus group interview (Phase 2); three paired interviews where the ToC was presented to other lecturer practitioners to complement and verify the ToC model (Phase 3); and adjustment of the model based on the feedback of phase 3 (Phase 4). ResultsThe developed ToC model describes important preconditions that have to be in place to start a LIN: a shared vision, a facilitating support system and a diversity of participants who are open to change. It describes the mechanisms by which a wide range of activities can lead to an improvement of the quality of care through collaboration between practice, education and research by working, learning, performing practice based research and implementing new methods together. ConclusionThis study gives a comprehensive overview of the concept of the ‘Learning and Innovation Network’ (LIN); how the activities in the LIN can lead to impact; and under what conditions. Previously published findings supported elements of the ToC model. The overarching ToC model and the detailed appendix offer a theoretical and practice-based model for practitioners, managers and policy makers.

Introduction: The new generation elderly, the babyboomers, expect that elderly-care reflects their need to remain independent. In general elderly are perceived as inactive and vulnerable with negative outcomes on quality of care. However babyboomers don’t identify themselves as elderly and they have a higher level of self-efficacy. An elderly-care organisation in a medium-sized town in the Netherlands, strived for a suitable care design, that meets expectations of babyboomers and wanted to know how this care design could be implemented in the local setting. Theory/methods: The implementation Framework for Aged Care, developed by Meyers (1), was applied to a practice-oriented trajectory design. This framework is a fit-for-purpose implementation framework in the local social, cultural and economic context. The applied methodologies were literature research, desk and field research, which resulted in problem-clarification, an intervention design and an implementation advice. Results: Self-efficacy and self-reliance are determinants which influence the measure of independence of babyboomers. Therefore it is necessary for elderly-care to give attention to the increasing independence needs of babyboomers. Literature states that reablement is an effective intervention which increases independence by influencing self-efficacy and self-reliance. Reablement is a time-bound (six to twelve weeks) interdisciplinary, intensive and person- and goal orientated intervention in the homecare setting, delivered by trained staff (2). Homecare staff is not yet trained in the current situation to work from a perspective that increases independence. Therefore a training programme and reablement trajectory was developed based on literature. This training program focusses on changing behavioural determinants of homecare staff by using social influence from peers. Babyboomers can only be empowered to increase self-efficacy and self-reliance if homecare staff believes they contribute to this independence. The Implementation strategy was mainly oriented on the adoption of reablement, since this is a condition of success of reablement. Discussion: There is a risk of using untrained staff in reablement which may have negative outcomes on independence. Homecare staff can feel devalued as they perceive part of their care-role ‘to care for’ instead of ‘to care that’. Conclusions: By influencing the determinants of homecare staff and babyboomers, reablement shows to be effective by focusing on increasing independence of babyboomers. After a training programme which uses the social influence of peers, reablement can be implemented in the local context. Lessons learned: How we perceive elderly has an influence on the outcome and organisation of elderly care. Scandinavian research shows that reablement can be an intervention with positive societal effects on care in general and the prevailing paradigm of getting older.

For better serving people’s complex needs the subsequent movement to person-centered integrated care, requires inter-organizational cooperation and service provision by domain-overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter-organizational healthcare governance. Therefore, in a scoping review we studied the current state of knowledge and practice of accountability in healthcare in the Netherlands. We found that two of the included 41 studies show characteristics of accountability towards healthcare with characteristics of integration care components, such as integration of services with accompanying accountability arrangements and development of networked accountability. The first studies are found in the literature which report on accountability in integrated care. With this we add to the international discussion about accountability as an aspect of integrated care governance, by providing insight into the current state of art of accountability in Dutch healthcare.

Introduction:In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe.Methods:Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions.Results:The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: ‘people related’ and ‘governance and organisation’.Discussion and conclusion:The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services.

SamenvattingDoor corona hebben drie gehandicaptenzorgorganisaties versneld technologie voor beeldbellen en beeldzorg ingezet. Sinds 2021 wisselen zij daarover ervaringen uit in de Innovatie-impuls Gehandicaptenzorg. We inventariseerden hoe begeleiders, cliënten en naasten beeldzorg ervaren. Uit de interviews blijkt dat ze blij zijn met de mogelijkheden die beeldzorg biedt, maar ook dat ze het vooral zien als back-up. Voor duurzame implementatie van beeldzorg is een visie nodig op de toekomst van de zorg en de rol die digitale zorg daarin speelt. Deze resultaten zijn daar behulpzaam bij.

There has been an emergence in technology applications (apps) aimed at addressing needs amongst older adults and persons with cognitive impairment (PwCI). Despite the ubiquity of these apps, utilization is low, primarily due to a lack of involvement of PwCI and the perception that these apps have little motivational value. Engaging PwCI in creative processes such as co-design could lead to the creation of apps that better meets the needs of this population. The current study applies a user-centered, participatory approach to involve PwCI in the design of a new self-management and coaching app, RESILIEN-T. Co-design workshops were held with 12 PwCI across Italy, Netherlands and Canada; structured as four modules: (1) introduction and expectation setting, (2) user analysis, (3) storytelling, and (4) collaborative design. Based on interviews with PwCI, stories of individuals which reflect the target population were created (personas) and the solutions to the needs of these personas were discussed. Information about participant’s interests, computer proficiency and self-rated cognitive decline were collected. Participants were asked to try 10 existing apps and provided feedback on the design, usability and functionality. Lastly, participants were shown a prototype for RESILIEN-T and provided feedback based on the personas that they helped create. Co-design activities revealed that personalization is crucial for adherence. Aspects of physical and social activity, nutrition and cognition were most important to participants. Participants found many apps that are recommended for older adults do not appear age appropriate and seem condescending. These findings were common across PwCI from various nations.

Shared decision making (SDM) contributes to personalised decisions that fit the personal preferences of patients. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research we developed in a co-creation process with the end-users a training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility the intervention was implemented at two outpatient geriatric clinics in a pilot study (N=108). Key elements of the training for geriatricians include: developing skills how to involve older adults with MCC and informal caregivers in SDM and learning how to explore personal goals related to quality of life. Key elements of the preparatory tool for patients include: an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, invitation of informal caregivers to share their concerns. Through a process of co-creation both a training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end-users and based on the ‘Dynamic model of SDM with frail older adults’.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)