How to improve emergency care to adults discharged within 24 hours? Acute Care planning in Emergency departments (The ACE study): a protocol of a participatory design study

Background.A development towards earlier postnatal discharge presents a challenge to find new ways to provide information and support to families. A possibility is the use of telemedicine.Objective.To explore how using an app in nursing practice affects the nurses’ ability to offer support and information to postnatal mothers who are discharged early and their families.Design.Participatory design. An app with a chat, a knowledgebase, and automated messages was tried out between hospital and parents at home.Settings.The intervention took place on a postnatal ward with approximately 1,000 births a year.Participants.At the onset of the intervention, 17 nurses, all women, were working on the ward. At the end of the intervention, 16 nurses were employed, all women.Methods.Participant observation and two focus group interviews. The data analysis was inspired by systematic text condensation.Results.The nurses on the postnatal ward consider that the use of the app gives families easier access to timely information and support.Conclusions.The app gives the nurses the possibility to offer support and information to the parents being early discharged. The app is experienced as a lifeline that connects the homes of the new parents with the hospital.

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Developing a hospital-wide quality and safety dashboard: a qualitative research study

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-007784 ◽

2018 ◽

Vol 27 (12) ◽

pp. 1000-1007 ◽

Cited By ~ 7

Author(s):

Anne Marie J W M Weggelaar-Jansen ◽

Damien S E Broekharst ◽

Martine de Bruijne

Keyword(s):

Cognitive Abilities ◽

Development Process ◽

Phase 1 ◽

Quality And Safety ◽

Focus Group Interviews ◽

Qualitative Research Study ◽

Analytical Skills ◽

Development Processes ◽

Group Interviews ◽

Five Phases

BackgroundSeveral countries have national policies and programmes requiring hospitals to use quality and safety (QS) indicators. To present an overview of these indicators, hospital-wide QS (HWQS) dashboards are designed. There is little evidence how these dashboards are developed. The challenges faced to develop these dashboards in Dutch hospitals were retrospectively studied.Methods24 focus group interviews were conducted: 12 with hospital managers (n=25; 39.7%) and 12 support staff (n=38; 60.3%) in 12 of the largest Dutch hospitals. Open and axial codings were applied consecutively to analyse the data collected.ResultsA heuristic tool for the general development process for HWQS dashboards containing five phases was identified. In phase 1, hospitals make inventories to determine the available data and focus too much on quantitative data relevant for accountability. In phase 2, hospitals develop dashboard content by translating data into meaningful indicators for different users, which is not easy due to differing demands. In phase 3, hospitals search for layouts that depict the dashboard content suited for users with different cognitive abilities and analytical skills. In phase 4, hospitals try to integrate dashboards into organisational structures to ensure that data are systematically reviewed and acted on. In phase 5, hospitals want to improve the flexibility of their dashboards to make this adaptable under differing circumstances.ConclusionThe literature on dashboards addresses the technical and content aspects of dashboards, but overlooks the organisational development process. This study shows how technical and organisational aspects are relevant in development processes.

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137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.339 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S182-S182

Author(s):

Xue Fen Valerie Seah ◽

Yue Ling Rina Ong ◽

Wei Ming Cedric Poh ◽

Shahul Hameed Mohamed Siraj ◽

Kai-Qian Kam ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Patient Outcomes ◽

Phase 1 ◽

Surgical Site Infections ◽

Phase 2 ◽

Oral Antibiotics ◽

Post Intervention ◽

Phase 3 ◽

The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

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Enabling visibility of the clinician-scientists’ knowledge broker role: a participatory design research in the Dutch nursing-home sector

Health Research Policy and Systems ◽

10.1186/s12961-021-00715-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Margot Barry ◽

Wietske Kuijer ◽

Anke Persoon ◽

Loek Nieuwenhuis ◽

Nynke Scherpbier

Keyword(s):

Participatory Design ◽

Design Research ◽

Phase 1 ◽

Research Process ◽

Perceived Usefulness ◽

Knowledge Broker ◽

Phase 2 ◽

Phase 3 ◽

Academic Network ◽

Knowledge Intensive

Abstract Background A group of clinician-scientists and managers working within a Dutch academic network, experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists. They found no role clarity in literature, nor did they find tools or methods suitable for clinician-scientists. Clarifying role expectations and providing accountability for funding these knowledge broker positions was difficult. The aim of this research was to design a theory-informed tool that allowed clinician-scientists to make their knowledge broker role visible. Methods A participatory design research was conducted in three phases, over a 21-month period, with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Phase 1 constituted a literature review, a context analysis and a needs analysis. Phase 2 constituted the design and development of a suitable tool and phase 3 was an evaluation of the tool’s perceived usefulness. Throughout the research process, the researcher logged the theoretic basis for all design decisions. Results The clinician-scientist’s knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible (phase 1). A tool (the SP-tool) was developed in Microsoft Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities (phase 2). The SP-tool contributed to the clinician-scientists’ ability to make their knowledge broker role visible to themselves and their stakeholders (phase 3). The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician-scientist’s knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of clinician-scientists broker functions, which is an element necessary for the professionalisation of an occupation. Conclusions The SP-tool that was developed in this research, contributes to creating work visibility of the clinician-scientists’ knowledge broker role. Further research using the SP-tool could establish a clearer description of the knowledge broker role at the day-to-day professional level and improved ability to support this role within organisations.

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Improving Hand Hygiene Compliance in Hospitals by Design

Infection Control and Hospital Epidemiology ◽

10.1086/668772 ◽

2013 ◽

Vol 34 (1) ◽

pp. 102-104 ◽

Cited By ~ 1

Author(s):

Marijke Melles ◽

Vicki Erasmus ◽

Martijn P. M. van Loon ◽

Marc Tassoul ◽

Ed F. van Beeck ◽

...

Keyword(s):

Hand Hygiene ◽

Participatory Design ◽

Development Process ◽

International Studies ◽

Focus Group Interviews ◽

User Research ◽

3 Dimensional ◽

Group Interviews ◽

Hygiene Compliance ◽

Hospital Acquired

Essential in reducing hospital-acquired infections is adequate hand hygiene (HH) among healthcare workers (HCWs). International studies show, however, that HH guidelines are adhered to in less than 50% of required times. Research into HH behavior has shown that self-reported compliance is often higher than observed compliance, which seems to indicate that HCWs are unaware of their HH behavior. In addition, because of its frequency, HH behavior could be considered an automatic (or subconscious) behavior. Therefore, a (temporary) shift from the subconscious to the conscious could be a solution to change current HH behavior and create new habits. These insights formed the points of departure of the design project described here, which aimed to develop an alcohol-based hand rub (ABHR) dispenser to stimulate HCWs to better adhere to the international guidelines of HH. In order to increase the chance of success of the new dispenser, a participatory design approach was applied, meaning that all stakeholders of the dispenser (nurses, physicians, infection control practitioners, housekeeping) were actively involved in the different phases of the development process.The development process of the new dispenser consisted of 5 phases: analysis, idea finding (identifying promising design directions), and 3 idea iterations. Interim ideas were evaluated using functional 3-dimensional prototypes and the results applied to further develop the final concept. Methods of user research included observations and individual and focus group interviews.

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Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study (Preprint)

10.2196/preprints.14588 ◽

2019 ◽

Author(s):

Ulrika Müssener ◽

Marie Löf ◽

Preben Bendtsen ◽

Marcus Bendtsen

Keyword(s):

High School ◽

At Risk ◽

High School Students ◽

Mobile Phones ◽

Participatory Design ◽

Focus Group Interviews ◽

School Students ◽

Lifestyle Behavior ◽

Usability Tests ◽

Group Interviews

BACKGROUND Unhealthy lifestyle behaviors such as insufficient physical activity, unhealthy diet, smoking, and harmful use of alcohol tend to cluster (ie, individuals may be at risk from more than one lifestyle behavior that can be established in early childhood and adolescence and track into adulthood). Previous research has underlined the potential of lifestyle interventions delivered via mobile phones. However, there is a need for deepened knowledge on how to design mobile health (mHealth) interventions taking end user views into consideration in order to optimize the overall usability of such interventions. Adolescents are early adopters of technology and frequent users of mobile phones, yet research on interventions that use mobile devices to deliver multiple lifestyle behavior changes targeting at-risk high school students is lacking. OBJECTIVE This protocol describes a participatory design study with the aim of developing an mHealth lifestyle behavior intervention to promote healthy lifestyles among high school students. METHODS Through an iterative process using participatory design, user requirements are investigated in terms of technical features and content. The procedures around the design and development of the intervention, including heuristic evaluations, focus group interviews, and usability tests, are described. RESULTS Recruitment started in May 2019. Data collection, analysis, and scientific reporting from heuristic evaluations and usability tests are expected to be completed in November 2019. Focus group interviews were being undertaken with high school students from October through December, and full results are expected to be published in Spring 2020. A planned clinical trial will commence in Summer 2020. The study was funded by a grant from the Swedish Research Council for Health, Working Life, and Welfare. CONCLUSIONS The study is expected to add knowledge on how to design an mHealth intervention taking end users’ views into consideration in order to develop a novel, evidence-based, low-cost, and scalable intervention that high school students want to use in order to achieve a healthier lifestyle.

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‘Drawing’ conclusions

European Physical Education Review ◽

10.1177/1356336x16683898 ◽

2017 ◽

Vol 24 (4) ◽

pp. 449-466 ◽

Cited By ~ 7

Author(s):

Melissa Parker ◽

Ann MacPhail ◽

Mary O’Sullivan ◽

Déirdre Ní Chróinín ◽

Eileen McEvoy

Keyword(s):

Physical Activity ◽

Physical Education ◽

Primary School ◽

Phase 1 ◽

Primary School Children ◽

Focus Group Interviews ◽

Education Data ◽

Group Interviews ◽

Gendered Patterns ◽

The Relationship

This study explores the relationship between primary school physical education and physical activity as sites for the practice of physical activity of Irish primary school children. Understanding how children make connections between physical activity sites is important in shaping physical education experiences that promote lifelong participation. Children’s (aged 8–11) awareness, knowledge, and understanding of physical activity and physical education were examined using participatory methods of ‘draw and write’ ( n = 135) and focus group interviews ( n = 34). In Phase 1, data collection focused on physical activity, while Phase 2 focused on physical education and connections between physical activity and physical education. Data were analysed using a general inductive approach. Data analysis resulted in four themes: gendered patterns of participation; connections between physical education and physical activity; the nature and choice of participation in activities; and perceptions of ability. Children had varying understandings of the connections between their participation in physical education and physical activity. These findings highlight the importance of supporting all children to make explicit connections between their learning in physical education and their wider physical activity participation. An implication of the findings is that children need to be explicitly prompted to engage in physical activity. Without such encouragement, children are unlikely to draw linkages between physical activity and physical education.

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PROBLEMS OF COHERENCE IN THE WRITING OF VIETNAMESE EFL STUDENTS AND AN INTERVENTION TO IMPROVE STUDENTS’ WRITING PERFORMANCE

10.26686/wgtn.14914827 ◽

2021 ◽

Author(s):

Dao Pham

Keyword(s):

Treatment Group ◽

Focus Group ◽

Phase 1 ◽

Control Group ◽

Phase 2 ◽

Writing Quality ◽

Focus Group Interviews ◽

Writing Performance ◽

Efl Students ◽

Group Interviews

Coherence has been claimed to be one among the difficult aspects of writing to teach and learn . Both teachers and learners find it hard to explain why one piece of writing is incoherent and another is not. There have been a few studies (Gramegna, 2007; Wikborg, 1990) investigating the types of coherence breaks in EFL/ESL writing and a few studies (Johns, 1986; Lee, 2002b) investigating the effects of teaching aspects of coherence on students’ writing performance. However, there have been no studies identifying the coherence problems in students’ writing and then using these to teach students how to avoid these coherence problems. In addition to teaching students to avoid coherence problems, an approach called topical structure analysis (TSA) (Liangprayoon, Chaya, & Thep-ackraphong, 2013; Schneider & Connor, 1990) has been considered as an effective technique to help improve students’ writing coherence. Some studies (Attelisi, 2012; Connor & Farmer, 1990) have examined the effect of teaching TSA in promoting EFL students’ awareness of coherence, but investigating the effect of the combination of teaching coherence problems and TSA on EFL students’ writing performance has not been done in any previous studies. My study fills both of these gaps. There are two main phases in my study. In Phase 1, I developed a system of coherence problems based on the analysis of 69 essays written by Vietnamese EFL students. Then, this system of coherence problems was used to identify the types and frequency of coherence problems in the writing of Vietnamese EFL students. In Phase 2, an intervention was conducted in a university in Vietnam. Fifty-eight students participated in the intervention and were divided into a control group and a treatment group. While the combination of teaching the system of coherence problems developed in Phase 1 and teaching TSA was delivered to the treatment group in the intervention, the control group was taught other aspects of writing such as grammar, vocabulary, etc. The aim of Phase 2 of this study was to examine the effect of the intervention on students’ writing performance, especially on coherence and overall writing quality. Data for Phase 1 was 69 essays on a single topic. Using this set of essays, the types of coherence problems and their frequency were identified. Data for Phase 2 included three sets of writing. The first set of writing was 58 essays written by students in both the treatment group and the control group before the intervention was conducted. The second set of writing involved the students revising their first draft right after the intervention finished. The third set of writing was 58 new essays on a different topic from the first and the second sets written by students in the control and treatment groups four weeks after the intervention. These three sets of writing were analysed and rated by the same raters as in Phase 1. In addition, students completed questionnaires and participated in focus group interviews in Phase 2. Findings of Phase 1 show that there were five main types of coherence problems that Vietnamese EFL students had in their writing. These were macrostructure-related problems, topic unity-related problems, paragraph unity-related problems, cohesion-related problems, and metadiscourse-related problems. Of these five main types of coherence problems, paragraph unity-related problems were the most frequent ones, and “no/ little elaboration of the proposition made” was the most frequent subtype of paragraph-unity problems. Findings from Phase 2 show that there was a significant difference in terms of coherence problems, types of topical progression, and writing quality between the two groups after the intervention finished. To be specific, there were significantly fewer instances of coherence problems in the writing of the treatment group than in the writing of the control group, and the scores for coherence and overall quality achieved by the treatment group were significantly higher than those achieved by the control group. Also, the focus group interviews suggest that most students found the intervention helpful in improving their writing performance. This means the combination of teaching coherence problems and TSA to students had a positive impact on students’ writing coherence and writing quality. Based on the findings, some suggestions are made for teaching writing to EFL students in general and for the teaching of coherence in the Vietnamese university context in particular.

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PROBLEMS OF COHERENCE IN THE WRITING OF VIETNAMESE EFL STUDENTS AND AN INTERVENTION TO IMPROVE STUDENTS’ WRITING PERFORMANCE

10.26686/wgtn.14914827.v1 ◽

2021 ◽

Author(s):

Dao Pham

Keyword(s):

Treatment Group ◽

Focus Group ◽

Phase 1 ◽

Control Group ◽

Phase 2 ◽

Writing Quality ◽

Focus Group Interviews ◽

Writing Performance ◽

Efl Students ◽

Group Interviews

Coherence has been claimed to be one among the difficult aspects of writing to teach and learn . Both teachers and learners find it hard to explain why one piece of writing is incoherent and another is not. There have been a few studies (Gramegna, 2007; Wikborg, 1990) investigating the types of coherence breaks in EFL/ESL writing and a few studies (Johns, 1986; Lee, 2002b) investigating the effects of teaching aspects of coherence on students’ writing performance. However, there have been no studies identifying the coherence problems in students’ writing and then using these to teach students how to avoid these coherence problems. In addition to teaching students to avoid coherence problems, an approach called topical structure analysis (TSA) (Liangprayoon, Chaya, & Thep-ackraphong, 2013; Schneider & Connor, 1990) has been considered as an effective technique to help improve students’ writing coherence. Some studies (Attelisi, 2012; Connor & Farmer, 1990) have examined the effect of teaching TSA in promoting EFL students’ awareness of coherence, but investigating the effect of the combination of teaching coherence problems and TSA on EFL students’ writing performance has not been done in any previous studies. My study fills both of these gaps. There are two main phases in my study. In Phase 1, I developed a system of coherence problems based on the analysis of 69 essays written by Vietnamese EFL students. Then, this system of coherence problems was used to identify the types and frequency of coherence problems in the writing of Vietnamese EFL students. In Phase 2, an intervention was conducted in a university in Vietnam. Fifty-eight students participated in the intervention and were divided into a control group and a treatment group. While the combination of teaching the system of coherence problems developed in Phase 1 and teaching TSA was delivered to the treatment group in the intervention, the control group was taught other aspects of writing such as grammar, vocabulary, etc. The aim of Phase 2 of this study was to examine the effect of the intervention on students’ writing performance, especially on coherence and overall writing quality. Data for Phase 1 was 69 essays on a single topic. Using this set of essays, the types of coherence problems and their frequency were identified. Data for Phase 2 included three sets of writing. The first set of writing was 58 essays written by students in both the treatment group and the control group before the intervention was conducted. The second set of writing involved the students revising their first draft right after the intervention finished. The third set of writing was 58 new essays on a different topic from the first and the second sets written by students in the control and treatment groups four weeks after the intervention. These three sets of writing were analysed and rated by the same raters as in Phase 1. In addition, students completed questionnaires and participated in focus group interviews in Phase 2. Findings of Phase 1 show that there were five main types of coherence problems that Vietnamese EFL students had in their writing. These were macrostructure-related problems, topic unity-related problems, paragraph unity-related problems, cohesion-related problems, and metadiscourse-related problems. Of these five main types of coherence problems, paragraph unity-related problems were the most frequent ones, and “no/ little elaboration of the proposition made” was the most frequent subtype of paragraph-unity problems. Findings from Phase 2 show that there was a significant difference in terms of coherence problems, types of topical progression, and writing quality between the two groups after the intervention finished. To be specific, there were significantly fewer instances of coherence problems in the writing of the treatment group than in the writing of the control group, and the scores for coherence and overall quality achieved by the treatment group were significantly higher than those achieved by the control group. Also, the focus group interviews suggest that most students found the intervention helpful in improving their writing performance. This means the combination of teaching coherence problems and TSA to students had a positive impact on students’ writing coherence and writing quality. Based on the findings, some suggestions are made for teaching writing to EFL students in general and for the teaching of coherence in the Vietnamese university context in particular.

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Strategies to Improve Clinician-Patient Communication Experiences for Patients With Neurologic Conditions

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001091 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001091

Author(s):

Melissa J. Armstrong ◽

Neal J Weisbrod ◽

Carma L Bylund

Keyword(s):

Patient Outcomes ◽

Electronic Communication ◽

Improve Patient Care ◽

Active Listening ◽

Family Needs ◽

Verbal Skills ◽

Clinician Experiences ◽

American Academy Of Neurology ◽

Family Centered ◽

Improve Patient

Abstract:Increasing research supports that effective clinician communication with patients and families leads to improved patient outcomes, higher patient satisfaction, and improved clinician experiences. As a result, patient- and family-centered communication is the focus of a 2020 American Academy of Neurology quality measure and part of neurology residency training milestones. Clinicians across training levels can implement strategies for improving patient- and family-centered communication, including optimizing the communication environment, using verbal and non-verbal skills, focusing on the patient’s agenda, practicing active listening, demonstrating respect and empathy, individualizing encounters to patient and family needs, and providing clear explanations. These skills can be tailored for specialized encounters (e.g. when wearing masks, telemedicine) and for electronic communication. By purposefully identifying and incorporating key communication skills in everyday practice, clinicians have the opportunity to improve patient care and satisfaction and their own experiences in neurology clinical practice.

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