Search

This paper addresses the evaluation of nursing quality and safety beyond nursing tasks in specific healthcare settings and sets it in a context that conveys the sense of complexity and multifaceted nature of the contribution that nursing makes to the whole system. The paper describes research conducted in Tuscany during 2019 involving regional managers and heads of nursing departments. This research has led to the development of an integrated evaluation framework through focus groups and consensus process with the latter, which includes Performance Organizational climate data, Patient-Reported Experience Measures (PREMs), and Patient-Reported Outcome Measures (PROMs). This integrated framework aims at both making sense of extant measures as key performance indicators shared among different professionals while recognizing the important role of nursing care by adding specific measures and can be seen as a tool that boosts the sense of “teamness” in healthcare.

The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing &lsquo, Exploratory Health Laboratories&rsquo, to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the &ldquo, Health Labs&rdquo, towards innovative models of ethically grounded and evidenced-based PCC.

It is widely acknowledged that climate change has caused serious environmental issues, including drought, bushfires, floods, and heatwaves, and urban sustainability is currently seriously threatened as a result. Arden is one of the key urban regeneration areas set to experience dramatic residential changes under Melbourne’s development blueprint within the next 20 years. The Arden Structure Plan (2022) outlines specific implementation steps but does not go into detail about the strategies and tactics used to address climate change and urban sustainability. Therefore, there are still problems with the plan, including a lack of information and time-bound development targets, ambiguous public engagement, little focus on urban crime, and insufficient climate change adaptation measures. The plan also considers affordable housing, a mixed-use development pattern that will significantly decrease environmental harm, and active transportation options, primarily walking and bicycling. Considering climate change, this plan will make Arden a suitable location for population growth. This paper aims to evaluate the Arden Structure Plan and make recommendations on how to improve the plan’s urban sustainability and climate change considerations. Furthermore, it provides guidance on whether Arden is a suitable location for Melbourne’s population growth in light of the climate change impacts anticipated to occur by 2100.

Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and ‘any’ events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.

Controlling bovine tuberculosis (bTB) disease in cattle farms in England is seen as a challenge for farmers, animal health, environment and policy-makers. The difficulty in diagnosis and controlling bTB comes from a variety of factors: the lack of an accurate diagnostic test which is higher in specificity than the currently available skin test, isolation periods for purchased cattle, and the density of active badgers, especially in high-risk areas. In this paper, to enable the complex evaluation of bTB disease, a dynamic Bayesian network (DBN) is designed with the help of domain experts and available historical data. A significant advantage of this approach is that it represents bTB as a dynamic process that evolves periodically, capturing the actual experience of testing and infection over time. Moreover, the model demonstrates the influence of particular risk factors upon the risk of bTB breakdown in cattle farms.

Co-production is an approach to designing, delivering, and evaluating public services through strict collaboration among professionals and the people using services with an equal and reciprocal relationship. Health promotion initiatives that include education services rarely use the co-production approach. Nevertheless, the value of co-production is widely recognized, although it is considered a normative good, and scarce and mixed evidence is available in literature. The purpose of this paper is to provide evidence supporting the hypothesis that a co-production approach, applied to an intervention for preventing obesity, can be effective and efficient. To this end, an evaluation of the processes, outputs meant as intermediate results, and behavioral and economic outcomes of a public health-promotion initiative co-produced and co-delivered with adolescents (beFood) was conducted. Mixed methods were used, including field-observations, two self-reported questionnaires, and an opportunity&ndash, cost analysis that compared beFood to traditional approaches of public health promotion. The co-production model was successfully implemented and appears to be effective&mdash, more than 5000 adolescents were reached by only 49 co-producer adolescents, who reported behavioral changes (e.g., eating better and practicing more physical activity). The cost analysis showed that the co-production approach was also efficient, producing relevant savings and potentially making available more than 3000 h of professionals&rsquo, time. This research can support a re-thinking of public institutions&rsquo, organization, public initiatives&rsquo, design, and public servants&rsquo, role.

Low-carbon tourism is an effective solution to cope with the goal conflict between developing tourist economy and responding to carbon emission reduction and ecological environment protection. Tourism scenic spots are important carriers of tourist activities and play a crucial role in low-carbon tourism. There are multiple factors affecting the low-carbon performance of a tourism scenic spot, and thus the performance evaluation and ranking of low-carbon tourism scenic spots can be framed as a hierarchical multi-criteria decision making (MCDM) problem. This paper develops a novel method to tackle hierarchical MCDM problems, in which the importance preferences of criteria over the decision goal and sub-criteria with respect to the upper-level criterion are provided by linguistic-term-based pairwise comparisons and the assessments of alternatives over each of sub-criteria at the lowest level are furnished by positive interval values. The linguistic-term-based pairwise comparison matrices are converted into intuitionistic fuzzy preference relations and an approach is developed to obtain the global importance weights of the lowest level sub-criteria. A multiplicatively normalized intuitionistic fuzzy decision matrix is established from the interval-value-based assessments of alternatives and a method is proposed to determine the intuitionistic fuzzy value based comprehensive scores of alternatives. A case study is offered to illustrate how to build a performance evaluation index system of low-carbon tourism scenic spots located at Zhejiang Province of China and show the use of the proposed intuitionistic fuzzy hierarchical MCDM method.

Nowadays, water resource security is becoming increasingly prominent, and this problem is a primary bottleneck restricting China&rsquo, s future sustainable development. It is difficult to come to a unified conclusion on water resources security, and applications of highly feasible evaluation methods are lacking in practice. In this paper, a novel evaluation methodology is proposed for regional water resources security evaluation. First, water security is divided into two aspects: water quantity security and water quality security. The disposal rate of harmless household garbage, the excellent water resources proportion, and the functional water body loss proportion are creatively considered as indicators of water quality security in the evaluation system. In addition, a Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method is used to evaluate the water security levels in different regions. For distinguishing the importance of different indicators, a Best&ndash, Worst Method (BWM) is employed to calculate the indicator weights, as triangular fuzzy linguistic sets can more flexibly describe the preferences of decision makers (DMs) regarding the indicators, therefore, it is embedded in BWM to determine indicator weights. Moreover, the fuzzy BWM-TOPSIS method is applied to evaluate the water security levels of six regions in North China, a comparison analysis with the equal weight TOPSIS method as well as the fuzzy BWM-AHP method, and a sensitivity analysis for indicator weights are presented to illustrate the effectiveness of this proposed method. Finally, some suggestions based on the evaluation results are given for effective and rational utilization of water resources in North China.

This study evaluated the impact of &ldquo, In the Know&rdquo, mental health literacy training for Canadian agriculture. We hypothesized that &ldquo, would significantly increase participants&rsquo, knowledge around mental health, confidence in recognizing mental health struggles, confidence in speaking about mental health with others, and confidence in helping someone who may be struggling with mental health. &ldquo, was a 4-h, in-person program delivered by a mental health professional who also had experience in agriculture. Six sessions were offered in Ontario, Canada in 2018. Participants were farmers and/or worked primarily with farmers. A pre-training paper questionnaire was administered, followed by a post-training questionnaire at the end of the session and 3 and 6 month post-training questionnaires via email. Wilcoxon signed-rank tests were performed to compare participants&rsquo, self-reported knowledge and confidence across four timepoints. &ldquo, significantly improved participants&rsquo, self-reported mental health knowledge and confidence in recognizing mental health struggles, speaking to others, and helping others who are struggling immediately following training and often at 3 and 6 months post-training. This is the first study among farming populations to measure program impact with 3- and 6-month follow-ups. Given the reported associations between mental health literacy and increased help-seeking, disseminating &ldquo, more broadly across farming communities may help to increase mental health literacy and thus increase help-seeking among farmers.

Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B&rsquo, more Healthy Communities for Kids (BHCK), Children&rsquo, s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design, (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components, (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups, and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.

In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.