Search

Background: Narratives have the potential to promote person-centred practice, yet few studies have been undertaken on the impact of a narrative approach on learning for care professionals or students. With this in mind, we co-designed an educational programme on the use of older persons' narratives for professionals in research, education and nursing. Aims: To investigate the impact of attending a narrative educational programme on the learning of nursing and healthcare assistant students, and on their person-centred practice. We also examined what factors characterised and influenced this learning. Methods: This was a mixed-methods evaluation study. We evaluated the impact of a narrative educational programme on third-year healthcare assistant students and second-year nursing students. Students were invited to complete a survey before and after the educational programme. After the programme, we performed interviews with all the educators and some of the students. Results: Students' learning from the narratives was varied, and there were differences in the extent to which the programme raised awareness. Some students demonstrated new understandings, actions and behaviours. Students self-reported that they had experienced learning related to 12 learning outcomes and to their person-centred practice. According to educators and students, this learning was experiential and reflective, and was influenced by the students' level of participation, personal characteristics and openness to other perspectives, as well as the educators' guidance and the workplace conditions. Conclusion: This study shows that the educational programme 'Tell Me! Learning From Narratives' can contribute to the learning of healthcare assistant and nursing students in terms of their understanding of the field of narrative inquiry as well as the development of their person-centred practice. Providing support for educators is a prerequisite for the programme to work. Implications for practice: * The programme has the potential to contribute to a person-centred care curriculum * Self-evaluation, for example via the self-scan person-centred care survey in this study, prompts awareness in students * Educators should be supported in their use of a narrative approach, person-centred care values and didactic skills * Educators should reflect the values of person-centred care in their practice and in their relationships with students as role models [ABSTRACT FROM AUTHOR]

Background: Social interactions are important for people living with dementia in a nursing home. However, not much is known about interactions and relationships between residents and family caregivers and related experiences of family caregivers. We aim to advance the knowledge on how family caregivers interact with people living with dementia in a nursing home and how they maintain or redesign a meaningful connection.Methods: Qualitative research using interviews with family caregivers (n = 31) to explore perspectives on their interaction and relationship with the person living with dementia. Interviews were held during the reopening of nursing homes after the first COVID-19 lockdown in the Netherlands. In this situation, family caregivers became more aware of their interaction and relationship with the resident, which provided a unique opportunity to reflect on this. The interviews explored the interaction and relationship in a broad sense, not specifically for the COVID-19 situation. Thematic analysis was performed to analyze the data.Results: We were able to identify three key themes reflecting the experiences of family caregivers: (1) changes in the interaction and relationship, (2) strategies to promote connection, and (3) appreciation of the interaction and relationship. From the viewpoint of family caregivers, the interaction and relationship are important for both the resident living with dementia and for themselves, and family caregivers have different strategies for establishing a meaningful connection. Nevertheless, some appear to experience difficulties with constructing such a connection with the resident.Conclusions: Our results provide a basis for supporting family caregivers in perceiving and establishing mutuality and reciprocity so that they can experience togetherness. [ABSTRACT FROM AUTHOR]

Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross‐sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI‐HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West‐Friesland, the Netherlands. The interRAI‐HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio‐respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions. [ABSTRACT FROM AUTHOR]

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co‐created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors. [ABSTRACT FROM AUTHOR]

Introduction: In the northwest of the Netherlands, health and social care professionals have sought to structure and coordinate care and support for older people living at home with multiple health and social care needs. The region was selected as one of the case sites of a European project called SUSTAIN, which aimed to facilitate and evaluate improvements to established integrated care initiatives for older people living at home. By participating in the SUSTAIN project, local stakeholders collaborated with researchers to further improve their way of working. This case study describes the process and outcomes of the development and implementation of improvements, as well as the factors that influenced this improvement process. Insight into this process may provide valuable lessons that could be transferable to other integrated care initiatives Methods: Using a participatory approach, guided by the Evidence Integration Triangle (Glasgow, 2012), local stakeholders defined and implemented a tailored intervention aimed at improving collaboration and communication between health and social care professionals. Researchers monitored and evaluated this improvement process. Multiple data sources were used, including the Team Climate Inventory (n=11), interviews with managers and professionals delivering health and social care (n=8), meeting minutes (n=10) and field notes. Results and Discussion: The tailored intervention consisted of regular intervision meetings (i.e. meetings consisting of peer supervision and methodical discussion to reflect on professional development) as well as workplace visits. According to professionals, the intervention resulted in improved communication and collaboration. Facilitating factors included the safe and informal setting in which the meetings took place and the personal relationships that developed during the project. Managers also valued the intervention, although they voiced concerns about the scale and sustainability of the implementation. Issues such as staff shortages, time constraints and privacy regulations made it difficult to implement the intervention on a larger scale. In addition, lack of ownership and accountability among managers and different organizational cultures and interests hindered the improvement process. Still, this bottom-up participatory approach encouraged the development of trust, shared goals and a shared sense of urgency on the level of both managers and professionals. Conclusions: A shared sense of urgency, personal relationships and trust on different organisational levels were important factors facilitating the improvement of an established integrated care initiative in the Netherlands. Lessons Learned: This case study highlights that participatory approaches, in which interventions are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with competing interests. Limitations: Our study sample is relatively smalldue to the limited number of participating stakeholders. Still, similar patterns were found in the different data sources. In addition, given the relatively short implementation period, we were not able to assess whether the improvement impacted older people's experiences with care and support. Suggestions for further research: Further research may focus on the sustainability of improvements to established integrated care initiatives, and look into possibilities to scale up these improvement activities. [ABSTRACT FROM AUTHOR]

Introduction: Older people living at home may experience problems in the physical, cognitive, psychological, social and/or environmental life domains, leading to complex care needs. Integration of health and social care is widely acknowledged as an adequate way to address these complex needs. An important component of integrated care programs is a comprehensive geriatric assessment CGA which helps to identify older people's care needs and preferences. A CGA provides the basis for a tailored care plan, consisting of specific actions to support older people in their homes. In the wide range of integrated care programs for frail older people, different CGA tools are being used. To the best of our knowledge, a comprehensive overview of the characteristics of the different CGA tools is currently lacking. The aim of our study was therefore to describe and compare different CGA tools and procedures for conducting them. Methods: A systematic literature search in the electronic databases Embase/Medline and Scopus was conducted to search for papers describing CGAs in integrated care programs for older people living at home. Our search yielded 814 potentially relevant publications. Two researchers independently assessed eligibility based on title and abstract and full text screening. In total, 26 integrated care programs were included in our review. The identified integrated care programs were reviewed as to their main characteristics: country, program objective, target group, setting and involved professionals. Data extraction for information about the CGAs included: CGA tool/instruments, comprehensiveness i.e. life domains being addressed, multidisciplinarity i.e. extent to which professionals from different disciplines are involved, person-centredness i.e. extent to which older people and informal carers are involved and procedures to conduct a CGA. Results: Included studies shows a great variety of CGAs used in integrated care programs. Most integrated care programs were implemented in the Netherlands and the United States. The majority of CGAs seemed to address comprehensiveness, multidisciplinarity and personcentredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. Furthermore, some identified instruments are broadly used in different countries e.g. RAI-CHA, whereas others e.g. [G]OLD instrument are developed and used exclusively in one specific program. Discussion/conclusion: This study shows that integrated care programs, in different settings and for different target groups, have different ways of conducting a CGA. Due to this heterogeneity, older people's needs and preferences are being assessed and addressed in different ways. It is still unclear what works best in conducting a CGA in the context of integrated care and whether the existing range of CGAs is adequate. Limitations/suggestions for future research: We did not include the entire range of existing CGAs in this review, as several papers did not adequately describe the CGA tool and procedures used. A more thorough description of CGAs as a component of an integrated care program is recommended to complement the current overview of CGAs. Further research is recommended to develop guidance on how older people's problems and care needs should best be assessed and to prevent researchers and professionals from reinventing the wheel. [ABSTRACT FROM AUTHOR]

Background: Numerous integrated care initiatives have been rolled out in a wide range of settings and contexts, in order to improve care and support for frail older people living at home. Despite this rich and varied field of practical examples, evidence on the effectiveness of integrated care remains inconsistent and knowledge on successful implementation and transferability of experiences to other contexts is still limited. To take a step forward in the development of integrated care, the cross-European research project called SUSTAIN was initiated in 2015, with a two-fold objective: 1. to support and monitor improvements to established integrated care initiatives for older people living at home, and 2. to identify improvements that could be applicable and adaptable to other health and social care systems and regions in Europe. Over the past two years, local stakeholders from thirteen existing integrated care initiatives in seven European countries have worked together with SUSTAIN project partners to improve their current way of working. Supported by SUSTAIN project partners, stakeholders from the different initiatives (i.e. managers, health and social care professionals, representatives of older people and informal carers, local policy officers) designed and implemented improvement plans tailored to local priorities. Using a multiple case study design, SUSTAIN project partners monitored and evaluated experiences and outcomes related to the design and implementation of these improvements in each initiative (or 'case'). Comparing and integrating data from these different cases provides insight into what works for whom and in which context. Aims and objectives: During this workshop, we will share lessons learned so far from the implementation and evaluation of the improvement projects in the SUSTAIN project. The aim of the workshop is threefold: 1. inform the audience about the objectives and design of the SUSTAIN project, 2. illustrate outcomes and experiences related to designing and implementing improvements in three of the participating integrated care initiatives, and 3. present preliminary findings from the integration of outcomes and experiences of all participating initiatives. Format: During the first presentation, we will briefly show SUSTAIN's overall structure, approach and activities to generate evidence on improving integrated care. During the second, third and fourth presentation we will share experiences from participating integrated care initiatives located in West-Friesland (the Netherlands), the Arnhem region (the Netherlands) and Sabadell (Spain). The fifth presentation will focus on preliminary findings based on overarching analyses of experiences from all initiatives. After the presentations, we will discuss with the audience how lessons learned during the SUSTAIN project can bring the development of integrated care further. Target audience: This workshop is targeted at researchers and decision-makers who want to know more about improving established integrated care initiatives. Learnings: After this session, participants will have insight in: 1. the objectives and design of the SUSTAIN project, 2. case-specific experiences and outcomes related to improving integrated care, and 3. preliminary outcomes of the overarching analyses which supports the understanding of what works for whom, in which context and with what outcomes. [ABSTRACT FROM AUTHOR]

Background: Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the 'patient experience' is becoming increasingly important. For this purpose, the Person-Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages., Aim: This study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person-centred coordinated care of people with chronic conditions in the Netherlands., Participants and Methods: Adults with chronic conditions (N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T-tests (construct validity)., Results: The two-component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health-literate or less activated experienced less person-centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received., Conclusion: The Dutch P3CEQ is a valid instrument to assess the experience of person-centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health-literate persons, and improve their experiences of care., Patient Contribution: The P3CEQ has been developed in collaboration with a range of stakeholders. Eighteen persons with (multiple) chronic conditions participated as patient representatives and codesign experts in (four) codesign workshops. Other patient representatives participated in cognitive testing of the English-language instrument. The usability of the P3CEQ to capture the experience of person-centred coordinated care of older persons has been examined by interviewing 228 older European service users, including 13 living in the Netherlands, as part of the SUSTAIN project. More than a thousand persons with chronic conditions participated in the validation study of the Dutch P3CEQ., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Long-term care for older adults is in transition. Organizations offering long-term care for older adults are expected to provide person-centered care (PCC) in a complex context, with older adults aging in place and participating in society for as long as possible, staff shortages and the slow adoption of technological solutions. To address these challenges, these organizations increasingly use scientific knowledge to evaluate and innovate long-term care. This paper describes how co-creation, in the sense of close, intensive, and equivalent collaboration between science, care practice, and education, is a key factor in the success of improving long-term care for older adults. Such co-creation is central in the Academic Collaborative Center (ACC) Older Adults of Tilburg University. In this ACC, Tilburg University has joined forces with ten organizations that provide care for older adults and CZ zorgkantoor to create both scientific knowledge and societal impact in order to improve the quality of person-centered care for older adults. In the Netherlands, a "zorgkantoor" arranges long-term (residential) care on behalf of the national government. A zorgkantoor makes agreements on cost and quality with care providers and helps people that are in need of care to decide what the best possible option in their situation is. The CZ zorgkantoor arranges the long-term (residential) care in the south and southwest of the Netherlands. This paper describes how we create scientific knowledge to contribute to the knowledge base of PCC for older adults by conducting social scientific research in which the perspectives of older adults are central. Subsequently, we show how we create societal impact by facilitating and stimulating the use of our scientific knowledge in daily care practice. In the closing section, our ambitions for the future are discussed.

In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person-centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006-2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty-seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty-one different CGAs were identified, of which the EASYcare instrument, RAI-HC/RAI-CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter-)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel., (© 2019 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.)