Marijke Melles

Assessing the optimal location for alcohol-based hand rub dispensers in a patient room in an intensive care unit

BackgroundThe introduction of alcohol-based hand rub dispensers has had a positive influence on compliance of healthcare workers with the recommended guidelines for hand hygiene. However, establishing the best location for alcohol-based hand rub dispensers remains a problem, and no method is currently available to optimize the location of these devices. In this paper we describe a method to determine the optimal location for alcohol-based hand rub dispensers in patient rooms.MethodsWe composed a method that consists of a combination of qualitative and quantitative research methods. Firstly, different arrangements of dispensers were determined based on the results of two types of assessment: workflow observations and interviews with nurses and physicians. Each arrangement was then evaluated using two types of assessment: interviews with nurses and physicians and electronic measurements of the user frequency of the dispensers. This procedure was applied in a single-bed patient room on a thoracic surgery intensive care unit.ResultsThe workflow observations revealed that the activities of patient care were most often at the entrance and near the computer at the right side of the test room. Healthcare workers stated that the location of the dispenser should meet several requirements. Measurements of the frequency of use showed that the dispenser located near the computer, at the back of the room, was used less frequently than the dispenser located near the sink and the dispenser located at the entrance to the room.ConclusionThe applied method has potential for determining the optimal location for alcohol-based hand rub dispensers in a patient room. Workflow observations and the expressed preferences of healthcare workers guide the choice for the location of alcohol-based hand rub dispensers. These choices may be optimized based on measurement of the frequency of use of the dispensers.

Coping with different roles in intensive care nursing: design implications for digital support

Objectives The aim of this study is to arrive at design implications for the digital support of intensive care nurses, with a focus on supporting them in their roles as practitioners, as scholars and in their human response to their work. Methods Seventeen nurses from six different Dutch hospitals were interviewed using a newly developed digital prototype designed around these roles. The nurses were questioned about the suitability of four functions: two supporting the practitioner role (‘web of actors’ and ‘timeline and notes’); one supporting the scholar role (‘assessment of the patient’); and one supporting the role of human (‘perception of the shift’). The remarks of the nurses about these functions were grouped by their relevance to design (ie, the perceived added value of the function, suggestions for other uses, and the perceived negative impact of the function) and by topic. Results A total of 23 topics emerged: nine topics described the added values of the functions, nine were suggestions for other uses, and five concerned the negative impact of the functions as perceived by the participants. The main points of each topic were summarised, resulting in 23 design implications for digital role-based support.

Improving hand hygiene compliance in hospitals by design

markdownabstractEssential 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.

Supporting the scholar role in intensive care nursing.

This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patients condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented.

Web-Based Patient Education in Orthopedics: Systematic Review

Background Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. Objective The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. Methods CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. Results A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients’ knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Conclusions Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients’ knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only.

Tailored Patient Experiences

To achieve optimal patient-centered care for people undergoing a Total Hip Arthroplasty (THA), communication should ideally be tailored. In previous studies, three clusters of patients or patient ‘roles’ were identified based on communication preferences and clinical and psychological characteristics as a starting point for tailored communication in orthopedics. The current study aims to formulate initial guidelines for the design of tailored communication and information provision based on these roles. Two design cases were each evaluated as storyboards with twelve patients (three, seven, and two patients of each role, respectively). Generic and functionality-specific preferences were indicated by participants for both design proposals. Similarities in feedback per role provided the basis for generating an initial set of role-specific guidelines, that can be used to design tailored information and communication solutions.

Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics

Background and purpose — Little is known about heterogeneity in early recovery after primary total hip arthroplasty (THA). Therefore, we characterized subgroups of patients according to their hip function trajectory during the first 6 weeks after THA in a fast-track setting. Patients and methods — 94 patients (median age 65 years [41–82], 56 women) from a single hospital participated in a diary study. Patients recorded their severity of hip problems (Oxford Hip Score, OHS) weekly for 6 weeks after THA. Latent class growth modelling (LCGM) was used to identify patients with the same hip function trajectory and to compare these subgroups on patient characteristics. Results — LCGM revealed a fast (n = 17), an average (n = 53), and a slow (n = 24) recovery subgroup. Subgroups differed on the estimated weekly growth rate during the first 2 weeks (fast: 9.5; average: 5.3; slow: 2.7), with fewer differences between groups in the last 4 weeks (fast: 0.90; average: 2.0; slow: 1.7). Patients in the slow recovery group could be characterized as women of older age (mean age =69) who rated their health as lower preoperatively, needed more assistance during recovery, and were less satisfied with the outcomes of the surgery. Interpretation — We identified distinct recovery trajectories in the first 6 weeks after fast-track primary THA which were associated with patient characteristics.

The potential of service design for improving the implementation of shared decision-making

ABSTRACT This paper addresses the potential contribution of service design for improving the implementation of shared decision-making in healthcare. The iterative approach of design research is compared with the more linear, (social) scientific approaches often seen in health services research. Five foundational principles of service design are explored regarding their potential contribution to the improvement of the implementation of shared decision-making. Thus, this position paper can be seen as a call on service designers and healthcare professionals to combine their efforts to improve the implementation of shared decision-making in healthcare.