Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.

Background

Agile projects are statistically more likely to succeed then waterfall projects. The overall aim of this study was to explore the nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions aimed at supporting discharge planning.

Methods

An explorative design with quantitative and qualitative methods was used. Qualitative data was collected through seven focus group interviews. Quantitative data was collected via an ICT-system, and with an evaluation form submitted by fourteen registered nurses and nine district nurses.

Results

Qualitative result of the experiences with the agile development process and its outcome resulted in one theme, four categories, and ten subcategories. The theme was found to be about time and timing, namely the amount of time for the different activities and the timing of activities within and between organisations. The agile development process increased the participants’ readiness for change by offering time to learn, practice, engage and reflect, and then adopt the ICT as a support to daily practice. Quantitative results showed a variated adoption of the ICT.

Conclusion

There is a need for time to prepare, understand and adopt new tools, services and procedures and a need for additional time to prepare, understand and adopt the new among individuals, collectives, organizations, and sometimes even between different collectives or organizations. The agile development process offered the end-users involvement through the development process, which gave them time to change it both individually and collectively. However, there is a need for close collaboration between the development project team and management to reach an organizational change that is timely for both the individual and the collective change. When time or timing fails in the development or implementation process, there is a huge risk of non-adoption of new tools, services, or procedures or among the end-users.

Background

The original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice.

Aim

To translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts.

Methods

A systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach’s alpha was used to ascertain the internal consistency reliability.

Results

In the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action.

Conclusions

The results show initial satisfactory psychometric properties for the translation and first validation of the S-NoMAD. However, development of a highly valid and reliable instrument is an iterative process, requiring more extensive validation in various settings and populations. Thus, in order to establish the validity and reliability of the S-NoMAD, additional psychometric testing is needed.

Deficits in collaboration and information exchange during patient discharge from the hospital can cause negative consequences for the patient, such as delayed discharge, readmission, inadequate post-discharge care, and reduced quality of life. Information and communication technology (ICT) can contribute to easing and securing information exchange and collaboration at care transitions from one care provider to another. The overall aim of this doctoral thesis was to gain broader knowledge about the discharge planning process by exploring the experiences of the involved personnel both before and after the development and testing of ICT solutions.Studies I, II and III were conducted before the development and testing of ICT solutions. In study I, the experiences and views of registered nurses (RNs) and district nurses (DNs) regarding information exchange during the discharge planning process (DPP) for patients who required primary healthcare after discharge from hospital were probed. Data were collected through a web based questionnaire and were analysed with descriptive statistics, chi-squared test and qualitative text analysis. In study II, the experiences and views of DNs and homecare organisers regarding the DPP were explored. Individual interviews were conducted with nine DNs and five homecare organisers working in homecare. Data were analysed via qualitative content analysis using an inductive approach. In study III, the DPP was evaluated. Qualitative data from studies I and II together with data the development process and 12 interviews with RNs in hospital care were analysed using Normalisation Process Theory. In study IV, RNs’, DNs’ and homecare organisers’ experiences with an agile development process that included ICT testing were explored. An evaluation form was used to collect data on the experiences of RNs and DNs using videoconference technology. Data were analysed with descriptive statistics. Seven focus group interviews were also performed with 11 RNs, nine DNs and four homecare organisers after the development and testing of ICT. Data were analysed using qualitative content analysis. The results showed significant differences in perceived information exchange (I). Hindrances and feasibilities at the organisational, group and individual levels all affected the workflow. Demands, workload, time, collaboration, and engagement together with knowledge and professional confidence were factors that influenced the DPP (II). The results revealed that the previously DPP was not normalised or embedded within daily work before the development project began (III). RNs, DNs and homecare organisers had reached consensus on what the process was about (coherence) and how they evaluated the process (reflexive monitoring) but not on who performed the process (cognitive participation) and how it was performed (collective action). By integrating an agile development process with the results obtained from studies I, II and III, ICT solutions aiming to support the DPP were tested in study IV. Study IV revealed that the time and timing both at the individual, group, and organisational levels and between those levels was essential for the development and adoption of new processes and products among caregivers. Keywords: discharge planning process, collaboration, information exchange, ICT, experiences, nurses, homecare organisers, qualitative content analysis, descriptive statistics

BackgroundDischarge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers.MethodsThe study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff.ResultsUsing the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice.ConclusionThe result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.

Discharge planning is an important care process, but deficits in planning are common. The aim of this study was to explore district nurses’ (DNs) and home care organizers’ (HCOs) experiences and views of the workflow during the discharge planning process (DPP). Demands, workload, time, collaboration, and engagement, together with knowledge and professional confidence, are factors that influence workflow and outcome of the DPP for DNs and HCOs. Strengths and obstacles at the organization, group, and individual levels affect the workflow during the discharge planning. Knowledge of these strengths and obstacles should help care providers in their practice as well as help management and politicians become more aware of prerequisites needed to achieve a safe and efficient workflow for securing the patient’s discharge.

Objectives: Discharge planning is an important care process for managing transitions from the hospital to the community. It has been studied for >20 years, but few studies clarify the information exchanged between healthcare providers. This study aimed to describe nurses’ experiences and perceptions of information exchange during the discharge planning process, focused on what, when and how information is exchanged between the hospital and primary healthcare. Method: A web-based census survey was used to collect data; the data were analyzed using descriptive statistics and chi-squared test. A questionnaire was distributed to 194 registered nurses (129 respondents) from a central county hospital and 67 district nurses (42 respondents) working in 13 primary healthcare centres. Results: The results show a significant difference between given and received information between the two groups. Both groups thought the information exchange worked best when all participants met at the discharge planning conference and that the electronic information system was difficult to use. Conclusion: This study shows difficulties knowing what patient-related information needs to give and not receiving the expected information. These results can be used to develop knowledge about roles, work tasks and needs to enhance the outcome of the process and the information exchanged.