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Background
In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention.
Methods
This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed.
Discussion
This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers.
Background: To improve interprofessional collaboration between registered nurses (RNs) and general practitioners (GPs) for nursing home residents (NHRs), the interprof ACT intervention package was developed. This complex intervention includes six components (e.g., shared goal setting, standardized procedures for GPs’ nursing home visits) that can be locally adapted. The cluster‑randomized interprof ACT trial evaluates the effects of this intervention on the cumulative incidence of hospital admissions (primary outcome) and secondary outcomes (e.g., length of hospital stays, utilization of emergency care services, and quality of life) within 12 months. It also includes a process evaluation which is subject of this protocol. The objectives of this evaluation are to assess the implementation of the interprof ACT intervention package and downstream effects on nurse–physician collaboration as well as preconditions and prospects for successive implementation into routine care.
Methods: This study uses a mixed methods triangulation design involving all 34 participating nursing homes (clusters). The quantitative part comprises paper‑based surveys among RNs, GPs, NHRs, and nursing home directors at baseline and 12 months. In the intervention group (17 clusters), data on the implementation of preplanned implementation strategies (training and supervision of nominated IPAVs, interprofessional kick‑off meetings) and local implementation activities will be recorded. Major outcome domains are the dose, reach and fidelity of the implementation of the intervention package, changes in interprofessional collaboration, and contextual factors. The qualitative part will be conducted in a subsample of 8 nursing homes (4 per study group) and includes repeated non‑participating observations and semistructured interviews on the interaction between involved health professionals and their work processes. Quantitative and qualitative data will be descriptively analyzed and then triangulated by means of joint displays and mixed methods informed regression models.
Discussion: By integrating a variety of qualitative and quantitative data sources, this process evaluation will allow comprehensive assessment of the implementation of the interprof ACT intervention package, the changes induced in interprofessional collaboration, and the influence of contextual factors. These data will reveal expected and unexpected changes in the procedures of interprofessional care delivery and thus facilitate accurate conclusions for the further design of routine care services for NHRs.
Im Rahmen einer umfassenden Organisationanalyse durch das Projekt "Inklusive Beratung und Begleitung" der Hochschule Hannover wurde die Konzeptionalisierung und Praxis der Kooperationen der Jakob-Muth-Schule, anerkannte Tagesbildungsstätte aus Meppen einer näheren Betrachtung unterzogen und auf ihren Mehrwert im Kontext einer inklusiven Schullandschaft reflektiert. Anhand von Einzel- und Gruppeninterviews mit Lehrer*innen sowie pädagogischen Fachkräften konnten inklusionsförderliche und -hemmende Aspekte herausgearbeitet werden. Im Zuge einer resümierenden Betrachtung werden Ansatzpunkte zur Verbesserung der Zusammenarbeit und pädagogischen Praxis formuliert und zur Diskussion gestellt.
Im Rahmen der aktuellen Bildungsdebatte profilieren sich in zunehmendem Maße Museen und Bibliotheken als Akteure der kulturellen Bildung. Durch ihre ausdifferenzierten Angebote agieren sie dabei sowohl auf den formellen und außerschulischen Bildungs- wie auch unterhaltenden Freizeitmärkten, jeweils sowohl auf politischer sowie wirtschaftlicher und gesellschaftlicher Makro-, Meso- und Mikroebene. Dabei bietet sich insbesondere den vielen Museen, die über eine eigene Museumsbibliothek verfügen, eine signifikant potenzierte Möglichkeit, im Rahmen einer professionellen Öffentlichkeitsarbeit durch die Konzeptionierung ihrer Bibliothek zu einem Informations- und Kommunikationszentrum und deren Positionierung in der Produkt- und Kommunikationspolitik der Marketingstrategie des Museums, ihren (potentiellen) heterogenen Zielgruppen erweiterte und additive Angebote und dadurch neuartige Zugänge zu offerieren sowie die Einrichtung dadurch im Stadtraum öffentlichkeitswirksam neu zu verorten, indem eine derart strukturell und programmatisch revisionierte und professionell geführte Museumsbibliothek der Gesellschaft weitere Lern- wie auch Kommunikationsräume im Sinne eines Kulturzentrums eröffnet. Eine solch autonome und allseits anerkannte Museumsbibliothek, die als zentrale Abteilung des Museums eng mit den anderen Handlungsbereichen der Einrichtung, insbesondere jedoch der Museumspädagogik und der Kommunikationsabteilung zusammenarbeitet, bietet dem Museum des Weiteren durch ihre hybride Scharnierfunktion als museale wie auch bibliothekarische Einrichtung eine ideale Möglichkeit, sich als Ort der kulturellen Bildung innerhalb der (kulturellen) Bildungslandschaft der Region mit weiteren Anbietern dieser Ressorts, vor allem jedoch Bibliotheken und Schulen, kooperativ und öffentlichkeitswirksam zu vernetzen.
Angesichts der tiefgreifenden Veränderungen in der Medienbranche (z. B. Digitalisierung, Konvergenz) müssen Medienunternehmen gemeinsam mit externen Partnern innovative Geschäftsmodelle vorantreiben. Die vorliegende Arbeit untersucht die Bedeutung der Beziehungsqualität und der Nutzung von Steuerungsmechanismen für den Erfolg unternehmensübergreifender Geschäftsmodellinnovationen. Anhand eines Datensatzes von 198 Medienunternehmen weisen wir einen positiven Zusammenhang zwischen der Beziehungsintensität und der Umsetzung von Geschäftsmodellinnovationen nach. Dieser Zusammenhang wird durch ein starkes Vertrauen und detaillierte formelle Verträge zwischen den Partnern zusätzlich gefördert. Daraus lässt sich ableiten, wie Medienunternehmen Partnerschaften im Kontext von Business-Model-Innovationen effektiv gestalten können.
BACKGROUND:
Safety climate research suggests that a corresponding climate in work units is crucial for patient safety. Intensive care units are usually co-led by a nurse and a physician, who are responsible for aligning an interprofessional workforce and warrant a high level of safety. Yet, little is known about whether and how these interprofessional co-leaders jointly affect their unit's safety climate.
PURPOSE:
This empirical study aims to explain differences in the units' safety climate as an outcome of the nurse and physician leaders' degree of shared goals. Specifically, we examine whether the degree to which co-leaders share goals in general fosters a safety climate by pronouncing norms of interprofessional cooperation as a behavioral standard for the team members' interactions.
METHODOLOGY/APPROACH:
A cross-sectional design was used to gather data from 70 neonatal intensive care units (NICUs) in Germany. Survey data for our variables were collected from the unit's leading nurse and the leading physician, as well as from the unit's nursing and physician team members. Hypotheses testing at unit level was conducted using multivariate linear regression.
RESULTS:
Our analyses show that the extent to which nurse-physician co-leaders share goals covaries with safety climate in NICUs. This relationship is partially mediated by norms of interprofessional cooperation among NICU team members. Our final model accounts for 54% of the variability in safety climate of NICUs.
CONCLUSION:
Increasing the extent to which co-leaders share goals is an effective lever to strengthen interprofessional cooperation and foster a safety climate among nursing and physician team members of hospital units.