Design and usage of the HeartCycle education and coaching program for patients with heart failure

Background: Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor. Objective: The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program. Methods: The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain. Results: Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching. Conclusions: The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program

A novel approach to reduce sedentary behaviour in care home residents: the GET READY study utilising service-learning and co-creation

The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment

How Can we Use Simulation to Improve Competencies in Nursing?

This open access book offers an overview of theories related to simulation and describes different simulation areas within nursing. It illustrates how simulation may be used in different levels in professional education. The book deals with the role of the Simulation Facilitator, peer learning and the use of Virtual Reality in simulation. It provides new insights and paths to the development of the use of simulation within nursing and healthcare and contributes with new knowledge from research and experiences of implementation of different simulating scenarios within nursing and midwifery. It is intended to teachers in nursing and other healthcare professionals with an interest in the use of active learning methods

What do critical care nurses require from a clinical information system : is it possible for a system to meet these needs?

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Context-Aware and Secure Workflow Systems

Businesses do evolve. Their evolution necessitates the re-engineering of their existing "business processes”, with the objectives of reducing costs, delivering services on time, and enhancing their profitability in a competitive market. This is generally true and particularly in domains such as manufacturing, pharmaceuticals and education). The central objective of workflow technologies is to separate business policies (which normally are encoded in business logics) from the underlying business applications. Such a separation is desirable as it improves the evolution of business processes and, more often than not, facilitates the re-engineering at the organisation level without the need to detail knowledge or analyses of the application themselves. Workflow systems are currently used by many organisations with a wide range of interests and specialisations in many domains. These include, but not limited to, office automation, finance and banking sector, health-care, art, telecommunications, manufacturing and education. We take the view that a workflow is a set of "activities”, each performs a piece of functionality within a given "context” and may be constrained by some security requirements. These activities are coordinated to collectively achieve a required business objective. The specification of such coordination is presented as a set of "execution constraints” which include parallelisation (concurrency/distribution), serialisation, restriction, alternation, compensation and so on. Activities within workflows could be carried out by humans, various software based application programs, or processing entities according to the organisational rules, such as meeting deadlines or performance improvement. Workflow execution can involve a large number of different participants, services and devices which may cross the boundaries of various organisations and accessing variety of data. This raises the importance of _ context variations and context-awareness and _ security (e.g. access control and privacy). The specification of precise rules, which prevent unauthorised participants from executing sensitive tasks and also to prevent tasks from accessing unauthorised services or (commercially) sensitive information, are crucially important. For example, medical scenarios will require that: _ only authorised doctors are permitted to perform certain tasks, _ a patient medical records are not allowed to be accessed by anyone without the patient consent and _ that only specific machines are used to perform given tasks at a given time. If a workflow execution cannot guarantee these requirements, then the flow will be rejected. Furthermore, features/characteristics of security requirement are both temporal- and/or event-related. However, most of the existing models are of a static nature – for example, it is hard, if not impossible, to express security requirements which are: _ time-dependent (e.g. A customer is allowed to be overdrawn by 100 pounds only up-to the first week of every month. _ event-dependent (e.g. A bank account can only be manipulated by its owner unless there is a change in the law or after six months of his/her death). Currently, there is no commonly accepted model for secure and context-aware workflows or even a common agreement on which features a workflow security model should support. We have developed a novel approach to design, analyse and validate workflows. The approach has the following components: = A modelling/design language (known as CS-Flow). The language has the following features: – support concurrency; – context and context awareness are first-class citizens; – supports mobility as activities can move from one context to another; – has the ability to express timing constrains: delay, deadlines, priority and schedulability; – allows the expressibility of security policies (e.g. access control and privacy) without the need for extra linguistic complexities; and – enjoy sound formal semantics that allows us to animate designs and compare various designs. = An approach known as communication-closed layer is developed, that allows us to serialise a highly distributed workflow to produce a semantically equivalent quasi-sequential flow which is easier to understand and analyse. Such re-structuring, gives us a mechanism to design fault-tolerant workflows as layers are atomic activities and various existing forward and backward error recovery techniques can be deployed. = Provide a reduction semantics to CS-Flow that allows us to build a tool support to animate a specifications and designs. This has been evaluated on a Health care scenario, namely the Context Aware Ward (CAW) system. Health care provides huge amounts of business workflows, which will benefit from workflow adaptation and support through pervasive computing systems. The evaluation takes two complementary strands: – provide CS-Flow’s models and specifications and – formal verification of time-critical component of a workflow

Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial

BACKGROUND Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. METHODS The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. RESULTS Seven nursing homes (n~= 4 intervention groups, n~= 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: \textquotedblgood\textquotedbl; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. CONCLUSION The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial