Patient empowerment in intensive care—An interview study

Intensive care patients often experience a lack of control, as well as inner chaos. Experiences from intensive care can continue to affect patients for a long time. Empowerment is a positive and dynamic process that focuses on people's strengths, rights and abilities. It takes on different expressions for different people in different environments and must be described by the people involved. The aim of this study was to describe patient empowerment in an intensive care situation. The study was based on open-ended interviews with 11 patients in two intensive care units. The interviews were analysed according to the empirical phenomenological psychological method. The results showed that patient empowerment in intensive care consists of strengthening and stimulating the patients' own inherent joy of life and will to fight. A positive environment that encouraged feelings of value and motivation and in which the patient felt safe, received additional care and participated as he/she wished had a positive influence.     

Rehabilitation is a way of thinking,not a way of doing

There is strong evidence that the processes used by rehabilitation services are effective at reducing mortality and morbidity, yet purchasers still feel that there is insufficient evidence to warrant buying rehabilitation. Why? Evidence in support of many individual treatments is either weak or absent, but it is important not to conflate evidence about the process with evidence about specific actions. The absence of evidence concerning specific interventions should not be interpreted as meaning that rehabilitation is ineffective, and should certainly not be used as an excuse not to purchase rehabilitation. The evidence strongly suggests that the whole system works and until we have further evidence, the system should be bought as a whole. Further research into specific interventions should continue, but in addition there should be more research attention paid to the rehabilitation process itself.     

Improving health status and reduction of institutionalization in long‐term care—Effects of the Resident Assessment Instrument‐Home Care by degree of implementation

A cluster randomized controlled trial showed that the Resident Assessment Instrument (RAI) could not improve or stabilize the health status of people in need of long‐term care or reduce the rate of institutionalization in Germany among clients of home care agencies. The aim of this article is to investigate whether the effect of RAI depends on the degree of implementation. A factor analysis was used to distinguish between those agencies that implemented RAI intensively and those that did not. The clients of home care agencies working intensively with RAI were significantly less hospitalized (P = 0.0284) and fared slightly better according to activities of daily living (ADL, instrumental ADL (IADL)), cognitive skills (Mini‐Mental Status Test (MMST)) and quality of life (EuroQol (EQ‐5D)) compared with the control group. In contrast, those not working intensively with RAI had worse outcomes (IADL, MMST, EQ‐5D) than the control group (not significant). It is important to guarantee a successful implementation of RAI.     

Designing health innovation networks using complexity science and systems thinking: the CoNEKTR model

Rationale, aims and objectives Complex problems require strategies to engage diverse perspectives in a focused, flexible manner, yet few options exist that fit with the current health care and public health system constraints. The Complex Network Electronic Knowledge Translation Research model (CoNEKTR) brings together complexity science, design thinking, social learning theories, systems thinking and eHealth technologies together to support a sustained engagement strategy for social innovation support and enhancing knowledge integration. Methods The CoNEKTR model adapts elements of other face‐to‐face social organizing methods and combines it with social media and electronic networking tools to create a strategy for idea generation, refinement and social action. Drawing on complexity science, a series of networking and dialogue‐enhancing activities are employed to bring diverse groups together, facilitate dialogue and create networks of networks. Results Ten steps and five core processes informed by complexity science have been developed through this model. Concepts such as emergence, attractors and feedback play an important role in facilitating networking among participants in the model. Conclusions Using a constrained, focused approach informed by complexity science and using information technology, the CoNEKTR model holds promise as a means to enhance system capacity for knowledge generation, learning and action while working within the limitations faced by busy health professionals.     

Organ donation: reducing the risk of health care‐associated infection

Health care‐associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment. This does not detract from national guidelines and cannot replace expert advice but will raise awareness and complement safe and effective care delivery.