Yes / People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes and may often have complex needs requiring efficient and timely response by knowledgeable and compassionate staff. The aim of this study is to improve our understanding of health care professionals’ attitudes and knowledge of the barriers to integrated care for people with advanced dementia. In-depth, interactive interviews conducted with 14 health care professionals including commissioners, care home managers, nurses and health care assistants in the UK. Barriers to care for people with advanced dementia are influenced by governmental and societal factors which contribute to challenging environments in care homes, poor morale amongst care staff and a fragmentation of health and social care at the end of life. Quality of care for people with dementia as they approach death may be improved by developing collaborative networks to foster improved relationships between health and social care services.

No / In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors’ experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses’ working lives. / The authors would like to acknowledge the Burdett Trust for Nursing who funded the study

Yes / Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. Methods and analysis: Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). / UK NIHR grant number RP-PG-0612-20010.

The need for Registered Nurses (RNs) in the long-term care of older people is being questioned, particularly in the context of nursing shortages, while suggestions for 'professionalising' Care Assistant (CA) roles are emerging. Despite ongoing debates about the importance of their work, research has so far been unable to provide an evidence-base for the outcomes of the work of either RNs or CAs in UK care homes. Using a multi-method interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer, this qualitative research sought to illuminate the distinct contributions made by RNs and CAs to outcomes for older people in care homes. RNs and CAs from around the UK contributed 'significant' examples of their work for Phase 1 of the study and Phase 2 comprised researcher fieldwork (observation, interviews and documentary analysis) in three care homes around England. Participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. The findings offer a rich and detailed analysis of the realities of the work, much of which takes place 'behind closed doors' and has been described to a limited extent in the literature. They suggest that the CAs' daily support helps residents to function and to feel valued, and that close, reciprocal, family-type relationships develop. The health knowledge and clinical expertise of good RNs is critical in determining residents' health outcomes, particularly in the long-term, and RNs' 24-hour 'perceptual presence' can make life or death differences in acute or emergency situations. RNs also influence the environment, atmosphere and quality of care in the home. In the context of the literature, the findings offer new insights into the role and contribution of RNs and CAs, the outcomes of their work and the priorities of residents. The study produced new models of RN and CA roles in care homes, encompassing dimensions not previously acknowledged in the literature or their job descriptions, and a new framework within which the outcomes of care for older people could be evaluated. The research offers a positive image of work with older people in independent sector care homes.

The aim of this study is to create understanding for how employees perceive their skills at HVB in relation to their work with unaccompanied minors.The study is based on a qualitative method and were carried out with nine semi-structured interviews with staff from three different HVB. With the help of Bourdieu’s theoretical frame field, capital, and habitus we analyzed our materials.The study shows us among others that there is a lack of knowledge with the staff within the areas mental health and the pedagogic field. Furthermore, the result showed us that the staff experienced difficulties in how to refute the children’s needs. We find that the staff creates different strategies to cope with the children’s needs. Two prominent strategies emerged in our result. The staff contacted external help and took great support in the strength of the working group.

Existe a necessidade de modificar o processo de projeto diante da crescente complexidade envolvida em empreendimentos da construção. Há envolvimento de muitos profissionais, existência de distintas metas e interesses, além da ampliação do escopo dos projetos desenvolvidos. Além disso, o processo tradicional de projeto é geralmente desenvolvido de forma fragmentada, desconsiderando o conhecimento de vários estudos acadêmicos já desenvolvidos, sendo as decisões tomadas geralmente com base na experiência dos projetistas. Nesse sentido, uma das abordagens que vem sendo usada para melhorar os projetos de edificações é o projeto baseado em evidências (Evidence-Based Design - EBD). EBD é um processo que visa a melhorar as decisões de projeto tendo como base o uso das melhores evidências disponíveis de pesquisa, aliadas à prática profissional e a dados relacionados aos requisitos do cliente. O presente trabalho teve como objetivo desenvolver um modelo conceitual para guiar o uso do EBD no processo de projeto de edificações. A pesquisa foi dividida em três estágios. O primeiro estágio, de caráter exploratório, buscou a compreensão da pesquisadora quanto ao tópico investigado (EBD). No segundo estágio, buscou-se entender a aplicação do EBD no processo de projeto com enfoque na geração de valor Já o terceiro estágio buscou desenvolver formas de disseminação de resultados baseados em evidência. Ao longo dos três estágios, foram realizadas três revisões sistemáticas de literatura e também três estudos empíricos, sendo dois desenvolvidos no contexto de habitação de baixa renda no Brasil, enquanto que o terceiro foi realizado em um empreendimento da área da saúde no Reino Unido. O estudo apresenta tanto contribuições práticas como teóricas. Sob um enfoque prático, a principal contribuição é a possibilidade de integração de evidências existentes no processo de projeto a partir do desenvolvimento de algumas formas de coleta, processamento e análise dessas evidências. Em termos teóricos, este estudo propõe uma nova abordagem conceitual sobre nomenclatura e classificação de evidências para o processo de projeto usando EBD, com foco na geração de valor. É apresentada uma proposta de processo de projeto que busca uma melhor integração entre a prática profissional com conhecimentos produzidos pela academia, por meio de um processo de geração de conhecimento como uma forma de aprendizagem contínua. / There is a need for changing the design process due to the growing complexity of construction projects. There is a large number of stakeholders, which have a diversity of aims and goals, in addition to the broader scope of building projects. Moreover, the traditional design process is usually developed in a fragmented way, based mostly on the designers’ experience, often disregarding knowledge from other stakeholders involved. Evidence based design (EBD) is an emerging approach that aims to address this problem by supporting project decision-making with available evidence from research, in addition to professional experience and clients requirements’ data. This research work has proposed a conceptual model to guide the use of EBD in the building design process. The study was divided into three stages. The first stage had an exploratory character, in which the focus of the researcher was on understanding EBD. In the second stage, the aim was to study the application of EBD in the design process, focusing on value generation. The third stage consisted of devising forms of disseminating evidence-based results Three systematic literature reviews and three empirical studies were developed along those three stages. Two studies were concerned with affordable housing projects in Brazil, and one study involved a care home project in the U.K. This work provides both practical and theoretical contributions. From a practical viewpoint, the model proposed herein integrates evidences in building design process and proposes techniques to collect, process, and analyse such evidences. From a theoretical viewpoint, it introduces a new terminology and classification for evidences that can be incorporated in buildings design by using EBD, for increasing value generation. A proposal for a new design process that improves the integration between the professional practice and knowledge produced by academics, through a process for generating knowledge as a form of continuous learning.

Bakgrund: Tidigare forskning visar på en stressig arbetsmiljö för sjuksköterskor med flera komplexa arbetsuppgifter. Behovet av att delegera arbetsuppgifter ökar i och med detta och kraven på att delegera patientsäkert beskrivs som centralt. Den tidigare forskningen ger ingen klar bild över vem som har vilket ansvar i delegeringsfrågan. Syfte: Syftet med examensarbetet var att undersöka sjuksköterskors ansvar vid delegering av hälso- och sjukvårdsinsatser i kommunal verksamhet. Metod: Studien följer en kvalitativ ansats med en innehållsanalys. Insamlingen av data skedde via inspelade semistrukturerade intervjuer. För examensarbetet blev sex sjuksköterskor intervjuade. Resultat: Tre kategorier utformades av resultatet: ansvar gentemot patienten vid delegering, ansvar under delegeringstillfället och ansvar efter utförd delegering. Gemensamt hade informanterna ett standardiserat – webbaserad – delegeringsrutin. Dock fanns det lite till ingen uppföljning på delegeringar. Slutsats: delegeringsprocessen är komplex med oklar ansvarsbild. Sjuksköterskan ansvarar för att patienten i slutänden får god och säker vård även om det är helg, kväll eller sjukdomsfall i personalgruppen. / Background: Previous studies show a stressful work environment for nurses with complex job assignments. The demand to delegate job assignments is increasing as an aftermath and the requirement to delegate job assignments with patient safety in mind is described as a central factor. The previous studies gave no clear image of who has the responsibility in delegations. Objectives: The aim of this study was to examine the registered nurses’ experiences of responsibility during delegations. Method: The study has a qualitative approach and is assembled in content analysis. Data has been collected through semi structured interviews. For the study six nurses have been interviewed. Result: The manifested results formed up in three categories: responsibility towards patients when delegating, responsibility during the delegation and responsibility after the delegation. The informants had in common that they were following a standardized web-based delegation routine. Though there was slight to no follow up on the delegations. Conclusion: The delegation process is complex with unclear responsibility. The nurse is responsible for ensuring that the patient receives good and safe care in the end, even if it is weekend, evening or illness in the staff group.

Existe a necessidade de modificar o processo de projeto diante da crescente complexidade envolvida em empreendimentos da construção. Há envolvimento de muitos profissionais, existência de distintas metas e interesses, além da ampliação do escopo dos projetos desenvolvidos. Além disso, o processo tradicional de projeto é geralmente desenvolvido de forma fragmentada, desconsiderando o conhecimento de vários estudos acadêmicos já desenvolvidos, sendo as decisões tomadas geralmente com base na experiência dos projetistas. Nesse sentido, uma das abordagens que vem sendo usada para melhorar os projetos de edificações é o projeto baseado em evidências (Evidence-Based Design - EBD). EBD é um processo que visa a melhorar as decisões de projeto tendo como base o uso das melhores evidências disponíveis de pesquisa, aliadas à prática profissional e a dados relacionados aos requisitos do cliente. O presente trabalho teve como objetivo desenvolver um modelo conceitual para guiar o uso do EBD no processo de projeto de edificações. A pesquisa foi dividida em três estágios. O primeiro estágio, de caráter exploratório, buscou a compreensão da pesquisadora quanto ao tópico investigado (EBD). No segundo estágio, buscou-se entender a aplicação do EBD no processo de projeto com enfoque na geração de valor Já o terceiro estágio buscou desenvolver formas de disseminação de resultados baseados em evidência. Ao longo dos três estágios, foram realizadas três revisões sistemáticas de literatura e também três estudos empíricos, sendo dois desenvolvidos no contexto de habitação de baixa renda no Brasil, enquanto que o terceiro foi realizado em um empreendimento da área da saúde no Reino Unido. O estudo apresenta tanto contribuições práticas como teóricas. Sob um enfoque prático, a principal contribuição é a possibilidade de integração de evidências existentes no processo de projeto a partir do desenvolvimento de algumas formas de coleta, processamento e análise dessas evidências. Em termos teóricos, este estudo propõe uma nova abordagem conceitual sobre nomenclatura e classificação de evidências para o processo de projeto usando EBD, com foco na geração de valor. É apresentada uma proposta de processo de projeto que busca uma melhor integração entre a prática profissional com conhecimentos produzidos pela academia, por meio de um processo de geração de conhecimento como uma forma de aprendizagem contínua. / There is a need for changing the design process due to the growing complexity of construction projects. There is a large number of stakeholders, which have a diversity of aims and goals, in addition to the broader scope of building projects. Moreover, the traditional design process is usually developed in a fragmented way, based mostly on the designers’ experience, often disregarding knowledge from other stakeholders involved. Evidence based design (EBD) is an emerging approach that aims to address this problem by supporting project decision-making with available evidence from research, in addition to professional experience and clients requirements’ data. This research work has proposed a conceptual model to guide the use of EBD in the building design process. The study was divided into three stages. The first stage had an exploratory character, in which the focus of the researcher was on understanding EBD. In the second stage, the aim was to study the application of EBD in the design process, focusing on value generation. The third stage consisted of devising forms of disseminating evidence-based results Three systematic literature reviews and three empirical studies were developed along those three stages. Two studies were concerned with affordable housing projects in Brazil, and one study involved a care home project in the U.K. This work provides both practical and theoretical contributions. From a practical viewpoint, the model proposed herein integrates evidences in building design process and proposes techniques to collect, process, and analyse such evidences. From a theoretical viewpoint, it introduces a new terminology and classification for evidences that can be incorporated in buildings design by using EBD, for increasing value generation. A proposal for a new design process that improves the integration between the professional practice and knowledge produced by academics, through a process for generating knowledge as a form of continuous learning.

Existe a necessidade de modificar o processo de projeto diante da crescente complexidade envolvida em empreendimentos da construção. Há envolvimento de muitos profissionais, existência de distintas metas e interesses, além da ampliação do escopo dos projetos desenvolvidos. Além disso, o processo tradicional de projeto é geralmente desenvolvido de forma fragmentada, desconsiderando o conhecimento de vários estudos acadêmicos já desenvolvidos, sendo as decisões tomadas geralmente com base na experiência dos projetistas. Nesse sentido, uma das abordagens que vem sendo usada para melhorar os projetos de edificações é o projeto baseado em evidências (Evidence-Based Design - EBD). EBD é um processo que visa a melhorar as decisões de projeto tendo como base o uso das melhores evidências disponíveis de pesquisa, aliadas à prática profissional e a dados relacionados aos requisitos do cliente. O presente trabalho teve como objetivo desenvolver um modelo conceitual para guiar o uso do EBD no processo de projeto de edificações. A pesquisa foi dividida em três estágios. O primeiro estágio, de caráter exploratório, buscou a compreensão da pesquisadora quanto ao tópico investigado (EBD). No segundo estágio, buscou-se entender a aplicação do EBD no processo de projeto com enfoque na geração de valor Já o terceiro estágio buscou desenvolver formas de disseminação de resultados baseados em evidência. Ao longo dos três estágios, foram realizadas três revisões sistemáticas de literatura e também três estudos empíricos, sendo dois desenvolvidos no contexto de habitação de baixa renda no Brasil, enquanto que o terceiro foi realizado em um empreendimento da área da saúde no Reino Unido. O estudo apresenta tanto contribuições práticas como teóricas. Sob um enfoque prático, a principal contribuição é a possibilidade de integração de evidências existentes no processo de projeto a partir do desenvolvimento de algumas formas de coleta, processamento e análise dessas evidências. Em termos teóricos, este estudo propõe uma nova abordagem conceitual sobre nomenclatura e classificação de evidências para o processo de projeto usando EBD, com foco na geração de valor. É apresentada uma proposta de processo de projeto que busca uma melhor integração entre a prática profissional com conhecimentos produzidos pela academia, por meio de um processo de geração de conhecimento como uma forma de aprendizagem contínua. / There is a need for changing the design process due to the growing complexity of construction projects. There is a large number of stakeholders, which have a diversity of aims and goals, in addition to the broader scope of building projects. Moreover, the traditional design process is usually developed in a fragmented way, based mostly on the designers’ experience, often disregarding knowledge from other stakeholders involved. Evidence based design (EBD) is an emerging approach that aims to address this problem by supporting project decision-making with available evidence from research, in addition to professional experience and clients requirements’ data. This research work has proposed a conceptual model to guide the use of EBD in the building design process. The study was divided into three stages. The first stage had an exploratory character, in which the focus of the researcher was on understanding EBD. In the second stage, the aim was to study the application of EBD in the design process, focusing on value generation. The third stage consisted of devising forms of disseminating evidence-based results Three systematic literature reviews and three empirical studies were developed along those three stages. Two studies were concerned with affordable housing projects in Brazil, and one study involved a care home project in the U.K. This work provides both practical and theoretical contributions. From a practical viewpoint, the model proposed herein integrates evidences in building design process and proposes techniques to collect, process, and analyse such evidences. From a theoretical viewpoint, it introduces a new terminology and classification for evidences that can be incorporated in buildings design by using EBD, for increasing value generation. A proposal for a new design process that improves the integration between the professional practice and knowledge produced by academics, through a process for generating knowledge as a form of continuous learning.

Det finns flera sätt för en fastighetsägare att minska vakanser. Ett sätt är att konvertera fastigheten, eller delar av den, till ett annat ändamål som passar dagens efterfrågan. Lokalanpassningar har gjorts i alla tider med anledning av att det kan vara dyrare att riva och bygga nytt. En konvertering kan vara bra ur flera olika perspektiv. Ur ett hållbarhetsperspektiv kan det leda till ökade sociala-, ekonomiska- och miljömässiga värden. Under 1970-talet byggdes många kommersiella fastigheter runt om i världen. Historiskt sett har den kommersiella fastighetsbranschen varit cyklisk. Nederländerna var ett land som under 1990-talet led av höga vakanser, framförallt på kontorsfastigheter. Under slutet av decenniet skapades verktyget Conversion Meter som ett hjälpmedel för att bedöma potentialen att konvertera kontorsfastigheter till bostäder.   Idag finns tecken på att kontorsfastigheter inte möter hyresgästernas krav. Effektiva och flexibla kontorsfastigheter i centrala lägen är, ur hyresgästernas perspektiv, en attraktiv arbetsplats. Föråldrade kontorsfastigheter i perifera lägen har en lägre efterfrågan och riskerar i framtiden att få en ännu högre vakansnivå.  Samtidigt finns en stark efterfrågan på bostäder för äldre runt om i landet. Sverige står inför utmaningen att tillhandahålla särskilda bostäder för den åldrande befolkningen. En konvertering av föråldrade kontorslokaler i perifera lägen till denna typ av bostäder kan på många sätt ses som en möjlighet. Några av anledningarna är att fastighetens lokalisering är mindre avgörande, möjlighet att teckna längre hyresavtal till en generellt sett högre hyresnivå än för kontorslokaler samt möjlighet till statliga subventioner. Studien har undersökt möjligheten att utveckla Conversion Meter för att ta fram ett verktyg som kan vara tillämpbart vid en konvertering av kontorsfastigheter till särskilt boende för äldre på den svenska marknaden. Tre fallstudier har genomförts med den modifierade versionen av Conversion Meter. Studien visar att det går att modifiera Conversion Meter. Det modifierade verktyget har i studien kompletterats med en kassaflödesanalys samt med ett tillägg i checklistan för riskbedömning. Studien har visat att verktyget huvudsakligen modifierats utifrån målgruppens preferenser samt svenska byggnadstekniska- och juridiska aspekter.  Fallstudierna visar, med hjälp av kassaflödesanalys, att det är lönsamt att konvertera kontorsfastigheterna till särskilt boende för äldre. Störst lönsamheten visar fastigheten i Upplands Väsby. Beräkningarnas utfall påverkas av kalkylräntan, vakansnivån och skillnader i hyresnivå före och efter konverteringen. Potentiella invändningar mot studien kan vara att vissa parametrar i Conversion Meter inte är tillräckligt precisa samt att verktyget måste kontinuerligt uppdateras efter förändringar i gällande regelverk. / There are several ways for a property owner to reduce vacancies. One way is to convert the property to another purpose. Adaption of properties has always been done due to the fact that it may be more expensive to demolish and rebuild. Conversions of vacant office properties into other uses are desirable from a sustainability perspective because it may lead to an increase in social-, economic-, and environmental values. During the 1970s many commercial properties were built around the world. Historically, the commercial real estate industry has been cyclical.  Netherlands was one of the countries that suffer due to high vacancies during the real estate crisis in the 1990s, especially in office buildings. By the end of the decade, Conversion Meter was created as a tool to assess the potential of converting office properties into housing. Today there are signs that office properties do not meet the tenant’s requirements. Efficient and flexible office properties in central locations are attractive as a workplace. While outdated office properties in less popular locations have a lower demand and hence might have a risk of high vacancy rates. At the same time there is a high demand on housing for the elderly. Sweden faces the challenge of providing care homes for the aging population. A conversion of obsolete office spaces in peripheral locations into care homes can be seen as an opportunity. There are several reasons why property owners would be interested in this market. This includes the location being less sensitive to location aspects, having the possibility to establish long leases, and the ability to receive government grants during conversion as well as generally higher rental levels as compared to office spaces. The main aim of this study is to investigate whether it is possible to develop a modified version of Conversion Meter to measure the potential for converting office properties into housing for elderly in Sweden. Three case studies have been conducted by creating and using a modified version of Conversion Meter with cash flow analysis for office properties in Lidingö, Sollentuna, and Upplands Väsby municipalities. The study shows that it is possible to modify Conversion Meter to measure the potential for converting office properties into care homes. In the study, Conversion Meter has been modified to a Swedish context and a cash flow analysis has been added. Additionally, political risks have been added to the tool. The main differences between the models are the target group's preferences, legal and building law, addition of cash flow analysis, and addition of political risks. By using cash flow analysis, the case studies show that it is profitable to convert office buildings into care homes. The greatest profitability observed is in the property in Upplands Väsby. The outcome of the calculations depends on the level of interest rates, vacancy rates, and differences in rental levels before and after the conversion. Potential biases to the study include parameters in the modified Conversion Meter are not precise and the tool must undergo continuous updates after changes.