ABSTRACT
BackgroundImplementation of a comprehensive advance care planning (ACP) intervention package offered to nursing homes (NH) as part of a cluster-randomized trial (BEVOR) during the Covid-19 pandemic led to intensified efforts of the study team comprising ACP facilitators and trainers to improve take-up and adherence to intervention schedules. Analyzing institution-level barriers as well as enabling factors from the perspective of the study team aims to provide insights how to strengthen capacities of researchers and practitioners working towards organizational development and systems change.MethodsA qualitative approach drawing on data from documents containing guided structured self-reflection of the study team and notes from moderated case discussions with high-expertise ACP trainers and an professional organisation developer, using the framework analysis method to derive themes and compare patterns across the NHs participating in the study, pertaining to 3 experiential spaces (‘person' ‘ACP facilitator' and ‘NH').ResultsThe structured self-reflection and intensive exchange supported the ability of the study team to deal with challenges during implementation. Preliminary results indicate emotional challenges e.g. feelings of rejection when access to NH staff and time resources is blocked, and stress due to time pressure (personal). Investment of single NH staff members to remove barriers such as mistrust or fear encapsulated feelings of encouragement (personal, ACP facilitator). Institution-level enablers and barriers (NH), such as the extent of commitment and initiative of NH staff and management or treating physicians' investment, exposed a high temporal dynamic and unpredictability, e.g. sudden withdrawal or pick-up of commitment following changes in NH management.ConclusionIn depth-reflection and analysis, contextualizing experiences and practices, is a valuable resource during the ACP implementation to enhance intervention uptake in a trial or project context. Importantly, its collective character can help to refocus on the mutual goal of creating change as core driver and motivation for the work.
ABSTRACT
Introduction: In 2014, a newly designed, case-based seminar was successfully implemented in the subjects of health systems, health economics and public health care (GGG). The seminar "The Lonely Patient" is based on a real patient case and deals with the German health care system from the perspective of a patient. In order to create more space for discussion and exchange among students, the seminar was redesigned on the basis of the Inverted Classroom Method (ICM). Project description: Due to the COVID-19 pandemic, new, purely digital teaching formats had to be developed quickly in the sense of Emergency Remote Teaching. Therefore, the Inverted Classroom concept of the seminar was transformed into an online ICM. In order to promote active learning based on the ICAP model (Interactive, Constructive, Active, Passive), the online face-to-face part was designed as a synchronous interactive learner-centered course using the gamified audience response system Kahoot! Results: Evaluation results to date and feedback rounds with students indicate that the online ICM-version of the seminar leads to at least as good evaluation results as the previous face-to-face course. In particular, the students positively emphasize the use of Kahoot! as an activating digital medium. Discussion: Through the use of the ICM and the gamified audience response system Kahoot!, students could be activated in meaningful ways. The resulting discussions about the patient case and teaching content of the quiz questions in the synchronous online course could be implemented just as well as in the classroom-based course of previous semesters. Conclusion: The application of the online ICM, along with the consideration of the ICAP Model, has led to the successful implementation of a digital course within the context of the increased difficulty surrounding the emergency remote teaching. Additionally, students' learning success has remained at a similar level as during traditional classroom-based courses of previous semesters.