Developing a theory of change model for a learning and innovation network: A qualitative study.

AIM: The aim of this study is to further develop a preliminary framework into a model that can translate mechanisms into output and impact, based on the views of those working in practice and the relations between the mechanisms: a model that can inform practitioners and organizations on what has to be in place to shape a learning and innovating environment in nursing. BACKGROUND: A Learning and Innovation Network (LIN) is a network of healthcare professionals, students and education representatives who come together to be part of a nursing community to integrate education, research and practice to contribute to quality of care. In a previous study a preliminary framework was developed through a concept analysis based on publications. The preliminary framework describes input, throughput and output factors in a linear model that does not explain what the components entail in practice and how the components work together. DESIGN: Focus groups. METHODS: We designed a Theory of Change (ToC) in four phases. This was based on a focus group interview with lecturer practitioners (Phase 1); a first concept ToC based on thematic analysis of the focus group interview (Phase 2); three paired interviews where the ToC was presented to other lecturer practitioners to complement and verify the ToC model (Phase 3); and adjustment of the model based on the feedback of phase 3 (Phase 4). RESULTS: The developed ToC model describes important preconditions that have to be in place to start a LIN: a shared vision, a facilitating support system and a diversity of participants who are open to change. It describes the mechanisms by which a wide range of activities can lead to an improvement of the quality of care through collaboration between practice, education and research by working, learning, performing practice based research and implementing new methods together. CONCLUSION: This study gives a comprehensive overview of the concept of the 'Learning and Innovation Network' (LIN); how the activities in the LIN can lead to impact; and under what conditions. Previously published findings supported elements of the ToC model. The overarching ToC model and the detailed appendix offer a theoretical and practice-based model for practitioners, managers and policy makers.

Learning and innovation network in nursing: A concept analysis.

BACKGROUND: Approximately 4 years ago a new concept of learning in practice called the 'Learning and Innovation Network (LIN)' was introduced in The Netherlands. To develop a definition of the LIN, to identify working elements of the LIN in order to provide a preliminary framework for evaluation, a concept analysis was conducted. METHOD: For the concept analysis, we adopted the method of Walker and Avant. We searched for relevant publications in the EBSCO host portal, grey literature and snowball searches, as well as Google internet searches and dictionary consults. RESULTS: Compared to other forms of workplace learning, the LIN is in the centre of the research, education and practice triangle. The most important attributes of the LIN are social learning, innovation, daily practice, reflection and co-production. Often described antecedents are societal developments, such as increasing complexity of work, and time and space to learn. Frequently identified consequences are an attractive workplace, advancements of expertise of care professionals, innovations that endorse daily practice, improvement of quality of care and the integration of education and practice. CONCLUSIONS: Based on the results of the concept analysis, we describe the LIN as 'a group of care professionals, students and an education representatives who come together in clinical practice and are all part of a learning and innovation community in nursing. They work together on practice-based projects in which they combine best practices, research evidence and client perspectives in order to innovate and improve quality of care and in which an integration of education, research and practice takes place'. We transferred the outcomes of the concept analysis to an input-throughput-output model that can be used as a preliminary framework for future research.

[Daytime admission and day care for the elderly. Current provisions in development]. / Dagopvang en dagverzorging voor ouderen. Nieuwe voorzieningen in ontwikkeling

The last five years day centres for the elderly have been developed on a large scale in the The Netherlands. In this article a number of characteristics of forty day centres is described. By means of a content analysis these characteristics were derived from written reports. There is a considerable variety in the denominations of the schemes, the accommodation that is used, the number of days per week during which the centres are open, the responsible organizations, admission procedures and costs per day. The objectives of the day care schemes are directed towards the visitors, their caregivers and towards the functioning of services as such. Usually visitors come to the day centre once or twice a week. The large majority is 70 years or older, often experiencing psychosocial problems. Besides social-recreational activities, in general an activating and/or therapeutical package of care is offered, in a number of cases together with personal care. Frequently both professional workers and volunteers carry out the work, with or without external support. There are indications of the existence of three types of schemes, varying in professionalism and care that is offered. In the discussion some relevant topics for future research are outlined.

[The report "Care of the Aged": an ambiguous future scenario]. / De nota 'Zorg voor ouderen': een tweeslachtig toekomstscenario.

The Dutch governmental report 'Care of the elderly' is evaluated in the light of the findings of the study 'The elderly and their health in the Netherlands, 1984-2000'. The latter delineates three scenario's, by which in the near future the need of provisions may develop. The reference-scenario assumes a stable, relative demand for provisions, the growth-scenario an increasing and the shrinkage-scenario a decreasing demand. For economical and ideological reasons the Dutch government adheres to the shrinkage-scenario. Nevertheless, the same government also expresses severe doubts concerning the underlying assumptions. The proposed measures appear not to be consistent with the shrinkage-scenario. It is concluded that 'Care of the elderly' demonstrates ambiguity in its view on the future need of provisions by the elderly. This ambiguity appears to be largely determined by restricted financial and regulating means.

[Day treatment? An interim evaluation of day treatment in nursing homes]. / Dag behandeling? Een tussentijdse balans van dagbehandeling in verpleeghuizen.

Day-treatment has developed very rapidly in Dutch nursing homes. This development was due to several unproved positive expectations concerning the therapeutical results, the effects for relatives and caregivers at home and the substitutional effects of day-treatment. In this article these expectations are tested by means of a Dutch literature-review. From a psychosocial point of view, many patients benefit by day-treatment. Somatically, this is probably the case to a lesser extent. For persons in the home-situation, among whom informal and professional caregivers, day-treatment is an important and highly valued provision. To a certain degree there is a substitutional effect for somatic patients, to a considerably lesser degree for psychogeriatric patients. Sometimes, however, day-treatment accelerates an admission to a nursing home. Partly, day-treatment has attracted a new category of patients. A plea is made for sound effect-research, for which some recommendations are made. Moreover, there is a demand for well evaluated experiments with day-centers and for the partly maintenance of the daycare function in nursing homes. The substitution of nursing home beds for day-treatment capacity is considered as relevant only for a limited part of the population.