Background: Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies. Objectives: The objective of this study was to establish feasibility of an in-person, co-designed, peer- support model. Methods: Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia. Intensive care unit survivors (and their nominated caregiver, where survivor and caregiver are referred to as a dyad), >18 years of age, able to speak and understand English and participate in phone surveys, were eligible. Participants were randomised to the peer-support model (six sessions, fortnightly) or usual care (no follow-up or targeted information). Two sequential models were piloted: 1. Early (2-3 weeks post hospital discharge) 2. Later (4-6 weeks post hospital discharge). Primary outcome was feasibility of implementation measured by recruitment, intervention attendance, and outcome completion. Secondary outcomes included post-traumatic stress and social support. Results: Of the 231 eligible patients, 80 participants were recruited. In the early model we recruited 38 participants (28 patients, 10 carers; 18 singles, 10 dyads), with an average (standard deviation) age of 60 (18) years; 55 % were female. Twenty-two participants (58 %) were randomised to intervention. Participants in the early intervention model attended a median (interquartile range) of 0 (0-1) sessions (total 24 sessions), with 53% (n = 20) completing the main secondary outcome of interest (Impact of Event Scale) at the baseline and 37 % (n = 14) at the follow-up. For the later model we recruited 42 participants (32 patients, 10 carers; 22 singles, 10 dyads), with an average (standard deviation) age of 60.4 (15.4) years; 50% were female. Twenty-one participants (50%) were randomised to intervention. The later intervention model attended a median (interquartile range) of 1 (0-5) sessions (total: 44 sessions), with the main secondary outcome impact of events scale (IES-R) completed by 41 (98 %) participants at baseline and 29 (69 %) at follow-up. Conclusions: In this pilot trial, a peer-support model that required in-person attendance delivered in a later posthospital phase of recovery appeared more feasible than an early model. Further research should investigate alternative modes of intervention delivery to improve feasibility (ACTRN12621000737831). (c) 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

The COVID-19 pandemic saw rapid adoption of telehealth, including remote patient monitoring (RPM). There is limited evidence about how patients and staff experience such services in New Zealand. This study aimed to understand the acceptability of the RPM experience, particularly for Maori and Pacific peoples, and identify strengths, gaps, and limitations to inform future delivery of services. A mixed methods study was undertaken between 4 July and 11 September 2022 in Auckland. We conducted telephone surveys with patients and semi-structured interviews with patients and staff. Survey, and clinical and administrative data were analysed descriptively using SPSS. Interviews were analysed using Directed Content Analysis. 121 patients took part in the study, with the majority identifying as Maori and Pacific peoples (40% and 17%, respectively). We conducted 75 telephone surveys (62% response rate), and 30 semi-structured interviews (18 patients and 12 staff). Patients reported feeling safe and reassured while in the RPM service and that they would be willing to use it again. Staff reflected on a range of potential benefits that RPM offers, identified learnings and would like to see a more widespread rollout of RPM. This study demonstrated that remote monitoring of patients infected with Covid-19 can provide an acceptable model for a culturally diverse population. Future research could focus on applying this model to other patient groups, such as people with chronic conditions.

OBJECTIVES To conduct psychometric testing of the Chinese version of the National Health Service Sustainability Model as an instrument to assess the sustainability of innovation in the Chinese nursing setting. BACKGROUND Evidence-based practice is recognized worldwide as a way to improve the quality of healthcare; however, many evidence-based practice programmes decline over time and do not sustain the benefits of their improvements. A sustainability assessment tool is used internationally but its use has not been validated in China. DESIGN A methodological study to test instrument validity and reliability. METHODS The data collection was conducted from 15 June 2022 to 31 August 2022. The internal consistency of the Chinese version of the sustainability model was measured with Cronbach's alpha. Confirmatory factor analysis was used to test the model's structural validity. RESULTS Four hundred eighty-three questionnaires were returned, of which 478 were valid. The short time taken to evaluate the Chinese version of the sustainability model demonstrated its efficiency and ability to adapt to a busy clinical environment. The confirmatory factor analysis showed a good fit model and supported the convergence validity of the sustainability model. The Cronbach's alpha coefficient was 0.905 for the total scale, which indicated good internal consistency. CONCLUSIONS The results of this study suggest that the Chinese version of the sustainability model is a valid, reliable and efficient tool for measuring the sustainability of evidence-based practices in Chinese nursing settings.

Background International attention is being paid to the issue of making evidence sustainable after implementation. Developing an identification model is essential to promote and monitor the sustainability of evidence implementation. However, this model is not available in Chinese. This study aims to translate the National Health Service Sustainability Model into Chinese and to verify whether the model is adapted to the Chinese healthcare environment. Methods This study follows the translation and validation guidelines developed by Sousa and Rojjanasrirat. The translations include forward and backward translations and their comparison. Expert reviews were used to validate the content validity of the Chinese version of the National Health Service sustainability model. Cognitive interviews were used to assess the validity of the language in the Chinese setting. Results The translation was conducted by a bilingual research team and took 12 months. Expert reviews were undertaken with eight experts, and cognitive interviews with six participants. The content validity of the model is excellent, but at least 20% of the experts still felt that items one, three, five and nine needed refinements. In the cognitive interviews, most items, instructions and response options were well understood by the participants responsible for the evidence-based practice project. However, some language issues were still identified in items one, three, four, five, seven, nine, and ten. Participants reported that the sustainability results of the model assessment were consistent with their previous judgments of the items. Based on the expert review and interview results, items one, three, four, five, seven, nine and ten require further refinement. In summary, seven of the ten items have been amended. Conclusions This study provides insight into how the National Health Service sustainability model can be used in the Chinese healthcare setting and paves the way for future large-scale psychometric testing.

AIM:To co-design a rheumatic fever service model which enables young people with acute rheumatic fever/rheumatic heart disease (ARF/RHD) and their families to access the health and wellbeing services they need. METHOD:Co-design, a collaborative and participatory approach, was used to gather experiences and ideas from 21 consumers and 30 health professionals. Thematic analysis was undertaken. RESULTS:Māori and Pacific patients and their whānau/aiga identified the importance of whānau/aiga support and involvement throughout their ARF/RHD journey. They described that the way care was delivered was often frustrating, fragmented and lacked effective communication. Participants expressed the need for information to improve their understanding of ARF/RHD. Health professionals identified the need for better continuity of care and felt that they were currently working siloed from other professionals with little visibility of other roles or opportunity for collaboration. The ideas for improvement were grouped into themes and resulted in development and prototyping of peer support groups, patient and staff education resources, clinical dashboard and pathway development, and an enhanced model of care for delivery to patients receiving penicillin prophylaxis. CONCLUSION:The co-design process enabled consumers and staff of ARF/RHD services to share experiences, identify ideas for improvement, co-design prototypes and test initiatives to better support the needs of those delivering and receiving ARF/RHD services.

AIM To develop and validate a questionnaire to measure health CE at governance level. METHOD This study used qualitative and quantitative methods (including focus groups, cognitive interviews and an international survey), and consisted of two phases. In Phase 1, an initial list of items was generated and refined with feedback from health consumer representatives. In Phase 2, a draft survey was distributed to n=227 consumers from New Zealand, Australia and Canada. The benefit and relevance of using the questionnaire was explored through face-to-face interviews with five CE leaders from New Zealand healthcare organisations. RESULTS The proposed questionnaire comprises 25 statements relating to CE. Respondents indicate their level of agreement with the statements on a five-point Likert-type scale. Focus group and cognitive interview participants found the questionnaire relevant and easy to understand. The questionnaire scores correlated with the PPEET, another instrument measuring consumer engagement, and showed excellent internal consistency (Cronbach's alpha=0.97), unidimensionality and test-retest reliability (r=0.84). CONCLUSION The proposed questionnaire measures CE at governance level and can be used for international comparisons and benchmarking. It showed sound psychometric properties and its value and relevance was recognised by health consumer representatives and leaders with CE roles in New Zealand healthcare organisations.

The World Health Organization named 2020 the Year of the Nurse and Midwife to honour Florence Nightingale’s 200th birthday. Many have described 2020 as ‘unprecedented times’ due to the impact of the COVID-19 pandemic. During her career, Nightingale had similar experiences of widespread infectious disease following outbreaks of cholera and malaria amongst wounded soldiers during the Crimean War. It was these experiences that led her to believe that poor hygiene was responsible for so many deaths and to then identify the principles of infection control that we draw on today. From my perspective, she was a pioneer and has in many ways been the greatest role model for nursing of all time. Nightingale demonstrated strong skills in leadership and innovation which remain core competencies of contemporary nursing. I am going to reflect on these three characteristics within the context of the unprecedented times presented to us by COVID-19.

Experience-based co-design (EBCD) is a quality improvement approach that is being used internationally to bring service users and health professionals together to improve healthcare experiences, systems and processes. Early evaluations and case studies of EBCD have shown promise in terms of improvements to experience and organisational processes, however challenges remain in participation around shared power and decision making, mobilisation for implementation, sustainment of improvements and measurement of outcomes. The objective of this case study was to explore the emergent issues in EBCD participation and implementation in six quality improvement projects conducted in mental health, rehabilitation, blood and bone marrow transplant, brain injury rehabilitation, urinary incontinence and intellectual disability settings by the Agency for Clinical Innovation (ACI), New South Wales, Australia (2015-2018). Methods: A two stage process of analysis was employed. The first stage involved a case to case synthesis using a variable-oriented approach. In this approach themes were identified within individual cases and compared across cases in workshops with all project leads. In the second stage the case themes were synthesised within an overarching thematic that was identified as the main challenge in effective participation and implementation in these EBCD projects. The results: themes identified in the first stage of analysis related to different methods for gathering experiences and the activities used for the co-design of improvements. Variability in service user participation within co-design workshops was also discussed. Four out of the six projects implemented improvements in full. The prominent thematic overarching all six EBCD cases was the need for guidance on capability development and co-design preparedness for all participants in co-design not only project leads. In conclusion, variability in EBCD implementation makes it difficult to identify which component parts are essential for improving experiences and services, and which of these lead to sustained changes and benefits for service users and health professionals. One way to address this is to develop a model for co-design capability and preparedness that is closely linked with a set of eight mechanisms that have been previously identified as essential to achieving change in healthcare improvement initiatives. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Objectives: To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives. Design: Using experience-based co-design, qualitative data about participants’ preferences for a peer support model were generated via workshops. Participants’ perspectives of experience-based co-design were evaluated with focus groups. Setting: University-affiliated hospital in Melbourne, Australia. Subjects: Snowball sampling was used to recruit clinicians from across the care spectrum (ICU-community); critical care survivors and nominated family members were recruited using convenience sampling. Measurements and Main Results: Consensus on a peer support model was reached through the experience-based co-design process, with the following key themes: 1) socialization and group cohesion; 2) management of potential risks; and 3) individualized needs of patients and families. Evaluation of participants’ perspectives of the experience-based co-design method identified five key themes: 1) participation as a positive experience; 2) emotional engagement in the process; 3) learning from patients and family members; 4) feeling heard; and 5) practical challenges of experience-based co-design and readiness to participate. Conclusions: Experience-based co-design was a feasible approach to developing a peer support model for use with critical care survivors and was well received by participants. Future testing of the co-designed peer support model in a pilot randomized controlled trial will enhance understanding of peer support in critical care and the use of experience-based co-design as a design methodology.

There has been a surge in experience-based co-design (EBCD) efforts for quality improvement in health care and systems design globally. Service users together with staff are playing a far greater role than ever before in the redesign of services and systems of care. EBCD offers a systematic, bottom-up approach to improving service user and staff experiences of care. There is growing interest in the application and potential of EBCD; however, studies indicate common shared challenges, which coalesce around power, commitment to the process, methods for gathering experiences, designing improvements, implementation, and subsequent impact.

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Peer support holds promise to mitigate the effects of Post-Intensive Care Syndrome although the ideal model is unknown. Experience-based co-design (EBCD) offers a novel systematic methodology to build this complex intervention. EBCD engages patients, families and staff to co-design improvements in models of care. Study aims: 1. to identify barriers, facilitators, and pragmatic steps in co-designing a peer support model; 2. understand participants experience of EBCD and test feasibility. Methods: Qualitative inquiry of EBCD methodology using thematic analysis (informed by Grounded Theory) at a universityaffiliated hospital in Melbourne, Australia. Results: Nine survivors, six carers and 21 clinicians participated in the EBCD process. The most common facilitator to setting up a peer support model was normalization through shared experience. Survivors/carers wanted the opportunity to share the lived ICU recovery experience with their peers. The most common barrier identified by clinicians was potential emotional traumatization through group interactions. The pragmatic steps to set up an ideal peer support model were clearly identified from the data: model (face to face, educational-mutual support), location (hospital), duration (two hours), time of day (rotate to increase accessibility), frequency (once/month), attendance (participants self-select), content (participant story telling with rotating short talks from different clinicians), enhancing social interaction (Facebook group, social events). The EBCD experience was overwhelmingly positive for all participants. It provided clinicians an opportunity to step out of the clinical environment to consider service delivery for survivors/carers. For survivors/carers, EBCD supported their altruism by facilitating them to give something back to improve future care. Measures of feasibility such as participant attendance, implementation of EBCD process, engagement in process and quality of information obtained indicated the feasibility of using EBCD methodology in a critical care cohort. Conclusions: Survivors/carers wanted to share their lived recovery experience via a future peer support model but there was concern from clinicians regarding emotional traumatization in a group setting. The ideal model was easily identifiable by the EBCD process. EBCD was extremely wellreceived by all participants and is feasible in a critical care setting. Future testing of the codesigned peer support model via a pilot randomized controlled trial is required.

Purpose The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. Findings The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. Research limitations/implications Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. Practical implications The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. Originality/value This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist—the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an ‘explanatory theoretical model of change’ that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities—narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. Trial registration number The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results).

The Health Quality & Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector. Teams received training, guidance and mentorship in Experience Based Design (EBD) methodology.1 We evaluated the co-design programme to explore barriers and facilitators to the sustainability of the co-design projects and the EBD approach. The evaluation involved seventeen semi-structured interviews with programme participants, including seven team members, five sponsors, four patients and the programme facilitator. A further two team members provided written feedback. Eight teams provided completed workbooks. Data from the interviews and workbooks was thematically analysed. Team members saw support from sponsors as important to increase visibility and successful completion of co-design projects, mitigate barriers, and to secure resources and buy-in from peers. Five of nine participating teams reported dissatisfaction with the support received. Communication and competing priorities were challenges to sponsor engagement. Sharing co-design skills with peers and alignment with organisational strategy were seen as important for sustainability. Teams identified lack of secured resources or staff time, and consumer or staff attrition as key barriers to sustainability. The conclusion: buy-in from sponsors and senior leaders, support from colleagues, user-friendliness of co-design tools, consumer and staff availability, alignment, and system or culture change were key factors that influenced project sustainability.

The Health & Quality Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector. In the current programme teams received training, guidance and mentorship in Experience Based Design (EBD) methodology through a one day masterclass, seven WebEx sessions, coaching calls, email and through the completion of workbooks. We evaluated the co-design programme to explore the experiences, challenges and solutions that participating teams encountered while engaging with patients in their projects. The evaluation involved seventeen semi-structured interviews with programme participants, including seven team members, five sponsors, four patients and the programme facilitator. A further two team members provided feedback in written form and eight of nine teams provided completed workbooks. Data from the interviews and workbooks was thematically analysed. Health professionals identified key challenges to patient engagement as capturing diverse experiences, clear communication of project details and the availability and health of the patient. Patients advised the importance of improved communication, planning in advance and providing feedback and assurance about the value of their contribution. There are several important considerations to secure and maintain patient engagement in co-design. These include tailored strategies for approaching patients and capturing their experiences, pre-existing relationships and continued rapport building between patients and health professionals, good communication throughout the project, planning, and visibility of outcomes.

: Despite a surge of multidisciplinary interest in transition studies on low carbon mobilities, there has been little evaluation of the current state of the field, and the contributions of different approaches such as the Multi-Level Perspective (MLP), theories of practice, or the new mobilities paradigm. As a step in this direction, this paper brings together scholars representing different theoretical perspectives and disciplinary fields in order to discuss processes and uneven geographies of mobility transitions as they are currently theorised. First, we reflect upon the role of geographers and other social scientists in envisioning, enabling, and criticizing mobility transitions. Second, we discuss how different theoretical approaches can develop mobility transitions scholarship. Finally, we highlight emerging issues in mobility transitions research. the role of mobility, place and space in the constitution of social and life. Geographic Thought: A Critical 2012) and On the Move: Mobility in the Modern Western World four collections, Geographies of Mobilities: Practices, has written about airport architecture and the design of spaces of mobility for academic and general audiences. Her research revolves around the mobility-place nexus with a particular focus on spaces of transit, such as airports, urban public space, mobile sociality and intra-EU mobility. on various dimensions of the geography of mobility, including the how radical emission reductions from transport can be achieved and systems Dr. Frans Sengers is a postdoctoral researcher in the Copernicus Institute for Sustainable Development at Utrecht University in the Netherlands. The connecting theme running through his work is transformative change in urban contexts, especially in Asian cities. A key question is how socio-technical experimentation, institutional change and path-dependent regimes in cities across the globe co-produce our urban future. His current postdoc research centers on eco-city and smart city developments, comparing current activities in Europe and China. Before that time Frans completed his PhD thesis on the prospects for sustainable urban mobility in Thailand. C. van Unnikgebouw, 2, 10.29, Professor Mimi Sheller is Professor of Sociology and founding Director of the Center for Mobilities Research and Policy at Drexel University. She of the International Association for the History of Transport, Traffic and Mobility, founding co-editor of the journal Mobilities, and Associate Editor of the journal Transfers. She or co-editor of nine books, including Aluminum Dreams: The Making of Light Modernity Press, 2014); The Routledge and Locative Urry new

In November 2009 the NHS Institute for Innovation and Improvement published a list of eight high impact actions for nursing and midwifery and stated that, if implemented across the NHS, the actions could save over pounds 9 bn a year while improving the quality of care. The NHS Institute has now published a selection of case studies from different settings demonstrating successful initiatives relating to each action and a range of other supporting material. This article, the first in a Nursing Times series summarising the main information on how the high impact actions can be achieved, sets the context for the initiative. Subsequent articles will discuss the individual actions and offer practical information on implementation.

Pressure ulcers can occur in any patient but are most commonn in high risk groups such as: older people; those who are obese, malnourished orwith continence problems; people with certain skin types; andthose with certain underlying conditions. Pressure ulcers increase morbidityand mortality, and represent a significant proportion of NHS expenditure, yet the vast majority are avoidable. This article, the fifth in our series on the high impact actions for nursing and midwifery, looks at how nurses can prevent pressure ulcers in their patients.

In recent years, discharge initiatives that aim to free up hospital beds have become commonplace. However, new systems, such as bed management, have left many nurses feeling disengaged from the management of patient admission and discharge. They feel pressurised into speeding up discharge by the increasing focus on bed capacity and patient turnover, which can make them feel distanced from their primary role of caring for patients. Although new roles and initiatives can be valuable, changing the way nurses engage with discharge is key. Ensuring that the process is nurse led will lead to a faster discharge and less frustration for patients who are waiting to go home. This article, the last in our series on the high impact actions for nursing and midwifery, looks at how nursing staff can respond to the issue of discharge planning.