Despite increasing recognition of the importance of citizen engagement in health policy, there is limited evidence for comparing and evaluating engagement methods, especially through a mixed-methods approach. The aim of this research was to compare and evaluate two citizen engagement approaches by analysing variations in participants’ responses and assessing participant surveys to understand perceived contributions to policy development. This research used a concurrent mixed-methods research design to evaluate two distinct citizen engagement approaches in health policy development. The design combined qualitative (citizen panels and interviews) and quantitative (surveys) data collection and analysis to examine the nature of input and participants’ perceived outcomes across the two methods. Both engagement methods revealed overlapping themes, though the nature of contributions differed. Citizen panels produced broader, system-level suggestions and collective problem-solving. By contrast, individual interviews offered deeper, personal accounts, enriching the findings with emotionally grounded perspectives. This study demonstrates that both citizen panels and individual interviews offer valuable yet distinct contributions to health policy development. Panels generate system-level recommendations and collective solutions, while interviews provide nuanced, personal insights into lived experiences. Using both citizen panels and an in-depth interview engagement approach in a mixed-methods design broadens and deepens the evidence base, highlighting the need to align method choice with specific policy and research goals.

SPARK36 is a structured interview tool for nurse-led consultations with parents of 3-year-olds in Youth Health Care. Previous studies demonstrated its feasibility, reliability and known-groups validity. This study examined its convergent validity. In a cross-sectional study during the COVID-19 period, associations between scores on 12 SPARK36 domains and conceptually related subscales of three parent-reported instruments were explored. Correlations were assessed using Kendall’s Tau-C. Of the 599 parents of children attending a SPARK36 consultation, 286 (41.7

INTRODUCTION:We aimed to evaluate the interrater reliability of the Structured Problem Analysis of Raising Kids aged 36 months (SPARK36). The instrument guides Youth Health Care nurses during a parent-child consultation in assessing the risk for child developmental and parenting problems. METHODS:A cross-sectional study was conducted in Flemish School Health Services using a convenience sample of parents and their three-year-olds from January until June 2022. Two SPARK36-trained nurses completed the SPARK36 form during the parent-child consultation, with the second nurse listening to the first without interfering. Weighted Cohen's kappa (Kw) coefficients were used to examine agreement for the SPARK36 domains scores and the overall risk assessment. RESULTS:Fifty-five SPARK36-led consultations were performed by 5 nurses. For all 16 SPARK36 domains a substantial to almost perfect Kw ≥ (≥0.62) was measured, and an almost perfect Kw of 0.91 was found for the overall risk assessment. CONCLUSION:Our results indicate a high level of agreement between raters, suggesting that the nurses' use of the instrument after training and education comes with uniformity and objectivity in assessing child developmental and parenting problems. Using the SPARK36 can contribute to improving the quality of care by reducing variability in Youth Health Care nurses' assessments, finally leading to more equity.

BACKGROUND:Retrospective research has shown that the transition from home to a nursing home is a complex and often fragmented care process, which can lead to negative outcomes for the entire care triad: older people with dementia, informal caregivers, and professional caregivers. At present, comprehensive and real-time research covering the entire transitional care process is lacking in the literature. This study aimed to follow the experiences of the care triad during the transition from home to a nursing home in real time. METHODS:This real-time, multiple-case study employed the patient journey mapping methodology. Participants were recruited in the province of Limburg, the Netherlands, through partner healthcare organisations affiliated with the Living Lab in Ageing and Long-Term Care. Five care triads were included, each consisting of an older person with dementia awaiting nursing home placement, their informal caregivers, and the professional caregivers involved in the transition process. A total of 26 participants were interviewed. Data were collected between October 2021 and March 2023 through semi-structured interviews, follow-up moments, and detailed logbooks. Data analysis involved both individual and cross-case analysis. RESULTS:Care triads experienced an overarching sense of uncontrollability throughout the transition process. This was linked to three key factors. First, dependency within the care triad was marked by each participant feeling reliant on others. Second, transitions were crisis-driven rather than planned, as participants struggled to identify the right timing. This was influenced by uncertainty, societal taboos, and government policy. Third, the transition process was largely discontinued, with different professionals responsible for separate parts of the process and the dementia case manager becoming absent after the move. CONCLUSION:Policymakers and professional caregivers should collaborate to establish a more gradual transition process. Professional caregivers should adopt a guiding role and ensure continuity of care after the move. Future research should explore how to empower care triads throughout the transition from home to a nursing home.

BACKGROUND:Due to their serious consequences, falls are a well-documented problem in residential aged care facilities (RACFs). Although clinical practice guidelines (CPGs) on falls prevention in RACFs have been developed in many countries, their implementation remains challenging. Therefore, this study aimed to describe the development of a multifaceted plan for the implementation of a guideline on multifactorial falls prevention interventions in RACFs. METHODS:An implementation plan was developed as part of a large-scale falls prevention implementation initiative in Flanders (Belgium). The development process was guided by prior research and Intervention Mapping, which includes six stages: 1) logic model of the problem, 2) logic model of change, 3) programme design, 4) programme production and testing, 5) programme implementation plan, and 6) evaluation plan. A stakeholder group of nine experts actively participated in this development process. The implementation plan was pretested in six RACFs and adjusted to better align with their context. RESULTS:A three-phase implementation plan divided into seven steps was finalised. The first phase is preparation (steps 1 to 3), during which RACFs undertake the necessary preparations to start the implementation process by enabling broad support within their organisation, mapping the baseline situation, defining objectives, and setting priorities. The second phase (steps 4 and 5) concerns the actual implementation, which outlines the development and performance of implementation actions. In the third phase (steps 6 and 7), RACFs evaluate and adjust actions, and aim to sustainably anchor the implemented falls prevention policy in their daily practice and quality management system. CONCLUSION:We were able to develop a comprehensive implementation plan for falls prevention in RACFs. This plan supports RACFs in the implementation of tailored falls prevention interventions and maximise sustainability. Future research should further focus on larger-scale implementation and evaluating the effectiveness of the implementation plan in combination with the support of an external implementation facilitator. This includes assessing its impact on determinants, and implementation and clinical outcomes.

Currently, there is insufficient evidence supporting geriatric home rehabilitation after hospital discharge. Some studies demonstrate a positive effect, but meta-analytic evidence demonstrates uncertainty on the magnitude of the expected effect. Yet, evidence from other populations indicates that home rehabilitation could also be an effective strategy for older persons. Therefore, we aim to evaluate the effectiveness of geriatric home rehabilitation in older persons discharged from the hospital with disability. Given the potential challenges in recruiting participants delivering the intervention, and executing other study procedures in a multi-centre study, we will first carry out a pilot study. The pilot study will commence with an initial start-up phase at two centres: UZ Leuven and CHU UCL Namur, Belgium. Up to three participants per centre will be included to test the procedures and assessments, excluding randomisation and intervention delivery. The study then progresses to the full pilot phase to evaluate and confirm the feasibility of the proposed trial. This pilot study will take place at the same two centres. The pilot study aligns with the design of the envisioned full trial, i.e. a pragmatic, multicentre, individually randomised superiority trial. A 1 to 1 allocation ratio will be used for the pilot. A total of 24 participants from the two centres will be recruited to investigate the pilot study objectives. The pilot endpoints will be used to determine the feasibility of recruitment and study procedures including data collection, assessments and delivery of the intervention (a 6-week program consisting of exercise sessions 3 times per week, 45 min each). The results from the pilot study will be discussed within the pilot study steering group. Progression criteria will be reviewed to determine if the study progresses to a full trial, and which adaptations are needed. In case of a successful pilot, the study will progress to a full trial. The ambition of the full trial is to recruit 333 participants across 8 centres in Belgium, and to investigate the effectiveness of home rehabilitation for older persons discharged from the hospital with disability. Clinicaltrials.gov, NCT06404138 on 08 May 2024.

AIM:To describe the organisation of nurse-led clinics and the factors facilitating or hindering their implementation based on experiences in five countries. DESIGN:Descriptive multimethod study. METHODS:We analysed policy documents, nursing competency profiles and scientific literature and conducted 27 semi-structured interviews with stakeholders from the Netherlands, Ontario, Ireland, France and Finland between April and June 2023. We summarised relevant information on nurse-led clinic organisation in categories and mapped contextual factors following the Context and Implementation of Complex Interventions framework. RESULTS:In the Netherlands, Ontario and France, nurse-led clinics are implemented in all care settings. In all regions, clinics are led by nurses with varied educational backgrounds, but master-trained advanced practice nurses have more autonomy than bachelor-trained nurses. In France and Ireland, expanded scope of nursing practice is expected to be formally documented in a practice agreement or protocol. In all regions, nurses can prescribe medication under specific conditions. Interviewees stressed the relevance of continuous education for nurses and clear role delineation to facilitate the implementation of nurse-led clinics and collaboration with physicians. Organisational readiness, practical support and research to demonstrate quality, safety and cost-effectiveness of nurses' expanded roles were drivers of successful nurse-led clinic integration. CONCLUSION:Nurse-led clinics operate across various care settings and are staffed with nurses from diverse educational backgrounds, requiring adequate training and experience for autonomous practice. Successful implementation depends on clear role delineation, close collaboration with healthcare professionals, and supportive educational, legal and financial frameworks to ensure sustainable integration. IMPACT:Our comprehensive description of the organisation of nurse-led clinics-including legal, financial, educational and practical aspects- along with our analysis of contextual factors supporting their implementation, provides guidance to policymakers and healthcare organisations considering the successful and sustainable adoption of this model of care within their healthcare system. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

The transition from the structured environment of the hospital to the more independent home setting presents various challenges and opportunities that significantly impact the post-discharge journey. This qualitative descriptive study, conducted within the European TRANS-SENIOR consortium, explores the experiences of older adults and informal caregivers in Israel during hospital-to-home care transitions while identifying challenges and opportunities for optimizing care transitions. One-to-one interviews were conducted with seven older adults and nine informal caregivers who experienced hospital-to-home transitions within the past 12 months. Thematic analysis showed negative and positive experiences; challenges included fragmented healthcare management and a lack of person-centered care; opportunities for improvement in the care transition system included promoting individual autonomy, involvement in decision-making, and enhancing collaboration between hospitals and communities. Our findings can support research and clinical efforts and encourage policymakers to explore new ways of improving hospital-to-home transition experiences, leading to better patient outcomes and experiences.

Efficient hospital-to-home transitions for older adults and their informal caregivers are hampered by current fragmented care systems, resulting in communication and coordination lapses when people move between hospital-to-home settings. Such fragmentation often leads to suboptimal hand-overs of information and care, medication errors, and overlooked follow-up appointments, which, in turn, contribute to adverse health outcomes for the elderly population. This study aims to answer the question: “What policy interventions can improve the transitions from hospital to home for older adults and their informal caregivers” Thus the study focuses on delineating policy recommendations at the micro, meso, and macro levels to facilitate smoother and more beneficial hospital-to-home transitions for older adults and their informal caregivers. As part of the European Union Transitional Care Program (TRANS-SENIOR), this qualitative descriptive study leverages a multiple perspectives approach through in-depth interviews with older adults and informal caregivers. The goal is to pinpoint critical intervention zones of policy recommendations based on a holistic understanding of older adult and caregiver recommendations for improving hospital-to-home transitions. Findings show strategies that strengthen patient and caregiver engagement on the micro level. These include implementing personalized care plans and improving communication channels between healthcare providers and their recipients. The meso level targets healthcare organizations and systems, promoting the adoption of streamlined care coordination, enhanced discharge planning, and bolstered support services for caregivers. Such interventions are designed to smooth the transition process, ensuring that care continues seamlessly from hospital to home. At the macro level, our findings urge policy reforms to address broader systemic issues, such as the allocation of resources, the introduction of funding mechanisms, and the expansion of healthcare workforce capacity. These policy recommendations aim to create an enabling environment for effective care transitions, addressing underlying challenges that impede seamless care transitions. This paper presents a set of policy recommendations for policymakers, healthcare professionals, and stakeholders. These recommendations aim to tackle the multifaceted challenges associated with hospital-to-home transitions to enhance care experience and outcomes for older adults and their caregivers by addressing individual, organizational, and systemic issues.

Patient satisfaction during hospitalization for esophagectomy has been little studied. The aim of this study was to evaluate patients' satisfaction with a newly introduced enhanced recovery protocol (ERP) for esophagectomy. At hospital discharge, patients were invited to complete a questionnaire. This pseudonymized questionnaire contained 5-point Likert scales regarding items on multidisciplinary care (n = 7), information/communication (n = 7), length of stay (n = 1), and specific adaptations of care in the ERP (n = 11). One open question asked for patient experiences and suggestions for improving the ERP. Between May 2017 and December 2021, 521 patients were included in the ERP after esophagectomy. Of them, 327 patients (63%) completed the questionnaire. Response rates were evenly distributed between genders and slightly higher in younger patients (<60 years; 68%) as compared to elderly patients (>70 years; 60%). Quantitative analysis revealed high satisfaction rates for multidisciplinary care (86.8%), information/communication (84.9%), and ERP adaptations (82.2%), and length of stay was considered optimal in 80%. There were no significant differences in satisfaction observed between gender nor age groups. For the qualitative analysis, there were 108 open answers, resulting in 268 statements. Sentiments expressed in these statements were evaluated as negative, positive, or unspecified. Negative sentiments were attributable to alimentation, organizational factors, and communication. Positive sentiments were attributed to interpersonal relations, multidisciplinary care, and ERP. Overall, patients are very satisfied with the ERP for esophagectomy during hospitalization. By incorporating qualitative data, the results of this quantitative analysis are expanded and elucidated, showing areas where improvements to our ERP are possible to increase patient satisfaction.

BackgroundPolicymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care.ObjectiveThis study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).DesignUmbrella review.MethodsWe followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.ResultsWe included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.ConclusionsThe effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity among and within systematic reviews, and quality of reporting hamper the strength of the findings.

Abstract Background Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost–effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+ years) and informal caregivers’ involvement in health policy development. Method As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute’s methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. Results A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as “traditional”, “deliberative” and “others”, adopting the World Bank’s categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. Conclusion Although approaches for involving older adults and their informal caregivers’ involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.

Background Transitioning from hospital to home is not just a process but a crucial aspect of healthcare delivery, particularly for older adults and their informal caregivers. This transition from the structured environment of the hospital to the more independent home setting presents various challenges and opportunities that significantly impact the post-discharge journey and remains a critical and vulnerable phase for patients, especially those with complex medical needs or limited support systems. With a rapidly aging population, diverse cultural demographics, and a centralized healthcare system, Israel provides a multifaceted context to explore the intricacies of this transition process. This paper explores the experiences of older adults and informal caregivers navigating hospital-to-home care transitions in Israel and the challenges and opportunities in optimizing care transitions. Methods Conducted within the European TRANS-SENIOR consortium, we conducted a qualitative descriptive study using one-to-one interviews with Israeli older adults and informal caregivers. who experienced hospital-to-home transitions within the past 12 months. Interview questions explored negative and positive experiences navigating hospital-to-home transitions and challenges and opportunities for optimizing care transitions. Thematic analysis was used. Results Seven older adults and nine informal caregivers participated in interviews, revealing diverse perceptions of hospital-to-home transitions. The experiences of hospital-to-home transitions varied, with negative experiences characterized by abrupt farewells and a perceived lack of ongoing support, while positive experiences involved reassurance, empowerment, and follow-up care. Challenges included fragmented healthcare management and a lack of person-centered care, particularly for older adults without family support or facing critical conditions, Additional issues included bureaucratic hurdles, language barriers, and communication deficiencies. Opportunities for improvement in Israel's care transition system for older adults and informal caregivers include promoting individual autonomy, involvement in decision-making, and enhancing collaboration between hospitals and communities. Conclusion Challenges across the care continuum highlighted the need for targeted interventions to address communication, person-centered care, and continuity of care. Policymakers can use this information to develop and implement strategies to improve the transition process, ultimately leading to better patient outcomes and experiences.

AIM:To capture older people's, informal caregivers' and health professionals' ideas on potential interventions for empowering older people and informal caregivers in transitional care decision-making. DESIGN:A descriptive qualitative design was adopted. METHODS:The study was conducted between February and May 2022 in the region of Flanders, Belgium, as part of the TRANS-SENIOR consortium's collaborative research. Data were collected using focus groups, including older people, informal caregivers and healthcare professionals involved in any physical relocation of the older person across home, hospital or nursing home settings. Thematic data analysis was performed based on Braun and Clarke's six-step method. RESULTS:A total of 40 people participated in the focus groups. Four main themes were identified, which describe ideas on how to empower older people and informal caregivers in transitional care: Providing clear and timely information, preparing people for what is to come, person-centredness and providing professional and peer support for informal caregivers. CONCLUSIONS:Healthcare (professionals) should facilitate older people's and informal caregivers' empowerment in transitional care decision-making by setting them at the core and inception of the decision-making process. While informal caregivers support their loved ones in decision-making processes, they should also be supported and monitored for burdensome issues. IMPLICATIONS TO PATIENT CARE:Multicomponent, well-planned and personalised interventions are needed to empower older people and informal caregivers in transitional care decision-making. The ideas raised by all stakeholders who participated in this study can inform these interventions. REPORTING METHOD:Adhered to consolidated criteria for reporting qualitative research checklist. PATIENT OR PUBLIC CONTRIBUTION:Organisations advocating for the interests of older people and informal caregivers played a pivotal role in shaping the TRANS SENIOR project. Furthermore, the study benefitted from the collaborative input of AGE Platform Europe, which amplified the voices and representation of older people during the project design phase.

AIMS:The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. DESIGN:A co-design development process was conducted. METHODS:This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. RESULTS:A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. CONCLUSION:The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. IMPLICATIONS FOR THE PROFESSION:This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. IMPACT:What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. REPORTING METHOD:The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

Objectives: Alzheimer's disease and related dementias (ADRD) are prevalent conditions in long-term care homes (LTCHs) with most LTCH residents living with ADRD in many countries. Despite the prevalence of ADRD in LTCHs, a recent examination of LTCH quality measurement programs in 4 countries revealed few LTCH quality measures addressed ADRD, most commonly as a risk adjuster. We sought to better un-derstand how quality measurement programs address ADRD internationally.Design: International comparative analysis.Setting and Participants: We examined LTCH quality measures in 4 European countriesdGermany, Switzerland, Belgium, and the Netherlands.Methods: The specifications to calculate each measure were assessed to determine whether the measure was calculated without assessing for ADRD, included only residents with ADRD, excluded residents with ADRD, or was risk adjusted for the presence of ADRD among the LTCH residents.Results: A total of 143 measures were examined across 4 quality measurement programs. Thirty-seven percent of the measures explicitly address ADRD. The programs addressed ADRD in starkly different ways. In Germany, most (13 of 15) measures addressed ADRD, and did so as an exclusion or inclusion criterion, and in Switzerland all the measures addressed ADRD through risk adjustment. In Flanders, Belgium, all measures were calculated without assessing for ADRD. In the Netherlands, one-third of the measures explicitly addressed ADRD by restricting the measure to psychogeriatric units.Conclusions and Implications: Although limited to examining measures from LTCH quality measurement programs in 4 European countries, this study adds evidence that ADRD tends not to be addressed by LTCH quality measures, but when ADRD is addressed, it tends to be through inclusion or exclusion criteria. LTCH regulators, policymakers, and providers can use this information to assess options for addressing ADRD in quality measurement programs. Future research is needed to assess how standard indicators of ADRD care quality differ across quality measurement programs.(c) 2023 AMDA -The Society for Post-Acute and Long-Term Care Medicine.

WHAT IS KNOWN ON THE SUBJECT?: Seclusion and restraint still regularly occur within inpatient mental health services. The Council of Europe requires the development of a policy on for instance age limits, techniques and time limits. However, they only define the outer limits of such a policy by indicating when rights are violated. Within these limits, many choices remain open. Staff and service managers lack clarity on safe and humane procedures. Research literature provides limited and contradictory insights on these matters. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study resulted in 77 best practice recommendations on the practical application of restraint and seclusion as last resort intervention in inpatient youth and adult mental health services, including forensic facilities. To our knowledge, this is the first study in which the development of recommendations on this topic is not only based on scientific evidence, but also on an analysis of European human rights standards and consensus within and between expert-professionals and experts-by-experience. This approach allowed to develop for the first time recommendations on time limits, asking for second opinion, and registration of seclusion and restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The 77 recommendations encourage staff to focus on teamwork, safety measures, humane treatment, age and time limits, asking for second opinion, observation, evaluation and registration when applying seclusion and restraint as last resort intervention. The implementation of the best practice recommendations is feasible provided that they are combined with a broad preventive approach and with collaboration between service managers, staff (educators) and experts-by-experience. Under these conditions, the recommendations will improve safety and humane treatment, and reduce harm to both service users and staff. ABSTRACT:INTRODUCTION: Seclusion and restraint still regularly occur within inpatient mental health services. Professionals lack clarity on safe and humane procedures. Nevertheless, a detailed policy on for instance age limits, techniques and time limits is required. AIM:We developed recommendations on the humane and safe application of seclusion, physical intervention and mechanical restraint in inpatient youth and adult mental health services, including forensic facilities. METHOD:After developing a questionnaire based on a rapid scientific literature review and an analysis of human rights sources stemming from the Council of Europe, 60 expert-professionals and 18 experts-by-experience were consulted in Flanders (Belgium) through a Delphi-study. RESULTS:After two rounds, all but one statement reached the consensus-level of 65% in both panels. The study resulted in 77 recommendations on teamwork, communication, materials and techniques, maximum duration, observation, evaluation, registration, second opinion and age limits. DISCUSSION:Combining an evidence, human rights and consensus-based approach allowed for the first time to develop recommendations on time limits, asking for second opinion and registration. IMPLICATIONS FOR PRACTICE:When combined with a preventive approach and collaboration between service managers, staff (educators) and experts-by-experience, the recommendations will improve safety and humane treatment, and reduce harm to service users and staff.

Background and Objectives Four interventions to improve care transitions between hospital and home or community settings for older adults were implemented in Leuven, Belgium over the past 4 years. These complex interventions consist of multiple components that challenge their implementation in practice. This study examines the influencing factors, strategies used to address challenges in implementing these interventions, and implementation outcomes from the perspectives of health care professionals involved. Research Design and Methods This was a qualitative, collective case study that was part of the TRANS-SENIOR research network. Authors conducted semistructured interviews with health care professionals about their perceptions regarding the implementation. Thematic analysis was used, and the Consolidated Framework for Implementation Research guided the final data interpretation. Results Thirteen participants were interviewed. Participants reported major implementation bottlenecks at the organizational level (resources, structure, and information continuity), while facilitators were at the individual level (personal attributes and champions). They identified engagement as the primary strategy used, and suggested other important strategies for the future sustainability of the interventions (building strategic partnerships and lobbying for policies to support transitional care). They perceived the overall implementation favorably, with high uptake as a key outcome. Discussion and Implications This study highlights the strong role of health care providers, being motivated and self-driven, to foster the implementation of interventions in transitional care in a bottom-up way. It is important to use implementation strategies targeting both the individual-level factors as well as the organizational barriers for transitional care interventions in the future.

Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.

BACKGROUND:Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision-making.OBJECTIVE:To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision-making.METHODS:A qualitative descriptive study was conducted in the TRANS-SENIOR consortium's collaborative research using semistructured in-depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven.FINDINGS:Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision-making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors.CONCLUSIONS:Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision-making. However, their preferences for greater involvement in decision-making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age-tuned and person-centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment.PATIENT OR PUBLIC CONTRIBUTION:Older persons' representatives were involved in designing the TRANS-SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants.