ABSTRACT
BACKGROUND: To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW). AIM: To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts. METHODS: A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation - Behaviour (COM-B) model of the BCW. RESULTS: Five key themes emerged. The theme 'Learning and coaching on the job' linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme 'interpretation of vital sign trends' also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme 'Management of alarms' linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme 'Integration and compatibility with clinical workflow' linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme 'Added value for nursing care' linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care. CONCLUSION: Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation.
ABSTRACT
In the Rhine-delta, accumulation of microcontaminants in floodplain foodwebs has received little attention in comparison with aquatic communities. To investigate organochlorine and metal concentrations in a terrestrial foodchain, samples of soil, earthworms (Lumbricus rubellus), and shrew (Crocidura russula, Sorex araneus) livers and kidneys were taken from two moderately to heavily polluted floodplains. Chlorobiphenyl residues in earthworm fat were 0.10 to 3.5 times the concentrations in soil organic matter, whereas ratios for other organochlorines varied between 0.87 and 8.8. These ratios are one order of magnitude lower than expected from laboratory experiments with earthworms, and laboratory and field studies on aquatic invertebrates. Bioconcentration ratios for heavy metals are in accordance with literature values for other locations, confirming the high potential for cadmium accumulation in Lumbricidae. Concentrations of organochlorines in shrew liver lipids were 1.0 to 13 times the residues in earthworm fat. These values are higher than lipid-corrected biomagnification ratios for laboratory rodents, but equal to those measured for benthivorous birds in the Rhine-delta. On a dry weight basis, kidney-earthworm ratios for cadmium were about one order of magnitude lower than previously reported values for insectivores. Soil concentrations of many compounds in both floodplains did not meet Dutch quality standards. Yet, hexachlorobenzene, chlorobiphenyl 153 (PCB153), gamma-hexachlorocyclohexane, sigma DDT, and dieldrin residues in earthworms and shrews did not exceed diet levels expected to be safe for endothermic species. An exception was noted for cadmium in worms and shrew kidneys. Heavy metal pollution in soil was close to levels that are critical to earthworms in laboratory studies. Cadmium concentrations in shrew kidneys were below levels suggested to be safe for Sorex araneus, but above those that were critical to the rat.
