Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce.

BACKGROUND: Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals' perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. METHODS: Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. RESULTS: Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. CONCLUSIONS: The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals' point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients' healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation.

End-user support: a necessary issue in the implementation and use of EPR systems.

A successful integration of an IT-system is dependent not only of the quality of the information and the user interface features of the system but also of the organizations ability to support the users learning process. As IT is becoming more and more pervasive in the Health Care sector as such there is a need for a systematic approach to the question on how to support end-users. Based on an empirical study of an implementation process in a Danish Primary Health Care Services the concept of end-user support is discussed and it is argued that there is a need for a distinction between different kinds of support depending of the type of activity involved. First the organizations strategy for learning when the system was implemented is described. The evaluation of the learning strategy revealed that there was a need for different kinds of knowledge involving qualitatively different kinds of learning. Second the area of end-user support is discussed and it is argued that the common understanding of end-user support as something provided by DP staff, vendors or manuals are to narrow. Third a more differentiated way of thinking of support that link the need for different kind of knowledge and learning processes to different kinds of support is proposed. Finally Activity Theory is put forward as a possible basis that provide the opportunity of discussing issues belonging to different kinds of end-user support within an integrated framework.

Strategic planning of the master programme in health informatics at Aalborg University: targeting and updating the programme, to meet explicit customer needs.

Education is essentially giving people new skills and qualifications to fulfil certain tasks. In planning and managing educational programmes it is crucial to know what skills and what qualifications are needed to carry out the tasks in question, not to mention the importance of knowing what tasks are relevant to carry out. The programme in health informatics at Aalborg University produces health informatics professionals. The students are developing skills in solving informatics problems in health care organisations. The programme has been running for 3 years now and to maintain the perception of the aim for the programme a number of activities have been launched. In the following, the programme will be presented, the activities to obtain information on how to keep the programme targeted and updated will be described and the changes that are going to be introduced will be outlined.

Problem oriented project work in a distance education program in health informatics.

At Aalborg University, an important part of the distance education program within Health Informatics is problem oriented project work. Traditionally, distance education has been characterized by one-way communication and self study whereas the problem oriented project study form is based on cooperation and dialogue. In this paper, we describe the way in which we have implemented the problem oriented study form in a program within Health Informatics which is based on distance learning. First, we describe the program with regard to student, structure, aim, and activities. Second, we introduce the problem oriented project study form and present the basic principles behind this approach. Third, we explain important concepts and distinctions within the area of distance education. Finally, we describe the way in which we try to put the ideals of the problem oriented project work into practice. The use of a computer conferencing system is essential but in our experience, it is not in itself sufficient to provide the necessary support for the student project work.

Keeping education in health informatics on the right track.

The programme in health informatics at Aalborg University has been running for three years and is about to be revised and extended to a full masters programme. In this paper the programme is presented and the systematic activities to obtain the basis for the revision are described.