An explorative study on facilitating and hindering conditions of implementing degrees of freedom in nursing homes

Background: (Inter)nationally, there is a rapidly aging population and thus higher numbers of chronic conditions, such as dementia. Dementia is an increasing public health problem due to high prevalence and institutionalisation. The global ‘dementia challenge’ stimulates improving dementia care, including care in institutions, where people with dementia can live on closed-door units. However, there is evidence on the health benefits of freedom of movement. Also, new Dutch legislation states that a closed-door policy should ‘always be prevented, unless…’ One option to sustain safety in maintaining an open-door policy is degrees of freedom, in which technology is being used to only open doors for certain clients who are allowed to have more freedom of movement. However, research has shown the challenges in implementation due to, among others, shifts in delivering care. Objective: To analyse facilitating and hindering conditions during the implementation of degrees of freedom according to the main stakeholders. This will be facilitated by examining experiences of development, implementation and usage of degrees of freedom in nursing homes. Methods: This qualitative study was performed on four closed-door units for psychogeriatric clients in two Dutch nursing homes, which were at different stages of implementing degrees of freedom. The qualitative research methods were observations with field notes on both locations and fourteen semistructured interviews with the main stakeholders. The facilitating and hindering conditions influencing the implementation of degrees of freedom were evaluated by using the non-adoption, abandonment, scale-up, spread and sustainability framework (NASSS framework). Results: Five themes on facilitating and hindering conditions of implementing degrees of freedom emerged from the data: 1) experiences with and ease of use of technology, 2) challenges of people with dementia and degrees of freedom, 3) safety versus freedom, 4) adaption of work processes and 5) organization, locations and their exchanges in the wider context. The derived facilitating and hindering conditions could be aligned with all domains of the NASSS framework, which were labelled as either ‘complicated’ or ‘complex’. Notable was that most respondents were not in favour of the degrees of freedom. This was often the consequence of a dilemma between safety and freedom, which could play as a hindering condition during the implementation. Environmental factors, such as water nearby the exit of the location or units located on high levels, could play a role in the willingness of staff to let clients leave the units. Furthermore, the interaction between the two studied locations was investigated: exchange in and between organizations could be a facilitating condition. Lastly, the specific technology posed as a major hindering condition: respondents were highly unfavourable about the use of wristbands on people with dementia and argue for alternatives.Conclusion: The implementation of degrees of freedom has been shown to be complex, which could lead to non-adoption. Multiple facilitating and hindering conditions were described. While the NASSS framework showed how the degrees of freedom is labelled complicated to complex, the framework was found less suitable to apprehend the cultural, paradigm and mindset shift in the respondents. Practical implications included the importance of an integral approach, necessity of mindset shift in staff towards safety versus freedom and consequences for equality in the future of elderly care. Further research should focus on a large-scale research effort on improved technology, integral approach to facility design and internal and external stakeholder engagemen

An explorative study on facilitating and hindering conditions of implementing degrees of freedom in nursing homes

Background: (Inter)nationally, there is a rapidly aging population and thus higher numbers of chronic conditions, such as dementia. Dementia is an increasing public health problem due to high prevalence and institutionalisation. The global ‘dementia challenge’ stimulates improving dementia care, including care in institutions, where people with dementia can live on closed-door units. However, there is evidence on the health benefits of freedom of movement. Also, new Dutch legislation states that a closed-door policy should ‘always be prevented, unless…’ One option to sustain safety in maintaining an open-door policy is degrees of freedom, in which technology is being used to only open doors for certain clients who are allowed to have more freedom of movement. However, research has shown the challenges in implementation due to, among others, shifts in delivering care. Objective: To analyse facilitating and hindering conditions during the implementation of degrees of freedom according to the main stakeholders. This will be facilitated by examining experiences of development, implementation and usage of degrees of freedom in nursing homes. Methods: This qualitative study was performed on four closed-door units for psychogeriatric clients in two Dutch nursing homes, which were at different stages of implementing degrees of freedom. The qualitative research methods were observations with field notes on both locations and fourteen semistructured interviews with the main stakeholders. The facilitating and hindering conditions influencing the implementation of degrees of freedom were evaluated by using the non-adoption, abandonment, scale-up, spread and sustainability framework (NASSS framework). Results: Five themes on facilitating and hindering conditions of implementing degrees of freedom emerged from the data: 1) experiences with and ease of use of technology, 2) challenges of people with dementia and degrees of freedom, 3) safety versus freedom, 4) adaption of work processes and 5) organization, locations and their exchanges in the wider context. The derived facilitating and hindering conditions could be aligned with all domains of the NASSS framework, which were labelled as either ‘complicated’ or ‘complex’. Notable was that most respondents were not in favour of the degrees of freedom. This was often the consequence of a dilemma between safety and freedom, which could play as a hindering condition during the implementation. Environmental factors, such as water nearby the exit of the location or units located on high levels, could play a role in the willingness of staff to let clients leave the units. Furthermore, the interaction between the two studied locations was investigated: exchange in and between organizations could be a facilitating condition. Lastly, the specific technology posed as a major hindering condition: respondents were highly unfavourable about the use of wristbands on people with dementia and argue for alternatives.Conclusion: The implementation of degrees of freedom has been shown to be complex, which could lead to non-adoption. Multiple facilitating and hindering conditions were described. While the NASSS framework showed how the degrees of freedom is labelled complicated to complex, the framework was found less suitable to apprehend the cultural, paradigm and mindset shift in the respondents. Practical implications included the importance of an integral approach, necessity of mindset shift in staff towards safety versus freedom and consequences for equality in the future of elderly care. Further research should focus on a large-scale research effort on improved technology, integral approach to facility design and internal and external stakeholder engagemen

Coupled wake boundary layer model of wind-farms

We present and test the coupled wake boundary layer (CWBL) model that describes the distribution of the power output in a wind-farm. The model couples the traditional, industry-standard wake model approach with a "top-down" model for the overall wind-farm boundary layer structure. This wake model captures the effect of turbine positioning, while the "top-down" portion of the model adds the interactions between the wind-turbine wakes and the atmospheric boundary layer. Each portion of the model requires specification of a parameter that is not known a-priori. For the wake model, the wake expansion coefficient is required, while the "top-down" model requires an effective spanwise turbine spacing within which the model's momentum balance is relevant. The wake expansion coefficient is obtained by matching the predicted mean velocity at the turbine from both approaches, while the effective spanwise turbine spacing depends on turbine positioning and thus can be determined from the wake model. Coupling of the constitutive components of the CWBL model is achieved by iterating these parameters until convergence is reached. We illustrate the performance of the model by applying it to both developing wind-farms including entrance effects and to fully developed (deep-array) conditions. Comparisons of the CWBL model predictions with results from a suite of large eddy simulations (LES) shows that the model closely represents the results obtained in these high-fidelity numerical simulations. A comparison with measured power degradation at the Horns Rev and Nysted wind-farms shows that the model can also be successfully applied to real wind-farms.Comment: 25 pages, 21 figures, submitted to Journal of Renewable and Sustainable Energy on July 18, 201

An explorative study on facilitating and hindering conditions of implementing degrees of freedom in nursing homes

Background: (Inter)nationally, there is a rapidly aging population and thus higher numbers of chronic conditions, such as dementia. Dementia is an increasing public health problem due to high prevalence and institutionalisation. The global ‘dementia challenge’ stimulates improving dementia care, including care in institutions, where people with dementia can live on closed-door units. However, there is evidence on the health benefits of freedom of movement. Also, new Dutch legislation states that a closed-door policy should ‘always be prevented, unless…’ One option to sustain safety in maintaining an open-door policy is degrees of freedom, in which technology is being used to only open doors for certain clients who are allowed to have more freedom of movement. However, research has shown the challenges in implementation due to, among others, shifts in delivering care. Objective: To analyse facilitating and hindering conditions during the implementation of degrees of freedom according to the main stakeholders. This will be facilitated by examining experiences of development, implementation and usage of degrees of freedom in nursing homes. Methods: This qualitative study was performed on four closed-door units for psychogeriatric clients in two Dutch nursing homes, which were at different stages of implementing degrees of freedom. The qualitative research methods were observations with field notes on both locations and fourteen semistructured interviews with the main stakeholders. The facilitating and hindering conditions influencing the implementation of degrees of freedom were evaluated by using the non-adoption, abandonment, scale-up, spread and sustainability framework (NASSS framework). Results: Five themes on facilitating and hindering conditions of implementing degrees of freedom emerged from the data: 1) experiences with and ease of use of technology, 2) challenges of people with dementia and degrees of freedom, 3) safety versus freedom, 4) adaption of work processes and 5) organization, locations and their exchanges in the wider context. The derived facilitating and hindering conditions could be aligned with all domains of the NASSS framework, which were labelled as either ‘complicated’ or ‘complex’. Notable was that most respondents were not in favour of the degrees of freedom. This was often the consequence of a dilemma between safety and freedom, which could play as a hindering condition during the implementation. Environmental factors, such as water nearby the exit of the location or units located on high levels, could play a role in the willingness of staff to let clients leave the units. Furthermore, the interaction between the two studied locations was investigated: exchange in and between organizations could be a facilitating condition. Lastly, the specific technology posed as a major hindering condition: respondents were highly unfavourable about the use of wristbands on people with dementia and argue for alternatives.Conclusion: The implementation of degrees of freedom has been shown to be complex, which could lead to non-adoption. Multiple facilitating and hindering conditions were described. While the NASSS framework showed how the degrees of freedom is labelled complicated to complex, the framework was found less suitable to apprehend the cultural, paradigm and mindset shift in the respondents. Practical implications included the importance of an integral approach, necessity of mindset shift in staff towards safety versus freedom and consequences for equality in the future of elderly care. Further research should focus on a large-scale research effort on improved technology, integral approach to facility design and internal and external stakeholder engagemen

The role of policy in shielding, nurturing and enabling offshore wind in The Netherlands (1973–2013)

It is widely acknowledged that many renewable energy technologies cannot (yet) compete with incumbent (fossil fuel) options e.g. in terms of price. Transitions literature argues that sustainable innovations can nevertheless break out of their ‘niches’ if properly shielded, nurtured and empowered. Most studies using this perspective have focused on how innovation champions engage in shielding, nurturing and empowering (SNE) activities: none have so far focused specifically on the role that policy plays in relation to these three processes. This paper therefore aims to analyze the way in which policy constrains and enables the shielding, nurturing and empowering of renewable energy innovations. To do so, it presents a qualitative review of the development of offshore wind power (OWP) in The Netherlands over the past four decades. Based on interpretation of a wide variety of written sources (academic histories, reports, policy documents, parliamentary debate transcripts, news media) and nine semi-structured interviews, it discerns six periods of relative stability in the history of Dutch offshore wind. It then analyzes the effects of various policies on the shielding, nurturing and empowering of offshore wind in these periods. The paper contributes to transitions literature (1) by providing an analysis of how policies can enable and constrain the shielding, nurturing and empowering of renewable energy innovations, and (2) by bringing together, for the first time, fragmented accounts of the surprisingly long history of Dutch offshore wind development and implementation. Both contributions are timely, given the recent reprioritization of OWP on the Dutch policy agenda

De energietransitie: een nieuwe dimensie in ons landschap

De transitie naar een duurzame energievoorziening heeft op veel terreinen ingrijpende gevolgen voor onze samenleving. Het gaat onder meer om een verandering van leefomgeving en landschap. Voor een succesvolle energietransitie is het nodig om nu al rekening te houden met de ruimtelijke vormgeving van nieuwe energielandschappen en de manier waarop die tot stand komen. Dit betekent dat alle betrokkenen samen energielandschappen ontwerpen waarin mens en technologie elkaar op een nieuwe manier ontmoeten. Een andere manier van denken: niet het ruimtelijk inpassen, maar het creëren van landschappen die door mensen worden gewaardeerd en economisch haalbaar zijn. Landschappen die zorgen dat de overgang naar een duurzame, koolstofarme toekomst breed gedragen wordt en snel kan plaatsvinden. ECN en WUR hebben hun kennis over energietechnologie en landschapsarchitectuur gebundeld in dit paper. Zo willen ze een bijdrage leveren aan de discussie over wat wenselijk en noodzakelijk is om de energietransitie ruimtelijk in goede banen te leiden