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Background: Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening. Methods: A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up. Discussion: An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment. Trial registration: ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.

Aims: To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care. Design: A quantitative, cross-sectional design. Methods: An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) ‘washing the client with water and soap by default’, (2) ‘application of zinc cream, powders or pastes when treating intertrigo’, (3) ‘washing the client from head to toe daily’, (4) ‘re-use of a urinary catheter bag after removal/disconnection’ and (5) ‘bladder irrigation to prevent clogging of urinary tract catheter’. The top five related influencing factors reported were: (1) ‘a (general) practitioner advices/prescribes it’, (2) ‘written in the client's care plan’, (3) ‘client asks for it’, (4) ‘wanting to offer the client something’ and (5) ‘it is always done like this in the team’. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implement

OBJECTIVES: Systematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to the one open-ended question posed in the Dutch version of the Culture of Care Barometer (CoCB-NL) to examine (1) if the responses offered new insights into healthcare employees' perceptions of their work environment and (2) if the original CoCB had any themes missing. DESIGN: Retrospective text analysis using Rigorous and Accelerated Data Reduction technique. SETTING: University hospital in the Netherlands using the CoCB-NL as part of the annual employee survey. PARTICIPANTS: All hospital employees were invited to participate in the study (N=14 671). In total, 2287 employees responded to the open-ended question. RESULTS: 2287 comments were analysed. Comments that contained more than one topic were split according to topic, adding to the total (n=2915). Of this total, 372 comments were excluded because they lacked content or respondents indicated they had nothing to add. Subsequently, 2543 comments were allocated to 33 themes. Most comments (n=2113) addressed the 24 themes related to the close-ended questions in the CoCB-NL. The themes most commented on concerned questions on 'organisational support'. The remaining 430 comments covered nine additional themes that addressed concerns about work environment factors (team connectedness, team effectiveness, corporate vision, administrative burden and performance pressure) and themes (diversity and inclusion, legal frameworks and collective bargaining, resilience and work-life balance, and personal matters). CONCLUSIONS: Analysing responses to the open-ended question in the CoCB-NL led to new insights into relevant elements of the work environment and missing themes in the COCB-NL. Moreover, the analysis revealed important themes that not only require attention from healthcare organisations to ensur

Objectives A positive work environment (WE) is paramount for healthcare employees to provide good quality care. To stimulate a positive work environment, employees’ perceptions of the work environment need to be assessed. This study aimed to assess the reliability and validity of the Dutch version of the Culture of Care Barometer (CoCB-NL) survey in hospitals. Methods This longitudinal validation study explored content validity, structural validity, internal consistency, hypothesis testing for construct validity, and responsiveness. The study was conducted at seven departments in two Dutch university hospitals. The departments were included based on their managers’ motivation to better understand their employees’ perception of their WE. All employees of participating departments were invited to complete the survey (n = 1,730). Results The response rate was 63.2%. The content of the CoCB-NL was considered relevant and accessible by the respondents. Two factor models were found. First, confirmative factor analysis of the original four-factor structure showed an acceptable fit (X2 2006.49; df 399; p = <0.001; comparative fit index [CFI] 0.82; Tucker-Lewis index [TLI] 0.80; root mean square error of approximation [RMSEA] 0.09). Second, explanatory factor analysis revealed a five-factor model including ‘organizational support’, ‘leadership’, ‘collegiality and teamwork’, ‘relationship with manager’, and ‘employee influence and development’. This model was confirmed and showed a better fit (X2 1552.93; df 395; p = < 0.00; CFI 0.87; TLI 0.86; RMSEA 0.07). Twelve out of eighteen hypotheses were confirmed. Responsiveness was assumed between the measurements. Conclusions The CoCB-NL is a valid and reliable instrument for identifying areas needing improvement in the WE. Furthermore, the CoCB-NL appears to be responsive and therefore useful for longitudinal evaluations of healthcare employees’ work environments.

16 juni 2023, Contains fulltext : 295039.pdf (Publisher’s version ) (Open Access)

IntroductionIn the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care.ObjectiveThis study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization.MethodsA qualitative study was conducted using an interpretive phenomenological approach. To follow patients’ experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process.ResultsFifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care.ConclusionAwareness and responsiveness to patients’ perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.

Background: Adequate staffing is crucial for high quality patient care and nurses’ wellbeing. Nurses’ professional assessment on adequacy of staffing is the gold standard in measuring staffing adequacy. However, available measurement instruments lack reliability and validity. Objectives: To develop and psychometrically test an instrument to measure nurses’ perceived adequacy of staffing (PAS) of general hospital wards. Design: A multicenter cross-sectional psychometric instrument development and validation study using item response theory. Settings: Ten general nursing wards in three teaching hospitals in the Netherlands. Participants: A sample of 881 participants, including third and fourth year nursing students and nurse/care assistants. Methods: The 13-item self-reported questionnaire was developed based on a previous Delphi study and two focus groups. We interviewed five nurses to evaluate the content validity of the instrument. The field test for psychometric evaluation was conducted on ten general wards of three teaching hospitals in the Netherlands. Structural validity of the item bank was examined by fitting a graded response model (GRM) and inspecting GRM fit. Measurement invariance was assessed by evaluating differential item functioning (DIF) of education level and work experience. We examined convergent validity by testing the hypothesis that there was at least a moderate correlation between the PAS instrument and a single item measuring adequacy of staffing. Internal consistency and reliability across the scale were also examined. Results: A total of 881 measurements were included in the analysis. The data fitted the GRM adequately and item fit statistics were good. DIF was detected for work experience for the protocols item, but the impact on total scores was negligible. The hypothesis was confirmed and the item bank reliably measured two standard deviations around the mean. Conclusions: The Nurse Perceived Adequacy of Staffing Scale (NPASS) for nur

Background: The changing demands on healthcare require continuous development and education in the nursing profession. Homogeneity in nursing qualifications reduces educational inconsistencies between and within countries. However, despite various initiatives, modifying nurse education remains challenging because different countries have their own legislations, structures, motivations, and policies. Objectives: To summarize the characteristics of nurse education programs around the globe and analyze the similarities and differences between them. Design and methods: A scoping review was performed to identify different characteristics of nurse education programs in Organization for Economic Co-operation and Development (OECD) countries. Records published between January 2016 and July 2021 were searched in the PubMed, Cinahl, and ERIC databases. The reference lists of all included articles were also searched manually for relevant studies. Articles were eligible if they described nurse education in one or more of the selected countries with a focus on nursing degrees (both undergraduate and postgraduate programs), nursing titles, program duration, study load hours, or practice hours. Data were independently extracted using a predefined extraction sheet. We asked the respective nursing associations for confirmation and to provide any additional information. Results: After searching 9769 records, 117 were included in the synthesis. The included records described characteristics of undergraduate nursing educational programs (n = 50), postgraduate programs (n = 30), or both (n = 37). In total, 86 undergraduate and 82 postgraduate programs were described, with a great variety in degrees, nursing titles, study load hours, and practice hours. Conclusions: This study demonstrates that there is still considerable variation in nurse education programs between countries. These diverse educational pathways lead to different nursing titles and internationally standardized definit

Objectives: To describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care. Background: The prevalence of malnutrition in hospitalised patients continues to be high. Nurses' essential role in the identification and treatment of malnutrition is an important aspect of the fundamentals of care. Nurses have a key role in providing optimal nutritional care in the hospital. A systematic nursing approach, combined with an active role for patients, is required to effectively counteract malnutrition. Design: A multicentre qualitative study using ethnographic observations and focus groups. Methods: Direct observation of nutritional care was conducted on two nursing wards; nurses and inpatients were observed; and data were thematically analysed based on the fundamentals of care framework. Subsequently, six focus groups were held on three nursing wards with nurses, dietitians and nutrition assistants (n = 34). Data were analysed using open, axial and selective coding. The COREQ guidelines were used for reporting the study. Results: During 54 days, representing 183 h, 39 nurses were observed in two medical wards. Three activities in nutritional care delivery were identified from observing nurses and patients: (1) screening and assessment/at-risk determination, (2) nutritional care plans and (3) monitoring and evaluating outcomes and transition-of-care planning. In addition, the focus groups identified barriers, facilitators, needs and expectations for optimal nursing nutritional care delivery. Conclusions: This study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care. Rele

Background: The awareness of cancer therapy–related adverse cardiac effects is fueled by recent literature on cardiotoxicity incidence and detection strategies. Although this influences the sense of urgency, in current practice, cardiotoxicity monitoring and treatment is not structurally performed. With this study, we aimed to evaluate current perspectives on cardio-oncology and to assess needs, ultimately to determine an agenda for improvements in current practice. Material and methods: A national multidisciplinary 36-question survey was conducted. The survey was developed by a multidisciplinary team, theoretically based on an implementation checklist and distributed by email, through cardiology and oncology societies as well as social media. Results: One hundred ninety professionals completed the survey, of which 66 were cardiologists, 66 radiation oncologists, and 58 medical oncologists and hematologists. Many professionals were unaware of their specialisms’ cardio-oncology guidelines: 62.1% of cardiologists and 29.3% of the hematologists and medical oncologists respectively. Many cardiologists (N = 46; 69.7%), radiation oncologists (N = 45; 68.2%), and hematologists and medical oncologists (N = 38; 65.5%) expressed that they did not have sufficient knowledge to treat cardio-oncology patients and would either refer a patient or aspire to gain more knowledge on the topic. Conclusion: The field of cardio-oncology is advancing rapidly, with progress in stratification and detection strategies leading to the development of new guidelines and consensus statements. However, the application of these guidelines in current practice appears to be lagging. Professionals express a need for additional training and a practical guideline including risk stratification, monitoring, and treatment strategies. Multidisciplinary discussion and consensus on cardio-oncology care is vital to improve implementation of cardio-oncology guidelines, ultimately t

Background: Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low. Objective: This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not. Methods: A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study. Results: This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functio, This study was funded by ZonMw, the Netherlands Organization for Health Research and Development (grant 520001001). The authors would like to thank all the patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA) who contributed to this study.

Background: Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low. Objective: This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not. Methods: A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study. Results: This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functio, This study was funded by ZonMw, the Netherlands Organization for Health Research and Development (grant 520001001). The authors would like to thank all the patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA) who contributed to this study.

OBJECTIVES: To gain consensus on the items that determine adequacy of shift staffing. DESIGN: This was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general hospital ward. A literature review, focus group and five semistructured expert interviews were used to generate items for the Delphi study. SETTING: Multicentre study in The Netherlands. PARTICIPANTS: Nurses, head nurses, nursing managers, and capacity consultants and managers working for Dutch hospitals. RESULTS: Twenty-six items were included in the Delphi study. One hundred and sixty-eight, 123 and 93 participants were included in the first, second and third round, respectively. After three rounds, six items were included (mostly related to direct patient care) and nine items were excluded. No consensus was reached on 12 items, including one item that was added after the first round. CONCLUSIONS: This is the first study to specify items that determine adequacy of staffing. These items can be used to measure adequacy of staffing, which is crucial for enhancing nurse staffing methods. Further research is needed to refine the items of staffing adequacy and to further develop and psychometrically test an instrument for measuring staffing adequacy.

This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours ( p < .001) and from liquids with 5:22 hours ( p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.

The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses’ perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses. Methods. Questionnaires measuring nurses’ self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates. Results. This study shows that EBP-supportive leaders and work environments positively contribute to nurses’ self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level. Conclusions. To improve nurses’ active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses.

Background Matching demand and supply in nursing work continues to generate debate. Current approaches focus on objective measures, such as nurses per occupied bed or patient classification. However, staff numbers do not tell the whole staffing story. The subjective measure of nurses’ perceived adequacy of staffing (PAS) has the potential to enhance nurse staffing methods in a way that goes beyond traditional workload measurement or workforce planning methods. Objectives To detect outcomes associated with nurses’ PAS and the factors that influence PAS and to review the psychometric properties of instruments used to measure PAS in a hospital setting. Design and methods A scoping review was performed to identify outcomes associated with PAS, factors influencing PAS and instruments measuring PAS. A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Business Source Complete and Embase databases identified 2609 potentially relevant articles. Data were independently extracted, analysed and synthesised. The quality of studies describing influencing factors or outcomes of PAS and psychometric properties of instruments measuring PAS were assessed following the National Institute for Health and Care Excellence quality appraisal checklist and the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Results Sixty-three studies were included, describing 60 outcomes of PAS, 79 factors influencing PAS and 21 instruments measuring PAS. In general, positive PAS was related to positive outcomes for the patient, nurse and organisation, supporting the relevance of PAS as a staffing measure. We identified a variety of factors that influence PAS, including demand for care, nurse supply and organisation of care delivery. Associations between these factors and PAS were inconsistent. The quality of studies investigating the development and evaluation of instruments measuring PAS was moder

Background: Since 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Early recovery after surgery programs recommend restoration of oral intake as soon as possible. This study determines adherence to these guidelines up to 20 years after its introduction. Methods: A 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Fasting times were collected using an interview-assisted questionnaire. Results: During both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units. Duration of preoperative fasting was prolonged in 290 (90.3%) patients for solid foods and in 208 (67.8%) patients for clear liquids. Median duration of preoperative fasting from solid foods and clear liquids was respectively 2.5 and 3 times the recommended 6 and 2 hours, with no improvements from one period to another. Postoperative food intake was resumed within 4 hours in 30.7% of the patients. Median duration of perioperative fasting was 23:46 hours (interquartile range 20:00–30:30 hours) for solid foods and 11:00 hours (interquartile range 7:53–16:00 hours) for clear liquids. Conclusion: Old habits die hard. Despite 20 years of fasting guidelines, surgical patients are still exposed erroneously to prolonged fasting in 2 hospitals. Patients should be encouraged to eat and drink until 6 and 2 hours, respectively, before surgery and to restart eating after surgery.

Contains fulltext : 228581.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 228581.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 228581.pdf (Publisher’s version ) (Open Access)

Aims and objectivesTo describe and discuss the Basic Care Revisited (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. BackgroundWhile basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. DesignDiscussion paper MethodThe discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called Basic Care Revisited (BCR) as a solution to move forward and improve basic nursing care. DiscussionTo prioritise basic nursing care, we propose a research programme entitled Basic Care Revisited that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Relevance to clinical practiceRevaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes.

Aims and objectivesTo describe and discuss the Basic Care Revisited (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. BackgroundWhile basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. DesignDiscussion paper MethodThe discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called Basic Care Revisited (BCR) as a solution to move forward and improve basic nursing care. DiscussionTo prioritise basic nursing care, we propose a research programme entitled Basic Care Revisited that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Relevance to clinical practiceRevaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes.

The paper explores the evolution of standards setting and implementation, and especially the increased importance of the private sector in these dynamics, with a view to discuss public policy considerations from a producer perspective. Building on insights from South Africa, it provides an initial exploration of the implications at farm level of standard proliferation and the associated consolidation of retail based supply chains. It stresses changes in the institutional and marketing environment associated with standards development, and points out, in particular, the contrast between the long term trend of the withdrawal of state support in the agricultural sector and the increased involvement of retailers at farm level as a consequence of their prominent role in standard setting. Particular attention is given to the move from public to private standards and its implications for supply chain organisation and market access. The discussion of the evolution of organic and sustainability standards in South Africa presents a clear example of the evolving role of private and public stakeholders and their considerations behind standard setting as well as the private and public systems that accompany standard development and implementation. In line with generally observed trends, the paper shows how the governing process has mostly been driven by private initiatives, with governments lagging in the provision of minimum standards. It also highlights the private sector's innovative and increasingly comprehensive approach to integrating farming and sustainability initiatives, and illustrates how the resultant private systems strongly contrast with the fragmented framework at public level. We argue that this evolution tends to broaden the gap between smallholders and large scale farmers, as it is predominantly the latter that benefits from these changes. The paper concludes with public policy considerations.

Internationally, alternative food quality movements have given rise to a quality turn from the mass consumption model toward an increasing qualitative differentiation of products and demand (Allaire, 2002). While food quality trends and their implications have been widely analyzed internationally, little has been written on the local quality dynamics in South Africa, a country with clear dualistic socio-economic features. This paper aims to contribute to the understanding of South African consumers' present food quality evaluation with a specific focus on 'conventional' and 'advanced' quality attributes associated with fresh food produce (fruit / vegetable and meat). Primary data was collected during 2009 through an extensive nationally representative consumer survey (n=420) (LSM 7 - 10), preceded by focus groups and retailer observations of actual quality claims on fresh food labels. Statistical analysis involved descriptive and comparative analyses and Kmeans cluster analysis in SPSS 17.0. The paper substantiates the fact that when selecting food purchase outlets and fresh food products, South African consumers largely apply 'conventional' quality and convenience considerations (e.g. appearance, taste). Even though 'advanced' / credence attributes (e.g. animal welfare, environmental practices, safety) are generally less important the results also demonstrate that they already have a relatively significant foothold in the local market, being more established for higher LSM groups in particular and suggesting potential opportunity for market growth.. The complexity of consumers' behaviours and evaluation towards advanced food quality issues is also pointed out. Implications surrounding guaranteeing bodies and small-scale farmers' market access are also addressed, as well as study limitations and recommendations for future research.

Internationally, alternative food quality movements have given rise to a quality turn from the mass consumption model toward an increasing qualitative differentiation of products and demand (Allaire, 2002). While food quality trends and their implications have been widely analyzed internationally, little has been written on the local quality dynamics in South Africa, a country with clear dualistic socio-economic features. This paper aims to contribute to the understanding of South African consumers' present food quality evaluation with a specific focus on 'conventional' and 'advanced' quality attributes associated with fresh food produce (fruit / vegetable and meat). Primary data was collected during 2009 through an extensive nationally representative consumer survey (n=420) (LSM 7 - 10), preceded by focus groups and retailer observations of actual quality claims on fresh food labels. Statistical analysis involved descriptive and comparative analyses and Kmeans cluster analysis in SPSS 17.0. The paper substantiates the fact that when selecting food purchase outlets and fresh food products, South African consumers largely apply 'conventional' quality and convenience considerations (e.g. appearance, taste). Even though 'advanced' / credence attributes (e.g. animal welfare, environmental practices, safety) are generally less important the results also demonstrate that they already have a relatively significant foothold in the local market, being more established for higher LSM groups in particular and suggesting potential opportunity for market growth.. The complexity of consumers' behaviours and evaluation towards advanced food quality issues is also pointed out. Implications surrounding guaranteeing bodies and small-scale farmers' market access are also addressed, as well as study limitations and recommendations for future research.

The paper explores the evolution of standards setting and implementation, and especially the increased importance of the private sector in these dynamics, with a view to discuss public policy considerations from a producer perspective. Building on insights from South Africa, it provides an initial exploration of the implications at farm level of standard proliferation and the associated consolidation of retail based supply chains. It stresses changes in the institutional and marketing environment associated with standards development, and points out, in particular, the contrast between the long term trend of the withdrawal of state support in the agricultural sector and the increased involvement of retailers at farm level as a consequence of their prominent role in standard setting. Particular attention is given to the move from public to private standards and its implications for supply chain organisation and market access. The discussion of the evolution of organic and sustainability standards in South Africa presents a clear example of the evolving role of private and public stakeholders and their considerations behind standard setting as well as the private and public systems that accompany standard development and implementation. In line with generally observed trends, the paper shows how the governing process has mostly been driven by private initiatives, with governments lagging in the provision of minimum standards. It also highlights the private sector's innovative and increasingly comprehensive approach to integrating farming and sustainability initiatives, and illustrates how the resultant private systems strongly contrast with the fragmented framework at public level. We argue that this evolution tends to broaden the gap between smallholders and large scale farmers, as it is predominantly the latter that benefits from these changes. The paper concludes with public policy considerations.

Two central questions were therefore addressed by the project: "How can local communities efficiently protect their resources and differentiate their production through GIs?" and "What is the nature and extent of the required institutional and legal framework to achieve this objective? This project aimed to provide conceptual and procedural answers on the potential use of GIs in order to protect and utilize indigenous knowledge artefacts to the benefit of local communities.

Two central questions were therefore addressed by the project: "How can local communities efficiently protect their resources and differentiate their production through GIs?" and "What is the nature and extent of the required institutional and legal framework to achieve this objective? This project aimed to provide conceptual and procedural answers on the potential use of GIs in order to protect and utilize indigenous knowledge artefacts to the benefit of local communities.

In contrast to the centralised fresh produce procurement systems of South African retailers relying on preferred commercial suppliers, this paper draws on an in-depth analysis of the innovative procurement schemes of two rural-based supermarket chain stores in the Limpopo Province to source fresh vegetables locally from small-scale farmers. The objective is to derive lessons to guide public and private sector actors in promoting greater participation of small-scale producers in dynamic supply chains, through the exposure of the key drivers and success factors affecting the inclusion of small-scale vegetable farmers. The critical factors affecting the up-scaling and/or replication of this type of procurement relates to operation in a remote, emerging market, franchise stores with flexible procurement options, small-scale farmers with potential and land in close proximity to the supermarket, good communication and coordination, long term commitment, technical support, interest-free farm loans and diversity in product supply among farmers. Key indicators of mutually beneficial engagement are consolidated farming systems, improved farming income, low cost procurement of fresh vegetables (short supply chain), as well as fostering of the stores' broader community involvement strategy. Upscaling/replicating the scheme would probably require the involvement of external actors and the definition and establishment of public private partnerships. These should be tailored to the specific local conditions and capacities of the different stakeholders. Specific emphasis should be put on support towards the development of critical skills at local community level to empower small-scale farmers to sustain beneficial participation in the market.

This paper depicts how the general turn from mass consumption toward increased qualitative differentiation of products - the 'quality turn' - manifest in the South African agro-food system. The strong influence of these quality trends on agro-food systems evolution has been widely discussed in Europe and North America. We show that identifying quality related dynamics is bringing an interesting perspective into understanding some of the evolution of the local agro-food system. The discussion is mainly based on the perspective of the organic sector. Most domestic retailers' food quality positioning is in line with consumer trends, being general and price orientated. However, the retail sector has been entering and driving quality related niche markets, especially organics, fostering new organizational arrangements through certification schemes development. Price premiums and consumer behavior analysis associated with organic production reveal significant consumers' willingness to pay for immaterial product attributes (e.g. health) and reflect the current supply and demand imbalance in the organic sector. The leading role of the retail sector in conveying quality movements is instrumental in understanding the discussed evolution. Pointing out the growing interest in farmer's markets provides elements to foresee new development in the agro-food system and departure from the retail driven quality movement.

This paper depicts how the general turn from mass consumption toward increased qualitative differentiation of products - the 'quality turn' - manifest in the South African agro-food system. The strong influence of these quality trends on agro-food systems evolution has been widely discussed in Europe and North America. We show that identifying quality related dynamics is bringing an interesting perspective into understanding some of the evolution of the local agro-food system. The discussion is mainly based on the perspective of the organic sector. Most domestic retailers' food quality positioning is in line with consumer trends, being general and price orientated. However, the retail sector has been entering and driving quality related niche markets, especially organics, fostering new organizational arrangements through certification schemes development. Price premiums and consumer behavior analysis associated with organic production reveal significant consumers' willingness to pay for immaterial product attributes (e.g. health) and reflect the current supply and demand imbalance in the organic sector. The leading role of the retail sector in conveying quality movements is instrumental in understanding the discussed evolution. Pointing out the growing interest in farmer's markets provides elements to foresee new development in the agro-food system and departure from the retail driven quality movement.

In contrast to the centralised fresh produce procurement systems of South African retailers relying on preferred commercial suppliers, this paper draws on an in-depth analysis of the innovative procurement schemes of two rural-based supermarket chain stores in the Limpopo Province to source fresh vegetables locally from small-scale farmers. The objective is to derive lessons to guide public and private sector actors in promoting greater participation of small-scale producers in dynamic supply chains, through the exposure of the key drivers and success factors affecting the inclusion of small-scale vegetable farmers. The critical factors affecting the up-scaling and/or replication of this type of procurement relates to operation in a remote, emerging market, franchise stores with flexible procurement options, small-scale farmers with potential and land in close proximity to the supermarket, good communication and coordination, long term commitment, technical support, interest-free farm loans and diversity in product supply among farmers. Key indicators of mutually beneficial engagement are consolidated farming systems, improved farming income, low cost procurement of fresh vegetables (short supply chain), as well as fostering of the stores' broader community involvement strategy. Upscaling/replicating the scheme would probably require the involvement of external actors and the definition and establishment of public private partnerships. These should be tailored to the specific local conditions and capacities of the different stakeholders. Specific emphasis should be put on support towards the development of critical skills at local community level to empower small-scale farmers to sustain beneficial participation in the market.

This paper focuses on specific experiences in Africa, involving small and medium farmers and agro-processors. The national and case-study approach adopted is related and complementary to the cross-cutting document on 'Agrifood processing' prepared by John Wilkinson. The objective of the paper is to scrutinize and illustrate the capacity of farmers-to-processors linkages in Africa to foster the effectiveness of agricultural growth for poverty reduction, make advantage of untapped sources of growth and generate pro-poor development through adequate institutions.

This paper focuses on specific experiences in Africa, involving small and medium farmers and agro-processors. The national and case-study approach adopted is related and complementary to the cross-cutting document on 'Agrifood processing' prepared by John Wilkinson. The objective of the paper is to scrutinize and illustrate the capacity of farmers-to-processors linkages in Africa to foster the effectiveness of agricultural growth for poverty reduction, make advantage of untapped sources of growth and generate pro-poor development through adequate institutions.