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De Utrechtse Heuvelrug is een rijke bron van een grote hoeveelheid, helder en schoon water. Regen infiltreert in de zandige bodems boven op de Heuvelrug en komt in de lagergelegen flanken als kwel weer naar boven. Het water van de Heuvelrug dient vele functies. Al in de 17e eeuw werd het water gebruikt voor het vullen van de vijvers en grachten van buitenplaatsen en landgoederen. In de vennen, poelen en natte graslanden vormt kwel een onmisbare bron voor zeldzame planten, amfibieën en insecten. De Heuvelrug levert jaarlijks miljarden liters drinkwater van de hoogste kwaliteit. En water speelt een belangrijke rol voor de landbouw op de Heuvelrugflanken. Door de huidige knelpunten in combinatie met voortgaande klimaatverandering zijn er verschillende urgente uitdagingen voor het watersysteem van de Heuvelrug. Ook vanuit een actuele visie op circulariteit, integraliteit en duurzaamheid is er aanleiding om de huidige situatie opnieuw te beschouwen.

Objectives: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. Design: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. Participants: Visitors and healthcare professionals. Intervention: Allowing visitors using local regulations based on national guidelines. Measurements: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. Results: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. Conclusion: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are

Background: Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship.Objectives: To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. Design: A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. Setting: Long-term residential care facilitiesParticipants: Long-term care facility staff, residents, and relatives Methods: The realist review, (i) was co-developed with stakeholders to determine initial programme the-ories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) vali-dated and refined emergent theory with stakeholder groups.Results: 66 research papers were included in the review. Three key findings explain the relationship be-tween staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an im-portant influence on how organisational resources (sufficient staff effectively deployed, with the knowl-edge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings.Conclusion: Leaders (at all levels) through their role-modelling behaviours can use organisational re-sources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.Crown Copyright (c) 2021 Published by Elsevier Ltd. All rights reserved.

Aim: The aim of this study was to develop a decision support tool for nurses to facilitate aging in place of people with dementia and to test its usability. Background: Nurses play an important role in detecting practical problems preventing persons with dementia (PwD) from aging in place and advising them on possible solutions. These are complex and challenging tasks for nurses. Methods: A mixed methods study was conducted. The content development of the App comprised a literature and intemet search, and individual and group interviews with professionals (n = 8) and researchers (n = 5). The technical development was an iterative process in which usability was tested by the project team (n = 4), experts (n = 6), and end-users (n = 9), using heuristic evaluation, a think-aloud approach, and a questionnaire (PSSUQ). Results: The App contains a structured problem assessment for three problem domains-self-reliance, safety, and informal care-based on validated questionnaires and self-formulated questions. The problem assessment is linked to an overview of possible solutions for the problems detected. Three prototypes have been developed. The users of the third prototype were overall satisfied with the App as they scored on average 1.7 on the PSSUQ (range 1-7 and lower scores indicating higher satisfaction). Conclusions: A user-friendly prototype of the decision support App is now available. Users indicated to be very willing to use to App in daily practice. However, besides further technical development, implementation of the App into practice requires evidence supporting its efficacy, feasibility and effectiveness.