Search

BACKGROUND The transformation in global demography and the shortage of healthcare workers require innovation and efficiency in the field of healthcare. Digital Technology can help improve the efficiency of healthcare. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically, or sends a notification to the application. Barriers to the adoption of the system are unknown and it is unclear if the solution will be able to support healthcare workers in their work. OBJECTIVE Gaining insight into healthcare workers’ expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress, in order to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. METHODS A generic qualitative study was conducted from February to December of 2022. Interviews were conducted and a focus group was established with use of a topic list of healthcare workers from both the United Kingdom and the Netherlands. Thematic analysis according to Braun & Clarke was performed by two independent researchers. RESULTS 14 participants took part in the study: 6 participants joined the focus group and 8 participants took part in the individual interviews. Thirteen factors were identified, based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with healthcare activities and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, Patient category, Representatives, and Implementation strategy were identified as facilitators. Perception towards patient repositioning, Accessibility to pressure injury aides, and Connectivity were identified as barriers. CONCLUSIONS Several conditions have to be met in order to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process.

The main reason lighting control is being applied is to reduce energy consumption. However, there are many more reasons for lighting control to be optimised in buildings. Lighting systems can be controlled to enhance or optimise effects beyond vision. Automatic control of electric lighting systems or daylight systems is one way of adjusting someone’s personal lighting conditions. In addition, it is relevant for office workers to know how they can adjust their personal lighting conditions themselves in order to optimise their effects beyond vision (e.g. alertness). Therefore, this article describes a process of identifying predictors that influence personal lighting conditions. The dataset used in this article is gathered during a field study in the Netherlands in spring 2017. This article describes linear mixed models for daily mean illuminances and correlated colour temperatures both throughout the entire day and only at work. These models demonstrated that weather conditions, fixed and flexible personal conditions, office worker’s daily schedule and workspace characteristics influence personal lighting conditions. Weather conditions and fixed and flexible personal conditions though are difficult or impossible to control by the office workers themselves. However, adjustments in personal lighting conditions can be accomplished by the office workers themselves by changing their daily schedules and the workspace characteristics. The findings show that these two predictor categories may explain 4% to 20% of the variance in personal lighting conditions.

Purpose Board members and real estate managers (decision makers) play an important role in the decision-making process in nursing home organisations. This study aims to provide an understanding of underlying attributes and benefits sought by decision makers when making nursing home real estate decisions. Design/methodology/approach Decision makers from seven different nursing home organisations in The Netherlands were interviewed using the laddering technique to determine the individual requirements, the considerations of the decision alternatives, the relevant attributes and benefits and their mutual relationships. Findings This study details the motivations behind real estate management decisions in nursing home organisations. The findings show that apart from financial considerations, decision makers strive to enhance the quality of life and satisfaction of users with their real estate decisions and seek to include residents and employees in the process. These benefits are connected to the goals of well-being and innovation in health care. Furthermore, functionality, physical and functional flexibility and technology are key considerations when undertaking corporate real estate (CRE) decisions, to ensure that real estate management aligns with the strategic goals of the nursing home organisation. Practical implications The insights of this study can support decision makers in healthcare facilities to create strategic value with their real estate. Understanding how to obtain certain benefits from nursing home real estate may result in a better realisation of organisational objectives and user needs. Originality/value This study reveals the decision-making process in a nursing home context. Moreover, the laddering technique is used as a new method to explore and gain a deep understanding of CRE decision-making processes.

Light enables us to see and perceive our environment but it also initiates effects beyond vision, such as alertness. Literature describes that at least six factors are relevant for initiating effects beyond vision. The exact relationship between these factors and alertness is not yet fully understood. In the current field study, personal lighting conditions of 62 Dutch office workers (aged 49.7 ± 11.4 years) were continuously measured and simultaneously self-reported activities and locations during the day were gathered via diaries. Each office worker participated 10 working days in spring 2017. Personal lighting conditions were interpreted based on four of the six factors (light quantity, spectrum, timing, and duration of light exposure). Large individual differences were found for the daily luminous exposures, illuminances, correlated colour temperatures, and irradiances measured with the blue sensor area of the dosimeter. The average illuminance (over all participants and all days) over the course of the day peaked three times. The analysis of the duration of light exposure demonstrated that the participants were on average only exposed to an illuminance above 1000 lx for 72 minutes per day. The interpretation of personal lighting conditions based on the four factors provides essential information since all of these factors may be relevant for initiating effects beyond vision. The findings in the current paper give first in-depth insight in the possibilities to interpret personal lighting conditions of office workers.

Nightshift workers go against the natural sleep–wake rhythm. Light can shift the circadian clock but can also induce acute alertness. This placebo-controlled exploratory field study examined the effectiveness of light glasses to improve alertness while reducing the sleep complaints of hospital nurses working nightshifts. In a crossover within-subjects design, 23 nurses participated, using treatment glasses and placebo glasses. Sleepiness and sleep parameters were measured. A linear mixed model analysis on sleepiness revealed no significant main effect of the light intervention. An interaction effect was found indicating that under the placebo condition, sleepiness was significantly higher on the first nightshift than on the last night, while under the treatment condition, sleepiness remained stable across nightshift sessions. Sleepiness during the commute home also showed a significant interaction effect, demonstrating that after the first nightshift, driver sleepiness was higher for placebo than for treatment. Subjective sleep quality showed a negative main effect of treatment vs. placebo, particularly after the first nightshift. In retrospect, both types of light glasses were self-rated as effective. The use of light glasses during the nightshift may help to reduce driver sleepiness during the commute home, which is relevant, as all participants drove home by car or (motor) bike.

The discovery of the ipRGCs was thought to fully explain the mechanism behind the relationship between light and effects beyond vision such as alertness. However, this relationship turned out to be more complicated. The current paper describes, by using personal lighting conditions in a field study, further exploration of the relationship between light and subjective alertness during daytime. Findings show that this relationship is highly dependent on the individual. Although nearly all dose-response curves between personal lighting conditions and subjective alertness determined in this study turned out to be not significant, the results may be of high importance in the exploration of the exact relationship.

By 2050, 70% of the population will live in cities. The majority of the persons living in cities will be 60 plus years old. Ageing cities demands for cities environments to adapt to an ageing population. Modern cities though, don’t anticipate fast enough and in an adequate manner to face the challenges due to population-related transitions. Modifying and adapting the built environment with a focus on the aged population could help to support older people facing functional and cognitive decline.

This paper reports on the research methods used in five different projects aimed at supporting people living with dementia in their everyday lives and activities of daily living. In all five projects, people living with dementia and their informal carers were involved. Applied methods ranged from passive involvement in the form of observations to very active involvement consisting of consultation rounds and think-aloud sessions. The projects highlighted that people living with dementia can still contribute to the development of solutions that support them in the self-management of their symptoms and challenges, as well as technological solutions that support them in daily living. LinkedIn: https://www.linkedin.com/in/jvhoof1980/

Background: In in-patient care facilities, 1 in 5 medication doses is administered incorrectly. A hospital environment which supports the performance of the health-care staff will positively impact patient safety. Objectives: Determine which lighting leads to the least reading mistakes of medication labels. Design: Experimental study with repeated measures. Setting: Study was performed under controlled conditions in the Netherlands. Participants: In total the data of 37 participants are analyzed and described. Inclusion criteria were: female, aged between either 18–30 years old (M = 26.0, SD = 3.1) or between 55 and 67 years old (M = 57.9, SD = 2.7) years old, with normal vision. Eligible participants were personally invited to participate. Methods: Per participant, the readability of three different labels (Blister, Baxter and Orange) and four different font sizes (4.5 pt, 3.5 pt, 3.0 pt, and 2.5 pt Arial Capital) were assessed under nine different light conditions (three illuminances (E),100lx, 500lx, and 1000lx and three correlated color temperatures (T cp ): 3000 K, 4000 K, and 6500 K). The participants had to read out loud text sequences of 10 letters per medication label. The numbers of errors were counted and analyzed. Results: The results show a significant difference between numbers of errors related to: 1. Light condition, 2. Age, 3. Label material, 4. Font size. The impact of the light condition is not identical for the different types of label and the font sizes. The impact of the light conditions is the strongest for the smallest font size (2.5 pt) and participants with Visual Acuity < 1. Conclusion: Lighting has an impact on the number of errors. Older people make more errors than younger people. The type of label has an impact on the number of errors made. The font size has an impact on number of errors made. For font sizes cp of 4000 K. People with an insufficient Visual Acuity (VA) benefit most from a higher illuminance level, especially for the Orange labels. When the VA is well-adjusted (sufficient to good) and the font size is as recommended for medication labels (Arial Capital ≥ 4.5 pt) the impact of the lighting on number of errors is limited for all of the age groups.

Background: The diffusion of telehealth into hospital care is still low, partially because of a lack of telehealth competence among nurses. In an earlier study, we reported on the knowledge, skills, and attitudes (KSAs) nurses require for the use of telehealth. The current study describes hospital nurses' confidence in possessing these telehealth KSAs. Method: In a cross-sectional study, we invited 3,543 nurses from three hospitals in the Netherlands to rate their self-confidence in 31 telehealth KSAs on a 5-point Likert scale, using an online questionnaire. Results: A total of 1,017 nurses responded to the survey. Nine KSAs were scored with a median value of 4.0, 19 KSAs with a median value of 3.0, and three KSAs with a median value of 2.0. Conclusion: Given that hospital nurses have self-confidence in only nine of the 31 essential telehealth KSAs, continuing education in additional KSAs is recommended to support nurses in gaining confidence in using telehealth. [ J Contin Educ Nurs. 2019;50(1):26–34.]

BACKGROUND:Light and alertness studies have applied different measurement methodologies to determine lighting conditions. However, it has been demonstrated that researchers rarely measure or describe the lighting conditions of their studies in sufficient detail to generalize conclusions or derive universal guidelines.OBJECTIVE:Part I of this paper summarizes the current measurement methodologies used in light and alertness studies to potentially identify methodological issues. Part II determines the differences in lighting conditions for different viewing directions within an office environment.METHODS:A literature review (part I) and both experimental studies and an observational study (part II) were undertaken in this study.RESULTS:Part I demonstrates that most light and alertness studies include photometric quantities; however, it is recommended that one should measure radiometric quantities as well. Further, the light measurements should be performed at the individual level. Part II demonstrates large differences in lighting conditions between viewing directions. For example, when looking toward the window, vertical illuminances were at least 12 times higher when compared to looking in the opposite direction.CONCLUSIONS:Our findings suggest that when analysing or designing an office environment, office workers’ positions and viewing direction should be included in the determination of personal lighting conditions.

This study reports the outcomes of a systematic literature review, which aims to determine the influence of four indoor environmental parameters — indoor air, thermal, acoustic, and lighting conditions —on the quality of teaching and learning and on students' academic achievement in schools for higher education, defined as education at a college or university. By applying the Cochrane Collaboration Method, relevant scientific evidence was identified by systematically searching in multiple databases. After the screening process, 21 publications of high relevance and quality were included. The collected evidence showed that the indoor environmental quality (IEQ) can contribute positively to the quality of learning and short‐term academic performance of students. However, the influence of all parameters on the quality of teaching and the long‐term academic performance could not be determined yet. Students perform at their best in different IEQ conditions, and these conditions are task‐dependent, suggesting that classrooms which provide multiple IEQ classroom conditions facilitate different learning tasks optimally. In addition, the presented evidence illuminates how to examine the influence of the IEQ on users. Finally, this information supports decision‐makers in facility management and building systems engineering to improve the IEQ, and by doing so, allow teachers and students to perform optimally.

Dynamic lighting is one of the new trends in lighting research; providing the right lighting level at the right time could possibly increase the alertness and performance of office workers. However, they might have preferences that deviate from this “healthy” lighting. Simultaneously, the building environment becomes increasingly automated, with occupancy-based control as one of the most well-known examples to reduce offices’ lighting energy consumption. Nevertheless, preferences for lighting levels in the unoccupied area of the multi-occupant office space have not been addressed yet. Therefore, we studied luminance distribution preferences in relation to time of day and subjective alertness (SA) in a single occupancy scenario. Participants (N = 30) set the surrounding and background lighting six times a day as we first probed for SA. Our results clearly showed that a subset preferred varying luminance distributions; participants had fluctuating feelings of alertness, too. Preferences deviated sometimes from the typical dynamic lighting scenarios, suggesting that they do not always prefer healthy lighting. Moreover, we identified an effect of SA on the preferences, both with and without controlling for time of day. Hence, this study showed that we need to address these two factors when we want to provide satisfactory lighting conditions in case the office is not fully occupied. These are likely to affect other lighting preferences and therefore deserve more attention from research. Because we identified large individual differences, we suggest personalizing dynamic scenarios as the focus of future research.

Background: The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice. Aim: The aim of this study was to identify the needs, barriers and facilitators amongst community-dwelling older adults (60+) suffering from one or more chronic health conditions, in using online eHealth applications to support general practice services. Methods: A qualitative study, using semi-structured followed by think-aloud interviews, was conducted in the Netherlands. The semi-structured interviews, supported by an interview guide were conducted and analysed thematically. The think-aloud method was used to collect data about the cognitive process while the participant was completing a task within online eHealth applications. Verbal analysis according to the Chi approach was conducted to analyse the think-aloud interviews. Findings: A total of n = 19 older adults with a mean age of 73 years participated. The ability to have immediate contact with the GP on important health issues was identified as an important need. Identified barriers were non-familiarity with the online eHealth applications and a mismatch of user health needs. The low computer experience resulted in non-familiarity with the online eHealth applications. Faltering applications resulted in participants refusing to participate in the use of online eHealth applications. Convenience, efficiency and the instant availability of eHealth via applications were identified as important facilitators. Conclusion: To improve the use and acceptability of eHealth applications amongst older adults in the general practice, the applications should be tailored to meet individual needs. More attention should be given to improving the user-friendliness of these applications and to the promotion of the benefits such as facilitating older adults independent living for longer.

Long-term care facilities in the Netherlands try to implement new design approaches to enrich their environments and to cope with the changes and innovations in the Dutch healthcare sector. An enriched environment supports both quality of life of people with frail health and the well-being of the healthcare professionals who take care of them. Despite the increased attention devoted to built environments in relation to health, a gap in knowledge remains how to implement new design approaches. The aim of this study is to present a structural approach for a decision-making process to help to create enriched small-scale care facilities for older people with a frail health condition. A case study was conducted to understand how the structural approach contributes to implementing design features of an enriched environment. The structural approach identifies the key factors (such as shared language, collective understanding and involvement of stakeholders) that should be considered when developing such facilities and describes the critical steps for decision-makers for such environment. This case study provides a rich source of information from actual experiences for a better understanding of steering mechanisms for decision-making by the management of small-scale care facilities.

The current field study investigated the ambiguities regarding the relationship between office lighting and subjective alertness. In laboratory studies, light-induced effects were demonstrated. Field studies are essential to prove the validity of these results and the potential recommendations for lighting in future buildings. Therefore, lighting measurements and subjective health data were gathered in a Dutch office environment. Health data was collected by questionnaires and includes data on functional health, wellbeing and alertness. Multiple general, environmental, and personal variables were identified as confounders for the relationship between light and alertness. For six out of the total 46 participants a statistically significant correlation was found between horizontal illuminance (Ehor) and subjective alertness. Further research needs to incorporate a larger sample size and more potential confounders for the relationship between Ehor and alertness. Further research including these recommendations may explain why certain people respond to light while others do not.

Highly granular lighting control reduces the energy consumption of shared office spaces by automatically controlling lighting at unoccupied desks. Typically, lighting is switched off, but this approach results in non-uniform illuminance distributions. In offices where individual work areas are often not separated by partitions and occupants oversee the entire office space, a dimming approach might be more comfortable. Therefore, this study tests the feasibility of a new concept that involves the use of different dimming levels in the task, surrounding, and background area. We evaluated this concept on both user comfort and the energy use through a user study in a controlled environment (final N = 25). From this work, we concluded that most users (68–84%) are comfortable with different dimming levels throughout a workspace. Initial energy calculations based on assumed activity patterns showed promising results for the four most extreme dimming scenarios (LDP reduction > 26%). We identified two conditions as most promising in achieving both energy savings and comfort, namely when the dimming level was at minimum in the background area of the office space. These findings encourage research to continue investigating individual occupancy-based dimming as it has high practical value in the increasing smart office environment.

Health symptoms may be influenced, supported, or even controlled via a lighting control system which includes personal lighting conditions and personal factors (health characteristics). In order to be effective, this lighting control system requires both continuous information on the lighting and health conditions at the individual level. A new practical method to determine these continuous personal lighting conditions has been developed: location-bound estimations (LBE). This method was validated in the field in two case studies; comparisons were made between the LBE and location-bound measurements (LBM) in case study 1 and between the LBE and person-bound measurements (PBM) in case study 2. Overall, the relative deviation between the LBE and LBM was less than 15%, whereas the relative deviation between the LBE and PBM was 32.9% in the best-case situation. The relative deviation depends on inaccuracies in both methods (i.e., LBE and PBM) and needs further research. Adding more input parameters to the predictive model (LBE) will improve the accuracy of the LBE. The proposed first approach of the LBE is not without limitations; however, it is expected that this practical method will be a pragmatic approach of inserting personal lighting conditions into lighting control systems.

A healthy building environment, when looking from a gerontechnology perspective, should facilitate ageing adults' functioning, self-esteem, and prosperity. Creating healthy environments is becoming more and more relevant in society. Older adults tend to stay more indoors when compared to younger populations; ageing adults need to work longer than before since the retirement age is increasing. In order to create healthy building environments both outdoor and indoor, environmental aspects need to be considered. Steps towards creating healthy building environments demand further research on the association between indoor environmental factors and ageing adults, how the indoor environment affects older people's health due to pathological ageing, and how the indoor environment affects older people's well-being.

Not much is known about the favourable indoor air quality in long term care facilities (LTCFs), where older adults suffering from dementia live. Older adults, especially those who suffer from dementia, are more sensible to the indoor environment. However, no special requirements for the indoor air in long term care facilities exist. Due to the decrease in cognition function, it is hard to evaluate comfort and health in this group. Nevertheless, infectious diseases are a persistent problem. Based on literature an assessment methodology has been developed to analyse LTCFs to determine if differences in building characteristics and Heating, Ventilation and Air Conditioning (HVAC) systems influence the spread of airborne infectious diseases. The developed methodology is applied in seven long term care facilities in the Netherlands. After that,the methodology has been evaluated and its feasibility and applicability are discussed.From this study, it can be concluded that this method has potential to evaluate, compareLTCFs, and develop design guidelines for these buildings. However, some adjustments tothe methodology are necessary to achieve this objective. Therefore, the relation betweenthe indoor environment and infection risk is not yet analysed, but a consistent procedureto analyse this link is provided.

In indoor comfort research, thermal comfort of care-professionals in hospital environment is a little explored topic. To address this gap, a mixed methods study, with the nursing staff in hospital wards acting as participants, was undertaken. Responses were collected during three weeks in the summer (n = 89), and four weeks in the autumn (n = 43). Analysis of the subjective feedback from nurses and the measured indoor thermal conditions revealed that the existent thermal conditions (varying between 20 and 25 °C) caused a slightly warm thermal sensation on the ASHRAE seven point scale. This led to a slightly unacceptable thermal comfort and a slightly obstructed self-appraised work performance. The results also indicated that the optimal thermal sensation for the nurses — suiting their thermal comfort requirements and work performance — would be closer to 'slightly cool’ than neutral. Using a design approach of dividing the hospital ward into separate thermal zones, with different set-points for respectively patient and care-professionals’ comfort, would seem to be the ideal solution that contributes positively to the work environment and, at the same time, creates avenues for energy conservation.

The common ocular pathologies relating to the aging eye, such as cataract, diabetic retinopathy, glaucoma, or macular degeneration, are all known to reduce visual functioning. Less wellknown is the effect of common, age-related dry eye disease (DED). The impact of DED on daily activities can be intense, especially with reduced visual functioning, for example, an inability to watch television, or read from a tablet or smartphone screen. As a result of reduced visual functioning, DED is particularly problematic for ageing office-workers. Moreover, office work involving computer-use is known to adversely affect the tear film. Consequently, with the extension in retirement age in the working population, an increase in the incidence and extent of (dry) eye-related problems can be expected. This literature paper addresses the impact of age-related DED on visual functioning, the complexity of assessing visual functioning in daily activities at home or at work, the development of dry eye symptoms with increasing age, and the relationship of these issues with environmental factors. Special attention is made to the influence of light and light conditions that can positively and negatively influence visual functioning.

This work examined window/door opening as means of bedroom ventilation and the consequent effect upon occupants’ sleep, using data from 17 healthy volunteers. Bedroom CO 2 level, temperature, and relative humidity were measured over 5 days, for two cases: open window or door (internal, bedroom door), and closed window and door. Participant filled questionnaires and sleep diary provided subjective measure of sleep quality. Actigraphy objectively monitored the participants during sleep. Additionally, a FlexSensor, placed under pillows of participants, detected movement during sleep. Average CO 2 level for the Open conditions was 717 ppm (SD = 197 ppm) and for Closed conditions was 1150 ppm (SD = 463 ppm). Absolute humidity levels were similar for both conditions, while Open conditions were slightly cooler (mean = 19.7°C, SD = 1.8°C) than Closed (mean = 20.1°C, SD = 1.5°C). Results showed significant correlations (P

Indoor to outdoor transitions, and the subsequent occupant adaptation, impact thermal perception of occupants and their evaluation of a building. A mixed methods thermal comfort study in a classroom of Eindhoven University of Technology was conducted to provide a better understanding of thermal perception of students as they move into and adapt to their classroom environment. Data was collected over two weeks during heating period, with different heating set-points. A total of 384 students, in seven undergraduate level lectures, participated voluntarily. The thermal sensation vote, obtained at different time points through classes — 10 min, 20 min, and 45 min — was found to be significantly different (p 0.05). In the start of a lecture, perception varies primarily depending on the outside temperature, operative temperature, gender, and where the occupant came from. Comparing the two weeks' observations, second week having a 1.5 °C lower set-point, revealed that the most considerable differences occurred in the immediate response phase after indoor–outdoor transition. For nearly 20 min post transition, participants retain a thermal memory of their last exposure, gradually adapting as the lecture proceeds.

A substantial amount of studies have addressed the influence of sound on human performance. In many of these, however, the large acoustic differences between experimental conditions prevent a direct translation of the results to realistic effects of room acoustic interventions. This review identifies those studies which can be, in principle, translated to (changes in) room acoustic parameters and adds to the knowledge about the influence of the indoor sound environment on people. The review procedure is based on the effect room acoustics can have on the relevant quantifiers of the sound environment in a room or space. 272 papers containing empirical findings on the influence of sound or noise on some measure of human performance were found. Of these, only 12 papers complied with this review's criteria. A conceptual framework is suggested based on the analysis of results, positioning the role of room acoustics in the influence of sound on task performance. Furthermore, valuable insights are presented that can be used in future studies on this topic. While the influence of the sound environment on performance is clearly an issue in many situations, evidence regarding the effectiveness of strategies to control the sound environment by room acoustic design is lacking and should be a focus area in future studies.KeywordsNoise; Human performance; Sound environment; Speech intelligibility; Sound level

Lighting accounts for a significant amount of electrical energy consumption in office buildings, up to 45% of the total consumed. This energy consumption can be reduced by as much as 60% through an occupant-dependent lighting control strategy. With particular focus on open-plan offices, where the application of this strategy is more challenging to apply due to differences in individual occupancy patterns, this paper covers (1) to which extent individual occupancy-based lighting control has been tested, (2) developed, and (3) evaluated. Search terms were defined with use of three categories, namely ‘occupancy patterns’, ‘lighting control strategy’, and ‘office’. Relevant articles were selected by a structured search through key online scientific databases and journals. The 24 studies identified as eligible were evaluated on six criteria: (1) study characteristics, (2) office characteristics, (3) lighting system characteristics, (4) lighting control design, (5) post-occupancy evaluation, and (6) conclusions, and this was used to answer the research questions. It was concluded that the strategy has not been tested yet with field studies in open-plan offices, but that it needs further development before it can be applied in these type of offices. Although lighting currently tends to be controlled at workspace level, many aspects of the strategy can be further developed; there is potential to further increase energy savings on lighting within open-plan office spaces. Individual occupancy-based lighting control requires further validation, focussing on the factors influencing its energy savings, on its cost effectiveness, and on its acceptability for users.

The high Air Change Rates (ACRs) required for cleanrooms makes them energy intensive. This research elaborates on three strategies for energy efficient ventilation in pharmaceutical cleanrooms: Fine-tuning, Demand Controlled Filtration (DCF), and optimizing airflow pattern. To study the possibilities for fine-tuning and DCF, two case studies were investigated and simulations were performed to assess the potential of both options. Experiments in a demonstration cleanroom were used to examine how an ideal airflow pattern may be achieved in the cleanroom, resulting in a high contaminant removal efficiency. Results showed that DCF could lead to substantial energy savings, up to 93.6% in the specific case study facilities. Besides this, DCF based on occupancy could be implemented with negligible effect on the environmental cleanliness requirements. Fine-tuning, based on particle concentration, required representative measurement of the concentration in the cleanroom. It was more difficult to implement in practice. With respect to contaminant removal efficiency, best results (within the experiments performed, ACR in the range of 16h−1 – 38h−1), were obtained when air was supplied without a diffuser above the product area and when the work position was located close to the air extraction grilles.

The use of the Zora robot was monitored and evaluated in 14 nursing care organizations (15 locations). The Zora robot, a N&atilde, o robot with software, is designed as a social robot and used for pleasure and entertainment or to stimulate the physical activities of clients in residential care. In the first year, the aim was to monitor and evaluate how the care robot is used in daily practice. In the second year, the focus was on evaluating whether the use of Zora by care professionals can be extended to more groups and other type of clients. Interviews, questionnaires and observations were used as instruments to reveal the progress in the use of the robot and to reveal the facilitators and barriers. Care professionals experienced several barriers in the use of the robot (e.g., start-up time and software failures). The opportunity they had to discuss their experience during project team meetings was seen as a facilitator in the project. Furthermore, they mentioned that the Zora robot had a positive influence on clients as it created added value for the care professionals in having fun at work.

PurposeThe International Commission on Illumination (CIE) recommends researchers to investigate a wide variety of behavioural and health outcomes. However, researchers often investigate only a part of occupational health (OH) in relation to light. A literature study (2002–2017) regarding the relationship between office lighting conditions and OH was performed to identify gaps and methodological issues.MethodThe OH outcomes investigated in this paper were grouped according to the International Classification of Diseases and analysed per category: physical and physiological health, mental health, eye health, sleep parameters and visual comfort.ResultsFindings from the literature study (20 eligible papers) showed that all OH aspects were mostly but not exclusively measured subjectively. Furthermore, most studies investigated only a fraction of office lighting parameters and OH aspects.ConclusionsIt seems that Correlated Colour Temperature (CCT) and illuminance mainly correlate with OH. However, this may also be explained by gaps and methodological issues in studies described in eligible papers. Based on the literature study, an overview was composed elucidating gaps and methodological issues of office lighting and OH studies. It can be used to design and target the purpose of light and health research.

PO149

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed.157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (pAlthough functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation.

In the Netherlands, over 40% of nursing home residents are estimated to have visual impairments. This results in the loss of basic visual abilities. The nursing home environment fits more or less to residents’ activities and social participation. This is referred to as environmental fit. To raise professional awareness of environmental fit, an Environmental Observation tool for the Visually Impaired was developed. This tool targets aspects of the nursing home environment such as ‘light’, the use of ‘colours and contrasts’ and ‘furnishing and obstacles’. Objective of this study is to validate the content of the observation tool to have a tool applicable for practice. Based on the content validity approach, we invited a total of eight experts, six eye care professionals and two building engineering researchers, to judge the relevance of the items. The Item Content Validity approach was applied to determine items to retain and reject. The content validity approach led to a decrease in the number of items from 63 to 52. The definitive tool of 52 items contains 21 for Corridors , 17 for the Common Room , and 14 for the Bathroom . All items of the definite tool received an Item-Content Validity Index of ≥ 0.88 and a Scale-Content Validity Index of ≥ 0.71. The content validity index of the scale and per item has been applied, resulting in a tool that can be applied in nursing homes. The tool might be a starting point of a discussion among professional caregivers on environmental interventions for visually impaired older adults in nursing homes.

A local operating theater ventilation device to specifically ventilate the wound area has been developed and investigated. The ventilation device is combined with a blanket which lies over the patient during the operation. Two configurations were studied: Configuration 1 where HEPA-filtered air was supplied around and parallel to the wound area and Configuration 2 where HEPA-filtered air was supplied from the top surface of the blanket, perpendicular to the wound area. A similar approach is investigated in parallel for an instrument table. The objective of the study was to verify the effectiveness of the local device. Prototype solutions developed were studied experimentally (laboratory) and numerically (CFD) in a simplified setup, followed by experimental assessment in a full scale mock-up. Isothermal as well as non-isothermal conditions were analyzed. Particle concentrations obtained in proposed solutions were compared to the concentration without local ventilation. The analysis procedure followed current national guidelines for the assessment of operating theater ventilation systems, which focus on small particles (

Summary Background Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. Method In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Results Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Discussion/Conclusion Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (>40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs).A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals.Of 1573 NHPs present in the Netherlands, 125 (8%) responded.Results show that more than 50% of the NHPs regularly examine ‘distant vision’, ‘near vision’ and ‘the visual field’. However, 23%, 33% and 45% almost never or never examine the ‘visual field’, ‘near vision’ and ‘distant vision’, respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving ‘use of eye medication’, ‘eye disease’, and ‘eye surgery in the past’. Less commonly recorded is ‘the use of reading glasses’ as well as ‘eye pain’.Inside of the NH, (head) nurses and ward nurses (chi2 = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi2 = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are ‘never’ contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is ‘not structural’.This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP’s role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.

The purpose of the project was to increase the daily activities and exercises of single-living older people with one or more limitations in functioning after a period of rehabilitation.

The use of cleanrooms is increasing and the expectation is that this growth will continue in the coming decade. When compared to an average office building, cleanrooms consume large amounts of energy due to their high Air Change Rates (ACRs) and strict air conditioning requirements. Application of Demand Controlled Filtration (DCF) is a means to reduce the (fan) energy demand. The question is whether the air quality is compromised at reduced ACR and overpressure conditions in the non-operational hours of a cleanroom. In a cleanroom mock-up, experiments have been performed to investigate the particle concentration build-up for different cases with DCF, including an extreme case with zero ACR and zero pressure difference. For the DCF conditions and the specific case study, conditions for particle concentration outside the cleanroom, that may still provide high-quality Good Manufacturing Practices (GMP) conditions in the cleanroom, are derived from the results. Furthermore, it assumes DCF application via occupancy sensing, i.e. starting DCF 30 min after the last person left the cleanroom. When applying DCF for a normal workweek (production 08:00–17:00), fan energy savings higher than 70% can be obtained without compromising the air quality requirements under normal circumstances. DCF, in combination with a reduced pressure difference, therefore is regarded as a feasible solution to reduce the energy demand of cleanrooms when the personnel in the cleanroom are the main source of contamination. These results are obtained for the presented case study. Though assuming a conservative approach, confirmation of these outcomes for other cleanrooms is recommended.

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6–10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.

To understand how transition across different thermal zones in a building impacts the thermal perception of occupants, the current work examines occupant feedback in two work environments — nursing staff in hospital wards and the workers in an office. Both studies used a mix of subjective surveys and objective measurements. A total of 96 responses were collected from the hospital wards while 142 were collected from the office. The thermal environment in the hospital wards was perceived as slightly warm on the ASHRAE thermal sensation scale (mean TSV = 1.2), while the office workers rated their environment on the cool side (mean TSV = −0.15). The results also show that when the transitions were across temperature differences within ±2 °C, the thermal perception was not impacted by the magnitude of the temperature difference — as reflected in occupant thermal sensation and thermal comfort/thermal acceptability vote. This would imply that the effect of temperature steps on thermal perception, if any, within these boundaries, was extremely short lived. These findings go towards establishing the feasibility of heterogeneous indoor thermal environments and thermal zoning of workspaces for human comfort.