1. Kom verder. Saxion. De orthopedisch verpleegkundige en de wereld Onderzoek naar de betrokkenheid in BPU van verpleegkundigen van de afdeling orthopedie Naadloze Zorg voor de Oudere Orthopedische Patiënt

2. Kom verder. Saxion. The orthopaedic ward nurse and the world Study regarding involvement in BPU development of orthopaedic ward nurses Seamless care for the elderly orthopaedic patient

3. Kom verder. Saxion. The orthopaedic ward nurse and the world Nitie Mardjan Saxion research center for health, social work and technology prof Joy Notter Saxion research center innovation and entrepreneurship prof Jos van der Werf Seamless care for the elderly orthopaedic patient

4. Kom verder. Saxion. The orthopaedic ward nurse and the world Aim Theoretic framework Method Findings Conclusions Recommendations Seamless care for the elderly orthopedic patient

5. Kom verder. Saxion. aim 1.A systems theory perspective on organizational performance in relation to professional empowerment 2. Qualitative baseline establishment for development of the BPU to explore how nurses of the orthopaedic ward of the MST hospital manage the concurrent demands by the patients, the organization’s management and their professional standards 3.Follow up

6. lifeworldsystem theoretic framework Habermas, 1988 Kunneman & Slob, 2007

7. theoretic framework Habermas, 1988 Kunneman & Slob, 2007 system lifeworld

8. Kom verder. Saxion. theoretic framework N=1 N=x Weggeman, 2007 van der Werf, 2010

9. Targets must be achieved! Hello, I am here for my patients! … and what about me!? A1 Professional autonomy A2 Client attention E Economy Van der Werf, 2008 EA 2

10. Kom verder. Saxion. Research was limited MST hospital in Enschede the orthopedic ward nursing population phenomenon method A1 Professional autonomy A2 Client attention E Economy

11. Kom verder. Saxion. method 1.interpretative research (hermeneutic phenomenology) 2.topic interviews Exploratory research The phenomenon in its context no generalized statements

12. Kom verder. Saxion. method 1.systems theory 2.interpretative research (hermeneutic phenomenology) 3.topic interviews Exploratory research Method fits method: organized searching and learning in the social context designing smart new ways based on experience Principles of engaged scholarship van der Ven, 2007

13. Kom verder. Saxion. Baseline 2009 2 focusgroup interviews 9 individual interviews 1 interview with management Follow-up 2012 2 focusgroup interviews 1 individual interview 1 interview with management Literature research method

14. Kom verder. Saxion. Patient pillar Nursing pillar Organization pillar Santeon excellent care 1.Working with other nurses who are clinically competent 2. Good nurse-physician relationships and communication 3. Nurse autonomy and accountability 4. Supportive nurse manager/supervisor 5. Control over nursing practice and practice environment 6. Support for education 7. Adequate nurse staffing 8. Concern for the patient is paramount 8 essentials Empowerment

15. … the effort to obtain a relative degree of ability to influence the world Staples, 1990 Empowerment

16. Kom verder. Saxion. conclusion At baseline no marked difference was found in lived experience between BPU main group and other nurses At follow-up no marked difference was found in lived experience between BPU main group and other nurses on general issues At follow-up marked difference was found in lived experience regarding BPU process and results

17. Kom verder. Saxion. ‘We’ve become more of a team’ ‘We achieved a lot, I am actually proud of ourselves’ ‘BPU has made us being heard’ BPU focus group results

18. Kom verder. Saxion. ‘It’s been nice, but I expected more out of it’ ‘Some things have changed, but it waters down’ ‘What I brought back from England is not put to use’ non-BPU focus group results

19. Kom verder. Saxion. 1.Working with other nurses who are clinically competent 2. Good nurse-physician relationships and communication 3. Nurse autonomy and accountability 4. Supportive nurse manager/supervisor 5. Control over nursing practice and practice environment 6. Support for education 7. Adequate nurse staffing 8. Concern for the patient is paramount √ √ √ √ √ √

20. Kom verder. Saxion. ‘… you are dealing with patients you know, […] you don’t work in a factory’ results

21. Kom verder. Saxion. ‘A quiet moment is often only ½ hour and that is insufficient time to work something out’ results

22. Kom verder. Saxion. ‘All that paperwork. What is it about? Paperwork is partly based on distrust’ A1 Professional autonomy A2 Client attention E Economy results

23. Kom verder. Saxion. ‘It is always running or standstill’ results

24. Kom verder. Saxion. ‘Nearness’ ‘Distance’ conclusion

25. Kom verder. Saxion. Balancing nearness and distance in relation to patients requires empowerment in regards to both professional issues as well as organizational issues conclusion

26. Kom verder. Saxion. Periodically and structurally share relevant figures in relation to the nurses’ efforts Involving nurses in the re-design of care processes (paths) including surgery planning could enhance flow and efficiency recommendations Make clear the relationship between administrative processes and their purposes Attention for the involvement of all stakeholders Somehow organizational [E] issues would make an interesting BPU topic

27. Kom verder. Saxion. Brouwer, B.J.M. de, Hendriks, J. (2008). Magneetinstellingen. Pilot-studie naar de face-validiteit van de vertaling van de EOMII. Faculty of Health Medicine and Life Sciences. Maastricht University Brouwer, B.J.M. de, Hendriks, J., Peet, R. van der, Hollands, L., Jong, N. de (2009). Concept 'Magneetinstelling' meetbaar gemaakt. Tijdschrift voor Verpleegkundigen, 2009 (6), 26-30 Kramer, M. & Schmalenberg, C. (2008). Confirmation of a healthy work environment. Critical Care Nurse, 28 56 ‐ 63 Retrieved 19 03 2011 from: http://ccn.aacnjournals.org/content/28/2/56.full.pdf McClure, M.L. (2005). Magnet hospitals. Insights and issues. Nursing Administration Quarterly. 29(3) 198 ‐ 201 Weggeman, M. (2007). Leidinggeven aan professionals? Niet doen!; Over kenniswerkers, vakmanschap en innovatie. Schiedam: Scriptum Checkland, P. (1988). Systems thinking, systems practice. Oxford: Wiley Werf, J.J. (2008). Zorgbusiness in actie. Marktwerking en kennisdisseminatie. Lectorale rede. Deventer: Saxion Gamma hospital (2009). Startnotitie excellente zorg voor verpleegkundigen en patiënt4 Brouwer, B. de (2010). Excellente zorg. Tijdschrift voor Verpleegkundigen, 7/8 37 ‐ 40 RAAK International (2009). Subsidy number 2009 ‐ 1 ‐ 010. Retrieved 01 11 2010 from: http://www.innovatie ‐ alliantie.nl/projectenbank/raak ‐ project/1352560560.html Santeon (2010). http://www.santeon.nl/ consulted on 14 01 2011 V&VN/NPCF (2010a). Eindresultaten pilot excellente zorg. Utrecht: V&VN (unpublished) V&VN/NPCF (2010b). Eindresultaten pilot excellente zorg. Deel III – Resultaten nulmeting Utrecht: V&VN (unpublished) Staples, L. H. (1990). Powerful Ideas About Empowerment. Administration in Social Work 14(2): 29-42.