The influence of e-Learning on
implementation effectiveness
Master thesis MSc Business Administration, specialization Change Management
University of Groningen, Faculty of Economics and Business
October 2013 Lieke Sterkenburg Studentnumber S2042959 Eendrachtskade Zuidzijde 12-8 9726 CW Groningen +31610696946 a.g.sterkenburg@student.rug.nl
Supervisor University of Groningen: Supervisor / field of study:
Dr. C. Reezigt Dr. G.A. Welker
:
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”Tested interventions are underutilized.
Used interventions are under-tested.”
— Chambers and Kerner, 2007
ABSTRACT
In this paper a study has been conducted to investigate the influence of e-Learning on implementation effectiveness. The literature study has concluded that the concepts of self-efficacy and managerial support are related to e-Learning and implementation effectiveness. A survey was conducted at a hospital in the Netherlands to see how these relations work in practice. Before the implementation processes started, the questionnaire was distributed among nurses. The results of this questionnaire functioned as starting point of this study. Two months after implementation, six months after the first measurement, the questionnaire was redistributed under the same nurses. The results implicate that, in this study, e-Learning has no significant influence on self-efficacy and implementation effectiveness. In addition, this study shows that higher levels of self-efficacy of an employee influences the implementation effectiveness positively.
Key words: e-Learning, self-efficacy, managerial support, implementation effectiveness.
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Table of contents
INTRODUCTION ... 4 2. LITERATURE RESEARCH... 6 2.1 Organizational change ... 6 2.2 Implementation effectiveness ... 7 2.3 Self-efficacy ... 7 2.4 E-Learning ... 9 2.5 Managerial support ... 10 2.6 Conceptual model ... 11 3. RESEARCH METHOD ... 13 3.1 Research case ... 13 3.2 Data collection ... 14 3.2.1 Questionnaire ... 14 3.2.2 Research sample ... 14 3.2.3 Procedure ... 15 3.3 Measurement ... 15 3.4 Factor analysis ... 16 3.5 Data analysis... 17 4. RESULTS ... 184.1 Descriptive statistics and correlations ... 18
4.2 Repeated measures ... 20 4.3 Mediator analysis ... 22 4.4 Moderator analysis ... 23 5. DISCUSSION ... 24 5.1 Hypothesis 1 ... 24 5.2 Hypothesis 2 ... 24 5.3 Hypothesis 3 ... 26
5.4 Limitations of this research and implications for future research ... 27
5.5 Conclusion and managerial implications ... 28
REFERENCES ... 29
APPENDICES ... 36
Appendix A Questionnaire 1 ... 36
Appendix B Questionnaire 2 ... 43
4 INTRODUCTION
Every organization has to deal with implementation processes of organizational changes (Armenakis and Harris, 2009). Interest in organizational change as a topic continues to grow as organizations struggle to cope with technological advances, globalization and deregulation issues, which result in a rapidly changing and complex business environment (Burnes, 2004a). According to Beer and Nohria (2000) about 70% of all change initiatives fail due to many varying circumstances (Burnes, 2004a). Research has shown that an organization’s failure to benefit from an adopted change can often be attributed to a lacking implementation process rather than to the change itself (Klein and Sorra, 1996; Aiman-Smith and Green, 2002; Karimi, Somers and Bhattacherjee, 2007). Implementation failure occurs when employees use the innovation or change less frequently or less consistently than required for the potential benefits of the change to be realized. According to Klein and Knight (2005) changes may fail due to a poor fit IT, a lack of knowledge of employees and resistance of employees.
Therefore, the ultimate challenge of organizational change is to get support and gain targeted organizational members' use of an innovation by changing individuals' behaviour (Tornatzky and Fleischer, 1990). Enhancing these organizational or behavioural changes can be applied through change interventions or activities. An intervention is defined as ‘a planned activity to enhance organization’s effectiveness’ (French and Bell, 1990). These activities are part of an intervention- or implementation plan which aims at realizing the intended results of a change project (de Caluwé and Vermaak, 2003).
With the rapid change in all types of working environments, there is a constant need to educate employees in new technologies, policies and products found within the environment. Also the healthcare industry in the Netherlands is continuously changing. The staff of a hospital is required to meet the requirements set by government and the Health Care Inspectorate of the Netherlands. Since there are many new requirements and other changes, there are also a lot of educational interventions for nurses and other hospital staff. Hospitals expect that this trend will continue to grow. As a result, hospitals went looking for other educational interventions other than for example, team training and classroom teaching.
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6 2. LITERATURE RESEARCH
In this chapter, a short introduction of organizational change will be given in order to give a clear overview where, in a change process, implementation starts. Thereafter the dependent variable, implementation effectiveness, will be discussed. Furthermore the determinant of implementation effectiveness (in healthcare), self-efficacy, is presented. Finally, several hypotheses and the conceptual model of this study are displayed.
2.1 Organizational change
Change can be defined as the transformation of an individual or system from one state to another, a process that may be induced by internal or external factors (Swanwick, 2007). When characterized by how change comes about, there are multiple approaches of organizational change (Stace and Dunphy, 2001; Burnes, 2009; Cummings and Worley, 2005; Weick, 2000). However, the literature is dominated by two approaches: namely planned and emergent change (Bamford and Forrester, 2003). Planned change always tries to prepare for and take actions to reach a desired goal or organizational state and the desired goal is often described before the change starts (Poole and van de Ven, 2004). Planned change may also be referred to as blueprint, top-down, rational, linear or episodic changes (Burnes, 2009). The emergent change approach is seen as an open-ended on-going and unpredictable process aimed at responding to a changing environment (Burnes, 2009; Mintzberg, 1987).
7 2.2 Implementation effectiveness
This study is measuring the influence of e-Learning on the implementation process by reviewing the implementation effectiveness. Implementation effectiveness is defined as the consistent - and quality of collective use of the innovation or change (Klein, Conn, and Sorra, 2001). The collective use refers to the sum of the use of the innovation by all individuals (Klein, Conn, and Sorra, 2001).
According to Grol and Wensing (2011) effective implementation depends on a systematic approach and proper planning of the implementation interventions. Furthermore research shows that employees have to be ready for organizational change (Armenakis et al., 1993). This study will examine how e-Learning activities and readiness for change, especially the level of self-efficacy, a component of readiness for change, influences the implementation effectiveness.
2.3 Self-efficacy
Self-efficacy refers to the individual perception of whether one perceives him- or herself as possessing the necessary competencies to accomplish a task or job successfully (Bandura, 1982; Taylor, 1983; Gist, 1987).
If self-efficacy is low, the individual has the perception that he or she does not have all the competencies to perform the tasks (Gist, 1987). This means that the individual needs to obtain or deepen these competencies through learning new skills and knowledge. When an individual’s self-efficacy is high, there is little opportunity to develop and improve competency beyond where the individual was before. Individuals with a high level of self-efficacy feel that they have reached the top within their job, because they judge himself or herself as already possessing the knowledge, skills and abilities (Hackman and Oldham, 1980). Armenakis et al. (1993) stated that individuals who do not feel that they can meet the (new) competencies that are required to perform the changed tasks or jobs, will avoid these activities and will start to resist. Individuals, who are convinced that they have the capabilities in order to perform the new tasks or job, have a tendency to support the change. Since a low level of self-efficacy will lead to resistance, it is expected that the implementation has a large probability of failure in cases of low self-efficacy. The relationship between self-efficacy and the implementation effectiveness is hypothesized as follows:
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Self-efficacy can be influenced by interventions or activities which are aimed at increasing the knowledge and skills of employees (French and Bell, 1990). These activities are part of an intervention- or implementation plan which aims at realizing the intended results of a change project (de Caluwé and Vermaak, 2003). According to Hulscher, Laurant and Grol (2003) a wide variety of interventions can be used. For a change to be effective, it is imperative that organizational members believe that they are sufficiently competent to perform the change (Koh, Manias, Hutchinson, Donath and Johnston, 2008). Wensing and Grol (2005a) concluded that organizational members experience a range of barriers to use the innovation, these include barriers associated with competency such as gaps in knowledge. The interventions are focused on education and training (Moulding, Silagy and Weller, 1999; Fleuren, Wiefferink and Paulussen, 2004).
9 2.4 E-Learning
E-Learning refers to the use of internet technologies in order to deliver and enhance knowledge and performance of user groups (Rosenberg, 2001). E-Learning is also known as web-based learning, online learning, computer-assisted instruction or internet-based learning. With the rapid change in all types of working environments, there is a constant need to educate employees in new technologies, policies and products found within the environment. This development is a growing concern among healthcare professionals. They are required to keep their knowledge and skills continually up-to-date in order to enhance clinical practice. In some cases, e-Learning can help them maintain the professional requirement to keep up-to-date with the knowledge base of their different professions (NHS Executive, 2004).
Studies have found both advantages and disadvantages to use e-Learning in healthcare organizations. One of the advantages is determined by Tse and Lo (2008). They found that nurses develop their problem solving and critical thinking capabilities by doing a web-based e-Learning course. E-Learning is an interesting tool for hospital staff that works shift patterns that cover seven days a week, 24 hours a day. E-Learning helps to solve the problem of different time and different place phenomenon that is encountered by healthcare professionals (Rutkowski and Spanjers, 2007). Furthermore it also helps by maintaining core skills, including the ability to work with computers and use electronic libraries and critically appraise evidence for healthcare (Wilkinson, While, and Roberts, 2009). However, there are also disadvantages establishing an e-Learning approach in the education of healthcare staff. Gilchrist and Ward (2005) suggested that there are some difficulties in using e-Learning which relate to the IT skill level within the current nursing community. In a review, Gagnon,
Adkins, Fernandez & Robinson (2007) found that barriers for not finishing e-Learning were the physicians’ perceptions of time limitations, lack of discipline and unfamiliarity with computers and internet.
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on knowledge, skills and behaviour of nurses and doctors and the patient outcomes. Also Fairweather and Gibbons (2000) found that individuals using e-Learning, learned more efficiently and demonstrated better retention. Bandura (1982) found that learning and training had an impact on self-efficacy of individuals. For example, the level of self-efficacy of an individual increases when an individual, learning about a particular subject, gets confirmed that he or she has passed a test (Pintrich & Schunk, 2002). E-Learning is seen as a form of learning and training. Therefore we formulated the following hypothesis.
Hypothesis 2: An e-Learning module for nurses about medical, psychological and social problems in the patient group leads to a higher level of self-efficacy.
2.5 Leadership style - managerial support
A commonly used definition of leadership is that “it is a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task” (Chemers, 1997). Burnes (2009) describes the role of leadership as establishing a direction (vision and strategy), aligning people (getting people to understand and believe the vision), and motivating and inspiring. Successful organizational change must be planned, organized, directed and controlled and it requires effective leadership behaviours to introduce change successfully (Burnes, 2009). To implement new changes, managers need to deal with resistance and convince employees that the new change initiative is urgent and needed (Cannella and Monroe, 1997).
11 enables employees to face new challenges (Devos, Vanderheyden and Van den Broeck, 1998). In contrast, if managers do not support the interventions actively, employees will consequently not take the change initiative serious and will not acquire new knowledge (Devos et al., 1998). Baumgartel and Jeanpierre (1972) found that organizational members with a supportive manager were more likely to implement knowledge and skills acquired in their work. Facteau, Dobbins, Russell, Ladd and Kudisch (1995) concluded that employees who perceived a higher degree of support from their direct managers for training, have a greater motivation to attend and learn from training. An explanation is that the employees identify themselves with their manager. If the manager supports the initiated implementation, and employees identify themselves with the manager, employees are more likely to concentrate on the positive outcomes of the change initiative, which encourages learning. According to Bass (1985) a leader can also motivate his followers through challenging followers to create and share new ideas, gives support and guidance and preparing the followers for change. The following hypothesis is formulated:
Hypothesis 3: An e-Learning module for nurses about medical, psychological and social problems in the patient group, leads to a higher level of self-efficacy when the nurse perceives managerial support.
2.6 Conceptual model
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Figure 1 Conceptual model
The main research question of this study includes: How does e-Learning influences the implementation effectiveness? The main question will be answered with reference to hypotheses that are shown in the conceptual model. The three hypotheses include:
Hypothesis 1: A higher level of self-efficacy of nurses leads to higher implementation effectiveness.
Hypothesis 2: An e-Learning module for nurses about medical, psychological and social problems in the patient group leads to a higher level of self-efficacy.
Hypothesis 3: An e-Learning module for nurses about medical, psychological and social problems in the patient group, leads to a higher level of self-efficacy when the nurse perceives managerial support.
Implementation
intervention
The level of self-efficacy
The degree of perceived managerial support
Implementation effectiveness
- Collective use of the innovation
13 3. RESEARCH METHOD
This chapter focuses on the methods used for collecting and analyzing the data which are used for this study. This study consists of a literature review and quantitative research.
3.1 Research case
The hypotheses will be tested in a case study at an University Medical Center. In 2004, the then Dutch Minister for Health decided that all hospitals, from 2008 on, systematically have to manage the safety of care provision with the aid of a Safety Management System (SMS1). The SMS includes 10 different themes closely related to patient safety. Frail older people are the target group of SMS theme 5. From research it is known that hospitalization is a risky event for older people. 30-60% of older patients experience a functional decline after being hospitalized (Gill, Allore, Holford and Guo, 2004; Covinsky, Palmer, Fortinsky, Counsell, Stewart and Kresevic, 2003). The consequences of functional decline can be a decreased quality of life, increased length of hospital stay and an increased need for professional care at home (Rudberg, Sager and Zhang, 1996). According to Inouye, Studenski, Tinetti and Kuchel (2007). The decline in functioning is not only a problem in terms of decreased independence, but also results in a risk factor for geriatric syndromes such as fall, delirium, incontinence and further functional decline. Because the functional decline of older patients may be preventable, it is important to identify those patients who are at risk for a functional decline (Anpalahan and Gibson, 2008). Therefore, all clinical patients of 65 years and older should be screened for these risks when they are hospitalized. If screening shows that there is an increased risk, care providers (nurses and doctors) should initiate appropriate preventive and/ or treatment interventions.
The implementation strategy for the introduction of this screeningsbundle included changing the attitude of nurses towards the patients, developing new knowledge with nurses and informing the nurses’ leaders. The training of the nurses was based upon an e-Learning program in which the essence and techniques for conducting screening questions was explained. In this way, nurses could increase their knowledge about clinical patients of 65 years and older and fulfill the requirements of working with the screeningsbundle. Informing the nurses’ leaders was mainly aimed at conveying the need for implementing the screeningsbundle. The information was primarily distributed through meetings where project members informed nurses’ leaders about the latest developments. At the end of the meeting the nurses’ leaders had the opportunity to ask questions. From mid-November 2012 each
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department was required to screen all patients of 65 years and older. In October 2012, the central SMS-project team carried out a week of testing in order to test the application and way of working with the new screenings bundle.
3.2 Data collection
This study, about how e-Learning influences the implementation effectiveness, will be executed by using quantitative methods. Quantitative methods are useful to allow analysis and are precise because of reliable measurement (Burns, 2000). This study used a questionnaire in order to test the hypotheses.
3.2.1 Questionnaire
A questionnaire (appendix A) was used to gather data about knowledge and attitudes of nurses regarding frail older patients. The questionnaire was designed by the University Hospital in Nijmegen and is fully validated. Before the implementation processes started, the questionnaire was distributed among the nurses. The questionnaire was distributed among nurses who are working in different nursing departments. The results of this questionnaire functioned as starting point of this study. Two months after implementation, in February the questionnaire was redistributed under the same nurses.
The questionnaire was redistributed among the same nurses in order to measure changes in level of knowledge and perceived managerial support of nurses’ leaders at an individual level. In order to measure which nurses followed the e-Learning, the questionnaire was extended with some questions. The effectiveness of the implementation process is measured by the classification of used screening protocols for frail elderly people. Although the hospital has an IT system in which the nurses are required to enter the results of the screening per patient, it cannot be used for analysis at the individual level. Therefore, questions were added to the questionnaire about the degree of use by an individual (appendix B).
3.2.2 Research sample
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The final size of the sample, 100 nurses, depended on several factors. First, the manager of nursing department decided whether filling in the questionnaire was an obligation for the nurses or not. Secondly, the questionnaire was distributed a second time six months later. Due to the difference in time, for some of the nurses the work situation changed, a few nurses had changed jobs or had no time to fill in the questionnaire.
3.2.3 Procedure
In the first phase of the study, a member of the project team SMS asked managers which nursing departments wanted to participate in the study. Then the mutual expectations were discussed with the departmental managers. In most cases, the questionnaire was sent to the nurses the next working day. The questionnaire was sent digitally. Each nurse received a personal link in order to open the questionnaire. After a week, nurses that did not complete the questionnaire received a reminder. The same procedure was followed six months later.
The questionnaire was pre-tested by the developers of the questionnaire. Furthermore, the questionnaire was also used in another study within the UMCG and in other Dutch hospitals. To ensure that conducting the questionnaire digitally worked, the questionnaire was completed several times by the system administrator and researcher.
3.3 Measurement
For a study, it is important that the correct measurements are conducted. This section describes how the literature is linked to the questionnaire.
Implementation effectiveness
16 Level of self-efficacy
In literature self-efficacy refers to the individual perception of whether one perceives himself or herself as possessing the necessary competencies to accomplish a task or job successfully (Bandura, 1989; Taylor, 1983; Gist, 1987). The questionnaire asked about how nurses consider him or herself knowledgeable in relation to the patient group. The possible answers on the question about the level of self-efficacy were based on a 5-point Likert-scale, from not knowledgeable to very knowledgeable.
E-Learning
This intervention includes providing e-Learning (as training intervention). Since not all departments made the e-Learning compulsory, there is a distinction between participating and not participating in e-Learning. In the second questionnaire it was asked whether the nurse has completed the e-Learning module. The nurse had two answering options, yes and no.
Perceived managerial support
The questionnaire asked about the level of managerial support received by the nurses. This question was included in two measurement points. The answers of the second questionnaire are used to test the conceptual model. The possible answers on the question about the perceived managerial support were based on a 5-point Likert-scale, from never to always.
3.4 Factor analysis
Although the questionnaire has been validated, it is wise to perform a factor analysis because the questionnaire is been applied in other situations. Furthermore there are some questions added to the questionnaire.
17 3.5 Data analysis
18 4. RESULTS
The previous chapter consisted of an elaboration on the research methods used in the current study. In this chapter the results are presented. The first part of this chapter contains the descriptive statistics and the results of the correlation analysis. In the second part, the results of the repeated measures analyses are presented. The third part is about the results of the mediation analysis and the fourth part contains the results of the moderation analysis.
4.1 Descriptive statistics and correlations
In this research a total of 100 nurses completed the questionnaire (44 percent) of which 14 were male and 86 were female. The average age of the nurses was 38 years. In the hospital the average age of employees is 39.8 years. In table 1 the characteristics of the respondents are displayed.
Respondents percentage n = 100 1. Gender Male 14 Female 86 2. Age (Mean) 37,97 3. Tenure/years 0-9 42 10-19 20 20-29 16 30-39 18 40-49 4
4. Profession Nurse (nurturing) 3
Nurse (MBO) 30 Nurse (HBO) 61 Nurses’ leader 6 5. Hours/week 12-24 15 24-36 69 >36 16
Table 1 Sample characteristics
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Table 2 Descriptive statistics
Next to that, Pearson’s correlations were calculated to measure the direction and strength between the concepts. This overview is shown in table 3. From the table can be concluded that significant correlations exist between different variables. According to the correlation table can be concluded that there are two positive and significant relationships, namely between degree of managerial support and level of self-efficacy (relation 1) and level of self-efficacy and screeningsbundle usage (relation 2). The relationship between e-Learning and the level of self-efficacy cannot be considered as proven because the question e-Learning has two answer options, yes and no.
20 4.2 Repeated measures
Repeated measures analysis deals with response outcomes measured on the same experimental unit at different times or under different conditions. In this test, the population is divided into 2 different groups; Group 1 has completed the e-Learning (n=41) and group 2 did not complete the e-Learning (n=59). Furthermore, both groups completed the same the questionnaire at the same moments, namely in front of the implementation and after the implementation of the screeningsbundle. The results of the test ‘Repeated measures’ is shown in table 4.
Table 4 Repeated measures-Multivariate tests
The significant p-values show an effect of time on the dependent variable – a within-subjects effect reflected by the repeated measures. The effect of e-Learning on self-efficacy did not reach conventional levels of statistical significance of p<0.05.
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Table 5 Repeated measures - Mauchly's Test of Sphericity
A within-subjects design is a type of experimental design in which all respondents are exposed to the same condition(s). The result of the SPSS output is shown in Table 6.
Table 6 Repeated measures - Tests of within-subjects effects
The circled results show that the output cannot be classified as significant. From the table it can be seen that the P-value is greater than 0.05, namely P= 0,107. In order to give a meaningful statement about these results, an effect size is performed. Effect size is a different concept to statistical significance and it is often relevant to compute an effect size measure when the statistical significance, such as p < .05, has not been met.
22 4.3 Mediator analysis
Mediation is a hypothesized causal chain in which one variable affects a second variable that influences a third variable. The intervening variable is the mediator and “mediates” the relationship between a predictor and an outcome. Baron and Kenny (1986) suggested a four step approach in which several regression analyses are shown. Furthermore the significance of the coefficients is examined at each step. The purpose of the first three steps is to establish that zero-order relationships among the variables exist. A mediation is not possible if one or more of these relationships are non-significant (MacKinnon, Fairchild, & Fritz, 2007). The mediation analyses were done following the four steps of Baron and Kenny (1986). The results of the analysis are displayed in the table 7.
Screeningsbundle usage
Step 1 Step 2 Step 3
Gender 0,130 Age 0,013 e-Learning -0,094 -0,047 Level of self-efficacy 0,246* R² 0,135 0,094 0,251 R² 0,018 0,009 0,063 * P < 0,05
Table 7 Mediator analysis
Figure 1 displays the complete regression analysis, including the mediation component.
Figure 2 Regression analysis
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The result of the regression analysis shows that there is no mediation of the level of self-efficacy between e-Learning and screeningsbundle usage. As MacKinnon, Fairchild and Fritz (2007) stated; if one or more of the relationships are non-significant, researchers usually conclude that mediation is not possible, the direct relation of e-Learning and screeningsbundle usage can be classified as non-significant. Although mediation was not supported, there is a significant direct relation between e-Learning and the level of self-efficacy and between the level of self-efficacy and screeningsbundle usage.
4.4 Moderator analysis
The results of the analysis for the expected moderation of the degree of perceived managerial support on the relation between the implementation intervention e-Learning and the level of self-efficacy are shown in this section. In order to analyse the influence of the moderator, a multiple regression analysis needs to be performed. The result of the moderation analysis is shown in table 8.
Table 8 Moderator analysis
24 5. DISCUSSION
Previous studies have shown that e-Learning can be seen as an effective intervention which increases the expertise and skills of a large group in a relatively short time. However, little research is available on which factors are influenced by using e-Learning as an implementation intervention. This research explored the influence of e-Learning on the level of self-efficacy and implementation effectiveness in healthcare settings. In this study, the implementation effectiveness was defined as screeningsbundle usage. Most of the results in this study were not significant and, therefore, it is for now not possible to generalize the results. The results and their implications will be discussed more thoroughly in this chapter. First, the results of the first hypothesis will be discussed.
5.1 Hypothesis 1
Based on the results of the previous section can be concluded that hypothesis 1: “A higher level of self-efficacy of nurses, leads to higher implementation effectiveness” is proven. The results showed a positive (0,246) and significant (p< 0, 05) outcome. This means that nurses, who are convinced that they are capable of caring for frail elderly people, are using the screeningsbundle, on average, often or always. As mentioned in chapter 2 of the research, this can be explained by the fact that employees with confidence in their ability to cope with change should be more likely to contribute to redesign or innovation. In contrast, employees may resist changes that they believe exceed their coping capabilities (Armenakis et al., 1993; Bandura, 2000).
In addition, these results show that it makes sense to increase the level of self-efficacy of employees. However e-Learning is examined in this study, there may be several interventions that can increase self-efficacy. These factors are explained in more detail in section 5.2.
5.2 Hypothesis 2
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Learning completed) cannot be demonstrated because the results are not significant. In addition, based on performing an effect size analysis, it can be concluded that the differences between the groups and the two measurements are small. The explanations for this are manifold.
The first possible explanation is that this study has few respondents who have completed the e-Learning. The reason for this may be caused by several factors. According to Technology Acceptance Model of Davids (1993) a person’s behavioural intention concerning the use of e-Learning is influenced by perceived usefulness (the belief that using e-Learning will increase one’s performance) and perceived ease of use (the belief that one’s use of an application will be free of effort). Perceived usefulness is an indicator of the degree to which the use of an e-Learning will enhance a user’s job performance (Davis, 1989). The second factor of the Technology Acceptance Model is the perceived ease of use. Arbaugh (2002) described that e-Learning depends mainly on the use of computers or other IT systems as assisting tools. An organization or a teacher publish their materials on the platform and employees or students participate through IT networks. A more positive attitude toward the Information Technology and use of computers will result in more activated and effective learners (Piccoli, Ahmad and Ives, 2001). Furthermore, the conditions for the use of e-Learning should also be facilitated by the organization. This means that a nurse needs enough time and resources to complete the e-Learning (Hong, 2002).
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efficacy will be reduced due to the failure. Finally, Bandura (1993) writes that the psychological state of the individual also affects the level of self-efficacy. If one feel fearful or anxious they may judge themselves less capable to accomplish a given task. According to other studies, there are more factors which influence the level of self-efficacy. These factors include beliefs in the nature of ability, feedback received regarding previous experiences and specific task requirements. Future research is needed to determine the influence of the concepts- enactive mastery experiences, modelling, social persuasion and psychological states beliefs in the nature of ability, feedback received regarding previous experiences and specific task requirements – on self-efficacy.
For results of this hypothesis it should be taken into account that the measure for the level of self-efficacy was a self-rating one and was quite subjective. In a future study it is recommended to use a factor which objectively evaluates the knowledge and skills of the nurses.
5.3 Hypothesis 3
The third and final hypothesis of this study includes: An e-Learning module for nurses about the patient group, leads to a higher level of self-efficacy when the nurse perceives managerial support. Based on the results in Section 4.4 can be concluded that this hypothesis has not been proven. The majority of the results of this analysis are presented as non-significant. According to the results, only the influence of the degree of perceived managerial support on self-efficacy is significant. This is a direct relationship. This relationship indicates, the higher the degree of perceived managerial support, the higher the level of self-efficacy.
The direct relation between the degree of perceived managerial support and self-efficacy can be explained using different theories. First the theory of role models; Salanova, Llorens and Schaufeli (2011) stated that nurses’ leaders are expected to be able to increase levels of nurses’ self-efficacy by acting as role models and supportive leaders. Employees identify with role models who are then perceived in a positive light (Bandura, 1986); this serves to empower them to achieve the leader’s vision through the development of self-efficacy and self-confidence (Kirkpatrick and Locke, 1996; Yukl, 1998). In this way employees can learn from their leaders’ experiences.
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(Edmondson, 1999). Given that an important information cue for self-efficacy judgment is feedback from others, particularly from trustworthy others (Bandura, 1997; Gist and Mitchell, 1992), supportive leaders may increase members’ self-efficacy by offering more frequent positive feedback.
As shown, there are several possible explanations for the direct relationship between the degree of perceived managerial support and the level of self-efficacy. Future research is needed to determine whether the relationship is retained in combination with implementation effectiveness. This means that the level of self-efficacy mediates between the degree of perceived managerial support and the implementation effectiveness. Research by Gist and Mitchell (2002) has shown that this model - the level of self-efficacy mediates between the degree of perceived managerial support and the implementation effectiveness- is applicable in most general sectors. Although, healthcare is a specific sector and therefore it is recommended to investigate the applicability of this model in hospitals.
5.4 Limitations of this research and implications for future research
As in every study, there are always some things that could be improved. First of all the research was conducted within one organization and might not be applicable to other organizations, because every (organizational) change is unique. Furthermore it is a cross-sectional study, which means that it is only a small timeframe; the situation may provide other results if a longitudinal of the study was chosen. This also includes that no causal interferences can be made from it. Third, the study has a relatively small sample size, which puts a limitation on the results. The generalizability and applicability of the study can be improved by retesting the model with a larger sample size, with more variety. This could also explain why not all relations that were found in literature were also found in this research. Fourth, this study relied heavily on self-report measures of attitudes (individual perceptions). Self-reporting is known to be a source of bias. However, great care was taken in the selection of questionnaire scales, administration of the questionnaire, and anonymity to minimize bias, as the social desirability (Kantowitz, Roediger & Elmes, 2005). Moreover, self-report bias is an acceptable risk compared to the benefit of gathering primary data regarding the individual level of self-efficacy.
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instance tests. In addition it is recommended to increase the sample size of this study. If the sample consists of more hospitals, the specific organizational influences will be revealed.
A second recommendation is to investigate the relationship between the role of leadership, self-efficacy and implementation effectiveness in health care.
5.5 Conclusion and managerial implications
The main question of this research, which is mentioned in the introduction, includes; how does e-Learning influences the implementation effectiveness? As a replay to this question can be concluded that, in this study, e-Learning has no significant influence on the implementation effectiveness. This means that a manager should consider whether e-Learning in terms of cost compensate the benefits.
29 REFERENCES
Aiman-Smith, L., & Green, S. 2002. Implementing new manufacturing technology: The related effects of technology characteristics and user learning activities. Academy of
Management Journal, 45: 421-430.
Anpalahan, M., & Gibson, S.J. 2008. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Internal Medicine Journal, 38(1):16-23.
Arbaugh, J. B. 2002. Managing the on-line classroom: a study of technological and behavioral characteristics of web-based MBA courses. Journal of High Technology
Management Research, 13: 203–223.
Armenakis, A. A., & Harris, S. G. 2009. Reflections: our journey in organizational change research and practice. Journal of Change Management, 9:127-142.
Armenakis, A. A., Harris, S. G., & Mossholder, K. W. 1993. Creating readiness for organizational change. Human Relations, 46:681–703.
Armstrong, M. J. 2001. A Handbook of Personnel Management Practice. London: Kogan Page.
Bamford, D. R., & Forrester, P. L. 2003. Managing planned and emergent change within an operations management environment. International Journal of Operations &
Production Management, 23(5):546 – 564.
Bandura, A. 1982. Self-efficacy mechanism in human agency. American Psychologist, 37:122-147.
Bandura, A. 1986. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice- Hall, Inc.
Bandura, A. 1993. Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28:117-148.
Bandura, A. 1997. Self-efficacy: the exercise of control. New York: Freeman.
Bandura, A. 2000. Self-efficacy mechanism in physiological activation and health-promoting behavior. In J. Madden, Neurobiology of learning, emotion and affect, 229-270. New York: Raven.
Baron, R. M., & Kenny, D. A. 1986. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal
of Personality and Social Psychology, 51:1173-1182.
30
Baumgartel, H., & Jeanpierre, F. 1972. Applying new knowledge in the back-home setting: A study of Indian managers’ adaptive efforts. Journal of Applied Behavioral Science, 8:674-694.
Beer, M., & Nohria, N. 2000. Breaking the Code of Change. Boston: Harvard Business School Press.
Bernard, R.M., Abrami, P.C., Lou, Y., & Borokhovski, E. 2004. A methodological morass: How can we improve the quality of quantitative research in distance education?
Distance Education, 25(2): 176-198.
Burnes, B. 2009. Managing change (5th edition). Harlow: Prentice Hall.
Burnes, B., 2004(a). Emergent change and planned change, competitors or allies? The case of XYZ construction. International Journal of Operations & Product Management, 24:886-902.
Burns, J. M. 1978. Leadership. New York: Harper and Row.
Burns, R. 2000. Introduction to Research Methods. London: Sage.
Caluwé, L., de & Vermaak, H. 2003. Learning to Change. A Guide for Organizational
Change Agents. Thousand Oaks: Sage Publications.
Cannella, A. A., & Monroe, M. J. 1997. Contrasting perspectives on strategic leaders: toward a more realistic view of top managers. Journal of Management, 23: 213–237.
Chambers, D., & Kerner, J. 2007. Dissemination and implementation PARs: background,
overview, and review challenges. Presentation to the National Institutes of Mental
Health, National Cancer Institute.
Chemers, M. M. 1997. An integrative theory of leadership. Mahwab, NJ: Erlbaum.
Cohen, J. 1988. Statistical power analysis for the behavioral sciences (2nd Ed.). New Jersey: Lawrence Erlbaum.
Cook D. A., Levinson, A. J., & Garside, S. 2010. Time and learning efficiency in internet-based learning: a systematic review and meta-analysis. Advances in Health Science
Education, 15(5):755-770.
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L. & Kresevic, D. 2003. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of American
Geriatrics Society, 51(4):451-458.
31
Davis, F. D. 1989. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13:319–339.
Davis, F. D. 1993. User acceptance of information technology: System characteristics, user perceptions and behavioral impacts. International Journal of Man–Machine Studies, 38: 475–487.
Devos, G., Van den Broeck, H., & Vanderheyden, K. 1998. The concept and practice of a school-based management contest: integration of leadership development and organizational learning. Educational Administration Quarterly, 34(5):700-717.
Drennan, D. 1992. Transforming Company Culture. London: McGraw-Hill
Dubinsky, A., Yammarino, F., & Jolson, M. 1995. An examination of linkages between personal characteristics and dimensions of transformational leadership. Journal of
Business and Psychology, 9: 315-335.
Eby, L. T., Adams, D. M., Russel, J. E. A., & Gaby, S. H. 2000. Perceptions of organizational readiness: factor related to employees’ reactions to the implementation of team based selling. Human Relation, 53:419-442.
Edmondson, A. 1999. Psychological safety and learning behavior in work teams.
Administrative Science Quarterly, 44:350–383.
Facteau, J. D., Dobbins, G. H., Russell, J. E. A., Ladd, R. T., & Kudisch, J. D. 1995. The influence of general perceptions of the training environment on pretraining motivation and perceived training transfer. Journal of Management, 21:1-25.
Fairweather, P. G., & Gibbons, A. S. 2000. Distributed Learning: Two Steps Forward, One Back? Or One Forward, Two Back? IEEE Concurrency, 8(2):8-9.
Field, A. 2000. Discovering Statistics using SPSS for Windows. Delhi: Sage publications.
Fleuren, M., Wiefferink, K., & Paulussen T. 2004. Determinants of innovation within health care organizations: literature review and Delphi study. International Journal Quality
Health Care, 16(2):107-123.
Freemantle, N., & Watt, I. 1994. Dissemination: implementing the findings of research.
Health Library Review, 11(2):133-137.
French, W. L., & Bell, C. H. 1990. Organizational development. Englewood Cliffs, NJ: Prentice- Hall.
Furst, S. A., & Cable, D. M. 2008. Reducing employee resistance to organizational change: managerial influence tactics and leader-member exchange. Journal of Applied
32
Gagnon, A. C., Adkins, J. F., Fernandez, D. P., & Robinson L. F. 2007. Sr/Ca and Mg/Ca vital effects correlated with skeletal architecture in a scleractinian deep-sea coral and the role of Rayleigh fractionation. Earth and Planetary Science Letters, 261:280–295.
Gerrish, K., & Clayton, J. 2004. Promoting evidence-based practice: an organizational approach. Journal of Nursing Management, 12:114–123.
Gilchrist, M., & Ward, R. 2006. Facilitating access to on-line learning (Chapter 6). In: Glen, S. and Moule, P., eds. E-Learning in Nursing. London: Palgrave.
Gill, T. M., Allore, H. G., Holford, T. R., & Guo, Z. 2004. Hospitalization, restricted activity, and the development of disability among older persons. Journal of the American
Medical Association, 292(17):2115-2124.
Gist, M. E., & Mitchell, T. 2002. Self-efficacy: a theoretical analysis of its determinants and acquisition of computer skills. Personnel Psychology, 41:255-265.
Gist, M. E., & Mitchell, T. R. 1992. Self-efficacy: A theoretical analysis of its determinants and malleability. Academy of Management Review, 17(2):183-211.
Gist, M. E. 1987. Self-efficacy: Implications for organizational behavior and human resource management. Academy of Management Review, 12(3):472-485.
Grol, R., & Wensing, M. 2011. Implementatie; effectieve verbetering van de patiëntenzorg. Amsterdam: Reed Business.
Hackman, J. R., & Oldham, G. R. 1980. Work redesign. Reading, MA: Addison-Wesley.
Hatala, J., & Fleming, P. 2007. Making transfer climate visible: utilizing social network analysis to facilitate transfer of training. Human Resource Development
Review, 6(1):33–63.
Hinton, P. R., Brownlow, C., & McMurray, I. 2004. SPSS Explained. New York: Routledge.
Hong, K. S. 2002. Relationships between students’ and instructional variables with satisfaction and learning from a Web-based course. Internet and Higher Education, 5:267–281.
Hulscher, M. E. J. L., Laurant, M. G. H., & Grol, R. P. T. M. 2003. Process evaluation on quality improvement interventions. Quality & Safety in Health Care. 12:40-46.
Inouye, S. K., Studenski, S., Tinetti, M. E. & Kuchel, G. A. 2007. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of
American Geriatrics Society, 55:780-791.
33
Kantowitz, B. H., Roediger, H. L., & Elmes, D. G. 2005. Experimental psychology:
Understanding psychological research. Monterey, CA: Wadsworth.
Karimi, J., Somers, T. K., & Bhattacherjee, A. 2007. The Impact of ERP Implementation on Business Process Outcomes: A Factor Based Study. Journal of Management
Information Systems, 24(1):101-134.
Kirkpatrick, S. A., & Locke, E. A. 1996. Direct and indirect effects of three core charismatic leadership components on performance and attitudes. Journal of Applied Psychology, 81:36–51.
Klauss, R., & Bass, B.M. 1982. Interpersonal communication in organizations. New York: Academic Press.
Klein, K. J., & Knight, A. P. 2005. Innovation implementation: Overcoming the challenge.
Current Directions in Psychological Science, 14(5):243–246.
Klein, K. J., & Sorra, J. S. 1996. "The Challenge of Innovation Implementation." Academy of
Management Review, 21(4): 1055.
Klein, K. J., Conn, A. B., & Sorra, J. S. 2001. Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5):811-824.
Koh, S. S. L., Manias, E., Hutchinson, A. M., Donath, S., & Johnston, L. 2008. Nurses’ perceived barriers to the implementation of a fall prevention clinical practice in Singapore hospitals. BMC Health Services Research, 8:105-114.
Lam, Y. L., Wei, H. C. P., Pan, H. L. W., & Chan, C. M. 2002. In search of basic sources that propel organizational learning under recent Taiwanese school reforms. The
International Journal of Educational Management, 16(5):216-28.
MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. 2007. Mediation analysis. Annual Review
of Psychology, 58:593–614.
Mintzberg, H. 1987. Crafting strategy. Harvard Business Review, 66-75.
Moulding, N.T., Silagy, C.A., & Weller, D.P. 1999. A framework for effective management of change in clinical practice: Dissemination and implementation of clinical practice guidelines. Quality in Health Care, 8:177-183.
Mourier, P., & Smith, M. 2001. Conquering Organizational Change. Atlanta: CEP Press.
NHS Executive. 2004. Information for Health. London: Department of Health.
Noe, R. A., Hollenbeck, J. R., Gerhart, B., & Wright, P. A. 2006. Human Resource
Management: gaining a competitive advantage. New York: McGraw-Hill
34
Oldham, G. R., & Cummings, A. 1996. Employee creativity: Personal and contextual factors at work. Academy of Management Journal, 39:607 – 634.
Piccoli, G., Ahmad, R., & Ives, B. 2001. Web-based virtual learning environments: a research framework and a preliminary assessment of effectiveness in basic IT skill training.
MIS Quarterly, 25(4):401–426.
Pintrich, P. R., & Schunk, D. H. 2002. Motivation in education: Theory, research and
applications (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.
Poole, M. S., & Van de Ven, A. H. 2004. Handbook of Organizational Change and
Innovation. New York: Oxford University Press.
Rosenberg, M. J. 2001. E-Learning: Strategies for delivering knowledge in the digital age. New York :McGraw-Hill.
Rudberg, M. A., Sager, M. A., & Zhang, J. 1996. Risk factors for nursing home use after hospitalization for medical illness. Journal of Gerontology Series A: Biological
Science and Medical Science, 51(5):189-194.
Rutkowski, A. F., & Spanjers, R. 2007. Optimizing e-Learning in healthcare for nurses. International Journal of Healthcare Technology and Management, 8(3/4):354-369.
Salanova, M., Llorens, S., & Schaufeli, W. B. 2011. Yes, I can, I feel good, and I just do it! On gain cycles and spirals of efficacy beliefs, affect and engagement. Applied
Psychology: An International Review, 60:255-285.
Stace, D., & Dunphy, D. 2001. Beyond the boundaries: Leading and recreating the
successful enterprise. Sydney, Australia: McGraw-Hill.
Swanwick, T. 2007. Introducing large-scale educational reform in a complex environment.
Evaluation, 13:358-370.
Taylor, S. E. 1983. Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38(11):1161–1173.
Tornatzky, L., & Fleischer, M. 1990. The process of technology innovation. Lexington, MA: Lexington Books.
Tse, M. Y., & Lo, W. L. 2008. Telemedicine and e-Health, 14(9): 919-924.
Wang, G. G., & Wilcox, D. 2006. Evaluation of systematic training: knowing more than is practiced. Advances in Developing Human Resources, 8:528–39.
35
Wensing, M., & Grol, R. 2005a. "Educational interventions," in improving patient care: the
implementation of change in clinical practice. Edinburgh: Elsevier.
Wentling, T. L., Waight, C. L., Gallaher, J., La Fleur, J., Wang, C., & Kanfer, A. 2000.
E-Learning: a review of literature. Knowledge & Learning Systems Group, National
Center for Supercomputing Applications, University of Illinois, Urbana-Champaign.
Wilkinson, A., While, A. E., & Roberts, J. 2009. Measurement of information and communication technology experience and attitudes to e-Learning of students in the healthcare professions: integrative review. Journal of Advanced Nursing, 65(4):755 - 772.
Yu, H., Leithwood, K., & Jantzi, D. 2002. The comparative effects of transformational leadership on teachers commitment to change in Hong Kong and Canada. Journal of
Educational Administration, 1(4):368-384.
Yukl, G. 1989. Managerial leadership: A review of theory and research. Journal of
Management, 15: 251-289.
36 APPENDICES
Appendix A Questionnaire 1
Kwetsbare ouderen
Aanleiding onderzoek
37 Uitnodiging UMCG
Beste collega,
Voorafgaand aan de start van het werken met de screeningsbundel is afgesproken dat de verpleegkundigen van uw afdeling een online vragenlijst dienen in te vullen. Deze vragenlijst gaat over uw ervaring en mening als verpleegkundige over verschillende onderwerpen rondom de zorg voor kwetsbare oudere patiënten (65+). Na zes maanden wordt u gevraagd om de vragenlijst nogmaals in te vullen; op deze manier wordt gekeken naar het effect van de door uw afdeling gekozen implementatiestrategie. Voor uzelf is het een toets van uw eigen (hopelijk) toegenomen kennis en bewustwording.
De vragenlijst bestaat uit 23 vragen, weergegeven in twee onderdelen. Vult u alstublieft alle vragen zo compleet en eerlijk mogelijk in. Er zijn geen goede of foute antwoorden. We zijn alleen op zoek naar uw mening, welke verder anoniem zal blijven. De hoofdverpleegkundige van uw afdeling krijgt alleen een overzicht van de personen die de vragenlijst hebben ingevuld, niet van de persoonlijke antwoorden. Het is mogelijk om de vragenlijst tussendoor op uw computer op te slaan. Het invullen duurt ongeveer 15 minuten. Boven de vragen ziet u een balkje: de voortgangsindicator. Het balkje groeit naarmate u de vragenlijst afmaakt. U bent klaar als het hele vlak gevuld is.
Voor vragen en opmerkingen kunt u terecht bij Lieke Sterkenburg: a.g.sterkenburg@umcg.nl
38
Sectie 1: Algemene gegevens
1. Wat is uw geslacht? man vrouw
2. Wat is uw leeftijd? jaar
3. In welke aanstelling brengt u de meeste werktijd door?
verpleeghulp verzorgende verpleegkundige (MBO) verpleegkundige (HBO) anders, namelijk:
4. Hoeveel jaar ervaring heeft u in uw beroep? jaar
5. Hoeveel jaar werkt u in dit ziekenhuis? jaar
6. Op welke afdeling bent u werkzaam?
E1VA E2VA
E3VA E4VA
D2VA D4VA
K1VA K2VA
7. Hoeveel jaar werkt u op deze afdeling? jaar
39
Sectie 2: Praktijkervaring op de afdeling
9. Kunt u aangeven in welke mate de volgende interventies worden toegepast bij oudere patiënten waar u voor zorgt?
te weinig naar behoren te vaak a. Decubituspreventie
b. Verpleegkundige interventies om een delier te voorkomen
(bijvoorbeeld gebruik observatielijsten, prikkeldosering, aanreiken bril en gehoorapparaat, mobiliseren, activeren, aanbieden oriëntatiepunten zoals gebruik kalender en klok, foto’s van thuis, gevoel van veiligheid vergroten, familieparticipatie)
c. Verpleegkundige interventies om een val te voorkomen
(bijvoorbeeld regelmatig toiletgang aanbieden, bed op laagste stand zetten, gebruik nachtverlichting, geen obstakels in ruimte, benodigdheden binnen bereik van de patiënt, alarmeringssystemen)
d. Verpleegkundige interventies om ondervoeding te voorkomen
(bijvoorbeeld screenen op ondervoeding, regelmatig eten en drinken aanbieden, patiënt aan tafel tijdens de maaltijd, gezamenlijk eten)
e. Aanbod van activiteiten
(bijvoorbeeld lezen, spelletjes, dagprogramma, groepsgerichte activiteiten)
f. Incontinentiemateriaal g. Actief mobilisatiebeleid
(zo vroeg mogelijk mobiliseren door verpleegkundigen)
h. Sondevoeding
i. Blaaskatheters
j. Pijnmedicatie
k. Slaapmedicatie
l. Medicamenteuze vrijheidsbeperkende maatregelen
(bijvoorbeeld sedatieve medicatie, antipsychotica)
m. Fysieke vrijheidsbeperkende maatregelen
40
10. Op de afdeling waar u werkt, hoe tevreden bent u in de mate waarin:
erg ontevreden
neutraal erg tevreden
a. ... oudere patiënten met respect behandeld worden?
b. … het tempo aangepast wordt aan oudere patiënten?
c. … zelfredzaamheid van oudere patiënten gestimuleerd wordt?
d. … oudere patiënten beslissingen kunnen nemen omtrent hun eigen zorg en behandeling?
e. … mantelzorgers van oudere patiënten informatie krijgen?
f. … gecommuniceerd wordt met mantelzorgers over
beslissingen omtrent de zorg en behandeling van oudere patiënten?
g. … er signalering en aandacht is voor de belasting van mantelzorgers van oudere patiënten?
h. … verpleegkundigen de zorg aanpassen aan de behoeften van een oudere patiënt?
i. … verpleegkundigen bekend zijn met het feit dat er mogelijk een verschil kan zijn in het effect van medische/
verpleegkundige interventies op oudere patiënten ten opzichte van jongere patiënten?
j. … verpleegkundigen informatie opvragen over de situatie van een oudere patiënt vóór opname?
k. … in de planning van elke dienst rekening wordt gehouden met oudere patiënten?
l. … er adequate continuïteit van zorg tussen ziekenhuisafdelingen is?
m. … er adequate continuïteit van zorg is na ontslag?
11. Hoe verantwoordelijk voelt u zich voor:
helemaal niet
neutraal heel erg
a. ... valincidenten bij oudere patiënten?
b. … het ontwikkelen van decubitus bij oudere patiënten?
c. … achteruitgang van de voedingstoestand bij oudere patiënten?
d. … urineweginfecties bij oudere patiënten ten gevolge van blaaskatheters?
e. … behoud van mobiliteit bij oudere patiënten?
f. … gedragsproblemen bij een patiënt met dementie?
g. … oudere patiënten die angstig en/of somber zijn?
h. … het ontwikkelen van een delier bij oudere patiënten?
i. … verwondingen als gevolg van het gebruik van sedatieve medicatie bij oudere patiënten?
j. … verwondingen als gevolg van het gebruik van
vrijheidsbeperkende maatregelen bij oudere patiënten?
k. … (mis)communicatie met oudere patiënten en mantelzorgers?
41
12. Kunt u per item aangeven wat het beste uw praktijkervaring beschrijft?
nooit zelden soms vaak altijd
a. Ik observeer oudere patiënten nauwlettender dan jongere patiënten
b. Ik houd verwarde oudere patiënten nauwlettend in de gaten
c. Ik praat in eenvoudig taalgebruik tegen oudere patiënten
d. Ik praat luider een duidelijker wanneer ik met een oudere patiënt praat
e. Ik creëer optimale communicatieomstandigheden met oudere patiënten door onder andere gebruik te maken van de patiënt zijn of haar eigen bril en gehoorapparaat
f. Ik maak extra tijd vrij voor het opnemen van oudere patiënten
g. Ik gebruik de anamnesegegevens van een oudere patiënt om zorg te plannen
h. Ik betrek oudere patiënten in beslissingen omtrent hun gezondheid
i. Voor opgenomen oudere patiënten begin ik bij opname met de ontslagplanning
j. Ik maak meer tijd vrij voor het voorbereiden van het ontslag van een oudere patiënt dan voor het ontslag van een jongere patiënt
k. Ik neem een heteroanamnese af bij mantelzorgers van oudere patiënten
l. Ik betrek mantelzorgers van een oudere patiënt bij hun zorg
m. Ik ben alert op het feit dat oudere patiënten minder assertief kunnen zijn
n. Ik moedig oudere patiënten aan om hun zelfredzaamheid te behouden tijdens hun ziekenhuisopname
bijna geen minder dan de helft de helft meer dan de helft bijna alle-maal
13. In de laatste 12 maanden, welk deel van de patiënten waar u voor heeft gezorgd was 65 jaar of ouder?
bijna geen minder dan de helft de helft meer dan de helft bijna alle-maal
14. Ongeveer welk deel van uw dienst besteedt u aan de zorg voor oudere patiënten op uw afdeling?
niet
bevredigend
neutraal erg bevredigend
15. Hoe bevredigend is uw werk met oudere patiënten?
niet belastend
neutraal erg belastend
16. A) Hoe belastend vindt u het werken met oudere patiënten?
B) Kunt u aangeven wat u belastend vindt?
42
niet moeilijk
neutraal erg moeilijk
17. Hoe moeilijk vindt u het om te zorgen voor onrustige oudere patiënten?
niet erg kundig
neutraal erg kundig
18. Hoe kundig beschouwt u uzelf aangaande de zorg voor oudere patiënten?
nooit zelden soms vaak altijd
19. In welke mate ervaart u erkenning voor de zorg voor oudere patiënten door collega’s?
nooit zelden soms vaak altijd
20. In welke mate ervaart u ondersteuning door leidinggevenden in de zorg voor oudere patiënten?
slecht adequaat uitstekend
21. A) Hoe vindt u de scholing van verpleegkundigen op het gebied van zorgverlening aan oudere patiënten op uw afdeling?
B) Aan welke scholing heeft u op uw afdeling behoefte?
22. Sommige patiënten kunnen gedrag vertonen dat voor een ander storend overkomt, zo ook oudere patiënten. Hoe vaak vindt u dat oudere patiënten tijdens uw zorgverlening:
Noot: uiteraard kunnen oudere patiënten lief, grappig, ontroerend, bescheiden, etc. zijn, maar deze onderdelen zullen hier niet uitgevraagd worden.
nooit zelden soms vaak altijd a. …niet voor rede vatbaar zijn?
b. …niet coöperatief zijn? c. …veel aandacht vragen? d. …verward zijn?
e. …’s nachts onrustig zijn? f. …traag zijn?
43 Appendix B Questionnaire 2
Kwetsbare ouderen
Aanleiding onderzoek
44 Uitnodiging UMCG
Beste collega,
Voorafgaand aan de start van het werken met de screeningsbundel is afgesproken dat de verpleegkundigen van uw afdeling een online vragenlijst dienen in te vullen. Deze vragenlijst gaat over uw ervaring en mening als verpleegkundige over verschillende onderwerpen rondom de zorg voor kwetsbare oudere patiënten (65+). Na zes maanden wordt u gevraagd om de vragenlijst nogmaals in te vullen; op deze manier wordt gekeken naar het effect van de door uw afdeling gekozen implementatiestrategie. Voor uzelf is het een toets van uw eigen (hopelijk) toegenomen kennis en bewustwording.
De vragenlijst bestaat uit 23 vragen, weergegeven in totaal twee onderdelen. Vult u alstublieft alle vragen zo compleet en eerlijk mogelijk in. Er zijn geen goede of foute antwoorden. We zijn alleen op zoek naar uw mening, welke verder anoniem zal blijven. De hoofdverpleegkundige van uw afdeling krijgt alleen een overzicht van de personen die de vragenlijst hebben ingevuld, niet van de persoonlijke antwoorden. Het is mogelijk om de vragenlijst tussendoor op uw computer op te slaan. Het invullen duurt ongeveer 15 minuten. Boven de vragen ziet u een balkje: de voortgangsindicator. Het balkje groeit naarmate u de vragenlijst afmaakt. U bent klaar als het hele vlak gevuld is.
Voor vragen en opmerkingen kun u terecht bij Lieke Sterkenburg: a.g.sterkenburg@umcg.nl
45
Sectie 1: Algemene gegevens
1. Wat is uw geslacht? man vrouw
2. Wat is uw leeftijd? jaar
3. In welke aanstelling brengt u de meeste werktijd door?
verpleeghulp verzorgende verpleegkundige (MBO) verpleegkundige (HBO) anders, namelijk:
4. Hoeveel jaar ervaring heeft u in uw beroep? jaar
5. Hoeveel jaar werkt u in dit ziekenhuis? jaar
6. Op welke afdeling bent u werkzaam?
E1VA E2VA
E3VA E4VA
D2VA D4VA
K1VA K2VA
7. Hoeveel jaar werkt u op deze afdeling? jaar
