32 Chapter 2 RESULTS Using the six steps, we constructed and validated the content and scoring of the four cases. Consensus was achieved after Step 5. The results of each step are specified in Figure 2.3. Figure 2.3: The results of each step. Content Scoring Step 1: Experts round 1 Five Cases collected: • Two cases by two residents in geriatrics; • Two cases by one nurse specialising in geriatrics; • One case by three nurses on the geriatric care unit. Difficulty increasing aspects, according to the experts: • All geriatric cases are complex • Non-specific presentation • Patient can’t take care of him/herself • Patient is also (overloaded) caregiver for partner at home • More than one physical or cognitive problem • Limited social network • Limited mobility • Several comorbidities Step 2: Researcher Construction of four cases (four different medical problems, accumulating over time) based on one patient: • Usage of similar characteristics (e.g. medical background, social circumstances); • Two similar medical problems ◊ merged into 1onecase. Develop treatment plans for each case. All items fitted into five categories: • Additional diagnostics (e.g. scans) • Medication • Consults • Nursing actions • To-do before discharge Scoring treatment plans: Twenty items/points (least complicated case) up to 30 items/points (most complicated case) Difficulty: Aspects named by the experts in Step 1 fitted into the categories of INTERMED. Score cases for difficulty with INTERMED: 14, 28, 37, 41. Step 3: Experts round 2 Total cases: 1–4 Number of experts that answered (n=36) yes, yes if or no, to the question: Is the… Is the scoring of the treatment plan adequate? (n=36) Yes: 21 Yes if: 7 No: 8 Difficulty per case: patient description… treatment plan… INTERMED Expert, with INTERMED (n=4) Expert, without INTERMED (n=5) Realistic? Frequent? Adequate? 1 14 14 23 Yes 20 22 5 2 28 28 29 Yes if 10 10 17 3 37 34 34 No 6 4 14 4 41 40 31
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