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Background: Research on cognitive effects of educational games in general shows promising results. However, there are large variations in learning outcomes between individual educational games. Research on the design process and different design elements of educational games has led to some interesting directions, but some design aspects remain unclear. Objectives: We examined how an educational game designed on the basis of intrinsic integration theory, based on a strong alignment between game and learning goals, supports the learning of Newtonian mechanics. Methods: This study applied a mixed‐methods approach (N = 223). A pre‐ and post‐test design was used to examine possible learning and transfer effects fostered by playing the educational game, Newton's Race. To examine how players played the game, log data for each player were digitally recorded during gameplay. Results and Conclusions: Our findings demonstrated a significant positive learning effect of Newton's Race (p = 0.003, d = 0.201). This can be explained through the acquired log data. Log data show that players' gameplay mostly matched expected learning during the game, with physically correct game settings occurring more and more as gameplay progressed. The ability to transfer learned knowledge to other situations was shown to be limited to situations closely resembling the game environment. Implications: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time. To foster transfer to other situations we propose embedding the game within other instructional activities. Lay Description: What is already known about this topic?: Research on cognitive effects of educational games in general shows promising results.There are large variations in learning outcomes between individual educational games.Some design aspects remain unclear on the design process and different design elements of educational games.Attempting to integrate learning with gameplay, without affecting the enjoyability of the game, is not easily achieved. What this paper adds?: The current study fits within the research body that emphasizes the importance of aligning gameplay with learning in educational games (i.e., intrinsic integration).Evidence for intrinsic integration as a key element in the design process, found by examining players' log data.A better understanding of how an intrinsically integrated game supports the learning of Newtonian mechanics. Implications for practice and/or policy: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time.To foster transfer to other situations we propose embedding the game within other instructional activities. [ABSTRACT FROM AUTHOR]

Background Literature relating older people's goals of care to their varying frailty status is scarce. Objective To investigate goals of care in case of acute and/or severe disease in relationship to frailty status among the general older population. Method Older people aged ≥70 in the Netherlands completed a questionnaire. They were divided into three subgroups based on a self-reported Clinical Frailty Scale: fit (CFS 1–3), mildly frail (CFS 4–5) and severely frail (CFS 6–8). Seven goals were graded as unimportant (1–5), somewhat important (6–7) or very important (8–10): extending life, preserving quality of life (QoL), staying independent, relieving symptoms, supporting others, preventing hospital admission and preventing nursing home admission. Results Of the 1,278 participants (median age 76 years, 63% female), 57% was fit, 32% mildly frail and 12% severely frail. Overall, participants most frequently considered preventing nursing home admission as very important (87%), followed by staying independent (84%) and preserving QoL (83%), and least frequently considered extending life as very important (31%). All frailty subgroups reported similar preferences out of the surveyed goals as the overall study population. However, participants with a higher frailty status attached slightly less importance to each individual goal compared with fit participants (P trend-values ≤ 0.037). Conclusion Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The recent growth of the aviation industry, which poses significant environmental challenges, has heightened the pressure on the sustainability of airports. Airport sustainability requires a holistic approach that encompasses economic, social, environmental, and operational aspects. In this regard, the United Nations' 17 Sustainable Development Goals (SDGs) Agenda provides a roadmap for the aviation industry. However, despite recognizing the importance of SDGs, aviation authorities and airports often fail to effectively integrate them into their activities and annual reports. OBJECTIVE: This study aims to evaluate the significance of SDGs for airports and select the airport that prioritizes SDGs the most using Multi-Criteria Decision Making (MCDM) methodologies. METHODS: This study introduces a novel approach that integrates Step-wise Weight Assessment Ratio Analysis (SWARA) and Weighted Aggregated Sum Product Assessment (WASPAS) methods, which are MCDM techniques, to enhance airport sustainability. The SWARA method is employed to evaluate and assign weights to the SDGs in the context of airports. RESULTS: SDG 8 holds the highest level of significance among the goals concerning airports, while SDG 14 falls outside the scope of airport sustainability aspects. Then, five international airports that have been designated as green airports by aviation authorities and assessment organizations are selected, and the optimal alternative is determined using the WASPAS method, considering the weights obtained through SWARA. CONCLUSION: Dallas/Fort Worth International Airport is the top choice due to its successful implementations and reports aligning with the SDGs. [ABSTRACT FROM AUTHOR]

Purpose: Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequence, healthcare providers and organizations often lack knowledge to implement and align reablement to their national and local context. This study aimed to collect data on goal-setting and achievement, and multidisciplinary collaboration within reablement services to provide insight into how these processes inform reablement practice as well as to explore the experiences of healthcare professionals in Norway, New Zealand, and the Netherlands. Material and Methods: A qualitative exploratory design was used comprising three focus group interviews with 20 healthcare professionals (nursing and allied health) involved in reablement programs from the three countries. Purposive sampling was employed considering a mix of gender, age and educational level. Results: Findings reflected healthcare professionals' experiences and reablement processes in three main themes: (1) Goal-setting processes; clearly demonstrating goal-setting as an essential part of reablement and contributing to better understanding of users' motives; (2) Impact of goal-setting on multidisciplinary collaboration; promoting a sense of community, learning climate, job satisfaction and task-shifting; and (3) Behavior change techniques used to reach users' goals, promoting self-reflection and changing users' perspectives. Conclusion: This study offers valuable insights from three countries. Goal-setting serves a crucial role enabling effective reablement implementation across diverse contexts. More specifically, to facilitate tailoring of reablement programs to the user's needs as well as establish more effective multidisciplinary collaboration by promoting trust, shared vision, and utilizing each other's expertise. However, despite the acknowledgement of the significance of reablement, it was reported by all that a cultural shift is necessary for users, informal caregivers as well as healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design: Implementation Research. Setting: Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants: Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention: Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results: The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s): This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended. [ABSTRACT FROM AUTHOR]

Background: At the COP21, cities were recognised as key actors in combatting climate change. In supporting cities, climate city networks such as transnational climate networks (TCNs) and national climate networks (NCNs) have emerged to enable cities in building capacities and formulating climate policy whilst also encouraging citizen engagement and participation in public decision-making. This paper addresses the question whether and how TCN or NCN membership enables municipalities to implement citizen participation in public decision-making. Six propositions are presented addressing: presumed influence of TCN membership on citizen participation, organization of citizen participation, initiator capacity, goal setting, involvement of stakeholders, participatory methods used, and planning processes. A multi-case study research design is used to verify these propositions, comprising of four medium-sized cities in the Netherlands and three in Belgium. Results: Results of the analysis of four cities in The Netherlands show that municipalities having membership to climate city networks only to a low extent empower citizen participation via local climate agendas. Citizen participation emerges rather bottom-up via local initiatives or capacity building via EU framework programs—outside TCNs or NCNs—that better suit financial needs and provide more immediate benefits to municipalities. None of the six propositions were confirmed. A more positive image resulted from the Belgian cases that moderately confirmed four out of six propositions (i.e., organizing citizen participation, goal setting, selection of methods, and planning), and featured indirect empowerment via externally funded implementation projects following firm integration of participation in local climate policy through TCN influence. Conclusions: In terms of citizen participation selected municipalities in the Netherlands having TCN and/or NCN membership only to a small extent differ from those not having membership. This is partly due to poor implementation of TCNs and NCNs—with Covenant of Mayors and 'Klimaatverbond' lacking support structure and capacity—having lost importance during the past years. However, there is reason to believe that context makes a difference as revealed by the cases from Belgium, which revealed more positive results. [ABSTRACT FROM AUTHOR]

As research has become part of chaplaincy, many chaplains become involved in research, often in the double-role of chaplain-researcher. Despite the increase of involvement in research, how conducting research benefits chaplains' professional care for clients has not been studied. The present study aimed to describe how chaplains perceive the impact of participation in the Dutch Case Studies Project (CSP) on their professional expertise and positioning in the institution. A survey was distributed among participants of the CSP (N = 50) and was completed by 48 participants. We found that participation in research contributed to the expertise of chaplains (e.g., its goal-orientation, the use of theory and method) and their positioning as they try to legitimate their profession. This study thus substantiates the presumption that chaplains' engaging in research as chaplain-researcher contributes to the perceived improvement of the quality of chaplaincy care and its legitimation. [ABSTRACT FROM AUTHOR]

The author shares his view on older people's goals of care and person-centredness. He points out the inconsistent treatment of dementia and agrees with the treatment of iron deficiency anaemia in older people with intravenous iron supplementation. He raises the concern about the effects of antithrombotic treatment on frail older people undergoing rehabilitation.

Purpose: The purpose of this study was to explore the use of Complete Vocal Technique (CVT) voice therapy in acquired brain injury (ABI) patients Study: This study is an exploratory retrospective study. Method: Five ABI patients (two female and three male) with an average age of 20.6 years (SD = 3.5) received CVT voice therapy from an authorized CVT teacher at a neurorehabilitation facility in conjunction with physical rehabilitation therapy and speech and language therapy. Pre- and postmeasures included Voice Handicap Index, Maximum Phonation Time, electroglottography, and acoustic measures. Results: All voice measures improved for all five patients after receiving CVT voice therapy. Voice Handicap Index scores decreased from an average of 48.4 to 22.8. Maximum Phonation Time improved while the electroglottography and acoustic data showed improved phonation stability in jitter and shimmer measures. Overall, following the intervention, patients demonstrated improved loudness range, improved range in contact quotient for different sound conditions, faster-paced speech, extended functional pitch range, and decrease in unwanted creaking and breathiness. Conclusions: The findings suggest that CVT may be used as therapy in ABI populations with promising results. Both patient self-assessment and objective voice measures demonstrate improved voice function. Given the longitudinal nature of recovery in ABI patients, more studies are needed to qualify at which stage(s) of recovery the CVT interventions are most effective and beneficial. Randomized controlled trials for specific patient populations of ABI are needed to assess the interventions' effectiveness in specific ABI diagnoses. [ABSTRACT FROM AUTHOR]

A substantial number of (mostly health care) chaplaincy articles have emphasized the need for chaplaincy outcome research. In this study, we contribute to formulating intrinsic chaplaincy outcomes by first identifying chaplaincy goals. To this end, we have performed a scoping review of Dutch chaplaincy literature. We have focused on articles, books, and dissertations published between 2014 and 2019. Six distinct goals of chaplaincy were identified, using 86 fragments found in 33 sources: worldview vitality and plausibility, processing life events, deepening spirituality, relational affirmation, well-being, and exercising freedom of religion. Several of these main goals could be subdivided into more specific goals. Future research is needed to examine whether the found goals apply equally within the different types of chaplaincy and to examine their interrelations. In addition, future research should examine how these goals are pursued in practice and how they relate to client needs. [ABSTRACT FROM AUTHOR]

Introduction: In 24/7 disability care facilities, patient‐reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies. Methods: We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managers and 4 organization representatives. Data collection included observations during kick‐offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis. Results: The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID‐19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level. Conclusion: The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility‐specific learning goals. Stakeholder engagement and co‐created strategies may have strengthened the adoption of and experiences with the implementation. Patient or Public Contribution: In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainers and professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionals and managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact. [ABSTRACT FROM AUTHOR]

• The study proposes an analytical framework which draws on, and merges, two perspectives: multi-level governance and capacities for transformative climate governance. • Capacity development in the regional energy transition requires a governance mode that is geared towards a goal-oriented multi-actor yet flexible collaboration. • The Dutch regional energy strategy (RES) is a new type of governance arrangement that is suitable for facilitating orchestration in the regional energy transition. • RES allows for engagement of a variety of actors but suffers from undefined roles and ambiguous responsibilities of actors who are used to work in a hierarchical set up. • The current RES arrangement is characterised by a high dependence on traditional hierarchical structures and high transaction costs. In this paper we analyse how interactions between governing bodies influence Dutch energy regions' capacity to govern the energy transition. We develop an analytical framework which draws on, and merges, two different theoretical perspectives: multi-level governance and capacities for transformative climate governance. We apply this framework in an exploratory case study of the Dutch energy regions Holland Rijnland and Noordoost Brabant. Results are primarily derived using a set of interviews and desk study. Aided by the framework, we find that, while the Regional Energy Strategy (RES) arrangement is clearly geared towards facilitating orchestration through coordination and exchange of ideas and standpoints, the current governance approach, is hindered by unclear and ambiguous roles and responsibilities, a referral back to and dependence on traditional hierarchical structures, and high transaction costs. These interactions negatively influence capacity development in the regional energy transition by complicating strategic alignment and the creation of opportunity contexts. [ABSTRACT FROM AUTHOR]

Background: Due to the rising number of acutely hospitalised older people in the coming years, there is increased interest in tailoring care to the individual goals and preferences of patients in order to reach patient‐centred care. Aims: To investigate the goals of older hospitalised patients and the extent to which these goals were reached during hospitalisation. Methods: A single‐centre prospective cohort study was performed in The Netherlands between December 2017 and January 2018. Participants aged 70 years or older were included. In the first 3 days of hospitalisation, a semi‐structured interview was conducted to assess the patient goals regarding the hospital admission. At 1−2 weeks after discharge, patients were asked to what extent the recent hospitalisation had contributed to reaching their goals. Results: One hundred and four patients were included and follow up was completed for 86 patients. The main goals reported at hospital admission were 'remaining alive' (72.1%), 'feeling better' (71.2%) and 'improving condition' (65.4%). Hospitalisation seemed to have a positive contribution to reaching the goals 'remaining alive', 'knowing what is wrong', 'feeling better', 'reducing pain' and 'controlling disease'. Hospitalisation seemed to contribute little to reaching the goals in the categories 'enjoying life', 'independency and freedom', 'improving daily functioning', 'hobbies and work' and 'social functioning'. Conclusions: It is important for healthcare professionals to know the goals of their patients. The majority of these goals were not achieved at hospital discharge. It is important to be aware of this, so sufficient aftercare can be arranged and patients can be prepared. [ABSTRACT FROM AUTHOR]

Currently, Europe is dealing with a large number of asylum seekers. A recent report show that attitudes toward asylum seekers are not that negative in the Netherlands, and yet Dutch citizens living close to asylum seeker centers barely have contact with them. Because contact is vital for a multicultural society, we investigated the facilitators and barriers for Dutch citizens to establish and maintain contact with asylum seekers where they live close together. We conducted semistructured interviews with Dutch people and analyzed them using thematic analysis. We found four themes: Physical possibilities for Contact, Goals for Contact, Social Identities, and Positivity and Openness, and proposed a grounded theory model based on how the themes are related. The findings are discussed in relation to debates on multiculturalism and intergroup tolerance, and can be used to improve the integration policies by local governments, because they present clear conditions and practical information as to how contact can be established and maintained. [ABSTRACT FROM AUTHOR]

Healthy eating can be challenging for type 2 diabetes mellitus (T2DM) patients. The theory of salutogenesis, which focuses on the resources required to organize behavioural changes in everyday life, was used to develop an intervention for healthy eating. The aim was to describe the development, structure and content of this salutogenic intervention. The development consisted of two phases that were based on the operationalization of important key principles of salutogenesis. In Phase 1 (Exploration and synthesis), a systematic review and three qualitative studies were performed to explore important characteristics to enable healthy eating in everyday life. The results were used to develop the draft intervention. In Phase 2 (Validation and adjustment), interviews and workshops were conducted with T2DM patients, healthcare providers and scientists. Based on this, the draft intervention was modified into its final form. The developmental process resulted in a 12-week, group-based intervention that aimed to enable important resources for healthy eating via self-examination, reflection, setting goals and sharing experiences. Attention was also paid to disease information, disease acceptance, food literacy, stress management, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. The researcher's translation of the stakeholders' priorities into an intervention was corrected for and approved by the stakeholders concerned. This comprehensive salutogenic intervention was developed based on practical and scientific evidence. Providing transparency in developmental processes and content is important because it determines the scientific integrity and credibility of an intervention. [ABSTRACT FROM AUTHOR]

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Summary: Recovery from stress is essential for employees' well-being, even more so in jobs where high stress is inevitable. The purpose of this study was to examine the influence of achievement goal orientation on recovery from stress (i.e. need for recovery and vigour) over several years. We followed a sample of social workers in the Netherlands (N = 238) across four years, with three measurement points (T1–T3). Data were analysed with latent growth curve modelling. Findings: Results showed that need for recovery and vigour were fairly stable over time and therefore we could not examine the effects of achievement goal orientation on change in vigour and need for recovery over time. However, level of mastery goal orientation (mastery-approach and mastery-avoidance goal orientation) at T1 was positively related to the initial level of vigour at T1, even after controlling for job autonomy and workload. Our results indicate that mastery goal orientation is relevant for employees to feel energetic and vital in a job with high stress. Practical implications: Our results showed that organizations can prevent depletion among social workers by ensuring an acceptable workload, while vigour can be enhanced by selecting employees with high mastery goal orientation. Organizations can also contribute to the vitality of social workers by stimulating and fostering mastery goal orientation. [ABSTRACT FROM AUTHOR]

Persons with profound intellectual disability (PID) are mostly not able to use assistive technology (AT) independently. Caregivers play an important mediating role in implementing AT in the daily life of persons with PID. Both first-order barriers, extrinsic to caregivers, and second-order barriers, intrinsic to caregivers, influence the attitudes and behaviors of caregivers with regard to AT-use. It could be asked if increased knowledge on and experience with AT may impact the effect of first- and second-order barriers. This study investigated how knowledge and experience influence the professional caregivers' beliefs about which factors may impact the AT use in persons with PID and their intentions to use AT for persons with PID. A questionnaire on the experienced limitations and successes in using AT was developed. The questionnaire was send to professionals working with or responsible for persons with PID in various countries in Europe. In total the answers of 195 respondents were included in this study. This study's results demonstrate that AT is used for various reasons in persons with PID, mostly to support communication and interaction or for fun or relaxation. Based on the answers of the respondents can be concluded that both experience and knowledge of caregivers seem to influence first- and second-order barriers. Besides, a possibility to overcome the second-order barriers is to provide professionals with possibilities to increase their knowledge and experience. AT for persons with PID is mostly used for communication and interaction or for fun and relaxation. Professional caregivers belief that AT-use may positively influence various aspects in the life of persons with PID, especially communication and interaction, active engagement and participation in activities, and self-esteem of the person. Caregivers need to have sufficient experience in order to rate the barriers of AT-use as less limited in the group of persons with PID. In order to overcome the barriers experienced in implementing AT in persons with PID, knowledge of caregivers is essential. [ABSTRACT FROM AUTHOR]

Energy saving is an explicit goal of housing retrofitting in both the Netherlands and China. Retrofit providers expect to achieve this goal by applying insulation to apartment buildings and improvements in heating, cooling and ventilation. The aim of this paper is to explore both conceptually and empirically the interactions between householders and retrofit providers. Interaction activities are conceptualized in a framework of overlapping practices of retrofitting and everyday life. Empirical material is derived from interviews with retrofit providers and householders in the Netherlands and China. This paper shows that full energy saving potential in housing retrofitting fails to be accomplished, due to a limited involvement of householders at the consumption junctions in retrofit processes. Central to this failure are the limited options for residents to share pre-retrofit living experiences, to test future housing equipment beforehand and to customize retrofit packages. Also post-retrofit educational support, evaluation and monitoring is falling short to engage householders in their appropriation of their retrofitted apartment. [ABSTRACT FROM AUTHOR]

Background: Rising healthcare costs, an increasing general practitioner shortage and an aging population have made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in Extended Scope Physiotherapy (ESP). Although studies have focused on the perceptions of different stakeholders in relation to ESP, there is a large variety in the interpretation of ESP.Aim: To identify a paradigm of ESP incorporating goals, roles and tasks, to provide a consistent approach for the implementation of ESP in primary care.Methods: An exploratory, qualitative multi-step design was used containing a scoping review, focus groups and semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and indirect stakeholders such as lecturers, health insurers and policymakers related to primary care physiotherapy. The main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated with ESP. The 'framework' method, developed by Ritchie & Spencer, was used as analytical approach to refine the framework.Results: Two focus groups and twelve semi-structured interviews were conducted to explore stakeholder perspectives on ESP in Dutch primary care. A total of 11 physiotherapists, six general practitioners, five patients and four indirect stakeholders participated in the study. There was a lot of support for 'decreasing healthcare costs', 'tackling increased health demand' and 'improving healthcare effectiveness' as main goals of ESP. The most agreement was reached on 'triaging', 'referring to specialists' and 'ordering diagnostic imaging' as tasks fitting for ESP. Most stakeholders also supported 'working in a multidisciplinary team', 'working as a consultant' and 'an ESP role separated from a physiotherapist role' as roles of ESP.Conclusions: Based on the scoping review, focus groups and interviews with direct and indirect stakeholders, it appears that there is sufficient support for ESP in the Netherlands. This study provides a clear presentation of how ESP can be conceptualized in primary care. A pilot focused on determining the feasibility of ESP in Dutch primary care will be the next step. [ABSTRACT FROM AUTHOR]

Worldwide, the use of private supplementary tutoring, commonly referred to as shadow education, has become increasingly prevalent since the turn of the millennium. Recently, participation rates in the Netherlands have substantially increased. This paper aims to explore the place of shadow education in students' academic lives by studying the goals and experienced benefits that students identify. Data were collected through 37 semi-structured interviews with tutored students in secondary education in the Netherlands. Our findings indicate that students conceived of shadow education as a skill-building institution to which they turned to for self-study, to receive career support, and to boost their performance. Students' reflections reveal that shadow education builds upon and extends, but does not replace, learning activities at home and school. Based on our findings, we discuss how shadow education can function as a "third place" between school and home, occupying an increasingly prominent position in students' academic lives. [ABSTRACT FROM AUTHOR]

Purpose: Applying evidence-based grammar intervention can be challenging for speech and language therapists (SLTs). Language in Interaction Therapy (LIT) is a focused stimulation intervention for children with weak morphosyntactic skills, which was developed to support SLTs in incorporating results from effect studies in daily practice. The aims of this Clinical Focus are (a) to explain the principles and elements of LIT and stimulate use in daily SLT practice and (b) to describe the effects of LIT on morphosyntactic skills of 4- to 5-year-olds in special education, compared to usual care. Method: With a description of LIT, we provide guidance to implement evidence-based intervention. Important elements are as follows: proper selection of therapy goals, language facilitating techniques, child-centered and cliniciandirected elements, and the use of scripts. Our focus in the description is on the support and practical solutions LIT tries to provide to SLTs. We also explored the implementation of LIT in special education, to improve morphosyntax in 4- and 5-year-old children. We provided SLTs with training and designed protocols for each therapy session. The effects of LIT were measured in a single-case A-B design, repeated in five children with developmental language disorders (ages 4;2-5;7 [years;months]). Conclusion: We conclude that implementation of LIT is possible if LIT is enriched with support in goal selection, protocols to guide therapy sessions, and training and coaching. In the single-case study, four children showed more growth in mean length of utterance during and directly following the LIT intervention phase, compared to the baseline phase with usual care, and in two of them, this difference was significant. The grammatical complexity measure "TARSP-P" showed an overall significantly higher score at group level during LIT, but limited effects on an individual level. [ABSTRACT FROM AUTHOR]

Aim: To explore perceptions and preferences of children, parents, and physical therapists regarding the therapeutic alliance in pediatric physical therapy in a rehabilitation setting. Methods: Qualitative phenomenological analysis of interviews with children (n = 10), their parents (n = 10), and physical therapists (n = 10). Results: Three themes were identified: importance of trust in the physical therapist, transparency in sharing information, and negotiation concerning goals and tasks of treatment. Parents considered trust in the therapist's relational skills of greater importance to the therapeutic alliance than the therapist's technical skills. Although the physical therapists showed a strong willingness to meet the needs of children and parents, they seemed unaware of the emotional impact of positional inequality and the differences in roles and tasks of children, parents, and therapists during the treatment. Conclusion: All participants emphasized the importance of the quality of the therapeutic alliance. Nevertheless, positional inequality and differences in roles and tasks appeared to influence negotiation about goals and tasks of treatment. Children and parents are in a dependent relationship with the physical therapist. Physical therapists are challenged to find the right balance between their professional position and input on the one hand, and the emotional needs of child and parents on the other hand. [ABSTRACT FROM AUTHOR]

This study focused on the question of how to enhance a mastery-goal orientation in the classroom. We started from the perspective of the achievement goal theory, which assumes that the goals that students have (personal goals) relate to the goals that are set in the classroom (classroom goal structures). In classrooms where teachers focus on learning and effort -instead of normative standards and social comparison- mastery goals are enhanced. This type of classroom can be endorsed by focusing on the following classroom structures: Task design, Autonomy, Recognition, Grouping, Evaluation, and Time (TARGET). The present study investigated how classroom goal structures as perceived by students are related to students' personal goals. Based on survey data from 501 students from three secondary schools in the Netherlands, we found that the Task design dimension, concerning designing challenging and varied tasks, and the Time dimension, concerning e.g., pacing, predicted both mastery-approach and avoidance goals. Our findings provide insight in how perceived classroom goal structures are related to students' personal goals that focus on understanding/competence, thus informing teachers and educational developers where to start when it comes to improving student motivation. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcomes (PROs) provide information on a patient's health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting. Methods: We developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted. Results: The final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process. Conclusion: We developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to focus on the denial of social support to homeless persons and related societal effects of new local governance arrangements. Design/methodology/approach: Analysis of new data and secondary evaluative and comparative data on the policies, administrative structures and management styles of Copenhagen, Glasgow and Amsterdam have brought better understanding of the elements of local governance arrangements that influence the number of homeless persons who are denied access to services and the number of persons sleeping rough who are not eligible for social support. Theoretical explanations for the impact of governance arrangements on these processes and societal effects are considered. Findings: It appears that while the body of research, reports and policy documents on non-eligibility for homelessness services is growing, legal responses at best remain vague, and policies are still in the process of being developed. Modest progress on policy goals, and even more so on policy instruments, leading to less detrimental outcomes, can be explained by centralising and decentralising trends and the relationships between state and society. The latter may also be indicative of how the increased focus on the legal problems of some EU migrants can be explained. Research limitations/implications: The two points in time documented for the case studies are relevant in understanding processes underlying the current circumstances of homeless persons and homeless migrants and offer an interdisciplinary insight into governance and politics, law, and public and health service perspectives. Social implications: Good policy practice, as this paper shows, can lead to a difference in individual lives. Originality/value: Much is unknown about considerations inside government. This paper contributes by combining theoretical and insider perspectives. [ABSTRACT FROM AUTHOR]

Objective: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. Design: Qualitative interview study. Setting: Three geriatric rehabilitation centers. Subjects: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. Methods: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. Results: During inpatient rehabilitation, participants' main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. Conclusion: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge. [ABSTRACT FROM AUTHOR]

Objectives: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). Methods: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. Results: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a “persistence phase,” characterized by the use of “resource-depleting” assimilative strategies to remain engaged in goals, (2) a “reorientation phase” in accommodative strategies were used to regain balance, and (3) a “balancing phase” in which a combination of “resource-depleting” and “resource-replenishing” assimilative strategies was used to maintain balance. Conclusions: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation: Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals. [ABSTRACT FROM AUTHOR]

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Purpose: To deliver client-centered care, physiotherapists need to identify the patients’ individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting. Methods: An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices. Results: Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course. Conclusions: The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated. Implications for rehabilitation: Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice. The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient’s goals. Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement. Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application. [ABSTRACT FROM AUTHOR]

Fitness wearables and apps provide users with quantified information about their exercise behaviour. Users often access this information on online fitness communities (OFCs) such as RunKeeper or Strava. These OFCs do not only provide feedback on the user's performance but also offer social features. To date, little is known about the extent to which the different features in OFCs answer to users' motivations to exercise. This study addresses this question, by examining (1) whether there are differences in motivations for running between OFC users and non-users and (2) whether the use of particular features is driven by particular running motivations. A survey study was conducted among 717 runners, of which 57% used an OFC to support running activities. Results demonstrate that OFC users are more achievement-oriented than non-OFC users, especially regarding the attainment of personal goals. OFC users with physical motivations (e.g. weight loss) use self-regulatory features more frequently, while runners with social motivations more often use features that afford them to share activities on social media. Achievement-oriented runners appreciate features that allow them to track their progress and interact with other OFC users. No relation was found between the use of OFC features and psychological motivations for running. [ABSTRACT FROM AUTHOR]

Within primary care, nurses are expected to set goals and make action plans with patients. However, little information is available on how this is done. The aim of this study is to gain insight into how nurses set goals and action plans with patients. Data were collected from three practice nurses working in elderly care and five patients in the Netherlands. Practice nurse is the term for the home care registered nurse in the Netherlands. Five home visits for which goal setting and action planning were the main agreed‐upon objectives, were video‐recorded and transcribed. We found that explicit goal setting was not observable. However, in 16 episodes, action plans were discussed. Action planning was always initiated by the nurse and was oriented toward offering professional help or assistance in order to solve the patient's problems. In response, patients tended to resist the proposed solutions, with the result that action planning was abandoned. By the nurse proposing professional help, patients were positioned as passive rather than active agents. Our results contribute to the understanding of how nurses’ communicative behavior influences the extent to which patients feel encouraged to actively participate in goal setting/action planning. [ABSTRACT FROM AUTHOR]

This study addresses the question to what extent frontline managers’ people management activities contribute to mission achievement through frontline workers’ behaviors. Drawing on the case of elderly care, we contribute to the literature by: (1) providing a compact measure of mission achievement in elderly care and specifying the requisite employee behaviors; and (2) showing that frontline managers’ people management activities impact on employees’ behaviors, and ultimately on mission achievement. In doing so, we also contribute to more knowledge about elderly care, which is an under-researched sector, and about the role of line managers (instead of top managers) in HRM implementation. [ABSTRACT FROM AUTHOR]

Abstract: Background: To meet the challenge of multimorbidity in decision making, a switch from a disease‐oriented to a goal‐oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. Objective: This study aimed to develop conceptual descriptions of goal‐oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. Method: Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis. Results: Clinicians distinguished disease‐ or symptom‐specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. “Fundamental goals” are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. Conclusion: Based on the perspectives of clinicians, we expanded the concept of goal‐oriented care by identifying a three‐level goal hierarchy. This model could facilitate collaborative goal‐setting for patients with multiple long‐term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice. [ABSTRACT FROM AUTHOR]

A strategy of defining and checking explicitly formulated patient-specific treatments targets or "daily goals" in the intensive care unit has been associated with improved communication. We investigated the effect of incorporation of daily goals into daily care planning on length of stay in the intensive care unit. Furthermore, the type of daily goals and deviations from daily goals in daily care with or without documented reason were evaluated. Four university hospitals in the Netherlands, of which 2 study "daily goal" hospitals and 2 control hospitals, participated in a prospective before-after study. During the before phase of the study, daily goals were formulated by the attending physician but kept blinded from doctors and nurses caring for the patient. During the after phase of the study, daily goals were integrated in the care plan for patients admitted to the 2 study hospitals but not for patients admitted to the control hospitals. The implementation of daily goals was, after case-mix correction, not associated with a change in intensive care unit length of stay. However, this study showed that an improved administrative discipline, that is, the recording of the reason why a daily goal or standard protocol was not accomplished, is in favor of the daily goal implementation. [ABSTRACT FROM AUTHOR]

This paper describes the development of a Dutch online programme called Long Live Love+ focusing on positive, coercion-free relationships, contraception use, and the prevention of STIs, using the Intervention Mapping (IM) approach. All six steps of the approach were followed. Step 1 confirmed the need for a sexual health programme targeting young people aged 15 and over enrolled in higher level secondary education. Step 2 resulted in the production of a series of matrices-of-changes, including detailed programme objectives at the behavioural and the psycho-social level. Step 3 involved the selection of relevant methods and applications. Step 4 consisted of programme development, resulting in a sexual health programme with online and offline components, and including interactive exercises. Step 5 focused on adoption and implementation and included the production of a detailed teacher manual. Step 6 involved detailed planning for the process and effect evaluation and included interviews with teachers and focus group discussions with students to evaluate their experiences of the programme. The inclusion of a linkage group – and especially the inclusion of teachers in the development of the programme – turned out to be essential in terms of developing a programme in line with their context and needs. [ABSTRACT FROM AUTHOR]

Purpose: While the impact of visual impairments on specific aspects of young adults' lives is well recognised, a systematic understanding of its impact on all life aspects is lacking. This study aims to provide an overview of life aspects affected by visual impairment in young adults (aged 18-25 years) using a concept-mapping approach. Method: Visually impaired young adults (n = 22) and rehabilitation professionals (n = 16) participated in online concept-mapping workshops (brainstorm procedure), to explore how having a visual impairment influences the lives of young adults. Statements were categorised based on similarity and importance. Using multidimensional scaling, concept maps were produced and interpreted. Results: A total of 59 and 260 statements were generated by young adults and professionals, respectively, resulting in 99 individual statements after checking and deduplication. The combined concept map revealed 11 clusters: work, study, information and regulations, social skills, living independently, computer, social relationships, sport and activities, mobility, leisure time, and hobby. Conclusions: The concept maps provided useful insight into activities influenced by visual impairments in young adults, which can be used by rehabilitation centres to improve their services. This might help in goal setting, rehabilitation referral and successful transition to adult life, ultimately increasing participation and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to develop a whole medical system healthcare program as an alternative for group-oriented guidelines and as a basis for future studies on safety and (cost) effects. Mild to moderately severe depressive disorders were chosen as an illustrative example. Design: Literature surveys, monodisciplinary expert interviews, and multidisciplinary panel discussions were employed to describe the whole medical system, its important elements, and the way the important elements are integrated in daily practice. Results: The treatment of depressive disorders consists of four separate treatment phases in which 10 specific treatment goals are identified. Different disciplines may contribute to each goal. This gives an opportunity for the individualization of care. Within each discipline multiple options per goal are identified which leads to additional possibilities to individualize care. Conclusions: Individualized healthcare for patients with mild to moderately severe depressive disorders can be described in terms of treatment goals and treatment options to allow for personalization. The program may serve as the basis for future measurement of quality, cost effectiveness, and safety of provided care. [ABSTRACT FROM AUTHOR]

Objective About 20% of patients with type 2 diabetes achieve all their treatment targets. Shared decision making ( SDM) using a support aid based on the 5-years results of the ADDITION study on multifactorial treatment, could increase this proportion. Research design and methods Cluster-randomized trial in 35 former ADDITION primary care practices. Practices were randomized to SDM or care as usual (1:1). Both ADDITION and non- ADDITION type 2 diabetes patients, 60-80 years, known with diabetes for 8-12 years, were included. In the intervention group, patients were presented evidence about the relationship between treatment intensity and cardiovascular events. They chose intensive or less intensive treatment and prioritized their targets. After 1 year priorities could be rearranged. Follow-up: 24 months. Intention-to-treat analysis. Main outcome measure: proportion of patients that achieved all three treatment targets. Results At baseline 26.4% in the SDM group (n=72) had already achieved all three treatment goals ( CG: 23.5%, n=81). In the SDM group 44 patients chose intensive treatment, 25 continued their former less intensive treatment and three people switched from the more to the less intensive protocol. After 24 months 31.8% of the patients in the SDM group achieved all three treatment targets ( CG: 25.3%), RR 1.26 (95% CI 0.81-1.95). Mean systolic blood pressure decreased in the SDM group (−5.4 mm Hg, P<.01), mean HbA1c and total cholesterol did not change. Conclusions Despite an already high baseline level of diabetes care, we found strong indications that SDM on both intensity of treatment and prioritizing treatment goals further improved outcomes. [ABSTRACT FROM AUTHOR]

There are only limited treatment options available for brain tumor patients. In order to assess whether the (oncological) benefits outweigh the (functional) risks of treatment for an individual patient, it is important that physicians involve patients in decision-making and personalize the process. The aim of this study is to evaluate shared decision-making (SDM) during consultations of brain tumor patients and their neurosurgeons. For this observational study we collected 66 audio-recordings of pre-surgical consultations of adult brain tumor patients (glioma, meningioma) and neurosurgeons. A preliminary analysis based on a SDM template was conducted on 14/66 transcribed audio-recordings to assess in how many consultations the following key elements of SDM were present, namely 1) offering a choice to the patient and emphasizing that the patient's opinion is important in the decision, 2) discussing treatment options with benefits and risks and 3) asking about treatment preferences and personal goals. Next, thematic analysis will be performed by two independent researchers until data saturation is reached to gain insight into SDM. Preliminary Findings: show that 1) offering the patient a choice and emphasizing that the patient's opinion is important in decisions was done in 12/14 consultations; 2) discussing treatment options with benefits and risks was present in every consultation (14/14); and 3) in 12/14 consultations the neurosurgeon asked the patient about their treatment preference. However, explicitly asking the patient about personal goals occurred only in 3/14 consultations. By the time of the conference, we expect to have explored the decision-making process more in-depth and will be able to share the themes we have identified related to SDM. Key elements of SDM were present in most pre-surgical consultations, except for asking patients about their personal goals. This element seems pivotal for personalizing the decision-making process and making it truly shared. [ABSTRACT FROM AUTHOR]

Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method.Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports.Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the 'setting goals' and 'planning treatment' steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour.Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: Play is essential for children's development. Children with severe physical disabilities often experience problems engaging in play. In rehabilitation and special education for children with physical disabilities play-like activities and play for play's sake are important. OBJECTIVE: The current study aimed at examining the possibilities of using the IROMEC robot in rehabilitation and special education for children with severe physical disabilities. METHODS: A mixed methods approach, using individual interviews, two rounds of focus group interviews, a questionnaire and a final session to reach consensus, was used to examine the match between the goals in therapy and special education and the IROMEC robot. RESULTS: The existing play scenarios of IROMEC have the potential to support play for children with severe physical disabilities, especially in the domains of movement functions, learning and applying knowledge, communication/interpersonal interactions and relationships, and play. CONCLUSIONS: The current study helped to build a body of evidence to the possibilities of the IROMEC robot. The results of this study can be used to further develop meaningful robotic play interventions for children with severe physical disabilities. [ABSTRACT FROM AUTHOR]

The present paper addresses two crafting strategies employees may display in different life domains in order to attain desired outcomes. On the one hand, job crafting is targeted at increasing social and structural job resources and challenging job demands. On the other hand, leisure crafting is the proactive pursuit of leisure activities targeted at goal setting, human connection, learning, and personal development. We hypothesized that job crafting relates positively to employee work engagement and meaning-making, especially when occupational role salience is high. Furthermore, we hypothesized that leisure crafting relates positively to meaning-making, especially when job crafting opportunities are low. Using a sample of 105 Dutch employees and a weekly survey with three measurements, we found support for most of our hypotheses. All job crafting dimensions related positively to work engagement when occupational role salience was high. Also, increasing structural resources related positively to meaning-making when occupational role salience was high. Leisure crafting related positively to meaning-making when job crafting opportunities were low. We discuss directions for future research on work and leisure, and suggest how employees and organizations may benefit by encouraging job and leisure crafting. Practitioner points Employees can proactively build their own work engagement using job crafting, especially when they view their work as a source of personal satisfaction and development., In workplaces where opportunities to craft are low, employees could focus on their leisure time as a source of meaning and self-reflection., Managers can empower and coach employees to proactively seek growth and self-fulfilment both at work and outside work, via job crafting and leisure crafting., Organizations and managers should encourage employees to flourish not only at work but also during leisure time, communicating that work and leisure are two life domains that can help and complement each other. [ABSTRACT FROM AUTHOR]

Most people with profound intellectual and multiple disabilities (PIMD) have limited social contact and it is unclear what is done to maintain or increase these contacts. Individual support planning (ISP) can be used in the systematic enhancement of social contacts. This study analyses the content of ISPs with respect to the social contacts of people with PIMD. ISPs for 60 persons with PIMD in the Netherlands were inductively coded and illustrated with quotations. It turned out that every ISP contained information about social contacts. Of all the quotations extracted, 71.2% were about current conditions, 6.2% were about the future and less than 1% concerned actual goals. The social contacts of people with PIMD are mentioned in their ISPs, but this is rarely translated into goals. The results of the current study suggest that attention should be paid to ensuring that professionals understand the importance of social contacts and their application in practice. [ABSTRACT FROM AUTHOR]

Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal-related self-efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal-related self-efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal-related self-efficacy was positively related to QoL ( β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress ( β = −0.45, P < 0.001), income ( β = 0.14, P = 0.002) and being institutionalised ( β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal-related self-efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal-related self-efficacy by strength-based interventions. [ABSTRACT FROM AUTHOR]

Objectives To explore changes in care goals and treatment orders around the occurrence of pneumonia and intake problems, and whether hospitalization is in line with earlier agreed-upon do-not-hospitalize orders. Design Data were collected as part of the Dutch End of Life in Dementia study (2007-2011), a longitudinal observational study with up to 3.5 years of follow-up. Setting Long-term care facilities (N = 28) in the Netherlands. Participants Newly admitted nursing home patients (N = 372) in various stages of dementia. Measurements Semiannually, physicians completed questionnaires about care goals and treatment orders, and they continuously registered episodes of pneumonia, intake problems and hospitalization. We report on changes in care goals and treatment orders during follow-up in relation to the developing of pneumonia and intake problems and on hospitalization and reasons for hospitalization. Results The proportion of patients with palliative care goals and do-not-treat orders rose during follow-up, especially before death. Treatment orders most frequently referred to resuscitation and hospitalization (do-not order increased from 73% to 92%, and from 28% to 76%, respectively). The proportions of patients with a palliative care goal and do-not-treat orders were similar after developing pneumonia, but increased after intake problems. During follow-up, 46 patients were hospitalized one or more times. Hospitalization occurred despite a do-not-hospitalize order in 21% of decisions. The most frequently reported reason for hospitalization was a fracture, especially in patients with a do-not-hospitalize order. Conclusion Care plans, including global care goals (predominantly palliative care goals), are made soon after admission, and specific treatment orders are agreed upon in more detail when the condition of the patient worsens. Establishing care plans shortly after nursing home admission may help to prevent burdensome treatment. [ABSTRACT FROM AUTHOR]

Background: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings.Methods: The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands.Results: A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented.Conclusions: The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed.Significance: A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally. [ABSTRACT FROM AUTHOR]

Process evaluations of newly developed interventions are necessary to identify effective and less effective intervention components. First aim of this study was to identify key components of a psychosocial goal management intervention from the perspective of participants, and second aim was to evaluate the intervention’s fidelity. A mixed-methods approach was applied to 24 interviews with participants post-intervention and 16 audio recordings of random training sessions. Participants experienced three key components: (1) the content, in which specific exercises helped to raise awareness and (intention to) change goal management behaviour, (2) person-focused approach, specifically, the nurse as trainer and personal fit of the approach, and (3) social mechanisms, including facilitating group processes and interpersonal processes. Adherence to the protocol by the trainers was high, while differences were found in the degree to which they were able to apply the intended collaborative approach and psychological communication skills. The applied design provided valuable insights into the processes that took place. Both the effects experienced by participants in relationship to the content, approach and social mechanisms as well as the strengths and weaknesses found with regard to fidelity provide insights that can inform the development and implementation of person-focused interventions. [ABSTRACT FROM AUTHOR]

Objective: In 2006, a goal of reducing seclusion in Dutch hospitals by at least 10% each year was set. More than 100 reduction projects in 55 hospitals have been conducted, with €35 million in funding. This study evaluated the results.Methods: Data (2008 to 2013) were from a national register. Multilevel logistic regression examined determinants of seclusion.Results: Hospital participation in the register ranged from eight in 2008 to 66 in 2013, and admissions ranged from 11,300 to 113,290. The average yearly nationwide reduction of secluded patients was about 9%. Reduction was achieved in half of the hospitals. Some hospitals saw increased rates. In some hospitals where seclusion decreased, use of forced medication increased. Higher seclusion rates were associated with psychotic and bipolar disorders, male gender, and several ward types.Conclusions: Seclusion decreased significantly, and forced medication increased. Rates varied widely between hospitals. For many hospitals, more efforts to reduce seclusion are needed. [ABSTRACT FROM AUTHOR]