Search

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]

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]

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]

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]

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]

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]

Study Objective: The potential of perioperative goal-directed therapy (PGDT) to improve outcome after high-risk abdominal surgery remains subject of debate. In particular, there is a need for large, multicenter trials focusing on relevant patient outcomes to confirm the evidence found in small, single center studies including minor complications in their composite endpoints. The present study therefore aims to investigate the effect of an arterial waveform analysis based PGDT algorithm on the incidence of major complications including mortality after high-risk abdominal surgery.Design: Prospective randomized controlled multicenter trial.Setting: Operating theatres and Post-Anesthesia/Intensive Care units (PACU/ICU) of four tertiary hospitals in The Netherlands.Patients: A total number of 482 patients undergoing elective, abdominal surgery that is considered high-risk due to the extent of the procedure and/or patient comorbidities.Interventions: Hemodynamic therapy using an age-specific PGDT algorithm including cardiac index (CI) and stroke volume variation (SVV) measurements during a 24-h perioperative period starting at induction of anesthesia.Measurements: The average number of major complications (including mortality) within 30 days after surgery, the number of minor complications, hospital and PACU/ICU length of stay (LOS), amounts of fluids and vasoactive medications used. Complications were graded using the Accordion severity grading system.Results: The average number of major complications per patient was 0.79 (PGDT group) versus 0.69 (control group) (p = 0.195). There were no statistically significant differences in the number of minor complications, hospital LOS, PACU/ICU LOS, or grading of complications. Patients in the PGDT group received more fluids intraoperatively, more dobutamine intra- and postoperatively, while patients in the control group received more phenylephrine during the operation.Conclusions: PGDT based on a CI and SVV driven algorithm did not result in improved outcomes after high-risk abdominal surgery.Clinical Trial Registration: Netherlands Trial Registry: NTR3380. [ABSTRACT FROM AUTHOR]

Within the EU, energy transition at the local level is embedded in a complex stakeholder network with highly interdependent actors; if these actors have to collaborate to contribute to an efficient transition, they have to initiate a dialogue about their roles and interests. A good way to achieve this goal could be via serious gaming. Scholars suggest that serious games have the potential to increase multi-stakeholder's dialogue and collaboration on climate-change-related issues; however, empirical evidence on the effectiveness, and the process is still limited. The aim of this paper is to use the We-Energy Game as a case study to provide empirical evidence on how serious gaming could facilitate dialogue and collaboration among different stakeholders, and which specific features influence the engagement of participants with the issue. For that purpose, a qualitative analysis on feedback and observations of group discussions is conducted, together with a survey for 125 stakeholders from diverse municipalities in The Netherlands to assess what type of features influence the engagement. The study reveals that the game engages participants mostly at the cognitive level, and that key elements in this process are game design, the debriefing session, and the role of the facilitator. [ABSTRACT FROM AUTHOR]