Search

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-8519.2010.01810.x Byline: TINEKE A. ABMA (1), VIVIANNE E. BAUR (1), BERT MOLEWIJK (1), GUY A.M. WIDDERSHOVEN (1) Keywords: dialogical ethics; empirical ethics; participatory research; responsibility practices; elderly care; practice improvement; practical wisdom Abstract: ABSTRACT Since its origin bioethics has been a specialized, academic discipline, focussing on moral issues, using a vast set of globalized principles and rational techniques to evaluate and guide healthcare practices. With the emergence of a plural society, the loss of faith in experts and authorities and the decline of overarching grand narratives and shared moralities, a new approach to bioethics is needed. This approach implies a shift from an external critique of practices towards embedded ethics and interactive practice improvement, and from a legal defence of rights towards fostering interdependent practices of responsibility. This article describes these transitions within bioethics in relation to the broader societal and cultural dynamics within Western societies, and traces the implications for the methodologies and changing roles of the bioethicist. The bioethicist we foresee is not just a clever expert but also a relationally sensitive person who engages stakeholders in reciprocal dialogues about their practice of responsibility and helps to integrate various sorts of knowledge (embodied, experiential, visual, and cognitive-scientific). In order to illustrate this new approach, we present a case study. It concerns a project focusing on an innovation in elderly care, based on the participation of various stakeholders, especially older people themselves. Author Affiliation: (1)Department of Medical Humanities and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam Article note: Tineke A. Abma, Dept Medical Humanities, VU University Medical Centre, Postbox 7057, 1007 MB Amsterdam, The Netherlands. Email: t.abma@vumc.nl

Participatory action research is often informed by strength-based approaches such as appreciative inquiry. However, when social change and collective action appear to be difficult, feelings of powerlessness and suffering can arise. There is an ongoing debate on the place and importance of these so-called negative emotions within strength-based approaches. In a participatory action research project on citizen participation in the Netherlands we encountered a social and political context that was beyond our ability to change. We came to realize that change or action is not always possible in participatory action research and that 'pushing' for action can become a disempowering experience for those involved. In this article we share the moral dilemmas that we encountered and reflect on our own learning experiences as academic researchers. We argue that researchers need to anticipate upon these moral challenges by reflecting upon their personal position towards powerlessness and suffering. Nussbaum's notion of compassion can help researchers to create space for these experiences and to acknowledge these experiences as sources of generative knowledge. Researchers should carefully navigate between fostering action and expressing compassion in participatory action research. With this article we aim to contribute to a care ethical perspective on participatory action research that acknowledges vulnerabilities and precariousness in research practices. [ABSTRACT FROM AUTHOR]

Objectives: Many older adults have significant depressive symptoms but few people access care for these. This study explores which personal, clinical and need factors facilitate or hinder acceptance of a new outreaching preference-led intervention programme., Methods: From a sample of 9661 community-dwelling 65+ year olds, 244 persons with depressive symptoms according to the Patient Health Questionnaire-9 were included. Data on programme effectiveness in terms of care utilisation were collected. Associations between programme acceptance and personal, clinical and need factors were studied using quantitative (logistic regression analyses) and qualitative methods (semi-structured interviews with 26 subjects, who accepted (n = 20) or declined (n = 6) the programme)., Results: Fifty-six per cent (n = 137) took part in the interventions. Quantitative logistic regression analyses showed that participants were more often female, suffered from more severe depressive symptoms and perceived more loneliness. Qualitative analyses revealed that people accepting the intervention programme felt that medical terms as having a depressed mood were applicable to their situation, more often perceived their symptoms as hindering, felt lonely and more often perceived a need for care. They were more often advised by their general practitioner to participate than individuals who refused the interventions. Many participating individuals did not see a match between the intervention programme and their needs, especially with respect to meeting new people., Conclusion: Many older persons with depressive symptoms did not feel the need to take part in the programme. Providing support in alleviating loneliness and further adaptation to older adults' illness representations and perceptions when discussing depressive symptoms might enhance care utilisation.