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Item does not contain fulltext, BACKGROUND: During the course of their disease, patients are, apart from suffering physical discomfort, also confronted with psychological, social, and spiritual challenges. However, healthcare professionals often lack the knowledge and skills to address the spiritual dimension and are in need of support for taking this responsibility. Spiritual caregivers are experts in spiritual care, but their contribution to the integration of this care by other healthcare professionals is largely unknown. OBJECTIVE: The aim of this study was to investigate how Dutch spiritual caregivers view their role in increasing the integration of spiritual care in daily healthcare practice as provided by other healthcare professionals in the Netherlands, and how they address this role. METHODS: An online survey was conducted from May until June 2021 among spiritual caregivers working in Dutch healthcare. Data were analysed using descriptive statistics. RESULTS: The majority of the 174 respondents answered that they already fulfil a role in the integration of spiritual care by, for example, providing education, coaching on the job, or participating in multidisciplinary consultation. However, the majority of respondents experienced barriers to their contribution, such as confusion of terminology and use of language while collaborating with other healthcare professionals and reluctance to share information. CONCLUSIONS: While spiritual caregivers realise having the potential to make important contributions to the further process of integration of spiritual care into the daily practice of other healthcare professionals, some practices and perceptions, especially from within their own discipline, may hamper this.

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OBJECTIVES: Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA. METHODS: In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC). RESULTS: Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in

Contains fulltext : 194357.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 190142.pdf (publisher's version ) (Open Access)

Jaarlijks voert het PBL een lichte actualisatie uit op de Nederlandse ramingen voor de emissies van luchtverontreinigende stoffen met bijdragen van het RIVM. De ramingen geven de verwachte toekomstige ontwikkeling van emissies tot 2030. Deze notitie toont de actualisatie voor de rapportage 2017, inclusief een korte toelichting op de belangrijkste veranderingen ten opzichte van de ramingen die gemaakt zijn in het kader van de Nationale Energieverkenningen uit 2015 (NEV 2015).

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11 juli 2016, Contains fulltext : 167536.pdf (publisher's version ) (Open Access), BACKGROUND: In the Netherlands, consent from relatives is obligatory for post mortal donation. This study explored the perspectives of relatives regarding the request for consent for donation in cases without donor registration. METHODS: A content analysis of narratives of 24 bereaved relatives (14 in-depth interviews and one letter) of unregistered, eligible, brain-dead donors was performed. RESULTS: Relatives of unregistered, brain-dead patients usually refuse consent for donation, even if they harbour pro-donation attitudes themselves, or knew that the deceased favoured organ donation. Half of those who refused consent for donation mentioned afterwards that it could have been an option. The decision not to consent to donation is attributed to contextual factors, such as feeling overwhelmed by the notification of death immediately followed by the request; not being accustomed to speaking about death; inadequate support from other relatives or healthcare professionals, and lengthy procedures. CONCLUSION: Healthcare professionals could provide better support to relatives prior to donation requests, address their informational needs and adapt their message to individual circumstances. It is anticipated that the number of consenting families could be enlarged by examining the experience of decoupling and offering the possibility of consent for donation after circulatory death if families refuse consent for donation after brain-death.

13 september 2016, Promotores : Leeuwen, E. van, Vernooij-Dassen, M.J.F.J. Co-promotor : Smeets, W., Contains fulltext : 159498.pdf (publisher's version ) (Open Access), This thesis concerns the decision making process of relatives, who are requested to give consent for organ donation of their beloved brain dead patient. We did a literature review. Proxies are not always satisfied about their decision: 10% of families regrets consent, but over 33% of relatives who refuse donation regret their refusal afterwards. Focus interviews with physicians, ICU-nurses and transplant coordinators show that these caregivers are not aware of this regret. Relatives were approached with in deptht interviews about their decision making (proxies who gave consent as well as who refused donation).Relatives followed always the wish of the patient who was registered in the National Donor Register. If the patient was not registered, families did not always follow his wish –if known. In cases when the wish was not known, relatives mostly refused donation. These relatives are often ambivalent about their decision. Support in decision making is advised for these situations.

Contains fulltext : 154942.pdf (publisher's version ) (Open Access), BACKGROUND: This article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives. METHODS: A content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision. RESULTS: Three themes were identified: 'conditions', 'ethical considerations' and 'look back'. Conditions were: 'sense of urgency', 'incompetence to decide' and 'agreement between relatives'. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased's body, especially when they do not know his/her preference. Donor families respect the deceased's last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments (lack of time, information etc.). Some non-donor families would like to be supported during decision-making. DISCUSSION: The discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants (most non-donor families) stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased's wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families. CONCLUSION: Discrepancies between willingness to consent to

Kwalitatief onderzoek naar het beeld van de geestelijke verzorging bij de orthodox evangelische afkickkliniek De Hoop te Dordrecht.

Eén van de taken van geestelijk verzorgers betreft de professionele begeleiding van en hulpverlening aan mensen bij zingeving aan hun bestaan, vanuit en op basis van geloofs- en levensovertuiging. Binnen het werkveld Verpleeg- en Verzorgingshuizen komen geestelijk verzorgers hieromtrent veel in aanraking met dementerende ouderen. De toegang tot het levensverhaal is door de ziekte dementie gehinderd en soms geblokkeerd. Het gebruik van teksten kan een middel zijn om de toegang tot het levensverhaal te open en/of de dementerende oudere weer te verbinden met diens levensverhaal. In deze scriptie is onderzocht welke waarde geestelijk verzorgers toekennen aan kennis van het levensverhaal van de dementerende oudere in hun begeleiding bij zingeving aan het bestaan en hoe zij vervolgens omgaan met de keuze en inzet van teksten (geschreven, gezongen en afgebeeld).

In Nederland heeft iedereen die noodgedwongen meer dan 24 uur aaneengesloten in een instelling verblijft recht op geestelijke verzorging. Daarbuiten wordt verondersteld dat mensen zelf in hun behoefte aan geestelijke verzorging kunnen voorzien met gebruikmaking van bestaande levensbeschouwelijke netwerken . De vraag rijst dan natuurlijk welke geestelijke bijstand de cliënten ontvangen die wel extramurale zorg ontvangen maar niet deel uit maken van een levensbeschouwelijk netwerk. Dit onderzoek richt zich op de kunde van de zorg professionals – met name verpleegkundigen - om de zingevingsvraagstukken bij patiënten in de extramurale zorg te kunnen herkennen en waar nodig adequaat te kunnen optreden. De hoofdvraag van dit onderzoek luidt als volgt: In hoeverre en op welke wijze worden patiënten in de extramurale zorg door verpleegkundigen bijgestaan in hun zingevingsvraagstukken? De belangrijkste conclusies die er op basis van de onderzoeksresultaten gesteld kunnen worden zijn: - De persoonlijke waarden van verpleegkundigen spelen een zingevende en een motiverende rol in hun werk. - De verpleegkundigen halen daarnaast kracht uit hun persoonlijke bronnen van zingeving. - De verpleegkundigen kijken verschillend naar de oorsprong van de zingevingsvraagstukken van patiënten. - De verpleegkundigen maken veel gebruik van hun ‘gevoel’ in het detecteren van zingevingsvraagstukken. - Hoewel de zingevingsvraagstukken nadrukkelijker naar voren komen in de terminale fase, komen zij in de aard wel overeen met de vragen die geneeslijk zieken lijken te stellen. - De verpleegkundigen benadrukken dat zij vanuit hun werkgever veel vrijheid ervaren om tijd en ruimte te maken voor gesprekken over de zingevingsvraagstukken van patiënten. - De verpleegkundigen werken met veel verschillende disciplines en met externe partijen samen in hun zorg voor de patiënt. - De verpleegkundigen verwijzen zelden door naar een geestelijk verzorger of naar andere partijen die geestelijke bijstand bieden.

Contains fulltext : 138323.pdf (publisher's version ) (Open Access), BACKGROUND: Effectiveness of the donation request is generally measured by consent rates, rather than by relatives' satisfaction with their decision. Our aim was to elicit Dutch ICU staffs' views and experiences with the donation request, to investigate their awareness of (dis)satisfaction with donation decisions by relatives, specifically in the case of refusal, and to collect advice that may leave more relatives satisfied with their decision. METHODS: Five focus groups with a total of 32 participants (IC physicians, IC nurses and transplant coordinators) from five university hospitals in the Netherlands. Transcripts were examined using standard qualitative methods. RESULTS: Four themes (donation request perceived by ICU staff from the perspective of relatives; donation request perceived by ICU staff from their own perspective; aftercare; donation in society) divided into 14 categories were identified. According to ICU staff, relatives mentioned their own values more frequently than values of the potential donor as important for the decision. ICU staff observed this imbalance, but reacted empathically to the relatives' point of view. ICU staff rarely suggested reconsideration of refusal and did not ask relatives for arguments. ICU staff did not always feel comfortable with a request in the delicate context of brain death. Sometimes the interests of patient, relatives and those on the waiting list were irreconcilable. ICU staff were mostly unaware of relatives' regret following their decisions. Aftercare did not provide this type of information. Donation request by IC physicians was influenced by the way organ donation has been regulated in society (law, donor register, education, media). CONCLUSIONS: Our findings lead to the hypothesis that giving relatives more time and inviting them to reconsider their initial refusal will lead to a more stable decision and possibly more consent.

Dit onderzoeksproject betreft meditatie als mogelijk aanbod in de geestelijke verzorging. Dit tegen de achtergrond van maatschappelijke veranderingen aangaande (ons beeld van) levensbeschouwing, spirituele behoeftes en wensen van de patiënt, en geestelijke verzorging. Deze scriptie bespreekt de resultaten van kwantitatief onderzoek in een algemeen ziekenhuis in het zuiden van Nederland. De centrale vraag is of patiënten belangstelling hebben voor c.q. belang hechten aan een aanbod in meditatie en zo ja, of er een samenhang bestaat met demografische of levensbeschouwelijke kenmerken, of fysiek, psychisch en/of levensbeschouwelijk welzijn. Meditatie blijkt in de literatuur onderwerp van onduidelijke of elkaar tegensprekende definities. Feitelijk is meditatie echter een fluïde beoefening met vele al dan niet levensbeschouwelijke vormen, achtergronden en doelen. Daarmee kan meditatie een van de benaderingen voor geestelijke verzorging zijn, nu de Nederlandse patiënt niet altijd meer te definiëren valt aan de hand van levensbeschouwelijke gebondenheid. Er is weinig onderzoek te vinden over de levensbeschouwelijke wensen van patiënten van Nederlandse instellingen, maar Amerikaanse literatuur benoemt een toenemende belangstelling voor alternatieve benaderingen (complementary and alternative medicine, of CAM), waaronder meditatie. Ons onderzoek wijst uit dat de grootste groep patiënten geen belangstelling voor meditatie heeft. Deze groep is in het algemeen ouder, en religieus gebonden. N is voor relevante groepen respondenten te laag om significantie te verkrijgen aangaande verbanden. Onder de kleinere groep patiënten mét ervaring met meditatie is verband gevonden met ervaring met activiteiten geassocieerd met ongebonden spiritualiteit (Kronjee e.a.). Wensen inzake resultaten van meditatie liggen vooral op medisch of psychisch vlak. Een kleiner aantal mensen uit wensen op levensbeschouwelijk vlak. Patiënten hebben meestal nauwelijks of geen ervaring met meditatie. Deze bevi