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Background: The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings. Aim: To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic. Design: An open observational online survey was developed and disseminated via social media and public fora (March–July 2020). Data were analyzed using descriptive statistics and logistic regression analyses. Participants: Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic. Results: The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home ( n = 68), in a hospital ( n = 114), nursing home ( n = 176) or hospice ( n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate. Conclusion: End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.

The COVID-19 lockdown of Dutch long-term care facilities between March and May 2020 affected the quality of lives of residents and opposed professional and personal ethics of care. This article, based on 25 in-depth interviews with healthcare chaplains, gives insight into what moral challenges appeared for care professionals. Moral challenges were related to: ‘family ruptures’, ‘residents’ loneliness and despair’, ‘cold-hearted deaths’ and ‘response and responsibilities’. The findings illuminate the complexity of providing care during the lockdown and show variation in the impact of these ethical experiences, in which both moral distress and moral resilience occurred.

Universities worldwide struggle to confront student allegations of non-consensual sexual contact (NCSC). This research looks at views of the most at-risk population, students in their first year at the university, freshmen, about a federally mandated response to public accusations that schools conceal reports to protect their reputations. United States activists claim that university inaction results in the breach of Title IX civil rights to receive an education free of sexual harassment and gender-based discrimination. The Title IX Mandate compels employees of U.S. federally funded schools to report disclosures of NCSC to a designated responsible university official. The traditional top-down legislation imposes a one-size-fits-all standard that may exclude student voices and undermine their autonomy, although well-intended. This qualitative participatory action research study is grounded in social constructionist theory. It employs Appreciative Inquiry (AI), a social constructionist application, to facilitate a student-informed inquiry. The survey about the sensitive topic of NCSC includes an informational student-created video about the responsibilities of university faculty and staff when students tell them about experiences of sexual coercion. The AI framework is a strengths-based, solution-finding method that diverse cultures can apply to all levels of conflict. The premise of the research is that university communities can facilitate meaningful and restorative solutions consistent with goals of higher education to promote autonomy and ensure the benefits and opportunities of education for all students. The primary study goal is to examine views of university freshmen about the effects of the federal Title IX Mandate on disclosures of non-consensual sexual contact (NCSC). The research allies cutting-edge qualitative text and sentiment analysis using R analytics to delve into the underlying attitudes of university freshmen about NCSC. Study results indicate that 18-year-old students want universities to take a directive approach when handling disclosures of NCSC. Nineteen and 20-year-old freshmen report they prefer to exercise more control over the process of how their disclosures are managed. Sentiment analysis shows that freshmen feel empowered when schools provide resources and information about NCSC. Older freshmen indicate they would engage in professionally supported confrontation with the person or persons who force NCSC. Implications are that students want universities to offer choices about confronting their coercers. Institutions of higher education are equipped to facilitate age-pertinent, solution-finding processes such as Appreciative Inquiry to develop restorative ways to intervene with reports of NCSC. Offering alternative Restorative Justice pathways to confront coercers of NCSC is vital for young adult students to use their voices and reclaim dominion over their lives… lives all too often destroyed by the conflict of non-consensual sexual contact. Keywords: Title IX Mandate, non-consensual sexual contact, Appreciative Inquiry, Restorative Justice, university freshmen, qualitative sentiment analysis with R.

Background: Volunteers make a huge contribution to the health and wellbeing of the population and can improve satisfaction with care especially in the hospice setting. However, palliative and end-of-life-care volunteer services in the hospital setting are relatively uncommon. The iLIVE Volunteer Study, one of eight work-packages within the iLIVE Project, was tasked with developing a European Core Curriculum for End-of-Life-Care Volunteers in hospital. Aim: Establish an international consensus on the content of a European Core Curriculum for hospital end-of-life-care volunteer services which support patients in the last weeks of life. Design: Delphi Process comprising the following three stages: 1. Scoping review of literature into palliative care volunteers. 2. Two rounds of Delphi Questionnaire. 3. Nominal Group Meeting. Setting/participants: Sixty-six participants completed the Round 1 Delphi questionnaire; 75% (50/66) took part in Round 2. Seventeen participants attended the Nominal Group Meeting representing an international and multi-professional group including, clinicians, researchers and volunteer coordinators from the participating countries. Results: The scoping review identified 88 items for the Delphi questionnaire. Items encompassed organisational issues for implementation and topics for volunteer training. Three items were combined and one item added in Round 2. Following the Nominal Group Meeting 53/87 items reached consensus. Conclusion: Key items for volunteer training were agreed alongside items for implementation to embed the end-of-life-care volunteer service within the hospital. Recommendations for further research included in-depth assessment of the implementation and experiences of end-of-life-care volunteer services. The developed European Core Curriculum can be adapted to fit local cultural and organisational contexts.

While qualitative research on intellectual disability is on the rise, researchers have frequently reported that their methods bring methodological and ethical challenges. The authors advance shadow...

Background: Early indications were of a major decline in specialist palliative care volunteer numbers during COVID-19. It is important that ongoing deployment and role of volunteers is understood, given the dependence of many palliative care services on volunteers for quality care provision. Aim: To understand the roles and deployment of volunteers in specialist palliative care services as they have adjusted to the impact of COVID-19. Design: Observational multi-national study, using a cross-sectional online survey with closed and free-text option questions. Disseminated via social media, palliative care networks and key collaborators from May to July 2021. Setting/participants: Any specialist palliative care setting in any country, including hospices, day hospices, hospital based or community teams. The person responsible for managing the deployment of volunteers was invited to complete the survey. Results: Valid responses were received from 304 organisations (35 countries, 80.3% Europe). Most cared for adults only (60.9%), provided in-patient care (62.2%) and were non-profit (62.5%). 47.0% had cared for people with COVID-19. 47.7% changed the way they deployed volunteers; the mean number of active volunteers dropped from 203 per organisation to 33, and 70.7% reported a decrease in volunteers in direct patient/family facing roles. There was a shift to younger volunteers. 50.6% said this drop impacted care provision, increasing staff workload and pressure, decreasing patient support, and increasing patient isolation and loneliness. Conclusion: The sustained reduction in volunteer deployment has impacted the provision of specialist palliative care. Urgent consideration must be given to the future of volunteering including virtual modes of delivery, micro-volunteering, and appealing to a younger demographic.

BackgroundInsights into the neurobiological basis of resilience can have important implications for the prevention and treatment of stress-related disorders, especially in populations that are subjected to high-stress environments. Evaluating large-scale resting-state networks (RSNs) can provide information regarding resilient specific brain function which may be useful in understanding resilience. This study aimed to explore functional connectivity patterns specific for (high) resilience in Dutch policemen after exposure to multiple work-related traumatic events. We investigated resting-state functional connectivity (RSFC) of the salience network (SN), limbic network, and the default-mode network (DMN).MethodsResting-state functional MRI scans were obtained from trauma-exposed executive personnel of the Dutch police force and non-trauma-exposed recruits from the police academy. Participants were divided into three groups: a resilient group (n = 31; trauma exposure; no psychopathology), a vulnerable group (n = 32; trauma exposure, psychopathology), and a control group (n = 19; no trauma exposure, no psychopathology). RSFC of the three networks of interest was compared between these groups, using an independent component analysis and a dual regression approach.ResultsWe found decreased resilience-specific positive RSFC of the salience network with several prefrontal regions. The DMN and limbic network RFSC did not show resilience-specific patterns.ConclusionThis study shows a differential RSFC specific for resilient police officers. This differential RSFC may be related to a greater capacity for internal-focused thought and interoceptive awareness, allowing more effective higher-order responses to stress in highly resilient individuals.

Increasingly, the lines of our lives are prescribed, mediated, drawn and knotted together by digital technologies. It has been argued that ‘digital footprints’, as a trail of user data points collected from online communities and networks, can assist in better understanding human behaviour and social interaction, initially focused on mainly real-time and retrospective analysis. In our attempts at sense-making of togetherness in a COVID-19/post-COVID-19 world, we believe it may be an oversimplification to conceptualise our daily data trails as ‘digital footprints’. The nature of our interaction with these technologies as well as their interaction with us have changed deeply ever since the rapid growth of digital connectivity. The character of these symbiotic relationships has been accentuated even more by our global experience of ‘connected disconnection’ during the pandemic’s lockdowns. Against this background, we expand the concept of ‘geno-digital spores’ as a more appropriate metaphor for the manner within which data and technology combine in new ways to create (or fracture) lines of togetherness.

This article aims to gain insight in the normative struggles of adult children caring for their ageing mother living with dementia. Two Dutch autobiographical books written by siblings recording their own caregiving experience were analysed using a narrative design. Children appear to understand their normative concerns through six fields of tension. Our analysis shows that filial caregivers describe two distinct approaches to deal with these normative tensions. One approach aims to preserve the child’s pre-existing personal beliefs and values, but also causes the child to demonstrate rigid and uncompromising behaviour at odds with the needs of their parent. The other approach is more reflective and flexible, prioritizing the needs of the vulnerable person over previously held values, providing an opportunity for better care. We conclude that caregiving children have to find their way between being faithful to their principles and showing moral flexibility.

The practice of citizenship education has predominantly been studied in general education. This article details an interview study of citizenship education of teachers in prevocational education in the Netherlands. We investigated whether and how vocational teachers reflected on their goals and teaching practices in citizenship education. Teachers did not perceive their teaching to be working on citizenship. However, they aimed at developing professional attitudes in their students, emphasising participation and ‘doing their work well’ in order to become respected and personally responsible workers/employees. In technical education, the development of pride in and shared responsibility for the quality of the students’ craftwork was emphasised. These findings are discussed in relation to Sennett’s views on the development of craftsmanship as citizenship. We see these views as strategic openings for an alternative to the dominant verbal, individualising and adaptation oriented approach of citizenship education.

Key Points Question What are the patient characteristics and circumstances associated with the request for euthanasia and physician-assisted suicide (EAS) in cases of multiple geriatric syndromes as reported in the case summaries of the Dutch Regional Euthanasia Review Committees? Findings In this qualitative study of 53 case summaries published by the Dutch Regional Euthanasia Review Committees, a combination of multiple geriatric syndromes, such as visual impairment, hearing loss, pain, and chronic tiredness, may have led, in most cases, to an accumulation of suffering on multiple dimensions, resulting in a request for EAS because of unbearable suffering. Meaning This study suggests that unbearable suffering leading to a request for EAS in older persons without a life-threatening condition is often associated with a combination of medical, social, and existential issues., Importance The Dutch Regional Euthanasia Review Committees (RTEs) reviewed and reported an increasing number of cases of euthanasia and physician-assisted suicide (EAS) requested by older people with multiple geriatric syndromes (MGS). Knowledge of the characteristics of cases of EAS for MGS is important to facilitate societal debate and to monitor EAS practice. Objective To examine the accumulation of patient characteristics, geriatric syndromes, and other circumstances as reported in the case summaries of the RTEs that led to unbearable suffering associated with a request for EAS and to analyze the RTEs’ assessments of these cases of EAS. Design, Setting, and Participants A qualitative content analysis was conducted of all case summaries filed from January 1, 2013, to December 31, 2019, under the category MGS and published in a national open access database. These case summaries were selected by the RTEs from the total of 1605 reported cases of EAS in the category MGS. Results The RTEs published 53 cases (41 [77%] female) under the category MGS. A total of 28 patients (53%) had always perceived themselves as independent, active, and socially involved. None of the patients suffered from life-threatening conditions. Multiple geriatric syndromes, such as visual impairment (34 cases [64%]), hearing loss (28 cases [53%]), pain (25 cases [47%]), and chronic tiredness (22 cases [42%]), were common. The request for EAS was often preceded by a sequence of events, especially recurrent falls (33 cases [62%]). Although physical suffering could be determined in all cases, the case descriptions found that suffering occurred on multiple dimensions, such as the loss of mobility (44 [83%]), fears (21 [40%]), dependence (23 [43%]), and social isolation (19 [36%]). Conclusions and Relevance This qualitative study suggests that an accumulation of geriatric syndromes leading to a request for EAS is often intertwined with the social and existential dimension of suffering. This leads to a complex interplay of physical, psychological, and existential suffering that changes over time., This study from the Netherlands looks at the association between having multiple geriatric syndromes and requesting euthanasia or physician-assisted suicide.

The current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious leaders of African-led migrant (Pentecostal) churches perceive their relationship with these VHTs. Thematic analyses of qualitative interviews (N = 21) revealed that both groups share the perception that VHTs are vulnerable, especially in view of so-called voodoo spells. Social and legal professionals noticed that West African VHTs prototypically appear as ‘demanding’ in a rather pro-active manner. Religious leaders on the other hand indicated that the VHTs feel at ease in the church in a more adaptive sense and may find ways of changing their lives after experiencing the Pentecostal “deliverance” ritual. Keywords: Human trafficking, Pentecostalism, West-African, migrant churches, cultural and intercultural identity, religious coping

Background:Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships.Methods:We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019.Results:A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor.Conclusions:Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.

This article aims to explore the moral ideas and experiences that students at Dutch universities of applied sciences (UAS) have of being a professional with an ‘ethical compass.’ Semi-structured interviews were held with 36 fourth-year Bachelor students divided over four institutions and three different programmes: Initial Teacher Education, Business Services and Information and Communication Technology. Findings show that students say they strive to be(come) moral professionals, but that they have difficulties recognising and articulating the moral aspects of their professional roles. They seem to lack a moral vocabulary and the moral knowledge to verbalise their aspirations and to provide arguments to explicate or legitimise their moral behaviour. While most students were critical of the support they received from their universities, they indicated that various other role models and (work) experiences did have a strong and positive influence on their moral development. In this article, we reflect on the findings in relation to international empirical research on students’ moral development and highlight the characteristics of UAS students.

PurposeThis study sought to identify those approaches used by coaches that enable teachers' moral learning in professional learning communities (PLCs). Coaches who support moral learning focus on questioning values, beliefs and bias, which is in contrast with learning only (new) knowledge or skills.Design/methodology/approachThis was an exploratory case study. Eleven meetings of three PLCs were observed; each PLC consisted of four teachers and one teacher–coach. Semi-structured interviews with the coaches were conducted to gain information about their approaches. Data were analysed using supportive coaching approaches derived from educational literature.FindingsIn total, 14 specific approaches regarding the support given by coaches for teachers' moral learning were identified. Four characteristics of coaches' attitudes that guided their approaches and seemed valuable in supporting moral learning were also identified. The findings showed the tensions the coaches encountered – for example, when balancing between offering a safe environment and encouraging critical reflection.Practical implicationsWith coaches' support, teachers can develop a more thoughtful understanding of the meaning of values, beliefs and bias for their actions in teaching practice.Social implicationsMaking explicit, and exploring precisely, what coaches do to support teachers' moral learning are useful for designing and improving professional development programmes that promote moral learning.Originality/valueThe research reported in this paper outlines how coaches can encourage teachers' awareness of the impact of their actions on pupils, which, in turn, helps teachers to meet the complex moral challenges of their practice.

Based on the findings of the International Civic and Citizenship Education Study, the International Association for the Evaluation of Educational Achievement notes in 2010 that the development of citizenship education is stagnating. In response to this stagnation, some countries, including the Netherlands, are tempted to act more prescriptively in matters of citizenship education. Prior to and in the interest of the search for a solution, we think it is first and foremost important to gain insight into the extent to which the Dutch policy on citizenship education itself contributes to the stagnation. Reconstruction of the policy theory (as a part of document analysis) is used as a method to analyse the various policy statements. Our analysis demonstrates that there are sufficient indications to state that what the Dutch government wants and why is unclear and that there are specific normative beliefs underlying the policy which may conflict with beliefs of the implementers. We assume that the indicators found are not conducive to enable or motivate school leaders to implement the policy as desired by the government.

Social quality in housing complexes for older adults depends largely on the opportunities to participate in social activities and the social connections between residents in the complex. The aim of...

This article discusses teachers’ moral learning in professional learning groups and corresponding challenges for teachers’ moral professionalism. A professional learning programme aimed as understa...

This qualitative study discusses the experienced identity of gender non-binary young adults. Despite growing positive discourse in the Netherlands toward gender minorities, in practice this group still faces exclusion and stigmatization of their identity. This article draws from Butler’s (2004, 2011) conceptions of deconstructing the hegemonic gender binary and heteronormativity. It explores the layered experiences of gender non-binary young adults in Amsterdam. Through participatory observations and in-depth interviews, this investigation unravels the self-narratives of those who identify with non-binary gender identities and demonstrates how they cope with their minority identity and resist exclusion.

BackgroundThe EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups.MethodsEarly in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care.ResultsThe EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region.ConclusionsBetter education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff.

Contains fulltext : 246942.pdf (Publisher’s version ) (Open Access) Substantial individual differences exist in how acute stress affects large-scale neurocognitive networks, including salience (SN), default mode (DMN), and central executive networks (CEN). Changes in the connectivity strength of these networks upon acute stress may predict vulnerability to long-term stress effects, which can only be tested in prospective longitudinal studies. Using such longitudinal design, we investigated whether the magnitude of acute-stress-induced functional connectivity changes (delta-FC) predicts the development of post-traumatic stress-disorder (PTSD) symptoms in a relatively resilient group of young police students that are known to be at high risk for trauma exposure. Using resting-state fMRI, we measured acute-stress-induced delta-FC in 190 police recruits before (baseline) and after trauma exposure during repeated emergency-aid services (16-month follow-up). Delta-FC was then linked to the changes in perceived stress levels (PSS) and post-traumatic stress symptoms (PCL and CAPS). Weakened connectivity between the SN and DMN core regions upon acute-stress induction at baseline predicted longitudinal increases in perceived-stress level but not of post-traumatic stress symptoms, whereas increased coupling between the overall SN and anterior cerebellum was observed in participants with higher clinician-rated PTSD symptoms, particularly intrusion levels. All the effects remained significant when controlling for trauma-exposure levels and cortisol-stress reactivity. Neither hormonal nor subjective measures exerted similar predictive or acquired effects. The reconfiguration of large-scale neural networks upon acute-stress induction is relevant for assessing and detecting risk and resilience factors for PTSD. This study highlights the SN connectivity-changes as a potential marker for trauma-related symptom development, which is sensitive even in a relatively resilient sample. 8 p.

Politiemensen worden met enige regelmaat uitgezonden naar aanleiding van internationale crisissituaties, ook vanuit Nederland. Bijvoorbeeld als liaison, voor een vredesmissie of na een incident waarbij Nederlanders betrokken zijn. Dit gebeurde ook na de ramp met vlucht MH17 in Oekraïne. In een (Nationaal) Staf Grootschalig Bijzonder Optreden (SGBO) gingen politiemensen aan de slag om slachtoffers te vinden, terug te brengen, te identificeren, leiding te geven, te begeleiden, onderzoek te doen, als familierechercheur, of anderszins te ondersteunen. Hoe blijf je dan mentaal weerbaar? Welke dynamiek tussen hulpbronnen en stressoren spelen daarbij een rol?

Contains fulltext : 246778.pdf (Publisher’s version ) (Open Access) It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context. 17 p.

IntroductionAdequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families.Methods and analysisThe iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights.Ethics and disseminationThe cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying.Trial registration numberNCT04271085.

In this article, we introduce a general theory about meaning in life developed by our first author, and apply it to the context of ageing. The seven components of meaning distinguished by this theory – purpose, moral worth, selfworth, control, coherence, excitement and connectedness – are discussed in turn. After presenting the theory, we confront the seven components with extensive life narratives of two older men – in a first empirical qualitative exploration of how meaning dimensions appear in the life experiences of older people. This dialogue between theory and narrative is used to provide concretisation and clarification of the seven components, thereby enhancing the understanding of the theory, while at the same time suggesting possible refinements and directions for future exploration of meaning in life in the context of ageing.

Did the Florentine philosopher Marsilio Ficino (1433-99) influence the art of his time? Art historians have been fiercely debating this question for decades. This book starts with Ficino’s views on the imagination as a faculty of the soul, and shows how these ideas were part of a long philosophical tradition and inspired fresh insights. This approach, combined with little known historical material, offers a new understanding of whether, how and why Ficino’s Platonic conceptions of the imagination may have been received in the art of the Italian Renaissance. The discussion explores Ficino’s possible influence on the work of Botticelli and Michelangelo, and examines the appropriation of Ficino’s ideas by early modern art theorists.

In this ethnographic study, we examine how older Calvinist Protestants in a conservative rural area of the Netherlands experience “meaning in life.” We aim to contribute to current research on meaning in life within social and religious contexts. Here, we specify the concept of meaning in life as connectedness. The latter is broadly interpreted as an overarching conceptual component of existential meaning. Indeed, connectedness appears to be of paramount importance in these older villagers’ experiences of meaning in life. All three authors of this paper collaborated during fieldwork. We analyzed documents such as local newspapers, websites, and (church) newsletters. We visited farms and attended local meetings and gatherings such as church- and community- services, and we conducted qualitative interviews with 29 people. The outcomes of our research point to three forms of connectedness: (1) social connectedness; (2) physical connectedness; and (3) transcendent connectedness.

SAGE: A new turn in mixed methods research is here: merged methods. This provocative book offers a novel analysis of current mixed methods research, complicating traditional approaches and challenging existing techniques. Moving beyond the binary quantitative-qualitative distinction, the book presents methodologically grounded ways to merge methods in social research and integrate interpretive and structural approaches in one instrument or procedure. The book: - Considers the importance of merging both epistemologies and methodologies. - Showcases eight merged methods research approaches, from the Delphi method to multimodal content analysis. - Explores the opportunities for merging methods using computational techniques, such as text mining. This innovative book is a must-read for any postgraduate student or researcher across the social sciences wanting to develop their understanding of mixed methods research.

Collaboration between teachers and child support workers is seen as a promising way to effectuate inclusive practice in mainstream education. This paper aims to explore how co-location of services promotes transformation of practice, and to expand an analytic framework for interdisciplinary collaboration. By combining these two perspectives, we intend to contribute to both theory and practice. The data consist of semi-structured interviews that explore the experiences of teachers and child support workers who co-work in three schools for secondary education. A template analysis was used to examine collaboration in co-location, and to further develop the framework with which we began our empirical research. The initial template consisted of dimensions of knowledge sharing in relation to dimensions of trust and dimensions of identity. The results showed that proximity can be divided into three different types, being spatial proximity, organisational proximity and personal proximity. These types of proximity, in turn, can be related to knowledge sharing, trust and identity. The contribution of the expanded framework for practice lies in its potential to shed light on how processes in interdisciplinary collaboration can be shaped.

Background: The COVID-19 pandemic affects care practices for critically ill patients, with or without a COVID-19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains. Aim: To give insight into aspects of end-of-life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID-19 pandemic in the Netherlands. Methodology: A qualitative study involving 25 in-depth interviews with purposively sampled bereaved relatives of patients who died during the COVID-19 pandemic between March and July 2020 in the Netherlands. We created a dignity-inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness-related aspects and the individual, relational and societal/organisational level of dignity. Results: Four themes concerning aspects of end-of-life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end-of-life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives. Conclusion: This study illuminates possible aspects of end-of-life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating.

In recent times of volatility and acceleration, leaders in organisations at a strategic level are facing increasingly complex adaptive challenges accompanied with a growing body of information, as for example seen with the COVID-19 pandemic. They are increasingly challenged by an uncontrollable dynamic. This review explores what the role is of reflective practices considering these challenges. The background of the study is the observation that likewise business research is accelerated in a tremendous speed, thereby remaining fragmented and interdisciplinary. Therefore, this study analyses the content of literature on leadership and reflectivity in current times. The aim is to investigate the main key-concepts and to create an agenda for further research. This review demonstrates that addressing slow questions and creating meaningful relations could play a critical role for leaders experiencing adaptive challenges and ‘shrinking time’. The meta-reflection in this review revealed two dimensions of reflective practices relevant for future investigation: firstly, intrapersonal, intuitive, and embodied reflection on the experiences of leaders; and secondly, dialogical ‘sense-making’ with others. This review shows that reflective practices have primarily been studied among professionals, and not among leaders. This raises the question: Is the general assumption that professionals ‘reflect’ and that leaders mainly ‘act’?

Five diagnostic criteria sets for pathological grief are currently used in research. Studies evaluating their performance indicate that it is not justified to generalise findings regarding prevalence rates and predictive validity across studies using different diagnostic criteria of pathological grief. We provide recommendations to move the bereavement field forward.

BackgroundImproving interdisciplinary and inter-organizational collaboration is increasingly regarded as maintaining and improving the quality of care. However, health and social care have been an area of organizational and disciplinary differentiation and fragmentation. Though interventions to increase the effectiveness of collaboration and barriers to collaboration have been the subject of research, there has been a lack of an overview of the aims, characteristics, and impacts of these interventions. A deeper understanding helps to determine future research focus.AimThe aim of this integrative review is to give an overview of aims, characteristics, and impacts of interventions fostering interdisciplinary or inter-organizational collaboration in health and social care.Method.The databases CINAHL, PubMed, Scopus, PsycINFO, and Worldcat were systematically searched using the terms: interventions, interdisciplinary, inter-organizational, and collaboration in health care. Snowballing and a cross reference check complemented the search strategy. A total of 367 unique records were found. Structuring and screening the literature for eligibility was conducted through the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework (Moher et al., 2009) and using online review software. The review of the literature followed the guidelines for integrative review methodological rigour and data relevance using the online systematic review software Covidence (Whittemore & Knafl, 2005). Covidence led to the inclusion of 28 studies.Findings and conclusion.Integrative synthesis shows that aims fostering interdisciplinary and inter-organizational collaboration are improving communication, teamwork, professional roles, conceptual underpinning, and the coordination of care. The main characteristics of the interventions are digital resources, simulation or role playing, learning conversations, collective activity, and implementing models or pathways. Impacts described include increased knowledge, improved collaboration, improved communication, enhanced role clarity, and developments around the systemic level of collaboration. Results suggest that interventions with aims and impacts on interpersonal normative aspects of collaboration beyond the focus on effectiveness and efficiency, are under-represented in the literature. To better understand how to improve these aspects of collaboration, it is expedient to research the value and characteristics of interventions beyond familiar forms, aims, and means.

In his philosophical project of a “deconstruction of monotheism,” Jean-Luc Nancy explores the hypothesis that the historical roots of secularization should be traced back to the beginnings of the monotheistic traditions. The secular is not exclusively a feature of modern culture. The complex connections and tensions between secularity and religion in recent decades can only be analyzed effectively if one rethinks the notion of the secular along these historical lines. The author offers a brief introduction into Nancy’s project, before focusing on a theme that is central to one of the monotheistic traditions, Christianity: that of the resurrection. He reads and comments on parts of Nancy’s essay Noli me tangere, an innovative interpretation of John 20.11–18. In dialogue with Nancy he then develops a new view on the resurrection, in which paradoxically death is given a central meaning. This also involves a new insight in the immanence of transcendence. In the resurrection, it is death itself that resurrects. The idea is criticized that death would be vanquished into a life after death–as dominant approach in Christian doctrine has it, thereby expanding the modest little epilogue that the tale of the “empty tomb” actually is in the gospels, to a massive foundation of Christian redemption. Resurrection is affirmed as a life in death as well as a death in life. The resurrection of the mortal, earthly and vulnerable God that Christ is, invites an affirmation of the here and now, of humanity and of the human body: a “yes” to the world, not to an afterworld. Parallel to this analysis, the author takes up Nancy’s suggestion that the resurrection, and in fact the entire gospel, is a parable, and that its “truth” is a parabolic truth: playing with the impossible and the miraculous, in which truth and falsehood become entangled with each other.

This paper discusses a case study of a Dutch work-integration social enterprise (WISE) to add to the debate on the contribution of employment to the citizenship of intellectually disabled people and those experiencing mental health conditions. In current welfare state policies, the value of labour market participation is narrowed down to regular employment, as workplace support and care provisions are seen as stigmatising and segregating. We argue that a more nuanced understanding is needed of the intersection of support arrangements with the benefits of employment. Building on ‘recognition theory’ by the German philosopher Honneth, our findings show that the work-integration social enterprise under study is successfully balancing the contrasting demands of logics of care and work, leading to experiences of ‘recognition.’ However, this balance is fragile and does not undo the misrecognition of disabled people as unable to live up to the productivity norms of a capitalist labour market.

Purpose: Many young adults with epilepsy are still living with their parents (Tailed transition to independence') despite reaching the adult age. This study evaluated patient-related variables and measures of loneliness correlated to 'failed transition to independence' in adults, 25-30 years of age, with (childhood-onset) epilepsy.Methods: Patients with (childhood-onset) epilepsy and 25-30 years of age were recruited from Epilepsy Center Kempenhaeghe. Inclusion criteria were: diagnosis of (childhood-onset) epilepsy, and an (estimated) IQ > 70. Patients were sent one questionnaire and informed consent was obtained from all participants. Questions included the patient's level of functioning and satisfaction on three transitional domains (medical status, educational/vocational status, independence/separation from their parents), satisfaction with their friendships, and the validated De Jong-Gierveld Loneliness Scale. 'Transition to independence' was defined and categorized in a continuum with scores ranging from 0 (Tailed transition') to 4 for all patients. A Bivariate Correlation analysis was used to compute correlations between patient characteristics and failed transition to independence.Results: 59 patients were included in the analysis, of which 19 (32.2%) had a failed transition to independence. A statistically significant correlation was found between transition to independence and the social loneliness scale (p = 0.047) and the total loneliness scale (p = 0.04), and for the patients self-reported satisfaction with their independence/separation from parents (p = 0.01) and friendships (p = 0.04).Conclusions: Adults with epilepsy with a failed transition to independence experience loneliness and are not satisfied with their current developmental and social situation.

Introduction: If asylum applicants need to prove that they have been persecuted in their home country, expert judgment of the psychological and physical consequences of torture may support the judicial process. Expert medico-legal reports can be used to assess whether the medical complaints of the asylum seeker are consistent with their asylum account. It is unclear which factors influence medical expert judgement about the consistency between an asylum seeker’s symptoms and story, and to what extent expert medico-legal reports are associated with judicial outcomes. Methods: We analysed 97 medico-legal reports on traumatised asylum seekers in the Netherlands. First, we evaluated the impact of trauma-related and other variables on experts’ judgments of the consistency of symptoms and story. Second, we evaluated the effect of experts’ judgments of symptom-story consistency on subsequent judicial outcomes. Results: Gender, receipt of mental health care and trauma-related variables were associated with symptomstory consistency. Positive asylum decisions were predicted by expert judgments about the presence of physical signs and symptoms of torture, and ill-treatment and their consistency with the refugee’s story, but not psychological symptoms. Conclusion: These results suggest that standardised procedures for the documenting of medical evidence by independent experts can improve judicial decision quality and the need to improve psychological and psychiatric assessments.

First- and second-generation Turkish and Moroccan migrants living in the Netherlands have a disproportionate incidence of health problems and relatively low employment rates. Health problems are an obstacle to employment, yet there is no one-to-one correspondence between health problems and capability to work. Social ties can reduce the negative impact of health problems on employment by providing social support and providing the comfort of feeling embedded in a close social circle. In this study, we examine whether the assumed negative impact of health problems on employment is reduced by the number of close social ties, the quantity of contact, and the proportion of co-ethnics among close social ties, and whether this protective effect varies across ethnic groups. Using survey data from the Netherlands Longitudinal Lifecourse Study (N = 3911), we find that close social ties reduce the negative impact of health problems on employment. However, this protective effect depends on both the aspect of social ties which is considered and ethnic background of the individual. Quantity of contact has a protective effect for native Dutch individuals; number of social ties and a higher proportion of co-ethnics had a protective effect for Moroccan individuals, and social ties have no protective effect for Turkish individuals.

The present study investigates the nature of Iranian student teachers’ reflections and their professional development in the context of teacher education practicums. The participants were student t...