Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.
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Adaptive governance describes the purposeful collective actions to resist, adapt, or transform when faced with shocks. As governments are reluctant to intervene in informal settlements, community based organisations (CBOs) self-organize and take he lead. This study explores under what conditions CBOs in Mathare informal settlement, Nairobi initiate and sustain resilience activities during Covid-19. Study findings show that CBOs engage in multiple resilience activities, varying from maladaptive and unsustainable to adaptive, and transformative. Two conditions enable CBOs to initiate resilience activities: bonding within the community and coordination with other actors. To sustain these activities over 2.5 years of Covid-19, CBOs also require leadership, resources, organisational capacity, and network capacity. The same conditions appear to enable CBOs to engage in transformative activities. How-ever, CBOs cannot transform urban systems on their own. An additional condition, not met in Mathare, is that governments, NGOs, and donor agencies facilitate, support, and build community capacities. This is the peer reviewed version of the following article: Adaptive governance by community-based organisations: Community resilience initiatives during Covid‐19 in Mathare, Nairobi. which has been published in final form at doi/10.1002/sd.2682. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
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Background: Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations. Aims: A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question:What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services? Methods & Procedures: The qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews.Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs. Outcomes & Results: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes. Conclusions & Implications: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.
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Academisch geschoolde leerkrachten kunnen in het primair onderwijs op allerlei manieren bijdragen. Scholen maken echter nog onvoldoende gebruik van hun kennis en kunde. Dit project richt zich op de ontwikkeling van een gemeenschap van studenten en opleiders met de focus op het vergroten van de onderzoekende cultuur binnen de opleidingsscholen en -instituten.
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Abstract Study Objective To provide an overview of patients' needs concerning goal‐setting, and indications of how those needs can be met by nurses. Methods A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal‐setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role. Results Patients need to be prepared for collaborating in goal‐setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs. Conclusions Both the literature about patients' needs regarding goal‐setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal‐setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.
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This article draws on Robinson, McNeill and Maruna’s argument (2012) about the adaptability of community sanctions and measures, observed through four distinctive penal narratives, in order to shed light on the regional development of community service in Wroclaw, Poland. While the managerial adaptation of community sanctions is underpinned by an inter-agency cooperation to fulfil the goals of the system, the contemporary rehabilitation iteration has become a toolkit of measures predominantly phrased around risk management, the reparative discourse seeks various means to repair harm, and the punitive orientation represent the turn to desert-based and populist sentencing frameworks. In this article, the first three are reflected upon along with the emerging, restorative adaptation of community sanctions. The last one is added to expand on the findings of previous research, which suggests the viability of the restorative orientation for community service in Poland (Matczak, 2018). A brief discussion of how punishment, probation and restorative justice can be reconciled is followed by the introduction of Polish Probation and the role of probation officers in delivering community service in Poland. Although the penal narratives are visible in the Wrocław model to different degrees and in various combinations, more research is required to evaluate the viability of a progressive orientation to punishment during a gradual optimisation of community orders. Originally published: Anna Matczak, The penal narratives of community sentence and the role of probation: The case of the Wrocław model of community service, European journal of probation (Vol. 13 nr. 1) pp. 72-88. Copyright © 2021year (The Author). DOI: 10.1177/2066220320976105
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Community activities are believed to contribute to the cultivation of social capital and social cohesion. For this study, a community ‘living room’, a community activity for lonely, elderly people in a mid-sized Dutch city, was studied. Interviews and observations showed that the community activity was experienced positively, and that social interactions in this particular setting were much appreciated in the face of loneliness. This held not only true for the participants, but also for the volunteers. Nevertheless, the activity did not significantly contribute to the development of social capital. Social contacts established during the activity did not extend beyond the setting. A general lack of trust is seen as a major factor inhibiting the development of social contacts beyond the setting.
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Introduction: Fall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults. Methods: This is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with communitydwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach. Results: All strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly. Discussion: This study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).
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Community care is becoming increasingly important. In the Netherlands, the percentage of people over the age of 65 is expected to increase to 22% by 2025, leading to more elderly patients, often with long-term and complex health problems (multimorbidity). Because many of these patients continue to live at home until a very old age, nurses are increasingly working outside of institutions. The 17 Dutch Bachelor nursing programmes responded to this development with a new national education profile 'Bachelor Nursing 2020 (BN2020)’ with more elements of community care. However, despite the increase in extramural care, the Dutch labour market has a shortage of community nurses with higher professional education qualifications, partly because most nursing students focus on the general hospital setting as the environment for their future career. Whether this is based on a perception of community care that deters making this choice has never been systematically investigated. It is also unclear whether a more community-oriented curriculum will better equip students for working in community care. In response to these issues, the nursing programme at the Amsterdam University of Applied Sciences (AUAS) redesigned its curriculum to include more elements of community care. Three perspectives were chosen for the redesign: (1) the influence of lecturers as role models, (2) positive placement experiences, and (3) five new ‘community-based’ themes in education. These new themes are as follows: patient self-management, shared decision-making, collaboration with the patients’ social system, healthcare technology, and allocation of care. The redesign also includes a ‘paved way’ into community care in the form of a coherent and attractive programme for interested students.This thesis describes whether and how the curriculum-redesign within higher professional education in nursing can be effective in terms of (1) stimulating a positive perception of community care and (2) realising a form of community care in line with the new themes in BN2020. In other words, that students will base choices in their actions/nursing interventions on these new themes in the education profile.
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Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.
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