Abstract Aims: To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings. Design: Exploratory qualitative study. Methods: Between May 2017 and September 2020, we used in-depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44). Results: We identified three crucial empowerment-enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of self-correction and self-motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation. Conclusion: We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another. Impact: The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long-term care sector.
DOCUMENT
Abstract Aims: To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings. Design: Exploratory qualitative study. Methods: Between May 2017 and September 2020, we used in-depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44). Results: We identified three crucial empowerment-enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of selfcorrection and self-motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation. Conclusion: We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another. Impact: The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long-term care sector
DOCUMENT
Several interventions have been developed to support families living with parental mental illness (PMI). Recent evidence suggests that programmes with whole-family components may have greater positive effects for families, thereby also reducing costs to health and social care systems. This review aimed to identify whole-family interventions, their common characteristics, effectiveness and acceptability. A systematic review was conducted according to PRISMA 2020 guidelines. A literature search was conducted in ASSIA, CINAHL, Embase, Medline, and PsycINFO in January 2021 and updated in August 2022. We double screened 3914 abstracts and 212 papers according to pre-set inclusion and exclusion criteria. The Mixed Methods Appraisal Tool was used for quality assessment. Quantitative and qualitative data were extracted and synthesised. Randomised-control trial data on child and parent mental health outcomes were analysed separately in random-effects meta-analyses. The protocol, extracted data, and meta-data are accessible via the Open Science Framework (https://osf.io/9uxgp/). Data from 66 reports—based on 41 independent studies and referring to 30 different interventions—were included. Findings indicated small intervention effects for all outcomes including children’s and parents’ mental health (dc = −0.017, −027; dp = −0.14, −0.16) and family outcomes. Qualitative evidence suggested that most families experienced whole-family interventions as positive, highlighting specific components as helpful, including whole-family components, speaking about mental illness, and the benefits of group settings. Our findings highlight the lack of high-quality studies. The present review fills an important gap in the literature by summarising the evidence for whole-family interventions. There is a lack of robust evidence coupled with a great need in families affected by PMI which could be addressed by whole-family interventions. We recommend the involvement of families in the further development of these interventions and their evaluation.
MULTIFILE
Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. Methods Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. Results Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. Conclusion A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here
MULTIFILE
Introduction: Self-management is considered a potential answer to the increasing demand for family medicine by people suffering from a chronic condition or multi-morbidity. A key element of self-management is goal setting. Goal setting is often defined as a moment of agreement between a professional and a patient. In the self-management literature, however, goal setting is regarded as a circular process. Still, it is unclear how professionals working in family medicine can put it into practice. This background paper aims to contribute to the understanding of goal setting within self-management and to identify elements that need further development for practical use. Debate: Four questions for debate emerge in this article: (1) What are self-management goals? (2) What is necessary to accomplish the process of goal setting within self-management? (3) How can professionals decide on the degree of support needed for goal setting within self-management? (4) How can patients set their goals and how can they be supported? Implications: Self-management goals can be set for different (life) domains. Using a holistic framework will help in creating an overview of patients’ goals that do not merely focus on medical issues. It is a challenge for professionals to coach their patients to think about and set their goals themselves. More insight in patients’ willingness and ability to set self-management goals is desirable. Moreover, as goal setting is a circular process, professionals need to be supported to go through this process with their patients.
DOCUMENT
Abstract Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. Study setting: Sixteen skilled nursing facilities. Study design: Prospective study, comparing three consecutive cohorts. Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71–85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients’ needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients’ and informal caregivers’ perceptions of health service delivery.
DOCUMENT
Background: after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective: the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design: single-blind, randomised clinical trial. Setting: the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects: cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods: the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results: in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI -4.7 to 18%], risk ratios 1.14 [95% CI 0.91-1.42], P = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion: in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months.
DOCUMENT
Background: Adverse Childhood Experiences (ACEs) are an overlooked risk factor for behavioural, mental and physical health disparities in children with intellectual disabilities (ID) and borderline intellectual functioning (BIF). Aims: To gain insight into the presence of the 10 original Wave II ACEs and family context risk variables in a convenience sample of children with ID and BIF in Dutch residential care. Methods and procedures: 134 case-files of children with ID (n = 82) and BIF (n = 52) were analysed quantitatively. Outcomes and results: 81.7 % of the children with ID experienced at least 1 ACE, as did 92.3 % of the children with BIF. The average number of ACEs in children with ID was 2.02 (range 0???? 8) and in children with BIF 2.88 (range 0???? 7). About 20 % of the children with moderate and mild ID experienced 4 ACEs or more. Many of their families faced multiple and complex problems (ID: 69.5 %; BIF 86.5 %). Multiple regression analysis indicated an association between family context risk variables and the number of ACEs in children. Conclusions and implications: The prevalence of ACEs in children with ID and BIF appears to be considerably high. ACEs awareness in clinical practice is vital to help mitigate negative outcomes.
DOCUMENT
Students growing up with a family member with a chronic illness often delay or drop out of school when the combination of family care and their educational programme is too demanding. This study aims to describe the themes experienced by students growing up in this situation. A qualitative focus group design was used. The recruitment for this study was done through an online survey where students could indicate whether they also wanted to participate in a focus group. Twenty-five Dutch students (age 18-25 years) who grew up with a family member with a chronic illness participated in one of the total of seven focus groups. A qualitative inductive analysis was used to identify codes and main themes. Students growing up with a family member with a chronic illness experience responsibility issues, loyalty conflicts, peer alienation, role reversal, negative influence on personal development, daily worries and confronting situations. They reported substantial impact in terms of their general well-being, their family relationships and in their choices for their future. Students articulated that growing up in this situation has a serious and substantial impact on their lives. Further research is required in order to gain comprehensive insights into the requests of these students regarding personal and family support.
DOCUMENT
Background: The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL. Methods: A mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (n = 7), focus groups with team members (n = 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (N = 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis. Results: NitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses. Conclusions: NitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.
DOCUMENT
