Objective: To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design: Implementation Research. Setting: Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants: Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention: Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results: The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s): This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
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Objective: To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. Design: Prospective, pre-post study. Setting: A university medical center. Participants: Patients admitted to the pulmonology and nephrology/gastro-enterology wards. Intervention: The movement intervention consisted of (1) self-monitoring of patients' physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. Main measures: Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. Results: A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0-10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. Conclusions: The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.
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PURPOSE: To evaluate the feasibility and outcomes of a tailored, goal-directed, and exercise-based physical therapy program for patients with metastatic breast cancer (MBC).METHODS: This was an observational, uncontrolled feasibility study. The physical therapy intervention was highly tailored to the individual patient's goals, abilities, and preferences and could include functional, strength, aerobic, and relaxation exercises. Feasibility outcomes were participation rate (expected: 25%), safety, and adherence (percentage of attended sessions relative to scheduled sessions). Additional outcomes were goal attainment, self-reported physical functioning, fatigue, health-related quality of life, and patient and physical therapist satisfaction with the program.RESULTS: Fifty-five patients (estimated participation rate: 34%) were enrolled. Three patients did not start the intervention due to early disease progression. An additional 22 patients discontinued the program prematurely, mainly due to disease progression. Median intervention adherence was 90% and no major intervention-related adverse events occurred. A goal attainment score was available for 42 patients (of whom 29 had completed the program and 13 had prematurely dropped out). Twenty-two (52%) of these patients achieved their main goal fully or largely and an additional 15 patients (36%) partially. Eighty-five percent would "definitely recommend" the program to other patients with MBC. We observed a modest improvement in patient satisfaction with physical activities (Cohen's dz 0.33).CONCLUSION: The tailored intervention program was feasible in terms of uptake, safety, and outcomes and was highly valued by patients and physical therapists. However, disease progression interfered with the program, leading to substantial dropout.TRIAL REGISTRATION: NTR register: NTR6475.
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We examined the effects of age on automatic and voluntary motor adjustments in pointing tasks. To this end, young (20–25 years) and middle-aged adults (48–62 years) were instructed to point at a target that could unexpectedly change its location (to the left or right) or its color (to green or red) during the movement. In the location change conditions, participants were asked to either adjust their pointing movement toward the new location (i.e., normal pointing) or in the opposite direction (i.e., anti-pointing). In the color change conditions, participants were instructed to adjust their movement to the left or right depending on the change in color. The results showed that in a large proportion of the anti-pointing trials, participants made two adjustments: an early initial automatic adjustment in the direction of the target shift followed by a late voluntary adjustment toward the opposite direction. It was found that the late voluntary adjustments were delayed for the middle-aged participants relative to the young participants. There were no age differences for the fast automatic adjustment in normal pointing, but the early adjustment in anti-pointing tended to be later in the middle-aged adults. Finally, the difference in the onset of early and late adjustments in anti-pointing adjustments was greater among the middle-aged adults. Hence, this study is the first to show that aging slows down voluntary goal-directed movement control processes to greater extent than the automatic stimulus-driven processes.
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Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
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Self-directed learning is often embraced as an important educational goal, although for quite different reasons, from the improvement of school learning to the critical assessment of the claims of democracy. Most reasons imply that self-direction is important in learning throughout life. Therefore process-oriented teaching, which aims to foster self-directed lifelong learning, needs a broad and multidimensional theoretical basis. The important role of experiences in the social and cultural context, prior knowledge, and the emotional aspects in learning is highlighted, and related to self-directed learning in life. Important aspects of process-oriented teaching are summarized in four principles. A multidimensional approach of learning also provides a conceptual basis to teachers learning. Developing a process-oriented approach in teaching presents a major challenge for teachers as well as for schools.
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Self-directed learning is often embraced as an important educational goal, although for quite different reasons, from the improvement of school learning to the critical assessment of the claims of democracy. Most reasons imply that self-direction is important in learning throughout life. Therefore process-oriented teaching, which aims to foster self-directed lifelong learning, needs a broad and multidimensional theoretical basis. The important role of experiences in the social and cultural context, prior knowledge, and the emotional aspects in learning is highlighted, and related to self-directed learning in life. Important aspects of process-oriented teaching are summarized in four principles. A multidimensional approach of learning also provides a conceptual basis to teachers learning. Developing a process-oriented approach in teaching presents a major challenge for teachers as well as for schools.
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Hoofdstuk 20 Part II in Understanding Penal Practice van Ioan Durnescu en Fergus McNeill Criminological and penological scholarship has in recent years explored how and why institutions and systems of punishment change – and how and why these changes differ in different contexts. Important though these analyses are, this book focuses not so much on the changing nature of institutions and systems, but rather the changing nature of penal practice and practitioners The first part of the book focuses on understanding practice and practitioners, exploring how changing social, cultural, political, and organisational contexts influence practice, and how training, development, professional socialisation and other factors influence practitioners. The second part is concerned with how practitioners can be best supported to develop the skills and approaches that seem most likely to generate positive impacts. It contains accounts of new practice models and approaches, as well as reports of research projects seeking both to discover and to encourage effective practices
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Present-day students are expected to be lifelong learners throughout their working life. Higher education must therefore prepare students to self-direct their learning beyond formal education, in real-life working settings. This can be achieved in so-called hybrid learning configurations in which working and learning are integrated. In such a learning configuration, learning is typically trans-boundary in nature and embedded in ill-structured, authentic tasks. The goal of this study is to develop a set of design guidelines for an intervention that would strengthen students’ capacity for self-directed lifelong learning within a hybrid learning configuration, a one-semester elective course at a university of applied sciences in the Netherlands. The research approach was educational design research. An intervention was designed, implemented and evaluated during two iterations of the course. Evaluation methods included interviews with students and the course facilitator, questionnaires, and students’ logs and reports. We developed five intervention design guidelines that will promote self-directed learning. Our conclusion is that the intervention was usable and effective: at a basic level, the students did develop their capacity for self-directed lifelong learning. Further research is needed to investigate conditions for realizing higher levels of proficiency in self-directed lifelong learning throughout the curriculum and beyond.
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The principal aim of this study is to explore the relations between work domains and the work-related learning of workers. The article is intended to provide insight into the learning experiences of Dutch police officers during the course of their daily work. Interviews regarding actual learning events and subsequent changes in knowledge, skills or attitudes were conducted with police officers from different parts of the country and in different stages of their careers. Interpretative analyses grounded in the notion of intentionality and developmental relatedness revealed how and in what kinds of work domains police officers appear to learn. HOMALS analysis showed work-related learning activities to vary with different kinds of work domains. The implications for training and development involve the role of colleagues in different hierarchical positions for learning and they also concern the utility of the conceptualisation of work-related learning presented here.
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