As migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how–in light of impairment–ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients’ minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents’ impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.
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Huisartsen in Nederland staan momenteel voor belangrijke keuzes. Zo nopen de elkaar in rap tempo opvolgende veranderingen in het zorgveld tot ingrijpende keuzes ten aanzien van samenwerking. Dit betreft niet alleen samenwerking met ondersteuners in de eigen praktijk, maar ook met externe partijen zoals gemeenten, andere eerstelijns zorgverleners, wijkteams en medisch specialisten. Dit omdat steeds meer zorg uit de tweede lijn (ziekenhuis) naar de eerste lijn wordt verplaatst. De ‘span of control’ wordt daarmee groter en daardoor ontstaat ook een (nieuwe) huisvestingsbehoefte. Allemaal keuzes waarmee de huisarts worstelt.
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Background: The number of people with multiple chronic conditions receiving primary care services is growing. To deal with their increasingly complex health care demands, professionals from different disciplines need to collaborate. Interprofessional team (IPT) meetings are becoming more popular. Several studies describe important factors related to conducting IPT meetings, mostly from a professional perspective. However, in the light of patient-centeredness, it is valuable to also explore the patients’ perspective. Objective: The aim was to explore the patients’ perspectives regarding IPT meetings in primary care. Methods: A qualitative study with a focus group design was conducted in the Netherlands. Two focus group meetings took place, for which the same patients were invited. The participants, chronically ill patients with experience on interprofessional collaboration, were recruited through the regional patient association. Participants discussed viewpoints, expectations, and concerns regarding IPT meetings in two rounds, using a focus group protocol and selected video-taped vignettes of team meetings. The first meeting focused on conceptualization and identification of themes related to IPT meetings that are important to patients. The second meeting aimed to gain more in-depth knowledge and understanding of the priorities. Discussions were audio-taped and transcribed verbatim, and analyzed by means of content analysis. Results: The focus group meetings included seven patients. Findings were divided into six key categories, capturing the factors that patients found important regarding IPT meetings: (1) putting the patient at the center, (2) opportunities for patients to participate, (3) appropriate team composition, (4) structured approach, (5) respectful communication, and (6) informing the patient about meeting outcomes. Conclusions: Patients identified different elements regarding IPT meetings that are important from their perspective. They emphasized the right of patients or their representatives to take part in IPT meetings. Results of this study can be used to develop tools and programs to improve interprofessional collaboration.
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Background: Accurate measurement of health literacy is essential to improve accessibility and effectiveness of health care and prevention. One measure frequently applied in international research is the Short Assessment of Health Literacy (SAHL). While the Dutch SAHL (SAHL-D) has proven to be valid and reliable, its administration is time consuming and burdensome for participants. Our aim was to further validate, strengthen and shorten the SAHL-D using Rasch analysis. Methods: Available cross-sectional SAHL-D data was used from adult samples (N = 1231) to assess unidimensionality, local independence, item fit, person fit, item hierarchy, scale targeting, precision (person reliability and person separation), and presence of differential item functioning (DIF) depending on age, gender, education and study sample. Results: Thirteen items for a short form were selected based on item fit and DIF, and scale properties were compared between the two forms. The long form had several items with DIF for age, gender, educational level and study sample. Both forms showed lower measurement precision at higher health literacy levels. Conclusions: The findings support the validity and reliability of the SAHL-D for the long form and the short form, which can be used for a rapid assessment of health literacy in research and clinical practice.
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Background: Parents of children with profound intellectual and multiple disabilities (PIMD) have extensive care duties. This study describes the phenomenon “parenting a child with PIMD.” Method: We conducted in-depth interviews with 25 Dutch parents. A reflective lifeworld research. Findings: The essential meaning of the phenomenon was understood as “continuously struggling to create and maintain new equilibriums that protect the child and the family from hardship; changing in context through time.” The following eight constituents were identified: (1) medical complexity; (2) multidimensional weariness; (3) care for siblings; (4) social connectedness; (5) uncertainty about the future; (6) wrecking bureaucracy; (7) dependency on healthcare delivery; and (8) financial concerns. Conclusions: Healthcare services should provide families with easy access to assistive technology and services needed to manage family life. Responsiveness to parents’ challenges offers them the possibility to participate in society. Healthcare professionals should address the parents’ perspectives related to the child’s quality of life.
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Background: In Turkey, nursing care in hospitals has gradually included more older patients, resulting in a need for knowledgeable geriatric nurses. It is unknown, however, whether the nursing workforce is ready for this increase. Therefore, the aim of this study is to validate the Knowledge about Older Patients Quiz (KOPQ) in the Turkish language and culture, to describe Turkish hospital nurses’ knowledge about older patients, and to compare levels of knowledge between Turkish and Dutch hospital nurses. Conclusions: The KOPQ-TR is promising for use in Turkey, although psychometric validation should be repeated using a better targeted sample with a larger ability variance to adequately assess the Person Separation Index and Person Reliability. Currently, education regarding care for older patients is not sufficiently represented in Turkish nursing curricula. However, the need to do so is evident, as the results demonstrate that knowledge deficits and an increase in older patients admitted to the hospital will eventually occur. International comparison and cooperation provides an opportunity to learn from other countries that currently face the challenge of an aging (hospital) population.
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Abstract from the authors: "In this paper we discuss our experiences of facilitating collaborative creative activities within healthcare. The study consists of a larger case study on innovation scouting with the staff at the emergency room backed up by a series of seven retrospective mini-case studies. By means of discussing our experiences we identify some insights and challenges. Challenges for design facilitators working in this domain relate to: 1) dealing with the clash of professional eco-systems, the informal designers’ way of working with the formal and procedural healthcare operations; 2) Positioning yourself ‘at the right table’ in order to find backing for concepts; and, 3) steering the intertwined processes of developing strategic direction and concrete products and services on the floor." Tanja van der Laan is spatial designer, lecturer and researcher, creative research group HKU Design (Hogeschool voor de Kunsten Utrecht).
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This study addresses the burgeoning global shortage of healthcare workers and the consequential overburdening of medical professionals, a challenge that is anticipated to intensify by 2030 [1]. It explores the adoption and perceptions of AI-powered mobile medical applications (MMAs) by physicians in the Netherlands, investigating whether doctors discuss or recommend these applications to patients and the frequency of their use in clinical practice. The research reveals a cautious but growing acceptance of MMAs among healthcare providers. Medical mobile applications, with a substantial part of IA-driven applications, are being recognized for their potential to alleviate workload. The findings suggest an emergent trust in AI-driven health technologies, underscored by recommendations from peers, yet tempered by concerns over data security and patient mental health, indicating a need for ongoing assessment and validation of these applications
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In Proceedings of the first CARPE conference november 2011
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I will examine the ways in which a hidden crisis can be exposed from a communications point of view. Therefore, this examination of the concept of crisis entrepreneurship is also relevant tot communication professionals. The article is in the form of proto-research and will shed light on the dilemmas experienced by crisis entrepreneurs and the interactional solutions they apply to cope with such dilemmas
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