Background: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods: A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results: Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion: Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
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Young widowhood, conceptualized as the loss of one’s spouse before the age of 50, is a profoundly painful and distressing loss (Den Elzen, 2017, 2018). The literature on young widowhood shows the death of a partner generally causes a fragmentation of the self, as it violates expectations of the normal life cycle, namely growing old together (Haase and Johnston, 2012; Levinson, 1997). Premature loss of one’s spouse tends to be experienced by the surviving partner as distressing or traumatizing, such as having witnessed their suffering in illness or through accident (Den Elzen, 2018) or in struggling with unfinished business (Holland et al, 2020). Whilst post-traumatic stress is well-known and has been widely researched across various disciplines, the concept of post-traumatic growth is much newer and by contrast has received less attention. PTG was introduced as a scholarly concept by Tedeschi and Calhoun in the mid-1990s and is defined as a positive psychological change as a result of the struggle with highly challenging life events (2004). Calhoun and Tedeschi’s notion of PTG has been backed by a recent systematic review. In the first meta-analysis of moderate-to-high PTG, Wu et al. found that of the 10,181 subjects, about 50% experienced PTG (2019). They also reported that women, young people and victims of trauma experienced higher levels of PTG than men, the elderly and those who experienced indirect trauma. PTG has attracted some controversy, with some researchers questioning its scientific validity (Jayawickreme and Blackie, 2014). Others caution against the minimization of people’s suffering. Hayward is a trauma counsellor who advises approaching PTG carefully, highlighting that if it is introduced with clients too early it can "often be construed as minimizing someone's pain and suffering and minimizing the impact of the loss" (cited in Collier, 2016, n.p.). In addressing the critique of PTG, Calhoun and Tedeschi (2006) emphasize that the focus on investigating positive psychological change following trauma does not deny the common and well-documented negative psychological responses and distress following severe life stresses: “Negative events tend to produce, for most persons, consequences that are negative” (p.4). They argue however, and their research supports this finding, that for many people distressful events can foster positive psychological changes. We view PTG as a possibility following (profound) loss, and emphasize that PTG may continue to co-exist with painful and/or unresolved emotions regarding the loss itself. We conceptualize PTG as a continuum and not as an either/or binary with grief. Further, we wish to highlight that PTG is a highly individual process that depends on many factors, and we are not suggesting that the absence of PTG is to be seen as a failure. This chapter intends to contribute to the study of PTG through a person-centered approach. The most used method to assess PTG is the 21-item posttraumatic growth inventory developed by Calhoun and Tedeschi in 1996 (Jayawickreme & Blackie, 2014). Self-reported posttraumatic growth has been the foundation of PTG research, which has aimed to identify to what extent PTG evokes improved psychological and physical health. In discussing our own creative narrative processes of PTG, our practice-led-research lens aims to contribute to research on how PTG might be fostered. We propose a Writing-for-wellbeing approach in this context and explore what it offered us both as writers and widows and what it might offer the field of Writing-for-wellbeing and by extension clinical and scholarly practice.
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Technology and architectural solutions are needed as a means of support in future nursing homes. This study investigated how various monodisciplinary groups of stakeholders from healthcare and technology envision the nursing home of the future and which elements are necessary for its creation. Moreover, differences in needs and interests between the various stakeholders were considered. This qualitative study gathered data via 10 simultaneous sticky note brainstorm sessions with 95 professional stakeholders, which resulted in 1459 quotes in five categories that were clustered into themes and processed into word clouds. The stakeholders prioritized the needs of the resident and placed the most importance on the fact that a nursing home is primarily a place to live in the final stages of one's life. A mix of factors related to the quality of care and the quality of the built environment and technology is needed. Given the fact that there are differences in what monodisciplinary groups of stakeholders see as an ideal nursing home, multidisciplinary approaches should be pursued in practice to incorporate as many new views and stakeholder needs as possible.
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Lecture in PhD Programme Life Science Education Research UMCU. Course Methods of Life Science Education Research. Utrecht, The Netherlands. abstract Audit trail procedures are applied as a way to check the validity of qualitative research designs, qualitative analyses, and the claims that are made. Audit trail procedures can be conducted based on the three criteria of visibility, comprehensibility, and acceptability (Akkerman et al., 2008). During an audit trail procedure, all documents and materials resulting from the data gathering and the data analysis are assessed by an auditor. In this presentation, we presented a summative audit trail procedure (Agricola, Prins, Van der Schaaf & Van Tartwijk, 2021), whereas in a second study we used a formative one (Agricola, Van der Schaaf, Prins & Van Tartwijk, 2022). For both studies, two different auditors were chosen. For the study presented in Agricola et al. (2021) the auditor was one of the PhD supervisors, while in that presented Agricola et al. (2022) was a junior researcher not involved in the project. The first auditor had a high level of expertise in the study’s topic and methodology. As a result, he was able to provide a professional and critical assessment report. Although the second auditor might be considered to be more objective than the first, as she was not involved in the project, more meetings were needed to explain the aim of the study and the aim of the audit trail procedure. There are many ideas about the criteria that qualitative studies should meet (De Kleijn en Van Leeuwen, 2018). I argue that procedures of checking for interrater agreement and understanding, the triangulation, and audit trail procedures can increase the internal validity of qualitative studies. Agricola, B. T., Prins, F. J., van der Schaaf, M. F., & van Tartwijk, J. (2021). Supervisor and Student Perspectives on Undergraduate Thesis Supervision in Higher Education. Scandinavian Journal of Educational Research, 65(5), 877-897. doi: https://doi.org/10.1080/00313831.2020.1775115 Agricola, B. T., van der Schaaf, M. F., Prins, F. J., & van Tartwijk, J. (2022). The development of research supervisors’ pedagogical content knowledge in a lesson study project. Educational Action Research. doi: https://doi.org/10.1080/09650792.2020.1832551 de Kleijn, R. A. M., & Van Leeuwen, A. (2018). Reflections and review on the audit procedure: Guidelines for more transparency. International Journal of Qualitative Methods, 17(1), 1-8. doi: https://doi.org/10.1177/1609406918763214 Akkerman, S., Admiraal, W., Brekelmans, M., & Oost, H. (2008). Auditing quality of research in social sciences. Quality & Quantity, 42(2), 257-274. doi: https://doi.org/10.1007/s11135-006-9044-4
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Background: Peer review is at the heart of the scientific process. With the advent of digitisation, journals started to offer electronic articles or publishing online only. A new philosophy regarding the peer review process found its way into academia: the open peer review. Open peer review as practiced by BioMed Central (BMC) is a type of peer review where the names of authors and reviewers are disclosed and reviewer comments are published alongside the article. A number of articles have been published to assess peer reviews using quantitative research. However, no studies exist that used qualitative methods to analyse the content of reviewers’ comments. Methods: A focused mapping review and synthesis (FMRS) was undertaken of manuscripts reporting qualitative research submitted to BMC open access journals from 1 January – 31 March 2018. Free-text reviewer comments were extracted from peer review reports using a 77-item classification system organised according to three key dimensions that represented common themes and sub-themes. A two stage analysis process was employed. First, frequency counts were undertaken that allowed revealing patterns across themes/sub-themes. Second, thematic analysis was conducted on selected themes of the narrative portion of reviewer reports. Results: A total of 107 manuscripts submitted to nine open-access journals were included in the FMRS. The frequency analysis revealed that among the 30 most frequently employed themes “writing criteria” (dimension II) is the top ranking theme, followed by comments in relation to the “methods” (dimension I). Besides that, some results suggest an underlying quantitative mindset of reviewers. Results are compared and contrasted in relation to established reporting guidelines for qualitative research to inform reviewers and authors of frequent feedback offered to enhance the quality of manuscripts. Conclusions: This FMRS has highlighted some important issues that hold lessons for authors, reviewers and editors. We suggest modifying the current reporting guidelines by including a further item called “Degree of data transformation” to prompt authors and reviewers to make a judgment about the appropriateness of the degree of data transformation in relation to the chosen analysis method. Besides, we suggest that completion of a reporting checklist on submission becomes a requirement.
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Background: The dynamics of maternal and newborn care challenge midwifery education programs to keep up-to-date. To prepare for their professional role in a changing world, role models are important agents for student learning. Objective: To explore the ways in which Dutch and Icelandic midwifery students identify role models in contemporary midwifery education. Methods: We conducted a descriptive, qualitative study between August 2017 and October 2018. In the Netherlands, 27 students participated in four focus groups and a further eight in individual interviews. In Iceland, five students participated in one focus group and a further four in individual interviews. All students had clinical experience in primary care and hospital. Data were analyzed using inductive content analysis. Results: During their education, midwifery students identify people with attitudes and behaviors they appreciate. Students assimilate these attitudes and behaviors into a role model that represents their ‘ideal midwife’, who they can aspire to during their education. Positive role models portrayed woman-centered care, while students identified that negative role models displayed behaviors not fitting with good care. Students emphasized that they learnt not only by doing, they found storytelling and observing important aspects of role modelling. Students acknowledged the impact of positive midwifery role models on their trust in physiological childbirth and future style of practice. Conclusion: Role models contribute to the development of students’ skills, attitudes, behaviors, identity as midwife and trust in physiological childbirth. More explicit and critical attention to how and what students learn from role models can enrich the education program.
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Introduction: Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. Methods: This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Results: Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
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Post-war urban neighbourhoods in industrialised countries have been shown to negatively affect the lifestyles of their residents due to their design. This study aims at developing an empirical procedure to select locations to be redesigned and the determinants of health at stake in these locations, with involvement of residents’ perspectives as core issue. We addressed a post-war neighbourhood in the city of Groningen, the Netherlands. We collected data from three perspectives: spatial analyses by urban designers, interviews with experts in local health and social care (n = 11) and online questionnaires filled in by residents (n = 99). These data provided input for the selection of locations to be redesigned by a multidisciplinary team (n = 16). The procedure yielded the following types of locations (and determinants): An area adjacent to a central shopping mall (social interaction, traffic safety, physical activity), a park (experiencing green, physical activity, social safety, social interaction) and a block of low-rise row houses around a public square (social safety, social interaction, traffic safety). We developed an empirical procedure for the selection of locations and determinants to be addressed, with addressing residents’ perspectives. This procedure is potentially applicable to similar neighbourhoods internationally.
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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
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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.
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