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Background: Engaging families in postsurgical care is potentially beneficial for improving cancer patient outcomes and quality of care. The authors developed a family involvement program (FIP) and in this study, the authors aim to evaluate the impact of the FIP on family caregiver burden and well-being. Moreover, the authors aim to assess the fidelity of the program. Materials and methods: This is a preplanned subgroup analysis of a patient-preferred prospective cohort study that included family caregivers of patients who underwent major oncological surgery for gastrointestinal tumors. Only patient-nominated family caregivers could participate in the FIP. Caregivers received structured training in fundamental caregiving tasks from healthcare professionals and then actively participated in these tasks. Caregiver burden and well-being were measured four times (at hospital admission, at hospital discharge, and at 1 and 3 months posthospital discharge) using the Caregiver Strain Index+ (CSI+) and the Care-related Quality of Life instrument (CarerQoL-7D). The fidelity of the FIP was assessed by recording completion of care activities. In addition, family caregivers were asked whether they would participate in the FIP again. Results: Most of the 152 family caregivers were female (77.6%), and their mean age was 61.3 years (SD=11.6). Median CSI+ scores ranged between -1 and 0 and remained below the cutoff point of experiencing burden. CarerQoL-7D results indicated no significant differences in family caregivers' well-being over time. Upon discharge, over 75% of the family caregivers stated that they would recommend the FIP to others. The highest compliance with all fundamental care activities was observed during postoperative days 2-4. Conclusion: The family caregivers of oncological surgical patients who participated in the FIP exhibited acceptable levels of caregiver burden and well-being. These findings suggest that the FIP is a valuable intervention to equip family caregivers with the skills to navigate the uncertain period following a patient's hospital discharge.
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afstudeerscriptie van studente Psychologie Yasmin Gharavi gepubliceerd in BMC Psychiatry: Background: Family members who care for patients with severe mental illness experience emotional distress and report a higher incidence of mental illness than those in the general population. They report feeling inadequately prepared to provide the necessary practical and emotional support for these patients. The MAT training, an Interaction- Skills Training program (IST) for caregivers, was developed to meet those needs. This study used a single-arm pretestposttest design to examine the impact of the training on caregivers’ sense of competence (self-efficacy) and burden.
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ACHTERGROND: Familieleden die mantelzorg verlenen aan patiënten met een ernstige psychische aandoening ervaren emotionele belasting en rapporteren een hogere incidentie van psychische klachten vergeleken met de algemene populatie. Zij geven aan dat ze onvoldoende zijn voorbereid op het verlenen van de noodzakelijke praktische en emotionele steun aan deze patiënten. Om in deze behoeften te voorzien is de MAT-training opgezet, een trainingsprogramma interactievaardigheden voor mantelzorgers. Dit onderzoek hanteert een pre-posttestopzet. Op basis hiervan werd het effect van de training op het gevoel van competentie (eigen-effectiviteit) van de mantelzorgers onderzocht en de mate van belasting die zij ervoeren. METHODEN: Aan de training namen 100 personen deel die mantelzorg verleenden aan een familielid. Zij werden geworven binnen drie instellingen voor geestelijke gezondheidszorg. De mate van belasting werd vastgesteld met behulp van de Involvement Evaluation Questionnaire, een vragenlijst die de betrokkenheid meet. De mate van eigen-effectiviteit werd gemeten met behulp van de Self-Efficacy Questionnaire. Aan de hand van de variantieanalyse met herhaalde metingen (RM-ANOVA) werd onderzocht of trainingsdeelname iets veranderde aan de mate waarin deze mantelzorgers belasting en eigen-effectiviteit ervoeren. Aan de hand van de Pearson-correlatie werd gekeken naar het verband tussen eigen-effectiviteit en belasting. RESULTATEN: Uit de resultaten blijkt dat na de training de mate van eigen-effectiviteit na verloop van tijd significant toenam (p<0,001) en dat de mate van belasting significant afnam (p<0,001). Tegen de verwachting in bleek er echter geen verband te bestaan tussen een toename in de mate van eigen-effectiviteit en een afname in de mate van belasting. De mantelzorgers hadden veel waardering voor de training. CONCLUSIE: Familieleden die mantelzorg verlenen aan patiënten met een ernstige psychische aandoening ervoeren een groter gevoel van competentie en een significante afname van de mate van belasting na het volgen van het trainingsprogramma. De training werd erg gewaardeerd en bleek te voorzien in de behoefte van mantelzorgers aan de vereiste vaardigheden in complexe mantelzorgsituaties. Dit artikel is een vertaling van ‘Evaluation of an interaction-skills training for reducing the burden of family caregivers of patients with severe mental illness: a pre-posttest design’, van Yasmin Gharavi et al., BMC Psychiatry 2018;18:84.
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Research has demonstrated that teachers working in early childhood education and care (ECEC) are proficient in offering emotional support to young children, but markedly weaker when it comes to instructional support. We conducted a controlled experimental study in the Netherlands, to investigate the effects of targeted in-service training on improving teachers’ instructional support. Teachers (N = 72) were randomly assigned to four conditions: an intensive early childhood education (ECE) training (N = 17), video interaction guidance (VIG) (N = 16), a combination of both training programs (N = 18), or a control condition with no training (N = 21). Teachers’ interactive skills were measured pre- and postintervention, according the scales of the Caregiver Interaction Profile (CIP). The ECE training improved the proficiency of teachers’ verbal communication and offering developmental stimulation. VIG proved to be effective in teachers’ fostering positive peer interactions between children. Intensive and targeted training can successfully improve the quality of teachers’ instructional support in ECEC settings, although more research on effective elements of professional development of ECEC teachers is needed.
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Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Background: Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods: We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n=4). Results: The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions: The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment.
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Abstract Background Visuospatial neglect (VSN) is a cognitive disorder after stroke in which patients fail to consciously process and interact with contralesional stimuli. Visual Scanning Training (VST) is the recommended treatment in clinical guidelines. At the moment, several mixed reality versions of Visual Scanning Training (VST) are being developed. The aim of this study was to explore the opinions of end-users (i.e., therapists) on the use of Virtual Reality (VR) and Augmented Reality (AR) in VSN treatment. Methods Therapists played one VR and two AR Serious Games, and subsequently flled out a questionnaire on User Experience, Usability, and Implementation. Results Sixteen therapists (psychologists, occupational, speech, and physiotherapists) played the games, thirteen of them evaluated the games. Therapists saw great potential in all three games, yet there was room for improvement on the level of usability, especially for tailoring the games to the patient’s needs. Therapists’ opinions were comparable between VR and AR Serious Games. For implementation, therapists stressed the urgency of clear guidelines and instructions. Discussion Even though VR/AR technology is promising for VSN treatment, there is no one-size-fts-all applicability. It may thus be crucial to move towards a plethora of training environments rather than a single standardized mixed reality neglect treatment. Conclusion As therapists see the potential value of mixed reality, it remains important to investigate the efcacy of AR and VR training tools.
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Background: Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Methods: Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Results: Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. Conclusions: The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors.
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