Purpose: Collaborative deliberation comprises personal engagement, recognition of alternative actions, comparative learning, preference elicitation, and preference integration. Collaborative deliberation may be improved by assisting preference elicitation during shared decision-making. This study proposes a framework for preference elicitation to facilitate collaborative deliberation in long-term care consultations. Methods: First, a literature overview was conducted comprising current models for the elicitation of preferences in health and social care settings. The models were reviewed and compared. Second, qualitative research was applied to explore those issues that matter most to clients in long-term care. Data were collected from clients in long-term care, comprising 16 interviews, 3 focus groups, 79 client records, and 200 online client reports. The qualitative analysis followed a deductive approach. The results of the literature overview and qualitative research were combined. Results: Based on the literature overview, five overarching domains of preferences were described: “Health”, “Daily life”, “Family and friends”, ”Living conditions”, and “Finances”. The credibility of these domains was confirmed by qualitative data analysis. During interviews, clients addressed issues that matter in their lives, including a “click” with their care professional, safety, contact with loved ones, and assistance with daily structure and activities. These data were used to determine the content of the domains. Conclusion: A framework for preference elicitation in long-term care is proposed. This framework could be useful for clients and professionals in preference elicitation during collaborative deliberation.
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BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
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This article investigates the transformative impacts of regular nature-based adventure activity engagement and its long-lasting effects on eudaimonic well-being (EWB), specifically mental health. Although extant research highlights a wide range of well-being and mental health benefits from participation in such pursuits, less is known about experienced outdoor adventure enthusiasts for whom adventure is a fundamental and transformational part of their lives. The study builds on an existing conceptual framework that synthesizes pertinent research concepts on nature-based activity engagement and subjective well-being benefits. It presents key findings from 40 semi-structured in-depth online interviews with respondents from the UK, Germany, and Serbia. Interview data were collated and analyzed using a thematic framework approach. The findings highlight the importance of outdoor adventure activity engagement for respondents’ mental and physical health and long-term well-being. Regular activity participation can be transformational in reducing feelings of ill-being and enhancing EWB. It can improve self-efficacy and identity development and promote the fulfilment of psychological needs, facilitated by key transformational catalyzers. Continually entering a liminal state, experiencing emotions, and overcoming challenges and risks during engagement are crucial to “successful” long-lasting transformation. Further research should continue to explore adventure’s transformational and EWB benefits to develop long-term data.
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Background Clients facing decision-making for long-term care are in need of support and accessible information. Construction of preferences, including context and calculations, for clients in long-term care is challenging because of the variability in supply and demand. This study considers clients in four different sectors of long-term care: the nursing and care of the elderly, mental health care, care of people with disabilities, and social care. The aim is to understand the construction of preferences in real-life situations. Method Client choices were investigated by qualitative descriptive research. Data were collected from 16 in-depth interviews and 79 client records. Interviews were conducted with clients and relatives or informal caregivers from different care sectors. The original client records were explored, containing texts, letters, and comments of clients and caregivers. All data were analyzed using thematic analysis. Results Four cases showed how preferences were constructed during the decision-making process. Clients discussed a wide range of challenging aspects that have an impact on the construction of preferences, e.g. previous experiences, current treatment or family situation. This study describes two main characteristics of the construction of preferences: context and calculation. Conclusion Clients face diverse challenges during the decision-making process on long-term care and their construction of preferences is variable. A well-designed tool to support the elicitation of preferences seems beneficial.
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AI-driven lifestyle monitoring systems collect data from ambient, motion, contact, light, and physiological sensors placed in the home, enabling AI algorithms to identify daily routines and detect deviations to support older adults "aging in place." Despite its potential to support several challenges in long-term care for older adults, implementation remains limited. This study explored the facilitators and barriers to implementing AIdriven lifestyle monitoring in long-term care for older adults, as perceived by formal and informal caregivers, as well as management, in both an adopting and non-adopting healthcare organization. A qualitative interview study using semi-structured interviews was conducted with 22 participants (5 informal caregivers, 10 formal caregivers, and 7 participants in a management position) from two long-term care organizations. Reflexive thematic analysis, guided by the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, structured findings into facilitators and barriers. 12 facilitators and 16 barriers were identified, highlighting AI-driven lifestyle monitoring as a valuable, patient-centred, and unobtrusive tool enhancing care efficiency and caregiver reassurance. However, barriers such as privacy concerns, notification overload, training needs, and organizational alignment must be addressed. Contextual factors, including regulations, partnerships, and financial considerations, further influence implementation. This study showed that to optimize implementation of AI-driven lifestyle monitoring, organizations should address privacy concerns, provide training, engage in system (re)design and create a shared vision. A comprehensive multi-level approach across all levels is essential for successful AI integration in long-term care for older adults.
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This article analyzis two Dutch experiments in which the government guarantees a job to tackle long-term unemployment. The experiment with the Melkert jobs was carried out in the 1990s. Recently the municipality of Groningen implemented a project in which long-term unemployed people are offered a so-called basic job. The research results of this project demonstrate that the target group can do productive work on a regular basis and that basic jobs have a net positive social added value based on a Social Cost Benefit Analysis (SCBA).In this article we also pay attention to the recent academic debate betweenan unconditional basic income (BIG) and a job guarantee (JG).
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For delayed and long-term students, the education process is often a lonely journey. The main conclusion of this research is that learning should not be an individual process of the student connected to one lecturer, but rather a community where learning is a collective journey. The social interaction between lecturers, groups of delayed students and other actors is an important engine for arriving at the new knowledge, insights and expertise that are important to reach their final level. This calls for the design of social structures and the collaboration mechanism that enable the bonding of all members in the community. By making use of this added value, new opportunities for the individual are created that can lead to study success. Another important conclusion is that in the design and development of learning communities, sufficient attention must be paid to cultural characteristics. Students who delay are faced with a loss of self-efficacy and feelings of shame and guilt. A learning community for delayed students requires a culture in which students can turn this experience into an experience of self-confidence, hope and optimism. This requires that the education system pays attention to language use, symbols and rituals to realise this turn. The model ‘Building blocks of a learning environment for long-term students’ contains elements that contribute to the study success of delayed and long-term students. It is the challenge for every education programme to use it in an appropriate way within its own educational context. Each department will have to explore for themselves how these elements can be translated into the actions, language, symbols and rituals that are suitable for their own target group.
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Civil society as a social sphere is constantly subjected to change. Using the Dutch context, this article addresses the question whether religiously inspired engagement is a binder or a breakpoint in modern societies. The author examines how religiously inspired people in the Netherlands involve themselves in non-governmental organizations (NGOs) and voluntary activities. Religious involvement and social engagement in different European countries are compared and discussed. In addition, the author explores the models of civil society and applies these to both the Christian and Islamic civil society in the Netherlands. Using four religious ‘identity organizations’ as case studies, this article discusses the interaction of Christian and Islamic civil society related to secularized Dutch society. The character and intentions of religiously inspired organizations and the relationship between religious and secular involvement are examined. This study also focuses on the attitude of policymakers towards religiously inspired engagement and government policy on ‘identity organizations’ in the Netherlands.
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Background: During the process of decision-making for long-term care, clients are often dependent on informal support and available information about quality ratings of care services. However, clients do not take ratings into account when considering preferred care, and need assistance to understand their preferences. A tool to elicit preferences for long-term care could be beneficial. Therefore, the aim of this qualitative descriptive study is to understand the user requirements and develop a web-based preference elicitation tool for clients in need of longterm care. Methods: We applied a user-centred design in which end-users influence the development of the tool. The included end-users were clients, relatives, and healthcare professionals. Data collection took place between November 2017 and March 2018 by means of meetings with the development team consisting of four users, walkthrough interviews with 21 individual users, video-audio recordings, field notes, and observations during the use of the tool. Data were collected during three phases of iteration: Look and feel, Navigation, and Content. A deductive and inductive content analysis approach was used for data analysis. Results: The layout was considered accessible and easy during the Look and feel phase, and users asked for neutral images. Users found navigation easy, and expressed the need for concise and shorter text blocks. Users reached consensus about the categories of preferences, wished to adjust the content with propositions about well-being, and discussed linguistic difficulties. Conclusion: By incorporating the requirements of end-users, the user-centred design proved to be useful in progressing from the prototype to the finalized tool ‘What matters to me’. This tool may assist the elicitation of client’s preferences in their search for long-term care.
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Triggered by recent flood catastrophes and increasing concerns about climate change, scientists as well as policy-makers increasingly call for making long-term water policies to enable a transformation towards flood resilience. A key question is how to make these long-term policies adaptive so that they are able to deal with uncertainties and changing circumstances. The paper proposes three conditions for making long-term water policies adaptive, which are then used to evaluate a new Dutch water policy approach called 'Adaptive Delta Management'. Analysing this national policy approach and its translation to the Rotterdam region reveals that Dutch policy-makers are torn between adaptability and the urge to control. Reflecting on this dilemma, the paper suggests a stronger focus on monitoring and learning to strengthen the adaptability of long-term water policies. Moreover, increasing the adaptive capacity of society also requires a stronger engagement with local stakeholders including citizens and businesses.
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