Abstract: Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults’ perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled “by others” as compared to “self-labeling”, from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term “frail”, and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult’s perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it.
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Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19′s impact on patients receiving district nursing care, district nursing teams, and their organisations during the first outbreak in March 2020 as well as one year later; and (2) identify the needs of district nurses regarding future outbreaks. A mixed-methods, two-phase, sequential exploratory design was followed. In total, 36 district nurses were interviewed during the first outbreak (March 2020), of which 18 participated in the follow-up questionnaire in April 2021. Thirteen themes emerged, which showed that the COVID pandemic has substantially impacted patient care and district nursing teams. During the first outbreak, nurses played a crucial role in organising care differently and worked under high pressure, leading to exhaustion, tiredness, and psychosocial problems, including fear of infection. A year later, nurses were better prepared to provide COVID care, but problems regarding work pressure and mental complaints remained. The identified needs focus on a sustainable implementation of leadership roles for district nurses. At the organisational and national levels, more support and appreciation are needed in terms of trust and appropriate policies.
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Although empathy is an essential aspect of co-design, the design community lacks a systematic overview of the key dimensions and elements that foster empathy in design. This paper introduces an empathic formation compass, based on a comparison of existing relevant frameworks. Empathic formation is defined here as the formative process of becoming an empathic design professional who knows which attitude, skills and knowledge are applicable in a co-design process. The empathic formation compass provides designers with a vocabulary that helps them understand what kind of key dimensions and elements influence empathic formation in co-design and how that informs designers’ role and design decisions. In addition, the empathic formation compass aims to support reflection and to evaluate co-design projects beyond the mere reliance on methods. In this way, empathic design can be made into a conscious activity in which designers regulate and include their own feelings and experiences (first-person perspective), and decrease empathic bias. We identify four important intersecting dimensions that empathy is comprised of in design and describe their dynamic relations. The first two opposing dimensions are denoted by empathy and differentiate between cognitive design processes and affective design experiences, and between self-and other orientation. The other two dimensions are defined by design research and differentiate between an expert and a participatory mindset, and research-and design-led techniques. The empathic formation compass strengthens and enriches our earlier work on mixed perspectives with these specific dimensions and describes the factors that foster empathy in design from a more contextual position. We expect the empathic formation compass—combined with the mixed perspectives framework—to enhance future research by bringing about a deeper understanding of designers’ empathic and collaborative design practice.
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