PURPOSE: This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.MATERIALS AND METHODS: A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.RESULTS: Participants included three men and ten women, age ranging from 22-69 years, pain duration was 2-30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective.CONCLUSIONS: The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.
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De zogenoemde “21th century skills” worden, aldus het Ministerie van Onderwijs, steeds belangrijker. Het zijn eigenschappen die we terugvinden in de eindtermen van vrijwel alle hbo-opleidingen en die – in de woorden van Donald Schön – de kern zijn van een “reflective practitioner” : een vakvrouw of –man, die zichzelf in complexe situaties kan sturen en daardoor productief blijft. Eerder onderzoek van het lectoraat Pedagogiek van de Beroepsvorming heeft aangetoond dat een leeromgeving gericht op zelfsturing aan drie condities moet voldoen: er moet sprake zijn van praktijkgestuurd onderwijs, studenten moeten de kans krijgen een dialoog aan te gaan over de zin en betekenis van hun ervaringen in het praktijkgestuurde onderwijs en studenten moeten medezeggenschap hebben over hun eigen leerproces. Met name het realiseren van een dialoog blijkt echter heel moeilijk te zijn. Zowel docenten als studenten (en ook de onderwijsmanagers) zijn gewend aan onderwijs waarin zin en betekenis nauwelijks ter discussie staat. Het gevolg is dat ze vooral gericht zijn op reproductief en niet op betekenis-gericht leren. Zelfsturing vereist evenwel deze laatste vorm van leren. Zelfsturing vereist een dialoog over de zin en betekenis van ervaringen die de student “raken”. Dergelijke ervaringen roepen veelal emoties op die in eerste instantie niet begrepen worden. Zin en betekenis zijn “geen dingen in een doosje”; ze worden gaandeweg duidelijk in een gesprek waarin de docent verklaart noch verheldert, maar samen met de student op zoek gaat naar de juiste woorden. Dat zijn woorden waarvan de student voelt dat ze haar in staat stellen iets uit te drukken dat voorheen nog niet onder woorden gebracht kon worden. In dit boek wordt vanuit verschillende perspectieven en op basis van empirisch onderzoek ingegaan op de vraag in hoeverre het hbo er in slaagt een dergelijke dialoog met haar studenten te realiseren. Tevens wordt stilgestaan bij methoden om zo’n dialoog te realiseren.
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This dissertation describes a research project about the communication between communication vulnerable people and health care professionals in long-term care settings. Communication vulnerable people experience functional communication difficulties in particular situations, due to medical conditions. They experience difficulties expressing themselves or understanding professionals, and/or professionals experience difficulties understanding these clients. Dialogue conversations between clients and professionals in healthcare, which for example concern health-related goals, activity and participation choices, diagnostics, treatment options, and treatment evaluation, are, however, crucial for successful client-centred care and shared decision making. Dialogue conversations facilitate essential exchanges between clients and healthcare professionals, and both clients and professionals should play a significant role in the conversation. It is unknown how communication vulnerable people and their healthcare professionals experience dialogue conversations and what can be done to support successful communication in these conversations. The aim of this research is to explore how communication vulnerable clients and professionals experience their communication in dialogue conversations in long-term care and how they can best be supported in improving their communication in these conversations.
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Background: In postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score. Objectives: This study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process. Methods: A qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery. Results: Three main themes emerged that influenced the Numeric Rating Scale scores (0–10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration—which could be desired or undesired—and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients’ score-related and intrapersonal factors, a preliminary pain score was ‘‘internally’’ set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores. Conclusions: This study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration.
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In this chapter, we propose that the democracy we wish to see out in the world is influenced by the quality of our own “inner democracies”—that is: the quality of the democracies among and between the selves or voices in the landscape of the self. We must find ways out of the I-prisons we experience and perpetuate. With this in mind, we propose that ”writing the self,” a method whereby creative, expressive, and reflective writing is used to cultivate an internal dialogue and construct a new identity narrative (Lengelle, 2014), can assist in reshaping our stories about ”the Other and ourselves” and can contribute to personal and cultural healing and reconciliation. The inner dialogue reconciled is foundational for the external dialogue at the heart of global citizenship within education. Indeed, as Schellhammer argues, we must cultivate the self in order to become inter-culturally competent, and this includes facing shadow aspects through truthful dialogues with the self and caring for the self. https://doi.org/10.1007/978-3-319-62861-5_6 LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/
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In this article, we examined whether career writing—creative, expressive, and reflective writing—can increase luck readiness, which is the ability to respond and make use of (career) opportunities. Two 2-day writing courses were taught to third-year bachelor students, one before and one after work placements. In this exploratory study, results showed that luck readiness and work competence increased when students engaged in career writing. Specifically, flexibility, risk, and persistence increased among students in the experimental group. They also made jumps in optimism and efficacy, though no statistically significant differences were found in these domains.
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Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.
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Comment on Briggs et al., Health literacy and beliefs among a community cohort with and without chronic low back pain [Pain 2010;150:275–283]
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Higher education is tasked with preparing students for a culturally diverse and globalizing world. Additionally, western nations have an increasingly diverse student population and know the success of their students will depend in part on being able to navigate diversity. There is therefore good reason for institutions of higher learning to promote and facilitate the development of ‘global citizens’ – people who can work and relate across borders and boundaries, both real and perceived. However, teachers are not necessarily equipped to foster this learning. Many teachers are used to a reproductive way of teaching while the learning that is needed here is identity learning, directed at dialogue, internally as well as externally. This chapter proposes the potential of creative, expressive and reflective writing as a way in which personal development – a form of a reflexive internal dialogue – can be fostered to promote cultural healing and global citizenship. The writing method will be described and a case study on cultural healing in the context of Canada’s reconciliation efforts with Aboriginal people will be used to illustrate the learning process involved. The processes of writing the self and re-narrating identity has several promising benefits for both students and teachers in higher education. First it allows us to learn more about ourselves and what blocks our learning (i.e. promotes self-reflection). Second, it allows us to change our story and our identifications and therefore choose differently (i.e. self-direction). Third, it is a companion on the road of life where we literally learn to talk and listen to ourselves and articulate the tacit knowledge that can be unearthed through narrative, journal, and poetic writing. Fourth, the method is playful and creative and although tears are frequently shed in the process, students report a great enjoyment in writing and sharing their stories with others. It is a meaningful dialogue about experience and also has the potential of promoting cultural (Lengelle, Jardine, & Bonnar, 2018) healing in the context of a very diverse student body (Banks, 2015). It also has the potential for creating new bonds in the classroom and allows teachers in higher education to engage in the difficult work of facilitating global citizenship learning. The internal dialogue described here also allows us to ‘clean up’ judgements and become aware of the need to reach out to others. Not only the actual sharing of vulnerable writing in a class or online setting shows us we are not alone, but ‘writing the self’ focuses deliberately on where we have become fearful about our own and others’ identities and allows us a learning process to unearth those things, heal them in order to reach out to others.
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In the first half of the 20th century, the individual life course was largely determined by ‘standard biographies’ (Du Bois-Reymond, 1998; Meijers & Wesselingh, 1999) whereby identity – the story individuals tell themselves and share with others about the meaning of their lives (Meijers & Lengelle, 2012) – was constructed on the basis of socially prescribed ‘master narratives’ (Davies & Harré, 1990) or ‘grand narratives’ (Lyotard, 1984). This pattern changed in the second half of the 20th century with the advent of secularization, the lifting of socio-political barriers, growing prosperity and mobility and the resulting increase in possible choices. The ‘prescriptive power’ of these narratives became increasingly contested, especially by young people, resulting in a growing individualization of society (Bauman, 2001; Giddens, 1991). For most people, this movement towards individualization was not problematic as long as the ever-growing prosperity made it possible to have a second or third chance to make new choices. However, society soon became a risk society (Beck, 1992). LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/
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