Objective: To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. Methods: In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. Results: The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = −2.43, p = .05) and anxiety (β = −.26, p = .058) had a marginally significant direct effect on the patients’ perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = −.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. Conclusion: Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. Practice Implications: Tailoring SDM communication to health literacy levels is important for high quality SDM.
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Purpose This study aims to enhance understanding of the collaboration between chairs of nurse councils (CNCs) and members of executive hospital boards (BM) from a relational leadership perspective. Design/methodology/approach The authors used a qualitative and interpretive methodology. The authors study the daily interactions of BM and CNCs of seven Dutch hospitals through a relational leadership lens. The authors used a combination of observations, interviews and document analysis. The author’s qualitative analysis was used to grasp the process of collaborating between BM and CNCs. Findings Knowing each other, relating with and relating to are distinct but intertwined processes that influence the collaboration between BM and CNC. The absence of conflict is also regarded as a finding in this paper. Combined together, they show the importance of a relational process perspective to understand the complexity of collaboration in hospitals. Originality/value Collaboration between professional groups in hospitals is becoming more important due to increasing interdependence. This is a consequence of the complexity in organizing qualitative care. Nevertheless, research on the process of collaborating between nurse councils (NCs) and executive hospital boards is scarce. Furthermore, the understanding of the workings of boards, in general, is limited. The relational process perspective and the combination of observations, interviewing and document analysis proved valuable in this study and is underrepresented in leadership research. This process perspective is a valuable addition to skills- and competencies-focused leadership literature.
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De Hogeschool van Amsterdam, het Zijlstra Center (VU) en Hofmeier doen samen onderzoek naar de invulling van de onafhankelijke controlfunctie bij Woningcorporaties. Wij delen opvallende bevindingen en waarnemingen met u in enkele publicaties. Dit is de eerste, over de ruimte die gegeven wordt bij het inrichten van de onafhankelijke controlfunctie en het effect dat dat heeft. Voor de een geeft een ruime jas de mogelijkheid om er knus in weg te duiken, voor de ander zakt een ruime jas ongemakkelijk van de schouders. Wat kan ruimte in vereisten doen met de inrichting van de onafhankelijke control functie? Welke kansen en risico’s geeft dat corporaties in het algemeen en u als interne toezichthouder in het bijzonder? Rol ambiguïteit, rolconflicten en jobcrafting kunnen signalen zijn voor het niet goed ingericht zijn van de organisatie en daarmee mogelijk van missstanden. Het kan de RvC (en het bestuur) handvatten bieden voor toezicht via soft controls.
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Conflict lies at the core of urban sustainability transitions and the indispensable structural changes that accompany them. In this chapter we examine the RESILIO project, a multi-actor collaboration in Amsterdam aiming to transition towards a 'climate proof' city through smart water retention systems on urban roofs. The focus is on the conflict that emerged during discussions about controlling the smart valves on the rooftops which are designed to prevent urban flooding. Using a discourse analytical framework, the study analyses participant interactions, conflicting positions, and discursive strategies employed by the partners involved in the initiative. Participants utilised several discursive strategies, including identity, stake, and accountability management, to manage their positions in the conflict and influence the discourse. The study highlights the challenges of addressing conflict that involves redefining accountability and responsibility between public and private actors in the collaborative setting of transition initiatives. By doing so the findings contribute to a deeper understanding of how conflict can shape learning processes and foster sustainable urban transitions.
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Junior design professionals experience conflicts in collaboration with others, with value differences being one of the issues influencing such conflicts. In a retrospective interview study with 22 design professionals, we collected 32 cases of perceived conflicts. We used a grounded theory approach to analyse these cases, resulting in five conflict categories that group 24 distinct value differences arising in 10 critical moments, an event that causes the value-based conflict. Thus, value differences are underlying the perceived conflicts of junior design professionals on many different occasions during collaboration with others. Conclusions are drawn on setting up guidelines for addressing values in co-design practices and supporting junior designers in their professional development.
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In this study, we address the function of role models for entrepreneurship students. By using entrepreneurs as role models, students can get a better and realistic picture of the complexity of the entrepreneurial path. Choosing whom to interview as role model can be diverse, but it can be problematic if, as a result of that choice, the learning effect in the same group of students is different.
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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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Abstract Introduction: In 2017, the role of coordinating practitioner was introduced in the Netherlands in order to improve quality of care for patients who receive treatment in specialized mental health care. Psychiatric-mental health nurse practitioners (PMHNPs) can fulfil this role. Aim/Question: The aim was to obtain insight into how PMHNPs fulfil the coordinating practitioner role and what is needed to improve fulfilment of this role. Method: A survey among PMHNPs in the Netherlands was conducted between July-September 2018. In total, 381 PMHNP filled out the questionnaire; the response rate was 47.6%. Descriptive analyses were performed using SPSS 22® (IBM). Results: 92% Of the PMHNPs fulfilled the coordinating practitioner role and were generally satisfied with their role performance. The following conditions were formulated to improve this role: 1) recognition and trust in the expertise of PMHNPs, 2) a clear description of their role as coordinating practitioner, 3) strengthening multidisciplinary collaboration, and 4) sufficient training budget and opportunities. Discussion: In Dutch mental health care, PMHNPs have strengthened their position as coordinating practitioner in a short period of time. Follow-up research should be conducted to obtain further insights into elements that contribute to an optimal role as coordinating practitioner. Implications for Practice: Having PMHNPs act as coordinating practitioners can contribute to solving the challenges in mental health care regarding coordination of care and effective multidisciplinary collaboration.
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Objectives The aim of this study was to examine the reciprocal association between work–family conflict and depressive complaints over time. Methods Cross-lagged structural equation modeling (SEM) was used and three-wave follow-up data from the Maastricht Cohort Study with six years of follow-up [2416 men and 585 women at T1 (2008)]. Work–family conflict was operationalized by distinguishing both work–home interference and home–work interference, as assessed with two subscales of the Survey Work–Home Interference Nijmegen. Depressive complaints were assessed with a subscale of the Hospital Anxiety and Depression scale. Results The results showed a positive cross-lagged relation between home–work interference and depressive complaints. The results of the χ 2 difference test indicated that the model with cross-lagged reciprocal relationships resulted in a significantly better fit to the data compared to the causal (Δχ 2 (2)=9.89, P=0.001), reversed causation model (Δχ 2 (2)=9.25, P=0.01), and the starting model (Δχ 2 (4)=16.34, P=0.002). For work–home interference and depressive complaints, the starting model with no cross-lagged associations over time had the best fit to the empirical data. Conclusions The findings suggest a reciprocal association between home–work interference and depressive complaints since the concepts appear to affect each other mutually across time. This highlights the importance of targeting modifiable risk factors in the etiology of both home–work interference and depressive complaints when designing preventive measures since the two concepts may potentiate each other over time.
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Our current smart society, where problems and frictions are smoothed out with smart, often invisible technology like AI and smart sensors, calls for designers who unravel and open the smart fabric. Societies are not malleable, and moreover, a smooth society without rough edges is neither desirable nor livable. In this paper we argue for designing friction to enhance a more nuanced debate of smart cities in which conflicting values are better expressed. Based on our experiences with the Moral Design Game, an adversarial design activity, we came to understand the value of creating tangible vessels to highlight conflict and dipartite feelings surrounding smart cities.
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