Introduction: People on the autism spectrum often struggle to transition smoothly between occupations in daily life. Objective: This qualitative inquiry aimed to understand the human and non-human factors that influence occupational transitions from the perspectives of adults on the autism spectrum. Method: Using a constructivist grounded theory design, this study purposively gathered data from eight adults on the autism spectrum who shared their viewpoints via semi-structured interviews and self-produced written texts. Framed by the Cultural Historical Activity Theory, an iterative process of constant comparative analysis was employed, yielding six categories that constituted the assembly of a working theory on occupational transitions among adults on the autism spectrum. Results: Drawn from eight participants, the six categories were: 1) getting ready, 2) the attributes of the occupation, 3) the others, 4) strategies of the moment, 5) cumulative stress, and 6) possible ends of the process. Conclusion: Our findings revealed a nuanced understanding on occupational transitions for adults with autism. First, materiality (non-human entities) serves various purposes in occupational transitions, implying that in some cases, intangible materials (tacit knowledge) would be enough to initiate, aid, or terminate occupational transitions. Second, doing transitions together through the optimization of social support and resources can make occupational transitions more meaningful for adults in the autism spectrum. It is our ambition that these propositions be tested and emphasized in occupational therapy, healthcare, and social care practices.
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BACKGROUND: Acute admission to an intensive care unit (ICU) can negatively affect quality of life for patients and their relatives. Relatives play an important caregiving role after the patient's admission. More knowledge and understanding of their needs are necessary as the patient transitions home.AIM: This study aims to explore relatives' experiences of acutely admitted ICU patients' transition from the ICU to a general ward and then home.STUDY DESIGN: A qualitative study with a phenomenological approach was conducted. Interviews were in-depth and featured open-ended questions. The interviews took place after the patients transitioned from ICU to home and were conducted online by videoconference. Data were analysed using Colaizzi's seven-step method.RESULTS: Twelve relatives of acutely admitted ICU patients were interviewed. Five main themes emerged: (1) mixed feelings, (2) sense of not being involved, (3) limited information provision, (4) lack of acknowledgement as a caregiver, and (5) an uncertain future perspective. Relatives experience major uncertainties during transitions and prefer to be actively involved in care and care decisions.CONCLUSIONS: This study indicates that relatives of ICU patients experience a lack of guidance during the transitions from the ICU to a general ward and to home, or a follow-up facility. More focus is needed on the themes of mixed feelings, the sense of not being involved, limited information provision, lack of acknowledgement as a caregiver, and an uncertain future perspective. This increased focus might improve the guidance during these transitions.RELEVANCE TO CLINICAL PRACTICE: The insights from this study may help to improve the care of patients and their relatives during the transitions.
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Context: Inadequate handovers between hospital and home can lead to adverse health outcomes. A group particularly at risk is patients at the end of life because of complex health problems, frequent care transitions, and involvement of many professionals. Objectives: To investigate health care providers' views and experiences with regard to the transition from hospital to primary care in palliative care. Methods: This was a descriptive qualitative study. Three focus group discussions were held with 28 nurses and two focus groups with nine physicians. Participants were recruited from primary and hospital care. The focus groups were audiorecorded, transcribed verbatim, and analyzed thematically. Results: The following themes emerged from the data: lack of identification of and communication about the last phase of life; incomplete and insufficient handover; and uncertainty about responsibilities. Professionals emphasize the importance of proper handovers and transitional processes in these vulnerable patients. The transition between hospital to primary care is hindered by a lack of identification of the palliative phase and uncertainties about patient awareness. Direct communication between professionals is needed but lacking. The handover itself is currently primarily focused on physical aspects where psychosocial aspects were also found necessary. Furthermore, uncertainties with regard to physicians' responsibility for the patient seem to further hinder professionals in the transitional process. Conclusion: Efforts should be made to enhance knowledge and skills around identification of palliative needs and communication with patients about the end of life, especially in the hospital setting.
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Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Transitions in health care and the increasing pace at which technological innovations emerge, have led to new professional approach at the crossroads of health care and technology. In order to adequately deal with these transition processes and challenges before future professionals access the labour market, Fontys University of Applied Sciences is in a transition to combining education with interdisciplinary practice-based research. Fontys UAS is launching a new centre of expertise in Health Care and Technology, which is a new approach compared to existing educational structures. The new centre is presented as an example of how new initiatives in the field of education and research at the intersection of care and technology can be shaped.
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Sustainability transition research seeks to understand the patterns and dynamics of structural societal change as well as unearth strategies for governance. However, existing frameworks emphasize innovation and build-up over exnovation and break-down. This limits their potential in making sense of the turbulent and chaotic dynamics of current transition-in-the-making. Addressing this gap, our paper elaborates on the development and use of the X-curve framework. The X-curve provides a simplified depiction of transitions that explicitly captures the patterns of build-up, breakdown, and their interactions.Using three cases, we illustrate the X-curve’s main strength as a framework that can support groups of people to develop a shared understanding of the dynamics in transitions-in-the-making. This helps them reflect upon their roles, potential influence, and the needed capacities for desired transitions. We discuss some challenges in using the X-curve framework, such as participants’ grasp of ‘chaos’, and provide suggestions on how to address these challenges and strengthen the frameworks’ ability to support understanding and navigation of transition dynamics. We conclude by summarizing its main strength and invite the reader to use it, reflect on it, build on it, and judge its value for action research on sustainability transitions themselves.
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Background: Transmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. Objective: To examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. Design: A qualitative study design using semi-structured interviews. Setting(s): Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants: 19 community nurses. Methods: A topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. Results: Four themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. Conclusions: We highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstract: Community nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.
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AbstractQuality problem: Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions.Initial assessment and implementation: Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands.Choice of solution: A constructive grounded theory approach was used for data analysis.Evaluation: The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others.Lessons learned: The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.
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In the recent ‘Regional outlook’, the OECD (2014) convincingly argues that cities can be the drivers of national growth and recovery: in principle, their diversity and density makes people and companies more productive and innovative. This is not only a tale of large cities: over the last decade, as recent studies demonstrate (e.g. Dijkstra, 2013) many smaller and medium-sized cities across Europe were important economic engines. But this did not happen automatically: to make that happen, ‘getting cities right’ is the key challenge, and action on the city level matters! As demonstrated by recent OECD data (OECD, 2014), poorly organised cities fail to reap their economic potential.
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The challenges we collectively face, such as climate change, are characterized by more complexity, interdependence, and dynamism than is common for educational practice. This presents a challenge for (university) education. These transition challenges are often described as wicked or VUCA (Volatile, Uncertain, Complex, and Ambiguous) problems. In response, educational innovations that are inspired by ecology such as living labs are starting to emerge, but little is known about how learners engage within and with these more ecological forms of education. This work is an exploratory study into how learners navigate VUCA learning environments linked to tackling sustainability transition challenges, with a focus on the positive qualities of these experiences. This is done through interpretative phenomenological analysis (IPA) of seven students (using semi-structured interviews) of the MSC Metropolitan Analysis, Design and Engineering program, a joint degree from Wageningen University and Delft University of Technology in the Netherlands. The main findings, which are both psychological and educational, of this exploration include openness to new experiences (1), flexibility (2), a process appreciation of learning (3), a desire to create a positive impact on one’s direct biophysical environment (4) and society (5). In addition, we discuss the potential limitations of the malleability of these different qualities and propose future avenues for research into ecological learning for universities. This work closes by highlighting recommendations for educators to consider when designing or engaging in ecological forms of higher education that connect students to sustainability transitions.
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