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.
This contributed volume is based on the "European Core Competences Framework for health and social care professionals working with older people" (ECCF), developed and verified in a unique international cooperation between 26 universities and universities of applied sciences in 25 European countries, part of the European Later Life Active Network (ELLAN). In addition to the framework, the book outlines the necessary qualifications and describes the roles of professionals working with older people in health and social services. It explores healthy ageing for older people from different perspectives and describes the seven roles of health and social care professionals (Expert, Communicator, Collaborator, Organizer, Health and Welfare Advocate, Scholar, and Professional), before going on to define 18 related competences and elaborating them in performance indicators.Beyond the ECCF, the book explains the widely used CanMED role model and puts forward theories to support a client centered and integrated approach on health and social care in order to change attitudes toward older clients and offer better care and support. It also provides health and social care professionals, for example nurses, allied health professionals and social workers with new contextual information and cultural awareness. It gives a voice to students by addressing selected perspectives for professional development. The book includes questions for reflective learning helping to make the book a vital practical instrument for use in the educational context throughout Europe.Europe’s ageing populations represent a major challenge for both public health and social care systems. 18% of the population is 65 years old and over, and this proportion will increase in the coming years. As a result, more and more health and social care professionals will work with older people in different settings – at home, in the community, in hospitals or in long-term care settings.Older people, and especially the frail, face a host of interrelated issues, e.g. cognitive restrictions, functional restrictions, psychosocial problems, multimorbidity, polypharmacy and social isolation. These problems call for an integrated approach to health and social care, which this book supplies. It is intended for health and social care professionals, students and educators, for a better understanding of Europe’s ageing society and of the impact on care and services. Furthermore, the ECCF offers educational institutes a unique resource for curriculum development, education, training and assessment.
Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
