There is mounting evidence that efforts to mitigate the adverse effects of human activity on climate and biodiversity have so far been unsuccessful. Explanations for this failure point to a number of factors discussed in this article. While acknowledging cognitive dissonance as a significant contributing factor to continuing unsustainable practices, this article seeks to explore hegemonic rationality of industrial expansion and economic growth and resulting politics of denial. These politics promote the economic rationale for exploitation of the environment, with pursuit of material wealth seen as the most rational goal. Framed this way, this rationality is presented by political and corporate decision-makers as common sense and continuous environmentally destructive behavior is justified under the guise of consumer choices, hampering meaningful action for sustainable change. This article underlines forms of alternative rationality, namely, non-utilitarian and non-hierarchical worldview of environmental and human flourishing, that can advance sustainability. LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Behaviour change design has much to gain with the integration of insights from the behavioural sciences in the design process. However, this integration needs to be done without hampering the creative process. In two rich design cases aimed at health and safety behaviour change, we describe our efforts to develop a method for theory driven design based on the Double Diamond. Our method attempts to integrate insights from the Persuasive by Design-model (PbD) for behaviour change into the entire design process. Our case studies demonstrate that our method indeed augments the integration of theory and evidence in our designs, but only if the Double Diamond process model is complemented with an evaluation phase, and insights from the PbD-model are derived using rich, well developed tools.
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Comprehensive understanding of the merits of bottom-up urban development is lacking, thus hampering and complicating associated collaborative processes. Therefore, and given the assumed relevancies, we mapped the social, environmental and economic values generated by bottom-up developments in two Dutch urban areas, using theory-based evaluation principles. These evaluations raised insights into the values, beneficiaries and path dependencies between successive values, confirming the assumed effect of placemaking accelerating further spatial developments. It also revealed broader impacts of bottom-up endeavors, such as influences on local policies and innovations in urban development.
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Aim: The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations.
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Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Purpose: A model is developed to analyse what personality traits impact entrepreneurial cognitive and social strategic decision-making skills, originating from the effectuation framework. Design/methodology/approach: 128 participants from an entrepreneurial pre-launch programme were assessed by experienced incubator and business coaches. Personality was measured by a Big Five test. Based on a confirmatory factor analysis, the relationships were analysed between personality and three core dimensions of the effectuation framework: 1) the bird-in-hand principle, 2) the crazy quilt principle and 3) the pilot in the plane principle. Findings: Specific patterns (moderation effects) as opposed to levels of personality traits proved to be relevant. The bird-in-hand and the crazy quilt principles are related to the moderating effect between sensitivity to feedback, sociability and ambition. The pilot in the plane principle was related to the whole pattern of entrepreneurial key qualities embedded in the extraversion domain. Furthermore, relationships of personality with key issues in the effectuation framework were found, examples being reflecting on a high diversity of means or on own talents, conducting a thorough risk analysis and engaging in inspirational networking. The final model revealed a direct positive influence of the capacity to conduct a thorough risk analysis on the overall capacity to apply the effectuation principles. Originality/value: The research results offer deeper insights for the mobilisation and development of complex entrepreneurial behaviours. https://doi.org/10.1108/IJEBR-06-2019-0343 LinkedIn: https://www.linkedin.com/in/rainer-hensel-phd-8ba44a43/ https://www.linkedin.com/in/ronald-visser-4591034/
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Aim: to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers. Design: A multinational cross-sectional study using Q-methodology. Methods: First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed. Results: The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility. Conclusions: Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC. Impact: Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.
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In many learning spaces in higher professional education, students are required to do research. At the same time they, and many of their tutors, struggle with the doubt, the uncertainty and even the anxiety that often accompanies the research process. Research shows that uncertainty and safety (‘safe uncertainty’) play an important role in students’ experiences of the research process. In order to study this and to answer the question ‘how to cope with uncertainty during the research process?’, we have designed a tool called ‘research mapping’. In a workshop setting, research mapping visualizes first the research process and, secondly, the elements of safe uncertainty within. Subsequently, dialogue between the participants produces generalized insights in the research process and in the role of safe uncertainty in that process. Next to the benefits for students and tutors, also the learning space of doing research can be improved.
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OBJECTIVE: To describe professionals' perceptions of factors that facilitate or hamper the implementation and continuation of a physical activity promotion programme in rehabilitation.DESIGN: This study used a qualitative design.METHODS: Semi-structured interviews (n = 22) were conducted with rehabilitation professionals (n = 28) involved in the implementation of a physical activity promotion programme. Two additional interviews were conducted with the programme coordinators (n = 2). The study involved 18 rehabilitation organizations implementing the programme that targets people with disabilities or chronic diseases. Organizations were supported in the implementation process by the programme coordinators.RESULTS: Commonly perceived facilitating factors were: involvement of committed and enthusiastic professionals; agreement with their organizations' vision/wishes; the perceived additional value of the programme; and opportunities to share knowledge and experience with professionals from other organizations. Commonly perceived hampering factors were: uncertainty about continuing the programme; limited flexibility; and lack of support from physicians and therapists to implement the programme.CONCLUSION: Professionals perceived a heterogeneous set of factors that facilitate and/or hamper the implementation and continuation of a physical activity promotion programme in rehabilitation. Based on these findings, recommendations were formulated to enhance embedding of physical activity promotion during and after rehabilitation.
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Objective: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. Design: Cross-sectional survey. Subjects: Stroke patients, informal caregivers, health-care professionals. Methods: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. Results: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34–5.33), informal caregivers (OR 8.98; 95% CI 1.70–47.33) and healthcare professionals (OR 6.25; 95% CI 1.17–10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17–0.74). Limitations of the study include low response rates and possible response bias. Conclusion: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation. Lay Abstract The use of digital eRehabilitation after stroke (e.g. in serious games, e-consultation and education) is increasing. However, the use of eRehabilitation in daily practice is limited. As a first step in increasing the use of eRehabilitation in stroke care, this study examined which factors influence the willingness of stroke patients, informal caregivers and healthcare professionals to use eRehabilitation. Beliefs about the benefits of eRehabilitation were found to have the largest positive impact on willingness to use eRehabilitation. These benefits included reduced travel time, increased adherence to therapy or motivation, and better health outcomes. The willingness to use eRehabilitation is limited by a lack of knowledge about how to use eRehabilitation.
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