Background: Research on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”. Methods: We used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. Findings: We conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”. Discussion: Acknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. Conclusion: Good communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.
Background: The shift in healthcare to extramural leads to more patients with complex health problems receiving nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate, which contributes to widespread labour-market shortages. This study investigates the effect of a more ‘communitycare-oriented’ curriculum on nursing students’ perceptions of community care. Methods: A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018; response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the Netherlands. The intervention group underwent a new curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and intervention group were compared on demographics, placement preferences and perceptions with a chi-square or T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students’ perceptions of community care.Results: The comparison between the control and intervention group on students’ perceptions of community care shows no significant differences (mean 6.18 vs 6.21 [range 1–10], respectively), nor does the curriculum-redesign have a positive effect on students’ perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences also shows no significant differences and confirms the hospital’s popularity (72.7% vs 76.5%, respectively) while community care is less often preferred (9.2% vs 8.2%, respectively). The demographics ‘working in community care’ and ‘belonging to a church/religious group’ appear to be significant predictors of more positive perceptions of community care. Conclusions: Graduating students who experienced a more ‘community-care-oriented’ curriculum did not more often prefer community care placement, nor did their perceptions of community care change. Apparently, four years of education and placement experiences have only little impact and students’ perceptions are relatively static. It would be worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in with the language and culture of younger people. Keywords: Community care, Nurse education, Curriculum design, Perceptions, Career choice
Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
"Lifestyle and Digital Sovereignty, a new-media arts approach to collective technological empowerment for holistic care" is een praktijkgericht artistiek onderzoekstraject dat een nieuwe mediakunstinterventie creëert in het domein van de gezondheidszorg. Dit project onderzoekt hoe artistieke interventies die technologische processen integreren kennis kunnen genereren die kan worden toegepast in een bredere context, namelijk het verhogen van gezonde levensstijlgewoonten bij de bevolking. Het onderzoekt hoe artistiek onderzoek de digitale geletterdheid kan vergroten en deelnemers in staat kan stellen hun levensstijlgewoonten te beheren met behulp van kunstmatige intelligentie, waardoor ze op een soevereine manier kunnen interageren met technologische sensoren en systemen. Het project omvat een mensgerichte benadering van AI, in overeenstemming met de ethische en morele vereisten ervan. Het zal veldonderzoek toepassen in de vorm van AT-LABS: een ruimte in kaart gebracht door middel van technologie en artistiek geïntervenieerd door middel van geluid, licht en choreografie, om een optimale bodem te creëren voor artistiek onderzoek naar gemeenschapsvorming, technologisch gemedieerde interactie, digitale geletterdheid en performatieve praktijk, die een interdisciplinaire aanpak mogelijk maakt. De AT-LAB's vinden iteratief plaats tijdens het vierjarige doctoraatstraject. De informatie die bij elke interventie wordt verzameld, zal leiden tot aanpassingen en verbeteringen in de volgende iteraties. De tweede onderzoekslijn zal de artistieke mogelijkheden van nieuwe mediakunst in deze context bekijken en onderzoeken. Het project wordt uitgevoerd binnen het Consortium Healthy Living as a Service (HLaS), een programma geleid door het Universitair Medisch Centrum Groningen (UMCG). Verder zal worden samengewerkt met V2_ Lab for the Unstable Media, en ARC in het Noorden. Het wordt begeleid door Prof. Dr. Anke Coumans van de onderzoeksgroep Image in Context van de Hanze Hogeschool en Dr. Bianca Herlo, UDK Berlin, Design Research Group. Secundaire professionele begeleiders zijn Dr. Michel Dartel, V2_ Avans Hogeschool, en Prof. Dr. Claudine Lamoth, UMCG, en leider van het HLaS project.
