With this article, we aim to increase our understanding of how mobile virtual reality exposure therapy (VRET) can help reduce speaking anxiety. Using the results of a longitudinal study, we examined the effect of a new VRET strategy (Public Speech Trainer, PST), that incorporates 360° live recorded VR environments, on the reduction of public speaking anxiety. The PST was developed as a 360° smartphone application for a VR head-mounted device that participants could use at home. Realistic anxiety experiences were created by means of live 360° video recordings of a lecture hall containing three training sessions based on graded exposure framework; empty classroom (a) and with a small (b) and large audience (c). Thirty-five students participated in all sessions using PST. Anxiety levels were measured before and after each session over a period of 4 weeks. As expected, speaking anxiety significantly decreased after the completion of all PST sessions, and the decrement was the strongest in participants with initially high speaking anxiety baseline levels. Results also revealed that participants with moderate and high speaking anxiety baseline level differ in the anxiety state pattern over time. Conclusively and in line with habituation theory, the results supported the notion that VRET is more effective when aimed at reducing high-state anxiety levels. Further implications for future research and improvement of current VRET strategies are discussed.
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The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS: The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS: It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS: Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline.
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Background: For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. Methods: An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). Results: Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role. Conclusions: SDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.
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In recent decades the trend of public accountability, transparency and governance has become a priority in many public sectors, but in de media sector and the public broadcasting sector in particular there have only very recently been attempts to address the public in terms of accountability and responsiveness
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Pressure from politics and the public has created a greater demand for the media to be more accountable. Moreover, growing structural changes in the media landscape – including media concentration, commercialization, fiercer competition, an increasingly fragmented public, and the advent of new media – have also challenged how media should be accountable and responsive. This article looks at how Dutch broadcast media are responding to increasing pressure in terms of accountability and responsiveness through a case-‐study research from two leading broadcast news organizations. The need for more openness to and connection with the public is acknowledged, and among many journalists this is now even considered a necessity. However, when it comes to routinized daily application, there is a general resistance as it does not live within their professional autonomy and authority. New online instruments have created opportunities with more platforms and possibilities for the public to participate. However, at this point the online instruments put new constraints on the social system of organization with unforeseen activities and costs.
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This article traces the emergence of one particular genre of discourse, the genre of "new realism" in the Dutch public debates on multicultural society from the early 1990s till Spring 2002. The focus upon different "genres" implies an interest in the performative power of discourse, i.e. the way in which any discourse, in or by its descriptions of reality, (co)produces that reality. Four distinctive characteristics of "new realism" are detected in three subsequent public debates, culminating in the genre of "hyper-realism", of which the immensely successful and recently murdered politician Pim Fortuyn proved to be the consummate champion. Cet article explique le développement d'un genre particulier de discours, le "nouveau réalisme", au sein du débat public sur la société multiculturelle aux Pays Bas. La période étudidée s'étale du début des années 1990 jusqu'au printemps 2002. L'importance attribuée aux différents "genres" reflète un intérêt pour le pouvoir performatif du discours, notamment la facon dont le discours (co)produit la réalité qu'il décrit. On décèle quatre traits distinctifs du "nouveau réalisme" dans trois débats publics qui débouchent sur le "hyper-réalisme" genre dont Pim Fortuyn, homme politique ayant connu un grand succès et victime récente d'un meurtre,s'était fait le champion attitré.
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Objective: This article explores the use of experiential knowledge by traditional mental health professionals and the possible contribution to the recovery of service users. Design and Methods: The review identified scientific publications from a range of sources and disciplines. Initial searches were undertaken in databases PsycINFO, PubMed, and Cochrane using specific near operator search strategies and inclusion and exclusion criteria. Results: Fifteen articles were selected. These were published in a broad range of mental health and psychology journals reporting research in western countries. In the selected articles, a varying conceptualization of experiential knowledge was found, differing from therapeutic self-disclosure embedded in psychotherapeutic contexts to a relational and destigmatizing use in recovery-oriented practices. Nurses and social workers especially are speaking out about their own experiences with mental health distress. Experiential knowledge stemming from lived experience affects the professional’s identity and the system. Only a few studies explored the outcomes for service users’ recovery. Conclusion: A small body of literature reports about the use of experiential knowledge by mental health professionals. The mental health system is still in transformation to meaningfully incorporate the lived experience perspective from traditional professionals. There is little data available on the value for the recovery of service users. This data indicates positive outcomes, such as new understandings of recovery, feeling recognized and heard, and increased hope, trust, and motivation. More research about the meaning of experiential knowledge for the recovery of service users is desirable.
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Een actieonderzoek naar de ontwikkeling van een leerlingversterkend onderwijsprogramma met het doel leerlingen met een visuele beperking beter voor te bereiden op hun transitie naar volwassenheid en waar mogelijk een betaalde baan. Belangrijke thema's: inclusie en exclusie, empowerment, stem van de leerling, transitie naar volwassenheid en het burgerschapsmodel tegenover het medische model.
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