Search

Background: Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. Methods: In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. Results: Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. Conclusions: This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities. [ABSTRACT FROM AUTHOR]

Internalized HIV stigma is prevalent and research on internalized HIV stigma has increased during the past 10 years. The aim of this systematic review was to synthesize research on internalized HIV stigma and relationships with various health-related variables in order to better inform the development of interventions aimed at reducing internalized HIV stigma. We reviewed 176 studies with a quantitative design reporting correlates that were peer-reviewed, published in English before January 2021, drawn from PubMed, PSYCHINFO, Web of Science, EBSCO, and Scopus. Synthesis showed consistent associations between internalized stigma and negative psychological (e.g., depression, anxiety), social (e.g., lack of social support, discrimination, nondisclosure, and intersecting stigmas), and health (e.g., substance use, treatment nonadherence, negative clinical HIV outcomes) variables. We argue for a more socioecological approach to internalized stigma, with greater attention for intersectional stigmas, and more longitudinal research, if we are to effectively develop interventions that reduce internalized stigma. [ABSTRACT FROM AUTHOR]

Previous research suggests that empathy can be cultivated by social ideals and relationships with people. The current study examines family importance and religious importance as correlates of affective empathy, perspective taking, and generativity among a sample of adults aged 18 to 35 (N = 722). Given the ethnic and racial diversity represented by Millennials and Generation Z, the moderating role of racial group membership is explored as well. Results indicate that family importance is positively associated with affective empathy, perspective taking, and generativity for the overall sample, though the relationship is particularly strong for non‐Hispanic whites. Religious importance is significantly related to affective empathy and generativity (not perspective taking), primarily among Black, Indigenous, and/or People of Color. Due to the increasing visibility of victimization towards socially vulnerable groups, it is important to understand how attitudes oriented towards helping and empathizing with others are fostered. Implications for further research are discussed. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The way in which care providers describe incapacitated elderly people is not without implications. The different ways in which they describe their patients—client, patient, or a sick human being—have consequences for their relationships with these patients and the decision‐making processes. The aim of this study is to use insights from complexity thinking to understand the dynamic relations between various patient descriptions in decision‐making. Method: We conducted a retrospective qualitative empirical study. Health care professionals were interviewed on how their decisions with the families of the patients were made during the course of the patients' illness. Transcriptions of interviews with physicians, residential practitioners, nurses, and head nurses were made regarding their contribution to the decision‐making process. Methodologies of complexity thinkers can be helpful to not articulate the implications of individual patient descriptions, but also their interrelationships. Results: Instead of reducing their patients with the logic of the market to clients or with the logic of medicine to patients, health care providers learn in an emergent dialogic encounter to care for them as sick persons. Conclusions: Shared‐decision‐making favours the involvement of patients and their families in decision‐making. However, due to a domination of the logic of the market and the logic of medicine, decision‐making is problematic. As professional mediators, health care providers learn, however, to balance client demands, medical perspectives, and embodied dialogic care in decision‐making for voiceless patients. [ABSTRACT FROM AUTHOR]

Reintegration into school is a milestone for childhood brain tumor survivors, as well as for their parents, teachers, and healthcare providers. We explored their experiences following the school re-entry by conducting semi-structured interviews. Thematic analysis resulted in four main themes: "school performance," "psychosocial well-being," "support and approach," and "communication and collaboration." Children were pleased to return to school despite confrontation with adverse outcomes. Parents, teachers, and healthcare providers identified current and future concerns and challenges, as well as opportunities for academic and personal development. Their experiences highlight the importance of coordinated and systematic follow-up in close collaboration with healthcare providers. [ABSTRACT FROM AUTHOR]

Crew-resource management is an approach to work and training that focuses on non-technical skills and strategies to prevent human error in complex procedures. It was initially termed 'cockpit-resource management' and developed for aviation in the 1970s after several severe accidents; it has contributed to a measurable increase in flight safety. In recent years, this approach has been successfully implemented in other high- reliability environments; surgical disciplines have made particular use of crew-resource management strategies and training, with resulting reduced mortality rates. The stepwise implementation of different crew-resource management strategies in stroke care at our tertiary stroke centre has helped to speed up process times significantly, and to improve patient safety and staff satisfaction. Here, we summarise our experience in adapting different crew-resource management tools to acute stroke care, sharing specific tools that have proven valuable in our hands, and we encourage colleagues to implement such strategies in acute stroke care. [ABSTRACT FROM AUTHOR]

Adolescence and emerging adulthood are periods in life when individuals both question and define their place in society and form their identity. Meanwhile, active youth civic engagement represents a challenge for each democracy. The purpose of this study was to analyze the different forms of civic engagement among late adolescents and emerging adults and how they are related to personal identity and social identity, while adopting an integrative perspective through the lens of a person-oriented approach. The participants were 1217 (62.3% female) 16-24 year-old French students (Mage = 19.17; SDage = 1.83). First, derived from cluster analyses, the findings emphasized diversity in civic engagement, from strong civic participation (in different formal and informal ways) to various forms of passivity. Diversity was also highlighted for personal identity and social identity profiles. Second, a Configural Frequency Analysis revealed a typical pattern associating passivity in civic engagement, personal carefree diffusion and rejection of social identity. Overall, these findings highlight an absence of general youth disaffection and provide a meaningful specific pattern for the understanding of passivity in political and civic matters in late adolescence and emerging adulthood. [ABSTRACT FROM AUTHOR]

Background: To assess hospital performance, quality perceptions of various stakeholders are increasingly taken into account. However, because of substantial background differences, various stakeholder groups might have different and even contrasting quality perceptions. Purpose: We test the hypothesis that an overall perception gap exists between employees and patients with respect to perceived hospital quality. We additionally elaborate on how various employee groups differ from each other and from patients. Methodology: We use primary survey data on perceived hospital quality from 9,979 patients and 4,306 employees from 11 German hospitals. With a multilevel regression and variance analysis, we test the impact of respondent type (employee or patient) on quality perception scores and test the interaction with hospital size. We additionally contrast different employee groups and test differences for various quality dimensions. Results and Conclusion: Hospital employees score hospital quality consistently lower than patients and are also more heterogeneous in their assessments. This makes it from a managerial point of view relevant to subdivide employees in more homogeneous subgroups. Hospital size has no clear effect on the perception gap. Doctors compared to patients and other employee groups have substantially different perceptions on hospital quality. Practice Implications: Our findings fuel the practical and ethical debate on the extent that perception gaps could and should be allowed in the context of high-quality and transparent hospital performance. Furthermore, we recommend that the quality perception gap is a substantial part of the overall hospital evaluation for ethical reasons but also to enable managers to better understand the (mis)match between employees' priorities and patients' preferences. However, we do warn practitioners that perceptions are only to a limited extent related to the organizational level (in contrast to the individual level), and only minimal improvements can thus be reached by differentiating from other hospitals. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims, and objectives: How to clarify the implications of complexity thinking for decision making in the intensive care unit (ICU)? Method: Retrospective qualitative empirical research. Practitioners in an ICU were interviewed on how their decisions were made regarding a particular patient in a difficult, clinical situation. Transcriptions of these interviews were coded and retrieved in Maxqda, a software program. Assisted by complexity thinking, researchers focused on the decision‐making process and the shift from analytic approaches to complex approaches. Results: Originally, practitioners took their decisions with negligible transdisciplinary interactivity, drawing on analytical knowledge. Later on, they shifted to transdisciplinary practices, paying attention to more participation in their decision‐making processes within their complex environment. Conclusions: Complexity thinking demonstrates that this is a better model towards understanding transdisciplinary decision making then most analytical methodologies. [ABSTRACT FROM AUTHOR]

Context: There is a growing focus on the social missions of medical schools as a way of expressing an institutional commitment to service, responsibility and accountability. However, there has been little exploration of how a social mission translates to student experiences. Methods: This multicentre study explored how the social missions of eight medical schools (from Australia, Belgium, Canada, the Philippines, South Africa, Sudan and the USA) translated to their medical education programmes, and how their students perceived the mission. The study used a nested case study design involving interviews with final‐year medical students. Constructivist grounded theory techniques were used to analyse the data. Cultural‐historical activity theory concepts of externalisation and internalisation were used to structure the analyses. Results: The study identified substantial variation in the form, focus and depth of expression of each school's social mission, significant variation in how and to what extent the mission was externalised in the design of each school's undergraduate medical education programme, and significant variation in how students perceived the social mission and its translation to their training experiences. The translation of a social mission to educational outcomes depended on a cascade of externalisation and internalisation processes, each of which could alter or reinterpret the mission. Translation depended to a great extent on sensitising learners to the mission's values and issues and subsequently activating this knowledge in the context of direct clinical encounters that embodied the issues the mission was seeking to address. Conclusion: Whether a medical school's social mission is focused on equity of access to the medical profession or on its graduates serving particular community needs, the mission principles need to be translated into practice. This translation process involves a series of externalisation and internalisation steps, each of which determines how much and what aspects of the mission are translated. [ABSTRACT FROM AUTHOR]

Research on volunteering has mainly focused on the explanatory demographics and functional motives to volunteer, but little is known about the reasons that people might have not to volunteer. However, these reasons need more academic attention, as they form the barriers that organizations have to overcome when attracting new volunteers. We examine a sample of 1248 respondents on whether they volunteer, are interested in volunteering, or have no interest to volunteer. We verify whether demographic differences exist between these groups. By means of an exploratory factor analysis, we analyze the reasons not to volunteer for those who have no interest to volunteer. This complements earlier research by focusing on the barriers that people might have, instead of the benefits of volunteering that have extensively been documented. [ABSTRACT FROM PUBLISHER]

Introduction: In the worldwide COVID-19 pandemic, healthcare workers (HCWs) caring for people with intellectual disabilities (ID) face a unique risk above the already heightened occupational risk all HCWs are exposed to, but literature on this specific group is lacking. Understanding why individuals are hesitant to be vaccinated for COVID-19 is essential in order to provide the right measures in improving vaccination numbers. This article reviews the influencing factors of COVID-19 vaccine willingness and hesitancy in HCWs who work with people with ID. Methods: CINAHL, APA PsycArticles, APA PsycInfo, Web of Science, Semantic Scolar, Prospero, Outbreak Science, Cochrane and Scopus were searched for papers including the attitudes on COVID-vaccination of HCWs in the field of ID-care. Only two papers were found on HCWs working with people with ID, therefore the search was broadened to HCWs in general. Twenty-six papers were identified containing quantitative and qualitative data on 43,199 HCWs spread over 16 countries worldwide. Socio-demographical predictors of vaccine willingness were extracted and analysed, as well as attitudes of vaccine willingness and hesitancy. Results: Medical doctors, people of older age, men, and those previously vaccinated with the influenza vaccine were most willing to take the COVID-vaccine. Health factors and ethics were drivers of vaccine willingness; characterised by perceived COVID-threat and wanting to protect family members and others. Distrust and lack of information were the most common drivers of vaccine hesitancy; characterised by concerns on side effects, vaccine safety, vaccine efficacy, and speed of vaccine development. Limiting to the two papers investigating HCWs in the care of people with ID, some similarities were found: (1) only older age was a predictor for vaccine willingness and (2) concerns about possible side effects and the fast development of the vaccine were the main drivers for vaccine hesitancy. Additionally, vaccine willingness and hesitancy in HCWs are not stable over time and are affected by information sources and contextual factors. Conclusions: To achieve the highest COVID-vaccination degree worldwide amongst HCWs, recommendations are made for interventions on distrust-topics to nursing staff, people of younger age, women, and those not previously vaccinated within the HCW-population. Implications: Additional research is needed to specify more precisely the attitudes of HCWs caring for people with ID in general and in more countries worldwide. [ABSTRACT FROM AUTHOR]

Purpose: Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals’ (HP) performance to encourage stroke inpatients to be physically active.Method: This multicenter intervention study used a pre–post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs.Results: After the KB-intervention, many more patients (48%;N=217) reported at least some encouragement by HPs to be physically active than before (26%;N=243,p<0.000). HPs (N=288) on an average reported encouraging patients more often after the intervention, but this difference was significant only for occupational therapists and KBs.Conclusions: Based on patient’s reports of HP behaviour, the KB-intervention appears effective since more patients felt encouraged to be physically active after the intervention compared to before. Replication of this study in an experimental design is needed to allow causal inferences.Implications for rehabilitationWe advise rehabilitation teams to make use of knowledge brokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active.It seems worthwhile to involve physicians, nurses and patients’ families more frequently in efforts to encourage stroke patients to be physically active. [ABSTRACT FROM AUTHOR]

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of (false) hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. [ABSTRACT FROM AUTHOR]

The increasing use of telecare will profoundly change nursing care. How to understand these changes is, however, far from clear. This is because (i) studies on telecare seldom consider the situation it replaces, and (ii) current concepts and methods used to study the impact of telecare may not allow us to fully grasp these changes. We suggest that an analysis of the changing materiality of care practices is a suitable way to articulate and reflect on possible concerns. It allows us to compare care practices in the same terms before and after telecare has been introduced. To demonstrate this, we study the materiality of the classical care setting, the nursing house call, to map the situation before telecare is introduced. Building on science and technology studies, we apply four categories as heuristics to analyse materiality in care: signs, dis/enablers (or scripted things), tools and practical arrangements. We leave open the question of how material arrangements could or should be matters of concern in nursing care, and instead argue for studies that give insights into the everyday tinkering with the materiality of care that both nurses and patients need to engage in. [ABSTRACT FROM AUTHOR]

Background Relationships between support staff and clients with intellectual disability ( ID) are important for quality of care, especially when dealing with challenging behaviour. Building upon an interpersonal model, this study investigates the influence of client challenging behaviour, staff attitude and staff emotional intelligence on interactive behaviour of one of these relationship partners, being support staff. Method A total of 158 support staff members completed a questionnaire on staff interactive behaviour for 158 clients with ID and challenging behaviour, as well as two questionnaires on staff interpersonal attitude and emotional intelligence. Results Confronted with challenging behaviour as opposed to no challenging behaviour, staff reported less friendly, more assertive control and less support-seeking interpersonal behaviour. Also, staff used more proactive thinking and more self-reflection in dealing with challenging behaviour. Staff interpersonal attitude in general, mainly a harsh-dominant-resentful attitude, had a significant influence on most staff interactive behaviours towards an individual client with challenging behaviour. The influence of staff emotional intelligence, specifically intrapersonal abilities, on staff interactive behaviour towards an individual client with challenging behaviour was somewhat limited. Conclusions This research supports the necessity for training staff in general interpersonal attitudes towards clients as well as training in intrapersonal emotional intelligence, when confronted with challenging behaviour. Future research should focus more on the bidirectional dynamics of staff and client interactions. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships.Setting: Two university outpatient clinics, one staffed by family medicine and the other by primary care and categorical internal medicine residents.Design: Cross-sectional study of consecutive patients who had been followed by second- and third-year residents for at least one year.Measurements: Alcohol abuse was determined using the Michigan Alcoholism Screening Test (MAST), with a score > or = 5 considered positive. Rates of addressing alcohol use in the preceding year were determined by patient report and chart review. Attitudes were assessed using the Substance Abuse Attitude Survey (SAAS).Results: 334 patients of 49 residents completed the MAST. Rates of alcoholism among the patient groups were: family medicine, 8.3%; primary care, 29.1%; and categorical medicine, 18.0% (p < 0.001). Screening behavior varied by type of residency: 47% of the family medicine, 71% of the primary care, and 65% of the categorical residents' patients reported being asked about alcohol use in the preceding year (p < 0.001); chart documentation was present for 15% of the family medicine, 38% of the primary care, and 24% of the categorical residents' patients (p < 0.001). Perceived prevalence of alcohol abuse, confidence in intervening, and several scales on the SAAS were related to residency type and to addressing alcohol use, but controlling for these variables did not affect the association between residency type and either patient report or chart documentation of screening.Conclusion: Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes. [ABSTRACT FROM AUTHOR]

Background: A program supporting the initiation of insulin therapy in primary care was introduced in Belgium, as part of a larger quality improvement project on diabetes care. This paper reports on a study exploring factors influencing the engagement of general practitioners (GPs) in insulin therapy initiation (research question 1) and exploring factors relevant for future program development (research question 2). Methods: We have used semi-structured interviews to answer the first research question: two focus group interviews with GPs who had at least one patient in the insulin initiation program and 20 one-to-one interviews with GPs who were not regular users of the overall support program in the region. To explore factors relevant for future program development, the data from the GPs were triangulated with data obtained from individual interviews with patients (n = 10), the diabetes nurse educator (DNE) and the specialist involved in the program, and data extracted from meeting reports evaluating the insulin initiation support program. Results: We found differences between GPs engaged and those not engaged in insulin initiation in attitude, subjective norm and perceived behavioural control regarding insulin initiation. In general the support program was evaluated in a positive way by users of the program. Some aspects need further consideration: job boundaries between the DNE and GPs, job boundaries between GPs and specialists, protocol adherence and limited case load. Conclusion: The study shows that the transition of insulin initiation from secondary care to the primary care setting is a challenge. Although a support program addressing known barriers to insulin initiation was provided, a substantial number of GPs were reluctant to engage in this aspect of care. Important issues for future program development are: an interdisciplinary approach to job clarification, a dynamic approach to the integration of expertise in primary care and feedback on protocol adherence. Trial registration: ClinicalTrials.gov Identifier: NCT00824499 [ABSTRACT FROM AUTHOR]

This qualitative research examines the similarities and differences between three teaching departments within Universities of Applied Sciences (UAS) in the Netherlands that provide effective and three that provide less effective quality management. What are staff members’ conceptions and perceptions of quality, quality management and organisational values and how do they connect? Per department three semi-structured interviews were conducted. Within all departments the conceptions of quality and the preferred organisational values are quite similar: quality is seen as continuous improvement of education andhuman relations valuesare preferred. The differences concern practice. In contrast with less effective departments, effective departments have a structured quality management that is closely connected with day-to-day work and results in improvements. In addition, these effective departments realise the organisational values they prefer, whereas less effective ones fail to do so. The recommendation is to work on a culture that involves cooperation, open communications, flexibility and external orientation and the close involvement of quality management in the regular work of staff. [ABSTRACT FROM PUBLISHER]

The article discusses research which examined healthcare professionals' stand on palliative care patients' hope described in literature. It cites the association of palliative care patients' hope with their psycho-spiritual well-being. Findings revealed that 31 literary articles were of sufficient quality and described perspectives of nurses or physicians. The types of perspectives on hope of palliative care patients include realistic, functional and narrative perspective.

The issue of identity spatialisation lies at the interface between classic theories of social identity in social psychology and the environmental psychology approach in terms of sociospatial identity. This study of adolescents and young adults aimed to identify the influence of belonging to a place on self-construction according to place of residence in France. Two regions were compared: (a) the French Basque region, where there is high cultural specificity; and (b) Bordeaux region, which is less culture-specific. Data were collected from 229 adolescents and young adults from these two regions. The feeling of belonging to a region, sociospatial identity, and social identity were estimated using self-report questionnaires. Results demonstrate the existence of several forms of sociospatial identity. Basques tended to overinvest on the regional level-especially when they spoke the Basque language (Euskara)-whereas the sociospatial identity of Bordeaux inhabitants was multi-level. Furthermore, the expression of sociospatial identity was age-dependent. These findings help to define, measure, and interpret the processes and dynamics of identity associated with belonging to different territories. [ABSTRACT FROM AUTHOR]

We assess how age relates to the degree of balance in volunteers’ psychological contracts (PCs). Research on PCs treating age as a substantive variable remains scarce in the literature. Nonetheless, this seems important in light of the increasing age-diversity in the voluntary workforce, as several theories suggest that younger and older individuals may prefer different degrees of balance in their PC. Moreover, previous studies have empirically shown that age influences how people respond to other aspects of the PC, such as breach and fulfilment. We hypothesize that volunteers perceive different levels of PC imbalance depending upon their age. More specifically, we argue that older volunteers tend to perceive organization underobligation, whereas younger volunteers tend to perceive organization overobligation. In addition, we hypothesize that age moderates the effects of PC imbalance on the intention to stop volunteering in an organization. We use polynomial regressions and response surface analysis to examine survey data of 401 volunteers. Our results support our hypotheses, thus emphasizing the importance of including individual differences, such as age, in future research on PC balance. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the impact of an educational intervention that integrates concepts of a community re-engagement framework (CR) and interprofessional collaboration (IPC) on health care providers' (HCP) practice with persons living with stroke (PLS). Method: A mixed-methods design was used in which HCPs (n = 67) and PLS (n = 29) participated from 9 organizations across the care continuum. Pre- and postintervention surveys and interviews were conducted with the HCPs. One-on-one interviews with stroke clients were also conducted pre and post intervention. Quantitative responses were analyzed in SPSS (Chicago, Illinois, USA) for descriptive frequencies and differences between pre- and postintervention groups. Qualitative open-ended responses were thematically coded using NVivo7. Results: Significant increases occurred in HCPs' knowledge of CR, confidence levels in working with PLS, enhanced understanding of the complex needs of PLS, and positive self-reported impacts on practice. PLS reported positive perceptions of care pre and post intervention. Conclusions: The intervention provided HCPs with a common language and framework to work collaboratively and holistically in delivering care consistent with stroke best practices. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care. Materials and Methods: Between days 3 and 5, perceptions by families and ICU staff of family involvement in care were collected prospectively at a single center. Family members completed the Hospital Anxiety and Depression Scale (HADS) and a satisfaction scale (Critical Care Family Needs Inventory). Nurses recorded care provided spontaneously by families. Characteristics of patient-relative pairs (n = 101) and ICU staff (n = 45) were collected. Patients described their perceptions of family participation in care during a telephone interview, 206 ± 147 days after hospital discharge. Results: The numbers of patient-relative pairs for whom ICU staff reported favorable perceptions were 101 (100%) of 101 for physicians, 91 (90%) for nurses, and 95 (94%) for nursing assistants. Only 4 (3.9%) of 101 families refused participation in care. Only 14 (13.8%) of 101 families provided care spontaneously. The HADS score showed symptoms of anxiety in 58 (58.5%) of 99 and of depression in 26 (26.2%) of 99 family members. The satisfaction score was high (11.0 ± 1.25). Among patients, 34 (77.2%) of 44 had a favorable perception of family participation in care. Conclusions: Families and ICU staff were very supportive of family participation in care. Most patients were also favorable to care by family members. [Copyright &y& Elsevier]

Background: Numerous studies have investigated the relationships between various student, home and contextual factors and reading achievement. However, the relationship between such factors and reading attitudes has been investigated far less, despite the fact that theoretical frameworks of large-scale assessments and school effectiveness research emphasize the importance of non-cognitive outcomes.Methods: Based on a series of multi-group analyses using a structural equation modeling approach, we elucidate the relationships between student attitudes toward reading and student-, home- and context-related factors. In order to shed light on the role of different educational systems, we make use of the representative data from four national PIRLS samples (France, Germany, Italy and the Netherlands) from 2011 (n = 16,622). As gender differences are apparent in reading achievement and reading choices, we apply a multi-group comparative approach in order to control for potential gender-biased estimates caused by measurement non-invariance of the PIRLS instrument Attitude toward Reading.Results: Our results reveal the importance of individual student and home characteristics for promoting students’ reading attitudes, particularly the number of books at home and the amount of reading outside school. Our results also indicate that school- and classroom-related factors such as the time spent on reading and the availability of a classroom or school library show no or only little interrelation with students’ reading attitudes. These findings are relatively stable in the cross-country comparison.Conclusions: As expected, our results also support previous findings on gender differences in reading attitudes, as girls show more positive attitudes toward reading than boys. The implications of these results for researchers, politicians and practitioners are discussed. [ABSTRACT FROM AUTHOR]

Background Loss of personal dignity in patients with a serious and progressive disease is associated with psychological suffering and loss of the will to live. Preservation of a sense of dignity in the seriously ill should therefore be a primary concern throughout the illness trajectory from diagnosis onward. However, there is currently limited insight into the dynamics of patients’ sense of dignity during the progression of illness. Aim This longitudinal qualitative study investigates patients’ experiences with dignity over time in a diverse patient population (cancer, early-stage dementia and severe chronic illnesses). Method Nineteen patients were interviewed annually (max. 4 years), resulting in a data base of 56 interviews in total. Data were analyzed making use of thematic analysis. Results Three different trajectories over time could be distinguished: (a) a Dynamic Equilibrium in which the individual's sense of dignity was temporarily diminished followed by a return to previous levels; (b) a Downward Trend in which the sense of dignity was diminished with progression of the disease without a return to previous levels; and (c) Stability in which the sense of dignity remained unaltered despite changes in circumstances. Conclusion While there is a small group of patients for whom dignity remains unaffected by their disease experiences, most patients go through difficult times during which they struggle to maintain or regain their sense of dignity in the face of progressive loss. This longitudinal study offers insight into the dynamics behind this and enhances our understanding of why some patients manage to maintain their sense of dignity while others suffer from a diminished sense of dignity. [ABSTRACT FROM AUTHOR]

Background: While knowledge on factors affecting personal dignity of patients nearing death is quite substantial, far less is known about how patients living with a serious disease understand dignity. Objective: To develop a conceptual model of dignity that illuminates the process by which serious illness can undermine patients' dignity, and that is applicable to a wide patient population. Design: Qualitative interview study. Participants: 34 patients with either cancer, early stage dementia, or a severe chronic illness were selected from an extensive cohort study into advance directives. Method: In-depth interviews were carried out exploring the experiences of seriously ill patients with regard to their personal dignity. The interview transcripts were analyzed using thematic analysis and a conceptual model was constructed based on the resulting themes. Results: We developed a two-step dignity model of illness. According to this model, illness related conditions do not affect patients' dignity directly but indirectly by affecting the way patients perceive themselves. We identified three components shaping self-perception: (a) the individual self: the subjective experiences and internally held qualities of the patient; (b) the relational self: the self within reciprocal interaction with others; and, (c) the societal self: the self as a social object in the eyes of others. Conclusions: The merits of the model are two-folded. First, it offers an organizing framework for further research into patients' dignity. Secondly, the model can serve to facilitate care for seriously ill patients in practice by providing insight into illness and dignity at the level of the individual patient where intervention can be effectively targeted. [ABSTRACT FROM AUTHOR]