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Moral distress arises in the dynamic relationship between personal factors and the organizational and political contexts of care work. Whether moral distress actually leads to a reduced well-being of health care workers or a reduced quality of care in the sector depends to a large extent on how moral tensions are dealt with, also called moral resilience, and the protective conditions available. Research about moral distress and moral resilience within the field of health care has concentrated on staff nurses and physicians. Studies into palliative terminal care and/or about the role of coordinating staff are scarce. A study was conducted to gain insight into the moral challenges that coordinators in voluntary palliative terminal care encounter in their ambition to realize good care, how they deal with these challenges, and the individual and organizational characteristics that foster or hamper moral resilience. Interviews were conducted with 20 coordinators and were qualitatively analyzed. The results brought forward 3 moral challenges in working with volunteers and in collaborating with professional care, namely, striving for connection, negotiating autonomy, and struggling with open communication. However, coordinators seemed to face these challenges effectively. In conclusion, the relational narrative strategies used by coordinators to deal with these challenges, in combination with personal and organizational conditions, foster moral resilience.

Background There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. Methods For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. Results Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners’ death. Following physician-assisted dying, the fact that the partner’s euthanasia request was granted, helped others understand that the deceased person’s mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. Conclusion When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners’ presence during the death.

The COVID-19 lockdown of Dutch long-term care facilities between March and May 2020 affected the quality of lives of residents and opposed professional and personal ethics of care. This article, based on 25 in-depth interviews with healthcare chaplains, gives insight into what moral challenges appeared for care professionals. Moral challenges were related to: ‘family ruptures’, ‘residents’ loneliness and despair’, ‘cold-hearted deaths’ and ‘response and responsibilities’. The findings illuminate the complexity of providing care during the lockdown and show variation in the impact of these ethical experiences, in which both moral distress and moral resilience occurred.

Birth and death are fundamental human experiences [...]

Chaplaincy has become increasingly professionalized in response to both the standardization in healthcare and the changing religious landscape. Whereas several studies have paid attention to the professionalization of chaplaincy as a whole, no research has been found that describes the implications for individual chaplains. The present article describes the professionalization of Dutch chaplains in the last two decades. We compared the results of two surveys conducted with chaplains in the Netherlands in 1997 and 2017. We describe professionalization by distinguishing between the changed values, expertise, and positioning of chaplains. We found that chaplains’ expertise has been developed by a growing but highly diverse body of knowledge. Furthermore, a pluralization of chaplains’ worldviews was observed, including non-religious and non-affiliated positions. Lastly, no major changes were observed in the embedding of chaplains.

Purpose The aim of this study was to analyze the views of patients, police‐officers and emergency mental health workers on the use of the police cell as intervention in a mental health crisis. Design and Methods We analyzed interviews with individuals involved in police cell interventions, found first labels and categorized them in concordance with the four principles of biomedical ethics and compared them to relevant scientific literature. Findings and Practical Implications Professionals should know that emergency mental healthcare aimed at controlling the situation is not enough to provide good care. It probably generates better outcomes for patients in the short and long term when patient experiences are taken into consideration.

BACKGROUND: Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables.METHODS: We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis.RESULTS: Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05).LIMITATIONS: The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample.CONCLUSIONS: Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.

Death is accompanied by rituals in every culture. It seems universal that we symbolically approach this life transition. This study focuses on experiences of bereaved who could not physically attend a funeral during COVID-19. Ten Dutch bereaved were interviewed. Disembodiment in terms of (1) not participating in ritual time and place, (2) experiencing live-stream funerals as lonely, and (3) feeling a disruption of one’s grief, were revealed as main themes by thematic analysis. Without physical participation the respondents felt (partially) disconnected from the ritual and isolated from the community. The physical absence impacted ritual transformation and meaning making after a loss.

SEE ME: Sociale insluiting door zinvol ouder worden Prof. dr. Anja Machielse Universiteit voor Humanistiek In dit symposium presenteren we het Europese SEE ME-project (2020-2023, Erasmus+ funding). Doel van dit project is beter aan te sluiten bij de behoeften van ouderen die zorg ontvangen door de potenties, de sociale behoeften en de zingevingsbehoeften van ouderen centraal te stellen. Wanneer zorgverleners de potenties en behoeften van ouderen als uitgangspunt nemen, en aandacht hebben voor sociale verbindingen en de ervaring van zinvolheid, kan dat belangrijke winst in welzijn en gezondheid van ouderen opleveren. Het SEE ME-project omvat een literatuurstudie over de potenties en behoeften van ouderen, een empirisch onderzoek onder ouderen en zorgverleners (mantelzorgers, vrijwilligers en professionals) in 5 Europese landen (België, Duitsland, Italië, Spanje, Nederland) en casestudies van 6 ‘best practices’ in deze landen. Op basis van deze studies is een educatiemodel en een internationale trainingstoolkit voor verschillende groepen zorgverleners ontwikkeld. De innovatieve toolkit benadrukt de competenties waarover zorggevers moeten beschikken om de persoon achter de patiënt te zien, om sociale behoeften en zingevingsbehoeften te herkennen, en in te spelen op de positieve talenten en dromen van ouderen. Door ouderen echt te “zien”, draagt het project bij aan de sociale insluiting van ouderen. In dit symposium wordt achtereenvolgens ingegaan op (1) de conceptuele en empirische studies, (2) de competenties die zorgverleners nodig hebben om de behoeften van ouderen te zien, (3) een analyse van innovatieve benaderingen in 6 Europese ‘good practices’, en (4) het educatiemodel en de bijbehorende training toolkit. Het symposium sluit af met een interactieve dialoog over de mogelijkheden en uitdagingen van persoonsgerichte zorg.

Background. Religious and spiritual (R/S) struggles may impact mental health treatment and recovery processes. The current study investigates how R/S struggles play a role in mental illness and what approaches are experienced as helpful. Methods. Thirty-five semi-structured interviews with clinical mental health patients in a Christian (N = 15) and a secular (N = 20) mental health clinic were narratively analyzed. Results. R/S struggles are common in people who suffer from mental illness and often coexist together with R/S support, mostly fluctuating over time. In summary, patients experience R/S struggles as negative feelings (e.g., loneliness, shame, mistrust) and the absence of positive feelings (e.g., hope and peace). These are influenced by someone’s R/S background and beliefs, as well as by the illness and other events. All participants appreciated a receptive approach (1) and many preferred an active approach (2) by mental health professionals. Some patients reported benefits from a directive approach (3). Conclusions. R/S struggles are tightly connected with other aspects that play a role in patients with mental illness. Mental health professionals are recommended to listen to patients’ narratives and carefully consider whether or not further interventions, in order to enhance R/S support and reduce R/S struggles, might be appropriate.

Persons with a diagnosis of personality disorder struggle to experience meaning in life. This article explores how meaning in life of patients with personality disorder changes during intensive psychotherapy. In a qualitative study, life stories of nineteen Dutch patients receiving intensive psychotherapy, written both before and after treatment, were analyzed using holistic content analysis. Here, meaning in life was understood and operationalized in terms of the concept of orientation towards visions of the good by philosopher Charles Taylor. The findings suggest that patients experience both positive and negative shifts concerning meaning in life. On the one hand, in comparison to the first life stories, there is more awareness and insight about the way the ‘good’ is missing in the second life stories. On the other hand, there are more descriptions about being vulnerable, guilty or ashamed, whereas particular sources of meaning are missing.

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.

BackgroundPrevious research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms.MethodsWe performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning.ResultsAll participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners.ConclusionExpectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.

The present study investigates ritualizing abortion in the Netherlands. Explorative, qualitative research was conducted with semi-structured interviews (n = 13) with women who looked for counseling and 43 online personal stories about the abortion from the website of a national care and expertise center. The results reveal three main categories of ritualizing: (1) creating and using symbols privately and online, (2) remembering or honoring the experience and (3) embodied ritualizing. The data reveal that respondents find meaning in the ritualizing through sharing the experience with others, expressing various feelings through symbolic and ritual forms, fostering a connection with the child-to-be, showing respect, seeking closure and transforming the experience in a meaningful way. This research reveals types of ritualizing practices in relation to a meaningful life event such as abortion. For a specific group of women experiencing decision difficulty or existential concerns in relation to the abortion, ritualizing might be an interesting tool to be incorporated into post-abortion care practices.

Title: SEE ME: Social inclusion by meaningful ageing Abstract: In this symposium, we report on the European SEE ME project (2020-2023, Erasmus+ funding) that aims to develop an educational model and an international training toolkit for different groups of caregivers. The project's goal is to accommodate better the needs of older people receiving care by developing a broader view of what it means to grow older. The project starts from a comprehensive view of ageing that acknowledges the potentials of older people, encompasses social and meaning dimensions of the ageing experience, and envisions old age as a life stage in which autonomy and wellbeing are accessible for individuals with and without care needs. The innovative toolkit emphasises the competences of caregivers to SEE the older person behind the patient, SEE care as something more than physical and medical care, SEE social and meaning needs, and SEE the positive talents and dreams of older adults. Attention to the potentials of older people for maintaining (and restoring) social connectedness and meaningfulness, is a fundamental goal of caregiving, with significant expected gains in the overall health and wellbeing of older people. By "seeing" older people, the project contributes to the social inclusion of older adults. The presentations in this symposium are based on extensive literature reviews, complemented by empirical results of qualitative interviews with older adults and (informal, volunteer, and formal) caregivers in 5 European countries (Belgium, Germany, Italy, Netherlands, Spain). 1. Prof. dr. Machielse presents a comprehensive perspective on ageing that takes into account the potentials of older people, their social and meaning needs, and its implications for the provision of care to older adults. 2. Dr. van der Vaart presents results on innovative approaches in 'good 'practice' care projects and the skills and competencies that caregivers need to "see" and respond to the needs of older adults. 3. Prof. dr. De Donder presents the educational model and accompanying training toolkit with a specific focus on the evaluation of the first test of the training toolkit. 4. Dr. Dury presents the interim results of the six learning areas that are applying the training toolkit in their organisations.

In long-term care for people with dementia, person-centred care (PCC) is widely promoted as an approach that contributes to the well-being of persons in psycho-geriatric care. The goal of PCC is to acknowledge the personhood of residents and to indicate the responsibility of others to ensure the personhood of persons with dementia. In 2016 and 2018, qualitative empirical research was conducted with the purpose to enhance PCC and meaningful care. Five Dutch nursing homes and a total of eight communities of practice participated in the research project ‘People and their Stories’. The aim of this project was to strengthen the hermeneutic competence of care practitioners, with a focus on informal everyday interpersonal interactions between residents and care professionals. This article highlights how care professionals, by enhancing their hermeneutical competence, can do justice to the unique personhood of residents in everyday care practice. Three distinguished features for strengthening the hermeneutic competence of care professionals were formulated: respectful curiosity as a prerequisite, being able to differentiate between fact and meaning, and the awareness of own perspectives and assumptions.

In: themanummer ‘Ben ik de enige’

The current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious leaders of African-led migrant (Pentecostal) churches perceive their relationship with these VHTs. Thematic analyses of qualitative interviews (N = 21) revealed that both groups share the perception that VHTs are vulnerable, especially in view of so-called voodoo spells. Social and legal professionals noticed that West African VHTs prototypically appear as ‘demanding’ in a rather pro-active manner. Religious leaders on the other hand indicated that the VHTs feel at ease in the church in a more adaptive sense and may find ways of changing their lives after experiencing the Pentecostal “deliverance” ritual. Keywords: Human trafficking, Pentecostalism, West-African, migrant churches, cultural and intercultural identity, religious coping

BackgroundRecognition that the loss of a loved one may result in prolonged grief disorder (PGD) has gained broad attention recently. PGD may disturb daily functioning to such a degree that mental health treatment is required. Because PGD symptoms often resemble symptoms of common mental disorders (CMD) such as anxiety, depressive, and post-traumatic stress disorder, clinicians may not consider a PGD diagnosis. Moreover, cultural varieties in expression of PGD may complicate recognition. This study explores the prevalence of PGD among both natives and refugees with anxiety, depressive, or trauma- and/or stressor-related disorders as well as clinicians' awareness and knowledge of PGD symptoms. In addition, a psychoeducation module on PGD symptoms is developed through patient expert collaboration.MethodsPrevalence of PGD symptoms is investigated among 50 participants who are referred to outpatient clinics for anxiety, depression, or post-traumatic stress, using the Traumatic Grief Inventory—Self Report Plus (TGI-SR+) and the Bereavement and Grief—Cultural Formulation Interview (BG-CFI). Clinicians will be interviewed on knowledge (gaps) with respect to PGD symptoms. Finally, focus groups with patient experts are held to develop a psychoeducation module tailored to the patients' needs, norms and values.ResultsThis study will show prevalence of PGD among patients who are referred for anxiety, depression, and post-traumatic stress, awareness and knowledge of clinicians on PGD symptoms, and will offer patient expert informed psychoeducation.DiscussionResearch on prevalence and recognition of PGD is vital. Study results of the prevalence of PGD will be compared to previous studies. Recognition of PGD as distinct disorder from CMDs requires clinicians' awareness of symptoms related to the loss of a loved one. Thereby, clinicians need to take cultural aspects related to death, bereavement and mourning into consideration.Ethics and disseminationThe study protocol will be carried out in accordance with relevant guidelines and regulations. Exploratory research to assess the prevalence of PGD in patients suffering from CMDs will facilitate adequate diagnosis by increasing clinician's awareness of PGD symptoms. Tailored PGD psychoeducation, co-created by culturally diverse patient experts and clinicians will be made publicly available.

Every life has a beginning and an end. Natality and mortality are both profound existential fundaments of life that may lead us to question meaning in life as well as to find meaning. In spiritual care, the focus is often on mortality as a source of existential suffering, and on ways to deal with such suffering according to worldview traditions. In humanist traditions, mortality is not only seen as an existential threat but also as an existential given that people need to embrace to find meaning in life. Natality has received much less attention, both in spiritual care and in humanist thought. In this article, we build on philosophical ideas of Arendt and Butler to explore the significance of natality for a humanist perspective on meaning in life and spiritual care. We argue that taking natality into account results in a relational understanding of humanist spiritual care in which the notion of “relational transcendence” is a central element. Natality also means that we can initiate, create, and act in the world, which highlights the political dimension of humanist spiritual care. We reflect on the implications of natality and relational transcendence for humanist spirituality and chaplaincy and formulate some concrete building blocks for working from this perspective.

Background: In the Netherlands, people without a valid residence permit can be detained in immigration detention in order to keep them available for repatriation. International literature shows that immigration detention has a negative impact on psychological health, but little is known about the experience of people in Dutch immigration detention centers. Aim: In this qualitative study we describe the experience of people who have been detained in immigration detention in the Netherlands and the impact it has had on their psychological health. Method: We interviewed 9 patients who were treated for posttraumatic stress disorder at ARQ Centrum’45 and who had previously been detained in immigration detention. Interviewed were transcribed, coded and analyzed thematically. Results: The following themes emerged: not knowing what to expect, being treated as a criminal, the expectation of protection in the Netherlands, and retraumatization. These perceptions led to fear, hopelessness, shame, anger, and suicidality. Many participants had been in solitary confinement during detention, which had worsened their psychological health. Conclusion: Immigration detention was described as extremely disruptive and caused psychological harm. The circumstances of immigration detention should be improved by using clearer communication about the reason and duration of detention, a less prison-like approach, and by eliminating solitary confinement.

PurposeThis study sought to identify those approaches used by coaches that enable teachers' moral learning in professional learning communities (PLCs). Coaches who support moral learning focus on questioning values, beliefs and bias, which is in contrast with learning only (new) knowledge or skills.Design/methodology/approachThis was an exploratory case study. Eleven meetings of three PLCs were observed; each PLC consisted of four teachers and one teacher–coach. Semi-structured interviews with the coaches were conducted to gain information about their approaches. Data were analysed using supportive coaching approaches derived from educational literature.FindingsIn total, 14 specific approaches regarding the support given by coaches for teachers' moral learning were identified. Four characteristics of coaches' attitudes that guided their approaches and seemed valuable in supporting moral learning were also identified. The findings showed the tensions the coaches encountered – for example, when balancing between offering a safe environment and encouraging critical reflection.Practical implicationsWith coaches' support, teachers can develop a more thoughtful understanding of the meaning of values, beliefs and bias for their actions in teaching practice.Social implicationsMaking explicit, and exploring precisely, what coaches do to support teachers' moral learning are useful for designing and improving professional development programmes that promote moral learning.Originality/valueThe research reported in this paper outlines how coaches can encourage teachers' awareness of the impact of their actions on pupils, which, in turn, helps teachers to meet the complex moral challenges of their practice.

Social quality in housing complexes for older adults depends largely on the opportunities to participate in social activities and the social connections between residents in the complex. The aim of...

This article discusses teachers’ moral learning in professional learning groups and corresponding challenges for teachers’ moral professionalism. A professional learning programme aimed as understa...

Within monotheistic religions, guilt and forgiveness have long been important themes. In The Netherlands, however, the influence of traditional religions is declining. This qualitative interview study explored how non-religious and multireligious inmates experience guilt and forgiveness, and how the humanistic chaplain could address these issues within counselling. Guilt and forgiveness are complex constructs that are individually and subjectively experienced. Most inmates experience personal guilt and regret for what they have done. Some inmates cope with these feelings in a repressive way, where others have an active coping style. Both multireligious and non-religious inmates have a need for interpersonal forgiveness, especially from close relatives. In addition, multireligious inmates also have a transcendent need for forgiveness from a personal god. The humanistic chaplain may help inmates with an active reflection on guilt and forgiveness, which can contribute to a development on an existential level. Guilt and forgiveness ought to be approached from a counselling perspective and attention should be paid to the multiple meanings of personal responsibility. An active and critical reflection on guilt and forgiveness may lead to new meanings of the (criminal) past and create a positive change in the behaviour of detainees.

Spiritual care interventions depend upon the context in which care is provided, its institutional setting and the actors involved. In order to understand the relationship between interventions in spiritual care and the context in which care is provided, we study the spiritual interventions of military chaplains against the background of the armed forces. In our study, we demonstrate that the military context needs its own conceptualization to understand the pastoral practices of military chaplains. This article uses a qualitative comparative methodology and is based upon 13 case studies that have been generated over the course of five years by a team of eight military chaplains within the framework of the Dutch Case Study Project. The analysis results in four concepts that describe the relationship between spiritual care practices and the context of the armed forces in more detail: structuring pastoral availability, positioning within the military environment, existential negotiation of being human and being a soldier and transforming military time. We conclude that the study of spiritual care in context leads to a contextualized understanding of spiritual care practices and stimulates comparison of pastoral care practices across contexts.

Als geestelijk verzorger word je regelmatig benaderd om mee te doen aan onderzoek of gevraagd om deelnemers te werven onder bewoners, cliënten of patiënten. Om het participeren in onderzoek goed te laten verlopen, is het handig om te weten wat zoal de knelpunten zijn. De auteurs van dit artikel zetten deze op een rij en geven mogelijke oplossingen aan.

Veel cliënten willen graag dat spiritualiteit en zingeving ook in de behandeling aan bod komen. Welke kansen biedt dit en waar liggen de grenzen?

There is a reluctance within humanist chaplaincy to critically reflect on power dynamics during conversations. This reluctance stems from the idea that every person is capable of finding meaning in equal contacts and that chaplains do not have aims or direct the conversation. A study was conducted to gain insight into power dynamics in conversations between chaplains and patients, and how these power dynamics influence the co-creation of meaning. Power in a conversation is dynamic because of changing positions of power between conversation partners and depends on their initiative and response in a conversation. Based on feminist relational theories, power is conceptualized as both dominating and transformative, and within transformative power a distinction is made between agential and receptive forms of power. A secondary analysis was performed on qualitative interview data of six humanist chaplains. Dominating strategies taken from the Initiative-Response theory and verbal responses from chaplaincy literature have been used to map the power dynamics between chaplain and client. The results showed that both chaplain and patient use dominating strategies, and that transformative power is necessary to foster the co-creation of meaning. This transformative power can take both agential forms, such as direct leading by questions and focusing, and receptive forms, e.g., listening and affirming. The receptive forms were still the dominant strategies used by chaplains, but the results made clear that agential forms have taken ground within humanist chaplaincy, although some strategies may need to be developed further in training, such as focusing and self-disclosure by the chaplain.

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.

Er is steeds meer aandacht voor zingeving in verschillende sectoren van onze samenleving. Maar hoe meet je eigenlijk of die zorg voor zingeving goed gebeurt? In dit artikel presenteren de onderzoekers een instrument om deze zorg te evalueren. Het instrument is ontwikkeld in een leergemeenschap in de eerste lijn en beoogt bij te dragen aan het versterken van de zorg voor zingeving in de thuissituatie.