Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study

BACKGROUND: Health clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians. METHODS: The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups. RESULTS: A structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out. CONCLUSIONS: Intervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care

Clinical Problems in Community Mental Health Care for Patients with Severe Borderline Personality Disorder

The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and mental health care-related. Problems with attachment and dependency and social issues were important patient problems while a lack of skills was an important professional problem. Support from the patient’s social system and the mental health system were identified as limited, which resulted in both the patient and the professional feeling isolated. Patient, professional, and organisational characteristics of community care differ substantially from those of specialized care. The field is thus in need of a more tailored approach that takes these differences into account

What makes community psychiatric nurses label non-psychotic chronic patients as ‘difficult’: patient, professional, treatment and social variables

Contains fulltext : 99981.pdf (publisher's version ) (Open Access)Purpose To determine which patient, professional, treatment and/or social variables make community psychiatric nurses (CPNs) label non-psychotic chronic patients as ‘difficult’. Methods A questionnaire was designed and administered to 1,946 CPNs in the Netherlands. Logistic regression was used to design models that most accurately described the variables that contributed to perceived difficulty. Results Six variables were retained in the final logistic model. Perception-related variables (feeling powerless, feeling that the patient is able but unwilling to change, and pessimism about the patient’s change potential) dominated treatment-related variables (number of contacts per week and admission to a locked ward in the last year) and social variables (number of psychosocial problems). Conclusion This research shows that perceived difficulty is related to complex treatment situations, not so much to individual patient characteristics. If the constructed model has good predictive qualities, which remains to be tested in longitudinal research, it may be possible to accurately predict perceived patient difficulty. When used as a screening tool, such a model could improve treatment outcomes.9 p

How do patients come to be seen as ‘difficult’? A mixed-methods study in community mental health care

a b s t r a c t Across all health care settings, certain patients are perceived as 'difficult' by clinicians. This paper's aim is to understand how certain patients come to be perceived and labelled as 'difficult' patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among 'difficult' patients, and three case studies of 'difficult' patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The 'difficult' patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient's behaviours is made. The status of 'difficult' patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into 'difficult' or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients' contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here

Visions of Dutch Empire: Towards a Long-Term Global Perspective

What were the major developments in thinking about Dutch empire from the early modern period to the twenty-first century? What moral, political, legal and economic arguments have been put forth to justify, criticize or reform empire? How and under what circumstances did these visions and arguments change or remain the same? This article outlines a research agenda that addresses these questions. It argues for an approach that includes a long-term perspective from the early modern period to the postcolonial situation, which sees ‘Dutch’ history broadly, moving beyond national borders, and instead explicitly informed by influences and actors from across the globe. This implies a transnational and transimperial approach that can highlight these global connections as well as tensions; and finally, an approach that understands intellectual history as going beyond the big names of systemic thinkers, and includes visions of empire as negotiated in (day-to-day) practice.History and International Relation

Introduction. Intellectual history in imperial practice

The introduction asks where the Dutch empire fits in the intellectual history of empire. It explains the need to examine the trope of Dutch exceptionalism over the long term in transnational and transimperial perspectives. Methodologically it argues for including meaningful practices as sources and to look beyond systemic thinkers and examine how ‘intermediate thinkers of empire’ from across the globe articulated their visions in practice. Drawing on the concepts of upward and downward hermeneutics, this entails examining the interactions between ideas and practice; how ideas formed and were formed by socio-cultural and political practice. Such a history of visions of empire sheds new light on historiography and public debate, precisely because dominant notions within these are rooted in the intellectual history of Dutch imperial practice.NWO275-52-015History and International RelationsColonial and Global HistoryCities, Migration and Global Interdependenc