Goed verpleegkundig onderwijs: het zorgethisch perspectief. Een zorgethisch onderzoek naar de relationele afstemmingspraktijk in het hoger verpleegkundig onderwijs.

‘Goed verpleegkundig onderwijs: het zorgethisch perspectief’: Een zorgethisch onderzoek naar de relationele afstemmingspraktijk in het hoger verpleegkundig onderwijs Aanleiding: er zijn aanwijzingen dat er niet goed ‘gezorgd’ wordt in de praktijk van het hoger onderwijs. Dit gaat ten koste van het socialiseringsproces, het plezier in leren en de leeruitkomsten van studenten. Er is weinig zorgethisch onderzoek gedaan naar de afstemmingspraktijk van docenten en studenten in het hoger verpleegkundig onderwijs. Doel: inzicht geven in de ervaringen van docenten en studenten betreffende de relationele afstemmingspraktijk en beschrijven hoe dit bijdraagt aan goed onderwijs vanuit een zorgethisch perspectief. De gepresenteerde inzichten kunnen zowel het wetenschappelijke discours als de onderwijspraktijk verrijken. Theoretisch kader: dit onderzoek is uitgevoerd in het kennisgebied van de zorgethiek. Het concept ‘relationele afstemmingspraktijk’ vormt het conceptuele kader van dit onderzoek. Onderzoeksmethode: dit onderzoek is een zorgethisch onderzoek dat gebruik maakt van de hermeneutisch-fenomenologische methode. In dit onderzoek zijn geleefde ervaringen van docenten en vierdejaars studenten op de Hogeschool Utrecht betrokken. Voor de dataverzameling is gebruik gemaakt van focusgroep interviews en een observatie. Onderzoekscontext: dit onderzoek is geschreven in het kader van de afronding van de master Zorgethiek en beleid. Ethische overwegingen: dit onderzoek is uitgevoerd met toestemming van het management en de directie van het Instituut verpleegkundige studies van de Hogeschool Utrecht. Anonimiteit van de deelnemers is gegarandeerd. Bevindingen: verschillende ervaringen van docenten en studenten kenmerken de afstemmingspraktijk. Deze ervaringen zijn ambivalent, meervoudig en verschillen per persoon en moment. De afstemming vindt bewust en onbewust plaats. Er zijn vier thema’s gevonden die de ervaren afstemmingspraktijk kenmerken: 1) (geen) aandacht voor de unieke student, 2) een gerichtheid op doelen, 3) (on)gelijkwaardige relatie met de docent, 4) jezelf (niet) laten zien. De ervaren thema’s kunnen zowel bevorderlijk als belemmerend zijn voor de afstemming. Discussie en conclusie: Verschillende zorgethische inzichten en reflectie op de ervaringen van docenten en studenten kunnen de onderwijspraktijk verrijken. Zorgethiek heeft een ander perspectief op goed onderwijs dan de ambivalente ervaringen die zichtbaar worden uit de bevindingen. Door een onderwijspraktijk te zien als relationele afstemmingspraktijk krijgen studenten en docenten de mogelijkheid om te reflecteren op empathie, (on)gelijkheid, macht, doelen, verantwoordelijkheden en de docent-studentrelatie. Dit zorgt voor meer betrokkenheid, een hoger leerrendement en toekomend verpleegkundigen die nog beter voorbereid zijn om een (zorg)relatie aan te gaan in de beroepspraktijk

Community policing in the Netherlands: A continuously changing constant

__Abstract__ 1977 was an important year for the Dutch police as it was then that a seminal strategy document called ‘A Changing Police was published that would set the course for the next three decades. The writers of the report felt that for the police to bridge the growing gap between them and the society they serve, they would have to be innovative, and think outside of their usual security paradigms. They found their solution in community policing and the strategy document laid out the framework for Community Policing (COP) in the Netherlands. This document was widely considered a milestone in the development of Dutch policing (see Cachet et al. 1998). However, by 2005, the Dutch Board of Chief Commissioners felt it necessary to publish a new strategy document to once again map out the future of Dutch Policing. After nearly three decades, the Dutch police was again in need of a shared philosophy that would serve as a foundation for their mandate. This new document was titled ‘The Police in Evolution’ (PIE) but it stayed true to the values of COP by once again focusing on the local community and stressing community policing. In this paper we explore the establishment and development of Dutch COP. We look at several distinct phases in the long term development of Dutch COP, and examine the factors that explain the shifts that have taken place in the way Dutch COP is carried out. We ask also about the prospects of Dutch COP in the future. The paper will consist of four sections. In the first Section, we examine the historical roots and the development of Dutch COP since its inception in 1977. In Section 2, we look at the current state of affairs for COP in the Netherlands. In the third section, we put forward several explanations for the significant shifts that have taken place over the course of the COP’s 30-year history. In the fourth section, we discuss the prospects for Dutch COP in the coming years. Section 5 presents our conclusions

The 20-year longitudinal trajectories of social functioning in individuals with psychotic disorders

Objective: Social impairment is a long-recognized core feature of schizophrenia and is common in other psychotic disorders. Still, to date the long-term trajectories of social impairment in psychotic disorders have rarely been studied systematically. Methods: Data came from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. A never-psychotic comparison group was also assessed. Latent class growth analysis was applied to longitudinal data on social functioning from 485 respondents with schizophrenia spectrum disorders and psychotic mood disorders, and associations of the empirically derived trajectories with premorbid social adjustment, diagnosis, and 20-year outcomes were examined. Results: Four mostly stable trajectories of preserved (N=82; 59th percentile of comparison group sample distribution), moderately impaired (N=148; 17th percentile), severely impaired (N=181; 3rd percentile), and profoundly impaired (N=74; 1st percentile) functioning best described the 20-year course of social functioning across diagnoses. The outcome in the group with preserved functioning did not differ from that of never-psychotic individuals at 20 years, but the other groups functioned significantly worse. Differences among trajectories were already evident in childhood. The two most impaired trajectories started to diverge in early adolescence. Poorer social functioning trajectories were strongly associated with other real-world outcomes at 20 years. Multiple trajectories were represented within each disorder. However, more participants with schizophrenia spectrum disorders had impaired trajectories, and more with mood disorders had better functioning trajectories. Conclusions: The results highlight substantial variability of social outcomes within diagnoses—albeit overall worse social outcomes in schizophrenia spectrum disorders—and show remarkably stable long-term impairments in social functioning after illness onset across all diagnoses

Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health

Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population- based studies, neuroscience, experimental, and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus

The clinical effectiveness of evidence-based interventions for depression: A pragmatic trial in routine practice

Abstract BACKGROUND: Controversy persists about how effectively empirically-supported treatments for major depression work in actual clinical practice as well as how patients choose among them. We examined the acute phase effectiveness of cognitive therapy (CT), interpersonal psychotherapy (IPT), and combined psychotherapy-pharmacotherapy (PHT) in a naturalistic setting, allowing patients their choice of treatment. METHODS: The study compared CT (n=63), IPT (n=56), CT-PHT (n=34), and IPT-PHT (n=21) for 174 subjects with major depression in a secondary care mood disorders clinic. Patient preference, rather than randomization, determined treatment selection. The Beck Depression Inventory-II (BDI) was the primary outcome variable. Exclusion criteria were minimal. RESULTS: All treatments were associated with a reduction in depressive symptoms, with a 35% remission rate by week 26. Overall improvement was well within ranges reported in efficacy trials. On average, treatment effects of the different interventions straddled the same range, but moderation analyses revealed that BDI scores dropped faster in the first 16 weeks in patients who received CT alone than patients who received CT and pharmacotherapy, a pattern not found in patients who received IPT (with or without pharmacotherapy). LIMITATIONS: Limitations consist of a modest sample size, choice of treatment was made by participants which may have been influenced by many sources, and the absence of a non-active control group. CONCLUSIONS: This study supports the effectiveness of empirically-supported antidepressant treatments selected by patients in routine settings, and provides an indication that speed of therapeutic response may vary amongst treatments

Finding keys:A systematic review of barriers and facilitators for refugee children's disclosure of their life stories

The systematic review presented in this article aims to reveal what supports and hampers refugee children in telling their, often traumatic, life stories. This is important to ensure that migration decisions are based on reliable information about the children’s needs for protection. A systematic review was conducted in academic journals, collecting all available scientific knowledge about the disclosure of life stories by refugee minors in the context of social work, guardianship, foster care, asylum procedures, mental health assessment, and therapeutic settings. The resulting 39 studies were thoroughly reviewed with reference to what factors aided or hampered the refugee children’s disclosure of their life stories. The main barriers to disclosure were feelings of mistrust and self-protection from the side of the child and disrespect from the side of the host community. The facilitators for disclosing life stories were a positive and respectful attitude of the interviewer, taking time to build trust, using nonverbal methods, providing agency to the children, and involving trained interpreters. Social workers, mentors, and guardians should have time to build trust and to help a young refugee in revealing the life story before the minor is heard by the migration authorities. The lack of knowledge on how refugee children can be helped to disclose their experiences is a great concern because the decision in the migration procedure is based on the story the child is able to disclose

Effect of warm-up and precooling on pacing during a 15-km cycling time trial in the heat

PURPOSE:The best way to apply precooling for endurance exercise in the heat is still unclear. Therefore, we analyzed the effect of different preparation regimes on pacing during a 15-km cycling time trial in the heat.METHODS:Ten male subjects completed four 15-km time trials (30°C), preceded by different preparation regimes: 10 min cycling (WARM-UP), 30 min scalp cooling of which 10 min cycling (SC+WARM-UP), ice slurry ingestion (ICE), and ice slurry ingestion + 30 min scalp cooling (SC+ICE).RESULTS:No differences were observed in finish time and mean power output, although power output was lower for WARM-UP than for SC+ICE during km 13-14 (17±16 and 19±14 W, respectively) and for ICE during km 13 (16±16 W). Rectal temperature at the start of the time trial was lower for both ICE (~36.7°C) than both WARM-UP (~37.1°C) conditions and remained lower during the first part of the trial. Skin temperature and thermal sensation were lower at the start for SC+ICE.CONCLUSIONS:The preparation regime providing the lowest body heat content and sensation of coolness at the start (SC+ICE) was most beneficial for pacing during the latter stages of the time trial, although overall performance did not differ

Lung cancer symptom appraisal, help-seeking and diagnosis - rapid systematic review of differences between patients with and without a smoking history

BACKGROUND: Lung cancer is the leading cause of cancer death in the world. A significant minority of lung cancer patients have never smoked (14% in the UK, and ranging from 10% to 25% worldwide). Current evidence suggests that never-smokers encounter delays during the diagnostic pathway, yet it is unclear how their experiences and reasons for delayed diagnoses differ from those of current and former smokers. This rapid review assessed literature about patient experiences in relation to symptom awareness and appraisal, help-seeking, and the lung cancer diagnostic pathway, comparing patients with and without a smoking history. METHODS: MEDLINE, PsychINFO and Google Scholar were searched for studies (2010-2020) that investigated experiences of the pathway to diagnosis for patients with and without a smoking history. Findings are presented using a narrative synthesis. RESULTS: Analysis of seven quantitative and three qualitative studies revealed that some delays during symptom appraisal and diagnosis are unique to never-smokers. Due to the strong link between smoking and lung cancer, and low awareness of non-smoking related lung cancer risk factors and symptoms, never-smokers do not perceive themselves to be at risk. Never-smokers are also likely to evaluate their experiences in comparison with other non-smoking related cancers, where prognosis is likely better, potentially leading to lower satisfaction with healthcare. CONCLUSION: Never-smokers appear to have different experiences in relation to symptom appraisal and diagnosis. However, evidence in relation to help-seeking, and what is driving diagnostic delays for never-smoker patients specifically is lacking

Effects of Multisensory Context on Tofu and Soy Sauce Evaluation and Consumption

We examined the effects of an informative pitch and multisensory contexts as potential factors influencing individuals’ experience of tofu with soy sauce and the amount consumed outside the lab. Two hundred and sixteen participants watched one of two pitches (promoting either vegetarian diets or exercise) and were guided into one of three multisensory contexts (‘sustainable’, ‘meat’, or ‘neutral’ theme). Participants rated the aroma and appearance of soy sauce and the taste of tofu dipped in it using the intuitive ‘one touch’ EmojiGrid valence and arousal measuring tool. Our results showed that the ‘meat’ context increased arousal ratings for soy sauce and the tendency to consume more tofu relative to the other contexts. Pitch did not influence affective ratings or amounts consumed. We conclude that the multisensory context has the potential to positively affect peoples’ choices and perceptions of plant-based and sustainable food and promote its consumption