A practical guide

Publisher Copyright: © 2022 Kiekens et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Systems mapping methods are increasingly used to study complex public health issues. Visualizing the causal relationships within a complex adaptive system allows for more than developing a holistic and multi-perspective overview of the situation. It is also a way of understanding the emergent, self-organizing dynamics of a system and how they can be influenced. This article describes a concrete approach for developing and analysing a systems map of a complex public health issue drawing on well-accepted methods from the field of social science while incorporating the principles of systems thinking and transdisciplinarity. Using our case study on HIV drug resistance in sub-Saharan Africa as an example, this article provides a practical guideline on how to map a public health problem as a complex adaptive system in order to uncover the drivers, feedback-loops and other dynamics behind the problem. Qualitative systems mapping can help researchers and policy makers to gain deeper insights in the root causes of the problem and identify complexity-informed intervention points.publishersversionpublishe

Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for RTW after breast cancer treatment

BACKGROUND: Improvements in treatment have resulted in an increasing number of cancer survivors potentially being able to return to work after medical treatment. In this paper we focus on the considerations regarding return to work (RTW) of breast cancer absentees in the Belgian context and how these considerations are related to reactions from their social environment. METHODS: A qualitative study was performed to understand the RTW considerations of Belgian breast cancer absentees who had undergone breast cancer surgery in 2006. Twenty-two participants (mean age 46) were included and interviewed between May 2008 and August 2009 in their personal environment. An in-depth analysis (Grounded Theory) took place using the Qualitative Analysis Guide of Leuven (Quagol). RESULTS: Before the actual RTW, breast cancer employees try to build an image of the future resumption of work based on medical grounds and their knowledge of the workplace. Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job; (ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and (iv) they have doubts about being accepted in the workplace after returning. These inner thoughts are both product and input for the interaction with the social environment. The whole process is coloured by uncertainty and vulnerability. CONCLUSION: Our study demonstrated that mental preparation for RTW is not a linear process of improvement. It shows a detailed picture of four types of considerations made by breast cancer survivors before they actually resume work. Vulnerability appears to be an overarching theme during mental preparation. As the social environment plays an important role, people from that environment must become more aware of their influence on decreasing or increasing a woman’s vulnerability while preparing for RTW

Validation of the Dutch-language version of Nurses' Moral Courage Scale

Background:Moral courage as a part of nurses' moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses' moral courage, the development of culturally and internationally validated instruments is needed.Objective:The objective of this study was to validate the Dutch-language version of the four-component Nurses' Moral Courage Scale originally developed and validated in Finnish data.Research design:This methodological study used non-experimental, cross-sectional exploratory design.Participants and research context:A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses' Moral Courage Scale.Ethical considerations:Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses' Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively.Findings:The four-component 21-item, Dutch-language version of the Nurses' Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses' Moral Courage Scale. The scale's internal consistency reliability was high (0.91) corresponding with the original Nurses' Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses' Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale's construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure.Discussion and conclusion:The Dutch-language version of the Nurses' Moral Courage Scale is a reliable and valid instrument to measure nurses' self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale's validity and initiatives for its further development.</div

conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights

Funding Information: This study was partially funded by VLIR-UOS. The study sponsors had no role in the study design, the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Publisher Copyright: © 2022, The Author(s).Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods: We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results: Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The ‘healthcare burden’ subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions: Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.publishersversionpublishe

Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study

Up to one in three of older patients who are hospitalised develop functional decline, which is associated with sustained disability, institutionalisation and death. This study developed and validated a clinical prediction model that identifies patients who are at risk for functional decline during hospitalisation. The predictive value of the model was compared against three models that were developed for patients admitted to a general medical ward.; A prospective cohort study was performed on two cardiac care units between September 2016 and June 2017. Patients aged 75 years or older were recruited on admission if they were admitted for non-surgical treatment of an acute cardiovascular disease. Hospitalisation-associated functional decline was defined as any decrease on the Katz Index of Activities of Daily Living between hospital admission and discharge. Predictors were selected based on a review of the literature and a prediction score chart was developed based on a multivariate logistic regression model.; A total of 189 patients were recruited and 33% developed functional decline during hospitalisation. A score chart was developed with five predictors that were measured on hospital admission: mobility impairment = 9 points, cognitive impairment = 7 points, loss of appetite = 6 points, depressive symptoms = 5 points, use of physical restraints or having an indwelling urinary catheter = 5 points. The score chart of the developed model demonstrated good calibration and discriminated adequately (C-index = 0.75, 95% CI (0.68-0.83) and better between patients with and without functional decline (chi; 2; = 12.8, p = 0.005) than the three previously developed models (range of C-index = 0.65-0.68).; Functional decline is a prevalent complication and can be adequately predicted on hospital admission. A score chart can be used in clinical practice to identify patients who could benefit from preventive interventions. Independent external validation is needed

Realising skilled companionship in nursing: a utopian idea or difficult challenge

AIMS AND OBJECTIVES: The question being considered in this discussion article is whether nurses' practice can be usefully characterised in terms of skilled companionship. BACKGROUND: A nurse's role might be characterised as one of a 'skilled companion,' a concept that brings together the scientific and moral basis of nursing practice. It is this focus on integrating both 'skill' and 'companionship' characteristics of nurses' practice that largely determines their effectiveness as care providers and their specific contribution to health care outcomes. METHODS: Discursive article that invites readers to explore and arrive at a more comprehensive understanding of nurses' daily practice, one from an ethical perspective that is based on empirical data from the study of patients' caring experiences, nurses' caring experiences and nurses' ethical practice in daily care. CONCLUSIONS: Research in this era of health care highlights an important dilemma that the nursing profession is confronted with daily: realising nurses' role as a skilled companion in an environment where this concept of nursing care is discouraged, or even thwarted. Although the ethical dimension is explicitly and universally recognised as a core dimension of nursing care, research clearly highlights nurses' difficulties in translating this element into daily practice. Most disturbing in these findings is that both patients and nurses feel compelled to reach a compromise to 'survive' in this often-chaotic caring environment. RELEVANCE TO CLINICAL PRACTICE: It appears today that nurses' intrinsic strengths and potential are largely underutilised in daily practice. More than ever, the nursing profession is challenged to reflect on the future position, aspirations and responsibilities of nurses, to make clear choices, and to act accordingly. Viewing and implementing the nurse's role as one of a skilled companion promise better health care delivery in a postmodern world.status: publishe

"Because we see them naked" - Nurses' experiences ini caring for hospitalized patients with dementia: considering artificial nutrition or hydratation (ANH)

ABSTRACT The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described as encompassing the various stages of the care process: the nurses’ initial meeting with the vulnerable patient; the intense decisionmaking process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses’ involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given.status: publishe

Sociaal ondersteunende robots in de ouderenzorg. Een ethische analyse

Geconfronteerd met een verouderende populatie en een vermindering van het aantal (in)formele hulpverleners, staan maatschappijen voor de uitdaging hoe zij de zorg voor oudere volwassenen kunnen garanderen. Hoe kunnen we de waardigheid en veerkracht van oudere volwassenen bestendigen of zelfs versterken? Het gebruik van robotica wordt gezien als een mogelijk discours die hen tegemoet kan komen in zowel zorg als in sociale noden. In de voorbije jaren steeg het kwalitatieve empirische onderzoek dat zich richt op de ervaringen en percepties van oudere personen omtrent het gebruik van robotica in de zorg voor ouderen. Daarnaast brengt het gebruik van deze robotica een explosie aan ethische argumentatie met zich mee. Deze presentatie zal zich hoofdzakelijk richten op sociaal ondersteunende robotica. Deze kunnen omschreven worden als belichaamde (semi-) autonome technologieën die een zekere vorm van sociale, fysiologische en/of psychologische ondersteuning kunnen garanderen. Het doel van deze presentatie is om de twee bronnen aan informatie, de empirische data en de ethische argumentatie die ogenschijnlijk los staan van elkaar, systematisch bij elkaar te brengen om zo een ethische werkwijze te ontwikkelen omtrent het gebruik van robotica in de zorg voor ouderen. Doordat deze ethische werkwijze voortkomt uit deze twee informatiebronnen is zij gegrond in oudere volwassenen hun leefwereld maar bezit zij tegelijk ook een normatieve kracht. Het ontwikkelen van deze ethische werkwijze geeft ons inzicht in de ethische relevantie van de discripantie tussen wat reeds mogelijk is en wat gedacht wordt mogelijk te zijn in het gebruik van robotica in de zorg voor ouderen. Daarnaast belicht dit ook het verschil tussen wat een ethische assessment van robotica wordt genoemd en ethische reflectie over het gebruik van robotica. Uiteindelijk zal ook benadrukt worden dat de mogelijke plaats van robotica in de zorg voor ouderen uitsluitend bereikt kan worden aan de hand van case-by-case evaluaties.Posterstatus: publishe