Aandacht voor pillen of identiteit? Een zorgethische visie op de relatie tussen de specialist ouderengeneeskunde en de familie in de aanpak en behandeling van onbegrepen gedrag van mensen met dementie in het verpleeghuis.

Achtergrond Het behandelen van onbegrepen gedrag van mensen met dementie door het onjuist voorschrijven van psychofarmaca is ongewenst, omdat dit de kwaliteit van leven van de bewoner vermindert. Om dit helpen tegen te gaan is in de richtlijnen voor de aanpak van onbegrepen gedrag het betrekken van familie opgenomen als een van de acht kernelementen. Echter, in de praktijk blijkt dat familie vaak nog steeds weinig betrokken wordt en als dit wel gebeurt, weten we niet hoe specialisten ouderengeneeskunde dat doen en welke morele kwesties daar in spelen. Doel Dit onderzoek levert een bijdrage aan het (nog) beter invulling kunnen geven aan het betrekken van familie door specialisten ouderengeneeskunde in de analyse en behandeling van onbegrepen gedrag bij mensen met dementie in het verpleeghuis. Theoretische kader Dit onderzoek is gepositioneerd binnen het kennisgebied van de zorgethiek. Het begrip relationele autonomie vormt het conceptuele kader van dit onderzoek. Methode Dit onderzoek maakt gebruik van een narratieve onderzoeksbenadering, binnen Walkers meta-ethische raamwerk. Informanten en onderzoekscontext Vijf specialisten ouderengeneeskunde zijn volgens een narratieve methode geïnterviewd. Uit alle verhalen zijn er twee exemplarisch in dit onderzoek gepresenteerd. In beide verhalen dringt de familie bij de specialist ouderengeneeskunde aan op afbouw van gedragsmedicatie, echter doen zij dat op verschillende wijze. Ethische overwegingen Er zijn verschillende acties ondernomen om toestemming voor deelname en anonimiteit van de informanten te garanderen. Resultaten De informanten nemen de familie serieus in de wens om de medicatie af te bouwen en passen hun medicatiebeleid daar (deels) op aan. De morele grenzen daarvan worden echter bereikt als de bewoner, medebewoners en/of het personeel de dupe (dreigen) te worden en er niet meer personeel ingezet kan worden om het onbegrepen gedrag aan te pakken. De informanten zien zichzelf vooral als medische professionals en handelen van daaruit, in meer of mindere mate in samenwerking met collega zorgprofessionals. Een van de informanten treedt nader tot de leefwereld van de familie doordat zij ook aandacht geeft aan rouwverwerking bij een familielid. Discussie en Conclusie De morele kwesties die voor de informanten spelen doen zich voor in een sociale context waarin niet alleen de belangen van de bewoner, maar ook die van de medebewoners en het personeel een rol spelen. In dit spanningsveld zoeken zij telkens weer in relatie met de familie consensus over hun voorgestelde medicatiebeleid, waarin zij zelf uiteindelijk de doorslaggevende stem hebben. Een goede invulling van familiebetrokkenheid door de informanten in deze context, en misschien ook wel voor specialisten ouderengeneeskunde in vergelijkbare situaties, houdt rekening met afhankelijkheid en kwetsbaarheid en is gericht op het mede vormgeven van de identiteit van de bewoner en de familie zelf, waardoor hun lijden verlicht kan worden

"Precious time together was taken away":Impact of COVID-19 restrictive measures on social needs and loneliness from the perspective of residents of nursing homes, close relatives, and volunteers

During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being

Bildungsmonitoring auf der Systemebene

Nach einem Beschluss der KMK (Gesamtstrategie zum Bildungsmonitoring) sollen Bildungsprozesse in Deutschland durch vier miteinander verbundene Bereiche beobachtet und weiterentwickelt werden: regelmäßige Teilnahme an internationalen Schulleistungsuntersuchungen, zentrale Überprüfung der Bildungsstandards im Ländervergleich, Vergleichsarbeiten und gemeinsame Bildungsberichterstattung. Systemmonitoring ist ein Teil des Bildungsmonitorings. Im Studienbrief wird erläutert, warum Studien des Systemmonitorings durchgeführt werden und welche Ziele sie im Einzelnen verfolgen. Zudem werden die bekanntesten Studien im Rahmen des Systemmonitorings vorgestellt: TIMSS, PISA, IGLU und DESI. (DIPF

Family involvement in nursing homes: an interpretative synthesis of literature

Background Family involvement in nursing homes is generally recognized as highly valuable for residents, staff and family members. However, family involvement continues to be challenging in practice. Aim To contribute to the dialogue about family involvement and develop strategies to improve family involvement in the nursing home. Methods This interpretative synthesis consists of a thematic analysis and care ethical interpretation of issues regarding family involvement from the perspective of families in nursing homes reported in literature. Findings This study reveals the complexities of family involvement in the nursing home by drawing attention to the moral dimension of the issues experienced by families, as seen through the theoretical lens of Baier's care ethical concept of trust as a theoretical lens. The synthesis of literature resulted in a thematic categorization of issues reported by families, namely, family-staff relationship, psychosocial factors and organizational circumstances. The care ethical interpretation of the synthesis of literature showed that the concept of trust resonates with all reported issues. Trust evolves over time. Early issues are mostly related to getting to know each other. Secondly, families want to experience that staff are competent and of good will. Difficult feelings families may have, such as guilt or loneliness, and dealing with the deterioration of the loved one puts families in a vulnerable position. This power imbalance between family and staff impedes a trusting relationship. Issues related to organizational circumstances, such as understaffing, also undermine families' trust in staff and the nursing home. Discussion and conclusion Baier's theoretical concept of trust provides a deeper insight into the moral dimension of family involvement from the perspective of families in the nursing home. To improve family involvement in practice, we propose to aim future interventions at reinforcing trust in the relationship between family and staff as well as in the organizational context in which these care relationships occur

Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes

BACKGROUND: During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important.METHODS: We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design.RESULTS: Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions.DISCUSSION: Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.</p

Family involvement in nursing homes: an interpretative synthesis of literature.

BACKGROUND: Family involvement in nursing homes is generally recognized as highly valuable for residents, staff and family members. However, family involvement continues to be challenging in practice. AIM: To contribute to the dialogue about family involvement and develop strategies to improve family involvement in the nursing home. METHODS: This interpretative synthesis consists of a thematic analysis and care ethical interpretation of issues regarding family involvement from the perspective of families in nursing homes reported in literature. FINDINGS: This study reveals the complexities of family involvement in the nursing home by drawing attention to the moral dimension of the issues experienced by families, as seen through the theoretical lens of Baier’s care ethical concept of trust as a theoretical lens. The synthesis of literature resulted in a thematic categorization of issues reported by families, namely, family–staff relationship, psychosocial factors and organizational circumstances. The care ethical interpretation of the synthesis of literature showed that the concept of trust resonates with all reported issues. Trust evolves over time. Early issues are mostly related to getting to know each other. Secondly, families want to experience that staff are competent and of good will. Difficult feelings families may have, such as guilt or loneliness, and dealing with the deterioration of the loved one puts families in a vulnerable position. This power imbalance between family and staff impedes a trusting relationship. Issues related to organizational circumstances, such as understaffing, also undermine families' trust in staff and the nursing home. DISCUSSION AND CONCLUSION: Baier’s theoretical concept of trust provides a deeper insight into the moral dimension of family involvement from the perspective of families in the nursing home. To improve family involvement in practice, we propose to aim future interventions at reinforcing trust in the relationship between family and staff as well as in the organizational context in which these care relationships occur

Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes

Abstract Background During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As ‘safety’ prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. Methods We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. Results Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. Discussion Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives

Family involvement in dementia special care units. From moral perils to well-balanced practices of collaboration

The central aim of this study was to develop insights and guidelines for careprofessionals and families to enable them to collaborate constructively finetuned to moral appropriateness in contex

Gevolgen van restrictieve maatregelen door COVID-19 uitbraak op eenzaamheid en sociale behoeften van bewoners, naasten en vrijwilligers in verpleeghuizen

Due to the (privacy) sensitive nature of the data and contractual limitations, the data are stored in a secure location at Tilburg University and cannot be shared. A codetree was created to analyse the data of this qualitative study and consists of main codes and subcodes, regarding the topics of this project. The codetree is available. Topic of the research: This qualitative study reported on the consequences of the COVID-19 restrictive measures in nursing homes, from the perspective of residents, close relatives, and volunteers. The focus was on social needs, negative consequences such as loneliness, resilience and moral judgement concerning the measures. Main research questions: 1. What was the impact of the restrictive measures on experienced loneliness and social needs of residents, close relatives, and volunteers in nursing homes? 2. Which resources were used by residents, close relatives, and volunteers to deal with the restrictive measures and what helped them to minimize the consequences of the measures? 3. How has the ban on in-person visits been judged by residents, close relatives, and volunteers in retrospect? 4. What are lessons learned

Gevolgen van restrictieve maatregelen door COVID-19 uitbraak op eenzaamheid en sociale behoeften van bewoners, naasten en vrijwilligers in verpleeghuizen

Due to the (privacy) sensitive nature of the data and contractual limitations, the data are stored in a secure location at Tilburg University and cannot be shared. A codetree was created to analyse the data of this qualitative study and consists of main codes and subcodes, regarding the topics of this project. The codetree is available. Topic of the research: This qualitative study reported on the consequences of the COVID-19 restrictive measures in nursing homes, from the perspective of residents, close relatives, and volunteers. The focus was on social needs, negative consequences such as loneliness, resilience and moral judgement concerning the measures. Main research questions: 1. What was the impact of the restrictive measures on experienced loneliness and social needs of residents, close relatives, and volunteers in nursing homes? 2. Which resources were used by residents, close relatives, and volunteers to deal with the restrictive measures and what helped them to minimize the consequences of the measures? 3. How has the ban on in-person visits been judged by residents, close relatives, and volunteers in retrospect? 4. What are lessons learned