Ethical Dilemmas of Participation of Service Users With Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed

Tackling the problem of regulatory pressure in Dutch elderly care

Regulatory pressure is widely recognized as a problem in healthcare. At first sight the solution seems simple: discard rules and give caregivers more resources to provide personalize

Ethical Dilemmas of Participation of Service Users With Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed

Persoonsgerichte zorg, regeldruk en regelruimte: van regelreflex naar spiegelreflex

Regeldruk in de zorg is een breed gedeelde ergernis die verbonden is aan waardenconflicten. Dit komt doordat regels vaak een te beperkte invulling kennen van kwaliteit van zorg en daarmee sturen op de verkeerde dingen. Op basis van ons onderzoek naar regeldruk en regelruimte in de ouderenzorg pleiten we voor een verschuiving van een regelreflex naar een spiegelreflex. Om regeldruk op te lossen wordt vaak gepleit voor het schrappen van regels. Maar er moet ook gezocht worden naar passende regels. Hier is blijvende reflectie op en discussie over kwaliteit van zorg door verschillende actoren voor nodig. Een dergelijke spiegelreflex draagt bij aan het herkoppelen van het werk van verschillende actoren die actief zijn op verschillende niveaus in de zorg, waaronder zorgverleners, managers en externe partijen zoals toezichthouders

Together alone: organizing integrated, patient-centered primary care in the layered institutional context of Dutch healthcare governance

We aim to better understand the dynamic between professionals and institutions by scrutinizing how professionals conduct institutional work in a layered institutional context. To date, institutional scholars have either studied professionals or institutions as objects of maintenance or change. Here, we suggest an alternative ‘relational’ and ‘evolutionary’ interpretation of the relation between institutions and professionals. We do so by introducing a two-dimensional analytical framework. We illustrate the relevance of this framework by analyzing a policy implementation program called ‘Primary Focus’. This program sought to improve the provision of integrated and patient-centered primary care by organizing multidisciplinary collaboration. Progres

The different perspectives of patients, informal caregivers and professionals on patient involvement in primary care teams

__Background:__ Patient involvement in the decision-making process, especially for chronically ill elderly patients, has become an important element of patient-centred primary care in many countries, including the Netherlands. This study openly explores different perspectives of patients, informal caregivers and primary care professionals on patient involvement in primary care team interactions. __Methods:__ Sixty-four qualitative semi-structured interviews with chronically ill elderly patients, informal caregivers and primary care professionals from various disciplines. Underpinned by a phenomenology approach, this study used conventional content analysis for data analysis. __Results:__ Participants have different views of the roles of patients and informal caregivers in the primary care team and thus different expectations of the extent and level of

Government Influence on Patient Organizations

Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable