Development of a practical guideline for person centred goal setting in geriatric rehabilitation:A participatory action research

PurposeTo improve goal setting in Geriatric Rehabilitation (GR), by developing an evidence-based practical guideline for patient-centred goal setting.MethodsParticipatory action research (PAR) in a cyclical process, with GR professionals as co-researchers. Each cycle consisted of five phases: problem analysis, literature review, development, practical experience, feedback & evaluation. The evaluation was based on video recordings of goal setting conversations, and on oral and written feedback of the GR professionals who tested the guideline.ResultsIn two PAR-cycles the guideline was developed, consisting of eight recommendations for setting and using goals, and of practical advices elaborating three of the recommendations, concerning conversational skills specific for goal setting conversations. After the second cycle the research team concluded that the guideline was feasible in daily practice and effective when used consciously.ConclusionIn this study, a practical guideline for setting and using goals in GR was developed. GR teams can improve their patient centred working with goals by discussing the recommendations in their team and choosing the recommendations to work on. This can be supported by the development of an interdisciplinary training. The effect on quality of care should be subject to further investigation

Frames, polarity and causation

A polarity-sensitive item (PSI), as traditionally defined, is an expression that is restricted to either an affirmative or negative context. PSIs like ‘lift a finger’ and ‘all the time in the world’ sub-serve discourse routines like understatement and emphasis. Lexical–semantic classes are increasingly invoked in descriptions of the properties of PSIs. Here, we use English corpus data and the tools of Frame Semantics (Fillmore, 1982, 1985) to explore Israel’s (2011) observation that the semantic role of a PSI determines how the expression fits into a contextually constructed scalar model. We focus on a class of exceptions implied by Israel’s model: cases in which a given PSI displays two countervailing patterns of polarity sensitivity, with attendant differences in scalar entailments. We offer a set of case studies of polaritysensitive expressions – including verbs of attraction and aversion like ‘can live without’, monetary units like ‘a red cent’, comparative adjectives and time-span adverbials – that demonstrate that the interpretation of a given PSI in a given polar context is based on multiple factors. These factors include the speaker’s perspective on and affective stance towards the described event, available inferences about causality and, perhaps most critically, particulars of the predication, including the verb or adjective’s frame membership, the presence or absence of an ability modal like can, the grammatical construction used and the range of contingencies evoked by the utterance