A Conceptual Exploration of Psychological Empowerment with Older People. A Tailored Concept Mapping Approach.

Empowerment is central in gerontological social work. Operationalizing empowerment from the perspective of the target population is important to align with context specific interpretations of what empowerment means. This study aims at operationalizing psychological empowerment from the perspective of older people. A design was chosen that is based on the concept mapping method, though tailored to accommodate the specific principles we assume in empowerment research and to align with target specific conditions that come to play with older persons. The results show an empowerment with 58 statements divided over four components of empowerment; emotional, cognitive, relational and behavioural component.

Support needs of parents with intellectual disabilities: Systematic review on the perceptions of parents and professionals.

This review aimed to examine the perceptions of parents, professionals and informal network members regarding support needs of parents with intellectual disabilities (ID). In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, five databases were systematically searched and 19 qualitative studies were reviewed using thematic analyses. No data were available on the perceptions of the informal social network. Data on parents and professionals were categorized in four themes (type of support, sources of support, conditions of successful support and characteristics of support members). Data from professionals did not refer to emotional support needs or to the potential support of volunteers, friends and neighbours. Data from parents indicated a preference to be treated as 'full' parents, whereas professionals tended to focus on disabilities of parents. Results and implications contribute to insights into support needs of parents with ID from different perspectives and may help identify new entry points to improve future interventions and working alliances.

Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'.

BACKGROUND: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement. METHODS: The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. RESULTS: Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient. CONCLUSIONS: The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.

Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals.

AIMS AND OBJECTIVES: To evaluate the impact of supportive interventions perceived by both the intensive care unit patients' relatives and the healthcare providers, such as deferred intake interviews for providing information and discussing the emotional impacts, encouragement to keep a diary, and the introduction of weekly psychosocial rounds, on the perceptions of relatives of patients in the intensive care unit. BACKGROUND: Patient- and family-centred care is gaining interest, with a shift from provider-centric norms to care arranged around patients' and relatives individual beliefs and needs. This is expected to have a positive influence on the quality of care. Communication is one of the most important factors impacting the perceived quality of care in the intensive care unit from the perspective of patients' relatives. New interventions have been introduced to help the patients' relatives to meet their communication needs. DESIGN: A time-trend quantitative design. METHODS: Two convenience samples of relatives were included (in 2012 and 2013) in four different intensive care units from a large university medical centre in the Netherlands. RESULTS: Survey data from 211 relatives (75% net response rate in 2012) and 123 relatives (66% net response rate in 2013) were used for the analysis. The second measurement showed significant improvements regarding informational aspects of care, clarification of roles in participatory caretaking and shared decision-making. CONCLUSION: The results suggest that the additional support offered to patients' relatives increased perceived quality of care, particularly with respect to informational needs. However, patient- and family-centred care still requires a change in the mindset of healthcare professionals. This new point of view should overcome perceived barriers and foster a culture of partnership with patients' relatives in the intensive care unit. RELEVANCE TO CLINICAL PRACTICE: Training in providing psychosocial support for the needs of relatives leads to a stronger perception of patient-centredness.

Psychosocial Needs of Relatives of Trauma Patients.

In trauma care, the patient is the primary focus of attention. However, patients' relatives also need attention, for two main reasons. First, the support of relatives is an important factor in the convalescence of patients. Second, the trauma means a serious disruption of not only the life of patients, but also that of their relatives. The purpose of this study was to explore the needs of relatives of trauma patients, to what extent these needs are met by the support of social workers, and how relatives benefit from this support. The study was conducted in hospitals in The Netherlands. Needs were measured using the Dutch version of the Critical Care Family Needs Inventory. Results of in-depth interviews were used to develop a questionnaire to explore the type of social worker support and to what extent relatives benefit from this support. Findings show that trauma patients' relatives have a need for information, access to the patient and hospital staff, and psychosocial assistance. In most cases social workers supported relatives and relatives benefited from the support. To ensure that trauma patients' relatives receive the support they need, social workers should be involved in trauma care as the standard of good care.

Relatives' perspectives on the quality of care in an Intensive Care Unit: the theoretical concept of a new tool.

OBJECTIVE: To examine the potential of a questionnaire (CQI 'R-ICU') to measure the quality of care from the perspective of relatives in the Intensive Care Unit (ICU). METHODS: A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical structure. RESULTS: Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely 'Communication' and 'Involvement', were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC. CONCLUSIONS: The CQI 'R-ICU' seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication. PRACTICE IMPLICATIONS: The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.