Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study.

BACKGROUND: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. OBJECTIVE: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). METHODS: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum-Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. RESULTS: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum-Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. CONCLUSIONS: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.

BACKGROUND: Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS: Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS: Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS: Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

Perceived contribution of a hybrid serious game to the development of collaborative problem solving among undergraduate nursing students: A mixed method design.

BACKGROUND: Community health nurses collaborate in teams to address client care, organise services, and conduct preventive activities. Hence, it is crucial for students in this work context, to practise and enhance their collaborative problem-solving (CPS) skills. To facilitate this, a hybrid serious game called "Carion" was developed, immersing second-year nursing students in a semester-long experience of working as district nurses in self-managed teams. The game challenges them to collectively tackle authentic and fictional problems. However, the extent and manner in which this hybrid serious game contributes to students' CPS skill development is unknown. AIM: The aim of this study is to explore how students perceive the development of CPS by doing assignments carried out in the learning context of the hybrid serious game Carion. PARTICIPANTS: Two teams each consisting of five second-year nursing students, were selected for the qualitative case study. Two lecturers acting as team coaches also participated in this study. 110 (response rate 61 %) second-year students participated in the quantitative survey at the beginning of the semester, 109 students at the end of the semester. METHODS: The study is a mixed method design. The qualitative component involves a case study while the quantitative component consists of an online survey. Qualitative and quantitative data regarding collaborative problem solving was collected at different time points using focus group interviews, one-on-one interviews, digital logbooks and an online self-assessment tool. RESULTS: Qualitative analysis revealed insights into three key themes: (1) Collaboration, encompassing consulting with each other, and capitalising on each other's qualities and strengths; (2) Problem solving, encompassing quicker and easier problem solving, allocating assignments, coming to a joint solution, and problem-solving method; and (3) Learning from each other, encompassing learning from each other's knowledge and experience, and from each other's ideas. No growth in collaborative problem-solving development was statistically shown in the group. CONCLUSIONS: This study gives an ambiguous view on students' perception of their CPS development through involvement in various Carion assignments. Based on this exploratory investigation, prematurely labelling Carion as a potential educational environment for developing CPS among undergraduate nursing students in community healthcare would be unwarranted. Further research is needed, particularly in scrutinising the interplay between CPS and diverse learning activities, assignments and learning outcomes within this specific hybrid serious game context.

Older adults' active involvement in an undergraduate program in gerontology: Motives and meaning.

Two Dutch undergraduate programs in applied gerontology have teamed up with older volunteers to educate students in collaborating with older adults in the field of age-friendly service development. The research question of this study was: What are the motives and meanings of the older volunteers concerning their participation in an undergraduate program?An explorative descriptive qualitative design was used to study the motives and meanings of the older volunteers through semi-structured interviews (n = 11) and a focus group interview (n = 4). Two themes and nine categories emerged: (1) Personal norms and values (categories: responsible life attitude, contribution, self-determination), (2) Personal gain (categories: intergenerational education, personal development, staying healthy, pleasure, feeling appreciated, feeling connected). Personal norms and values and personal gains are meaningful to older volunteers in applied gerontology education. Universities should respect these when designing measures for improving participation methods.

Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study.

BACKGROUND: Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored. OBJECTIVES: To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults. DESIGN: Cross-sectional. SETTINGS: A University of Applied Sciences in the Netherlands. PARTICIPANTS: Nursing students, ≥16 years who were able to read and write in Dutch. METHODS: The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS. RESULTS: In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%). CONCLUSIONS: Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.

Gerontology competencies: Construction, consensus and contribution.

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative "Gerontology Competencies for Undergraduate and Graduate Education"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus. The comprehensive framework has ten major domains, employs three categories each including multiple selective competencies. Six Category I competencies are essential orientations to gerontology. Four Category II competencies are "interactional" processes of knowing and doing across the field. Category III provides eight selective competencies for sectors where gerontologists may work. From educators' feedback, gerontology characteristics emerged: multi-system approaches; interdisciplinary; communication of older adults' "voices" and strengths; research utilization. The discussion includes the contribution of competency-based gerontology to students and aging workforce development as well as next steps, outcome measurement, levelling and accreditation.

Nurturing gerontology students' intrinsic motivation to cocreate: The design of a powerful learning environment.

Professionals such as gerontologists play an important role in the design, development and implementation of age-friendly services. and products, by using working methods and principles of co-creation. A Dutch undergraduate applied gerontology programme aims to train students in the why, how and what of co-creation. The degree to which students are intrinsically motivated to develop competencies depends on how their psychological needs are met. These needs are autonomy, an awareness of competence and a sense of relatedness, as described in the self-determination theory. To nurture the intrinsic motivation of the applied gerontology students, a realistic, powerful learning environment called the Living Lab Applied Gerontology was designed and implemented. The aim of this paper is to present the design of this powerful learning environment and to discuss its value for nurturing the students' intrinsic motivation for co-creation. Based on a focus group with eight students, we identify directions for further research and development of living labs.

[Evaluation by case managers dementia : An explorative practice based study on types and content]. / Evaluatie door casemanagers dementie : Een explorerende praktijkstudie naar vormen en inhoud.

BACKGROUND: This practice based explorative study aims to provide insight into the ways in which case managers shape and fill up the evaluation phase of their support of the informal care network of persons with dementia. METHOD: A combination of quantitative and qualitative research methods were used. A group of 57 case managers of persons with dementia in three different organisational networks took part in this study. RESULTS: Results from the quantitative and qualitative data are organized into four themes: (1) attitude towards evaluation, (2) forms of evaluation, (3) implementation of evaluation and (4) content of evaluation. There are different ways in shaping evaluation and the content of it. The importance of interim and final evaluation is recognized, but is difficult to realize in a methodical way. Barriers experienced by the case managers include various factors associated both with clients as professionals. CONCLUSION: Case managers evaluate continuously and in an informal way to assess whether the extent of their assistance is meeting the needs of the client and informal network. Case managers do not use systematic evaluation to measure the quality of care they offer to persons with dementia and their caregivers. The findings demand a discussion on the level of clients, as well as on the professional and societal level about the way case managers should evaluate their support.

Competencies in European gerontological higher education. An explorative study on core elements.

This study explores whether there is a common core of competencies in European gerontology education programs by doing a cross-comparison of five undergraduate-level programs. Content analysis of competency profile documents at the five European educational programs were studied using thematic analysis. Study results document that there indeed is a common core of elements in gerontological educational programs. Three clusters which included a total of 15 categories were identified. The clusters were labeled professional attitude, communication skills, and service provision. Clusters and categories varied across the five programs. One program in particular included fewer clusters and categories. This may reflect a difference in focus in the program but could also reflect a less elaborately formulated competency profile document. The results of this study show that, at least at the level of formulating competencies, there is a strong agreement on the major components that are important for a gerontologist at the undergraduate level.

A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies.

Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement.