Tine Van Regenmortel

Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review

OBJECTIVES The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals. METHODS This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2]. RESULTS Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed. CONCLUSIONS It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness. PRACTICE IMPLICATIONS The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment.

Co-design for implementing patient participation in hospital services : A discussion paper

Patient participation is increasingly recognized as a key component in healthcare. Patients’ experiences and knowledge are considered as complementary and equal in importance to professionals’ knowledge [1], both in individual care contexts and in healthcare organization [2,3]. Direct patient participation methods have been proven to lead to patient-centeredness and better care [4], but developing and implementing such methods is often a complex matter [5,6]. The use of the co-design methodology could offer a solution for designing and implementing these complex interventions. “Experience-Based Co-Design” is a specific form of co-design in healthcare. “Experience-based” refers to how patients feel about the used healthcare services and how well they serve their needs. “Co-design” indicates that both patients and healthcare professionals act as designers of the healthcare services. Also, it can be seen as an implementation strategy as it has the potential to counter reluctance within healthcare teams [7]. Overall, EBCD is a rigorous participatory approach that enables both staff and patients to (re)design services together by sharing experiences, identifying priorities, implementing and evaluating improvements in care and service provision [8].

Building a working alliance between professionals and service users in family preservation. A multiple case study

In the margin of the ongoing experimental and quasi-experimental research projects on family preservation, some research projects focus on the process through which families accomplish change and acknowledge the importance of the working alliance. There is, however, little information about barriers and facilitators in building this working alliance. To fill this gap, we performed a multiple case study with a triangulation of ethnographical methods such as observation, in-depth interviews, case file analysis, and multistakeholder focus groups. We illustrate how, in a context of managerialism and transactional leadership, social workers find themselves in a continuous tension between complying with the expectations of their social organization and “tuning in” with the service users. This jeopardizes the working alliance between a social worker and a family. Consequences for research, practice, and policy regarding family preservation interventions are discussed.

The development of agency in professional youth work with girls and young women in the Netherlands

Summary Young people living in north-west European welfare states are challenged to develop their individual strength. This is especially difficult for girls living in vulnerable circumstances, because they face a form of marginalization. Girls work is a method of professional youth work that supports girls in their identity development, making them more capable of shaping their own lives now and as adults. This is conceptualized as agency, which consist of the properties: intentionality, forethought, self-reactiveness, self-reflection. This paper examines the extent to which girls work helps girls living in vulnerable circumstances to develop their individual strength. Findings The article is based on a questionnaire filled out by 393 girls who participate in 59 girls work activities in the Netherlands. This study shows that participation in girls work contributes to the development of intentionality of these girls (F(3,387) = 4.60, p = .004). Furthermore, girls who received an individual approach are better capable of reflecting on their actions than girls who only participated in group activities (F(2,388) = 3.10, p = .046). Applications The findings suggest that participation in girls work contributes to the intentionality of girls in vulnerable circumstances, which is an important step in the development of agency. But to accomplish this, girls need to learn how to act upon their personal intentions. However, the findings do not show that girls work contributes to the other properties of agency, suggesting that to support girls in shaping their own lives, youth workers need to contribute more to the other levels of agency.

Actively Coping with Violation: Exploring Upward Dissent Patterns in Functional, Dysfunctional, and Deserted Psychological Contract End States

Recently, scholars have emphasized the importance of examining how employees cope with psychological contract violation and how the coping process contributes to psychological contract violation resolution and post-violation psychological contracts. Recent work points to the important role of problem-focused coping. Yet, to date, problem-focused coping strategies have not been conceptualized on a continuum from constructive to destructive strategies. Consequently, potential differences in the use of specific types of problem-focused coping strategies and the role these different strategies play in the violation resolution process has not been explored. In this study, we stress the importance of focusing on different types of problem-focused coping strategies. We explore how employee upward dissent strategies, conceptualized as different forms of problem-focused coping, contribute to violation resolution and post-violation psychological contracts. Two sources of data were used. In-depth interviews with supervisors of a Dutch car lease company provided 23 case descriptions of employee-supervisor interactions after a psychological contract violation. Moreover, a database with descriptions of Dutch court sentences provided eight case descriptions of employee-organization interactions following a perceived violation. Based on these data sources, we explored the pattern of upward dissent strategies employees used over time following a perceived violation. We distinguished between functional (thriving and reactivation), dysfunctional (impairment and dissolution) and deserted psychological contract end states and explored whether different dissent patterns over time differentially contributed to the dissent outcome (i.e., psychological contract end state). The results of our study showed that the use of problem-focused coping is not as straightforward as suggested by the post-violation model. While the post-violation model suggests that problem-focused coping will most likely contribute positively to violation resolution, we found that this also depends on the type of problem-focused coping strategy used. That is, more threatening forms of problem-focused coping (i.e., threatening resignation as a way to trigger one’s manager/organization to resolve the violation) mainly contributed to dysfunctional and deserted PC end states. Yet, in some instances the use of these types of active coping strategies also contributed to functional violation resolution. These findings have important implications for the literature on upward dissent strategies and psychological contract violation repair.