Background: Measures against COVID-19 in nursing homes affected not only clients but also staff. However, staff perspectives on the importance of these measures remain underexplored. Objective: To... Show moreBackground: Measures against COVID-19 in nursing homes affected not only clients but also staff. However, staff perspectives on the importance of these measures remain underexplored. Objective: To investigate measures related to staff during the COVID-19 pandemic, staff perspectives of important measures and the involvement of staff in deciding on these measures. Design: A qualitative study. Setting(s): We analysed minutes of nursing home outbreak teams in the Netherlands and conducted group meetings with Dutch nursing home staff in different positions, prioritizing measures and discussing staff' involvement in deciding on the measures. Participants were recruited purposefully. Participants: The minutes of 41 nursing home organizations were collected during March-November, 2020. Four group meetings were organized in the same period, each with 5 to 7 participants, resulting in 23 participants. Methods: The meeting minutes were analysed using qualitative content analysis, whereas reflexive thematic analysis was used for the group meeting data. The group meetings were conducted online and structured by the Nominal Group Technique to discuss the importance of measures for staff. Results: Measures implemented for staff focused on prevention of COVID-19 transmission, (suspension of) educational activities, testing, additional tasks and staffing capacity, promoting wellbeing, and other means of support. The implemented measures overlapped with the measures considered important by staff. In addition, staff considered measures on decision-making support and communication to be important. Staff prioritized the measures in the group meetings because they affected their well-being, workforce scheduling, decision-making, or infection prevention. Furthermore, the group meetings revealed that decision-making shifted from mainly implementing national measures to more context-adjusted decision-making in the staff's or clients' situations. Conclusions: We showed that although nursing home staff were not always involved in decisionmaking during the first COVID-19 wave, there was overlap between the measures implemented by the organizations and measures considered important by staff. We suggest that organizations Show less
The dissertation explores the complex interplay between financial scarcity and its psychological effects, shedding light on its impact on decision-making, avoidance behavior, and perceived control.... Show moreThe dissertation explores the complex interplay between financial scarcity and its psychological effects, shedding light on its impact on decision-making, avoidance behavior, and perceived control. Through a series of experiments, we found that financial scarcity increases temporal discounting, indicating a tendency to prioritize immediate gains over future outcomes. A longitudinal study revealed a reciprocal relationship over time between financial scarcity and avoidance behavior, hinting at the existence of a psychological poverty trap. Furthermore, an experiment demonstrated that financial scarcity increases the tendency to delay bill payments. However, evidence regarding attentional disengagement from financial stressors, assessed with an eye-tracker, remained inconclusive. A global survey spanning 51 societies confirmed the negative link between financial scarcity and perceived control, but also uncovered significant cross-cultural variations. Surprisingly, in societies with lower welfare provisions and institutional quality, the negative relationship between financial scarcity and control was weaker. Likewise, collectivist and traditional values seemed to buffer against the negative effect of financial scarcity on control. The dissertation informs about the psychological reality of dealing with problematic household finances and its consequences on decisions. Show less
This research delves into the decision-making processes within Brazilian energy governance, with a particular focus on its engagement with international climate change mitigation agreements. The... Show moreThis research delves into the decision-making processes within Brazilian energy governance, with a particular focus on its engagement with international climate change mitigation agreements. The recurrent utilization of power relations strategies in the nation's energy governance hinders the development of policies that facilitate an transition towards sustainable energy sources. The presence of monopolistic and oligopolistic practices, fuelled by crony capitalism and rent-seeking, not only shapes policy decisions but also enforces the adoption of established technologies. Furthermore, the exploration of behavioural dynamics in policymaking, as investigated through behavioural economics, sheds light on the fact that policymakers are influenced not solely by political, economic, and institutional challenges, but also by deeply ingrained personal behaviours. These behaviours wield significant influence over the decision-making processes and contribute to the prevailing inertia in the Brazilian energy sector. Brazil stands as the fifth-largest country in the world, the sixth most populous, the thirteenth highest emitter of greenhouse gases, and boasts 60 percent of the Amazon, the planet's largest forest, within its borders. These attributes position Brazil at the forefront of global climate governance efforts. An in-depth understanding and vigilant monitoring of the Brazilian context play a vital role in advancing worldwide initiatives to combat climate change. Show less
This thesis investigated the extent to which participation of school students in decision-making processes can be achieved, including through participatory action research (PAR) in teacher... Show moreThis thesis investigated the extent to which participation of school students in decision-making processes can be achieved, including through participatory action research (PAR) in teacher education. Data were collected from observations, research reports of pre-service teachers (PSTs) and interviews with PSTs and teacher educators. The aim was to enable students-teacher collaboration at an intensive level and have real influence on changes in teaching practice. The study found that some PST-projects exhibited the first stages of development towards this goal and that student participation was possible within limited time frames and contexts. School students were involved in designing and implementing the research projects, and they thereby contributed to changes in the content of their teaching and learning or in their circumstances. The study also highlighted the need for a higher level of student participation than just having a voice and being able to express opinions.The study developed a matrix for describing and designing participatory research practices (the SPinSTAR matrix), which distinguishes four levels of participation during different research phases. Furthermore, the study provided a set of principles for PAR that can provide more detailed insights into the participatory qualities of practices and the intertwined mechanisms that influence student participation. Show less
Akkermans, A.; Prins, S.; Spijkers, A.S.; Wagemans, J.; Labrie, N.H.M.; Willems, D.L.; ... ; Vos, M.A. de 2023
PurposeIn intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open... Show morePurposeIn intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open exchange of standpoints and underlying arguments between doctors and families to arrive at the most appropriate decision. Yet, it is still largely unknown how doctors and families argue in real-life conversations. This study aimed to (1) identify which arguments doctors and families use in support of standpoints to continue or discontinue LST, (2) investigate how doctors and families structure their arguments, and (3) explore how their argumentative practices unfold during conversations.MethodA qualitative inductive thematic analysis of 101 audio-recorded conversations between doctors and families.ResultsSeventy-one doctors and the families of 36 patients from the neonatal, pediatric, and adult ICU (respectively, N-ICU, P-ICU, and A-ICU) of a large university-based hospital participated. In almost all conversations, doctors were the first to argue and families followed, thereby either countering the doctor's line of argumentation or substantiating it. Arguments put forward by doctors and families fell under one of ten main types. The types of arguments presented by families largely overlapped with those presented by doctors. A real exchange of arguments occurred in a minority of conversations and was generally quite brief in the sense that not all possible arguments were presented and then discussed together.ConclusionThis study offers a detailed insight in the argumentation practices of doctors and families, which can help doctors to have a sharper eye for the arguments put forward by doctors and families and to offer room for true deliberation. Show less
Labrie, N.; Kunneman, M.; Veenendaal, N. van; Kempen, A. van; Vliet, L. van 2023
Objective: To develop valid and realistic manipulations for video-vignette research using expert opinion rounds, in preparation of an experimental study on clinicians' (un)reasonable argumentative... Show moreObjective: To develop valid and realistic manipulations for video-vignette research using expert opinion rounds, in preparation of an experimental study on clinicians' (un)reasonable argumentative support for treatment de-cisions in neonatal care. Methods: In three rounds, N = 37 participants (parents/clinicians/researchers) provided feedback on four video -vignette scripts and completed listing, ranking, and rating exercises to determine which (un)reasonable argu-ments clinicians may provide to support treatment decisions. Results: Round 1: participants deemed the scripts realistic. They judged that, on average, clinicians should provide two arguments for a treatment decision. They listed 13-20 reasonable arguments, depending on the script. Round 2: participants ranked the two most salient, reasonable arguments per script. Round 3: participants rated the most plausible, unreasonable arguments from a predefined list. These results guided the design of 12 experimental conditions. Conclusion: Expert opinion rounds are an effective method to develop video-vignettes that are theoretically sound and ecologically realistic and offer a powerful means to include stakeholders in experimental research design. Our study yielded some preliminary insights into what are considered prevalent (un)reasonable arguments for clinicians' treatment plans. Practice implications: We provide hands-on guidelines on involving stakeholders in the design of video-vignette experiments and the development of video-based health communication interventions - both for research and practice. Show less
Schuijt, H.J.; Smeeing, D.P.J.; Groenwold, R.H.H.; Velde, D. van der; Weaver, M.J. 2022
Introduction: Identification of high-risk hip fracture patients in an early stage is vital for guiding surgical management and shared decision making. To objective of this study was to perform an... Show moreIntroduction: Identification of high-risk hip fracture patients in an early stage is vital for guiding surgical management and shared decision making. To objective of this study was to perform an external international validation study of the U-HIP prediction model for in-hospital mortality in geriatric patients with a hip fracture undergoing surgery. Materials and methods: In this retrospective cohort study, data were used from The American College of Surgeons National Surgical Quality Improvement Program. Patients aged 70 years or above undergoing hip fracture surgery were included. The discrimination (c-statistic) and calibration of the model were investigated. Results: A total of 25,502 patients were included, of whom 618 (2.4%) died. The mean predicted probability of in-hospital mortality was 3.9% (range 0%-55%). The c-statistic of the model was 0.74 (95% CI 0.72-0.76), which was comparable to the c-statistic of 0.78 (95% CI 0.71-0.85) that was found in the development cohort. The calibration plot indicated that the model was slightly overfitted, with a calibrationin-the-large of 0.015 and a calibration slope of 0.780. Within the subgroup of patients aged between 70 and 85, however, the c-statistic was 0.78 (95% CI 0.75-0.81), with good calibration (calibration slope 0.934). Discussion and conclusion: The U-HIP model for in-hospital mortality in geriatric hip fractures was externally validated in a large international cohort, and showed a good discrimination and fair calibration. This model is freely available online and can be used to predict the risk of mortality, identify high-risk patients and aid clinical decision making. (C) 2021 Published by Elsevier Ltd. Show less
International prosecutors are the gatekeepers to international criminal justice. They have the sole authority to prosecute people for the most serious crimes at international courts: genocide, war... Show moreInternational prosecutors are the gatekeepers to international criminal justice. They have the sole authority to prosecute people for the most serious crimes at international courts: genocide, war crimes, and crimes against humanity. Every day, they need to decide which situations to investigate; which crimes to charge; which witnesses to call; whether to negotiate pleas; and whether to appeal. Prosecutors make theses choices, and countless others, by exercising discretion. Discretion, this research argues, is the act of reaching a reasoned decision about the appropriate course of action to pursue. Discretion translates law from an abstract set of ideas and notions into practical action. How prosecutors exercise discretion shapes what international criminal justice is, how it develops, and what it does. What have international prosecutors considered when exercising discretion, and why?This research draws upon first-hand interviews with current and former senior prosecutors at the highest levels of international courts to explore the motivations and assumptions that drive the practice of prosecuting in international criminal justice. It argues that prosecutorial discretion is informed by the different role identities that prosecutors adopt towards the institutions, people, and concepts they encounter in their work. Specifically, it claims that prosecutors have been influenced by their roles as norm performers, builders, and guardians. This research concludes that adopting a relational understanding of the prosecutorial role, in which prosecutors are understood to have different roles within different relationships, allows a nuanced understanding of what international prosecutors do and explains why decisions are made. Show less
Even after thousands of years of experience in treating patients with TBI, decisions regarding the optimal treatment strategy remain difficult for both healthcare workers as policy makers. The... Show moreEven after thousands of years of experience in treating patients with TBI, decisions regarding the optimal treatment strategy remain difficult for both healthcare workers as policy makers. The first part of this thesis investigated the challenges of the treatment decision-making process in patients with (severe) TBI by focussing on three factors considered to be important in this process: patient outcome, in-hospital healthcare consumption, and in-hospital costs. The second part investigated the procedural difficulties in TBI research efficiency by focussing on the process of institutional review board approval and the use of informed consent procedures in patients with TBI with an inability to provide informed consent. Finally, we elaborate on the role of patient outcome and in-hospital costs in the acute treatment decision-making process in patients with severe TBI and make suggestions to optimize future research initiatives. Show less
Bor, A.; Mazepus, H.; Bokemper, S.E.; DeScioli, P. 2021
Background To optimize the focus of future public information campaigns in The Netherlands promoting the uptake of vaccines among adults and children, we quantified the contribution of several... Show moreBackground To optimize the focus of future public information campaigns in The Netherlands promoting the uptake of vaccines among adults and children, we quantified the contribution of several attributes to the vaccination decision. Method We performed a discrete choice experiment (DCE) among Dutch adults including six attributes, i.e. vaccine effectiveness, vaccine-preventable burden of disease (specified in severity and frequency), accessibility of vaccination in terms of co-payment and prescription requirements, frequency of mild side-effects, population-level vaccination coverage and local vaccination coverage among family and friends. Participants answered the DCE from their own perspective ('oneself' group) or with regard to a vaccine decision for their youngest child ('child' group). The data was analysed by means of panel mixed logit models. Results We included 1547 adult participants (825 'oneself' and 722 'child'). Vaccine effectiveness was the most important attribute in the 'oneself' group, followed by burden of disease (relative importance (RI) 78%) and accessibility (RI 76%). In the 'child' group, burden of disease was most important, but tied closely with vaccine effectiveness (RI 97%). Of less importance was the risk of mild vaccine-related side-effects and both population and local vaccination coverage. Interestingly, participants were more willing to vaccinate when uptake among the population or family and friends was high, indicating that social influence and social norms plays a role. Conclusions Vaccine effectiveness and disease severity are key attributes in vaccination decision-making for adults making a decision for themselves and for parents who decide for their children. Hence, public information campaigns for both adult and child vaccination should primarily focus on these two attributes. In addition, reinforcing social norms may be considered. Show less
Willems, S.A.; Kranenburg, F.J.; Cessie, S. le; Marang-van de Mheen, P.J.; Kesecioglu, J.; Bom, J.G. van der; Arbous, M.S. 2020
The aim of this study is to investigate how regional government matters in designing ‘context-specific’ regional innovation policy. To that end, the study develops a Public Administration... Show moreThe aim of this study is to investigate how regional government matters in designing ‘context-specific’ regional innovation policy. To that end, the study develops a Public Administration framework to conceptualise the different roles theoretically and applies this framework to capture these roles empirically in six European regions. The study employs a descriptive, multiple-case study research method comparing six regions, three German and three British regions. Qualitative data have been gathered from an existing dataset through archival records research and documentation analysis. The assumption that regions endowed with regional autonomy are better at contextualized policy design is not confirmed in this study. Instead, among the six case studies a great variety of regional government roles was found irrespective of government system type, and all regions engaged in multiple roles throughout the policy process to succeed at designing their ‘context-specific’ regional innovation policy. Understanding how ‘context-specific’ regional innovation policy comes about requires a differentiated conceptualisation of the role of regional government. This is the overall conclusion of the study. The study generates new insights about ‘context-specific’ regional innovation policy and makes an important contribution to better understanding the role of regional government as a policy-making actor to develop such a policy. Show less
De overheid mag kinderen onder voorwaarden van hun vrijheid beroven met als doel ze op te voeden en te beschermen. In de Nederlandse context wordt deze vorm van vrijheidsberoving ‘gesloten... Show moreDe overheid mag kinderen onder voorwaarden van hun vrijheid beroven met als doel ze op te voeden en te beschermen. In de Nederlandse context wordt deze vorm van vrijheidsberoving ‘gesloten jeugdhulp’ genoemd, geregeld in de Jeugdwet. Met dit onderzoek is beoogd om een kinder- en mensenrechtentoetsingskader op te stellen, waaraan de Nederlandse wet en de toepassing getoetst wordt. Tevens biedt het onderzoek inzicht in 200 jaar historie.Verder zijn 586 rechterlijke uitspraken over een periode van 10 jaar (2008-2017) geanalyseerd. Hieruit blijkt dat een plaatsing vaak gebaseerd is op het inzetten van acute hulp in een situatie waar in niets anders mogelijk lijkt te zijn. Doorgaans wordt daarbij onvoldoende gekeken naar het doel van deze plaatsing en de vrijheidsbeperkingen die dit met zich meebrengt.In dit onderzoek komen ten slotte 23 kinderen aan het woord die te maken kregen met een gesloten uithuisplaatsing. Uit het onderzoek blijkt dat de legitimiteit van het op grote schaal toepassen van deze maatregel onder druk staat, met name omdat het nogal eens ontbreekt aan passende zorg. Verschillende aanbevelingen worden gedaan om de legitimiteit te verbeteren, onder meer door middel van verdieping van het juridische toetsingskader, verkorting van de maximale duur van een plaatsing. Show less
The objective of the work presented in this thesis is to assess information provision about adjuvant systemic therapy during consultations between early-stage breast cancer patients and medical... Show moreThe objective of the work presented in this thesis is to assess information provision about adjuvant systemic therapy during consultations between early-stage breast cancer patients and medical oncologists in general. In this era of personalized medicine, prediction tools (e.g., Adjuvant!) are becoming an integral part of information provision during patient consultations. However, evidence is lacking about a) how prevalent the use of such tools is during patient consultations, and b) whether and how the use of such tools influences information provision. Therefore, this thesis in addition to assessing the availability and the quality of prediction tools for the early-stage breast cancer setting, also zooms in on the use of such tools during patient consultations and their impact on the content of consultations. Show less
Berkhout-Byrne, N.; Gaasbeek, A.; Mallat, M.J.K.; Rabelink, T.J.; Mooijaart, S.P.; Dekker, F.W.; Buren, M. van 2017
Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired... Show more Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired participation of minors. First, involvement in decision-making requires children and adolescents to be adequately informed about what participation in research entails. Second, the plea for increased involvement in decision-making requires further investigation whether children indeed can, should and want to play a role in the decision about research participation. This thesis addresses these issues and thereby contributes to insights in how to empower minors in the context of informed consent for research participation. New informed consent material was developed in close cooperation with children and other end-users, the process of which is described and evaluated. Also, insights in the role that minors can, should and want to play in the informed consent procedure are described. These insights were obtained by reviewing multidisciplinary scientific evidence on the competence of minors, by an ethical reflection on the view on children that we should adopt, and by consulting minors themselves about the perspectives on their role in decision-making. Finally, based on this research, recommendations are provided on how to empower minors in decision-making about research participation. Show less
Individuals who work in the public sector see themselves confronted with conflicting values, contradictory demands, and the need to serve an at times difficult to define __public interest__. This... Show moreIndividuals who work in the public sector see themselves confronted with conflicting values, contradictory demands, and the need to serve an at times difficult to define __public interest__. This book contributes to our understanding of what drives public service professionals__ decision-making in real-life dilemma situations by looking into the combined effect of public service motivation (PSM) and professionalism. Because there are persistent knowledge gaps about the meaning and behavioural consequences of these concepts when it comes to the context of dilemma situations, this book presents new approaches to the study of PSM and professionalism. Another important contribution of this study is related to the discussion about the stability of PSM. Several hypotheses and propositions are put to the test within a mixed-method research design based on data from research on Dutch veterinary inspectors. The results show that in order to clarify the meaning and behavioural consequences of PSM and professionalism in the context of dilemmas it is useful to combine our understanding of these two concepts with insights from identity theory. Mixed findings regarding the relationship between PSM and professionalism highlight our incomplete conceptual understanding of the topics studied, and call for future research that is sensitive to role perceptions. Show less
