Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how “factual” and “normative” orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors “manage” frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.
Governments use activation policies to stimulate unemployed citizens in finding work. Caseworkers are, as frontline workers, responsible for concrete activation trajectories based on these activation policies. Little is known about how caseworkers try to get clients to participate in these activation trajectories. In a qualitative, inductive study (consisting of observations and reflective interviews) in two welfare agencies, we identified 10 motivational strategies that caseworkers employed. The full-range leadership model appeared to be an appropriate perspective to understand, systematize, and reflect on these strategies, in particular as our analyses show that these motivational strategies can be placed on a continuum ranging from laissez-faire to transactional and transformational strategies. We found that caseworkers matched their motivational strategy to the situation and client but preferred transformational strategies. Our findings implicate chances but also challenges for activation in practice and literature on front-line workers.
Een discoursanalyse van taal van senior onderzoekers over publicatiedruk onder jonge wetenschappers laat zien dat de goede bedoelingen van seniors een bepaalde wreedheid in zich hebben. In een lezing op een summerschool werden promovendi aangespoord zich niets aan te trekken van publicatiedruk vanuit 'het systeem', terwijl seniors in comfortabele professoraanstellingen de universiteit op bijna fatalistische wijze abstraheerden tot een rigide publicatiefabriek waar zij zelf genoodzaakt zijn aan mee te werken. In plaats van jonge academici een rooskleurig, maar uiterst onzeker, toekomstperspectief voor te houden, worden zij beter geholpen wanneer senior onderzoekers (vertellen over hoe zij) zich hard maken voor waardering van kwaliteit.
In het boek Fantoomgroei, dat volgens mij nu zo'n beetje iedereen gelezen heeft, komen de schrijvers Noten en Heijne met een sprekend voorbeeld hoe die fixatie ons op het verkeerde been kan zetten. De olieramp in de Golf van Mexico was een ecologische ramp, maar bleek goed voor het bbp.' 'De heer Segers heeft het inderdaad goed gezien dat volgens mij iedereen dat boek gelezen heeft. (…) Maar de les uit dat boek is dat het macro bbp-cijfer niet genoeg is. Je moet ook kijken hoe dat neerslaat bij mensen.' * Yvonne La Grouw, Msc is PhD kandidaat bestuurskunde en politicologie aan de Vrije Universiteit Amsterdam en redactielid van Beleid en Maatschappij. Dr. Mark van Ostaijen is managing director van het LDE Centre Governance of Migration and Diversity en assistant professor aan de Erasmus Universiteit Rotterdam, en redactielid van Beleid en Maatschappij. Dit artikel uit Beleid en Maatschappij is gepubliceerd door Boom bestuurskunde en is bestemd voor anonieme bezoeker
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