Background: If nurses have the communication skills and the time, they can play an important role in increasing the intrinsic motivation of patients with coronary artery disease (CAD) to change their lifestyle. Motivational Interviewing (Mo-Int) can be used to further support this role. However, few nurses are sufficiently proficient in applying Mo-Int skills. Increasing these complex communication skills may contribute significantly to achieve lifestyle changes in CAD patients. Aims: The aim of this study was to evaluate the coaching of nurses to skilfully use Mo-Int in a secondary prevention programme for CAD patients.Methods: The design was a before–after study of a learning strategy as a follow-up on a short Mo-Int workshop. At (on average) four-monthly intervals, the nurses received, three times, feedback and coaching by telephone and email on their use of Mo-Int skills in audio-recorded conversations on lifestyle change with CAD patients. The Mo-Int consistency of the nurses’ communication skills was scored using the Motivational Interviewing Target Scheme 2.1 (range 0–32). Results: Of the 24 nurses, 13 completed all audio recordings. The mean change in Mo-Int consistency of these completers between the first and the last audio recording was 6.4 (95% confidence interval 3.2 to 9.5). This change indicates an improvement from ‘a small part of Motivational Interviewing practice’ to ‘a mainly sufficient degree of Motivational Interviewing practice’.Conclusion: A one-year follow-up on a Mo-Int workshop with feedback and coaching improves Mo-Int skills of nurses. Healthcare professionals should be aware of the importance of a follow-up on training in complex communication skills, to develop and preserve competency.
Background: If nurses have the communication skills and the time, they can play an important role in increasing the intrinsic motivation of patients with coronary artery disease (CAD) to change their lifestyle. Motivational Interviewing (Mo-Int) can be used to further support this role. However, few nurses are sufficiently proficient in applying Mo-Int skills. Increasing these complex communication skills may contribute significantly to achieve lifestyle changes in CAD patients. Aims: The aim of this study was to evaluate the coaching of nurses to skilfully use Mo-Int in a secondary prevention programme for CAD patients.Methods: The design was a before–after study of a learning strategy as a follow-up on a short Mo-Int workshop. At (on average) four-monthly intervals, the nurses received, three times, feedback and coaching by telephone and email on their use of Mo-Int skills in audio-recorded conversations on lifestyle change with CAD patients. The Mo-Int consistency of the nurses’ communication skills was scored using the Motivational Interviewing Target Scheme 2.1 (range 0–32). Results: Of the 24 nurses, 13 completed all audio recordings. The mean change in Mo-Int consistency of these completers between the first and the last audio recording was 6.4 (95% confidence interval 3.2 to 9.5). This change indicates an improvement from ‘a small part of Motivational Interviewing practice’ to ‘a mainly sufficient degree of Motivational Interviewing practice’.Conclusion: A one-year follow-up on a Mo-Int workshop with feedback and coaching improves Mo-Int skills of nurses. Healthcare professionals should be aware of the importance of a follow-up on training in complex communication skills, to develop and preserve competency.
Het DIEET project onderzocht hoe de eerstelijns diëtetiek effectief en toekomstbestendig zou kunnen zijn: meetbaar en stuurbaar. In het project is onderzocht wat de succes- en faalfactoren zijn in het handelen van de diëtist tijdens het eerste consult met een patiënt. Door observaties van 605 consulten bij 237 diëtistenpraktijken in heel Nederland zijn potentiele predictoren in kaart gebracht. Op basis van deze predictoren (zoals bijv. een directieve houding van de dietist tijdens het consult) en het vaststellen van een effectieve behandeling na 9 maanden is een model ontwikkeld. Het model bleek echter minder eenvoudig dan gedacht, en de verklaring daarvoor is eigenlijk wel eenvoudig: diëtetiek is MAATWERK. Zo bleek bijvoorbeeld dat bij oudere mannen de directieve houding van de diëtist wel samen gaat met een effectieve behandeling, bij jonge vrouwen werkt motivational interviewing beter. Dit is voor de diëtetiek (en volgens onze voorzichtige inschatting ook andere beroepsgroepen) volstrekt unieke informatie. Deze resultaten hebben we nog een keer kwalitatief met de Stuurgroep van het RAAK-MKB project DIEET besproken en unaniem besloten dat de impact van dit product (model) voor de praktijk heel groot is. Deze nieuwe inzichten zullen ook verwerkt worden in de nieuwe druk van het boek (landelijk lesmateriaal diëtetiek opleidingen) dat is ontwikkeld (Neelemaat F, Ozturk H, Weijs P. Kritisch Redeneren in de Diëtetiek; bol.com). Het ontwikkelde model bleek door het maatwerk fors ingewikkelder dan vooraf ingeschat. Dit model kan echter in een web-based applicatie worden ingebouwd en de predictoren kunnen worden ingevoerd. Met deze applicatie kan bij elke diëtetiek (paramedische) stage en bij elke diëtist professional een scan worden gedaan op effectief handelen. Bij de studenten zal een relatie worden gelegd met het stagecijfer en bij de professionals met de effectieve behandeling na 9 maanden. Implementatie van de webbased applicatie in de eerstelijns diëtetiek praktijk zal meteen breed worden ingezet. Echter onderdeel van deze aanvraag is een interventie en controle groep, waarbij de interventie groep wel feedback krijgt op basis van de score en de controle groep niet. De snelle feedback (na het consult en niet pas na 9 maanden) is namelijk de sleutel tot succes. Top-up subsidie is nodig om voor het bestaande model een web-based tool te ontwikkelen en ontsluiting naar onderwijs en beroepspraktijk te bevorderen. Om in de toekomst goed gebruik van de tool door professionals, onderzoekers, studenten en docenten mogelijk te maken, is een geïntegreerde web-versie van de tool wenselijk waarin nieuwe updates eenvoudig kunnen worden doorgevoerd. Tot slot kan met Top-up de tool beter ontsloten worden voor de praktijk en voor inzet in het onderwijs door het maken van enkele goede casus beschrijvingen en het presenteren van de tool door middel van bijvoorbeeld workshops. Door Top-Up op deze manier in te zetten krijgt de doorwerking van de resultaten van het RAAK-project een flinke extra impuls.
In leaving the more traditional territories of the concert performance for broader societal contexts, professional musicians increasingly devise music in closer collaboration with their audience rather than present it on a stage. Although the interest for such forms of devising co-creative musicking within the (elderly) health care sector is growing, the work can be considered relatively new. In terms of research, multiple studies have sought to understand the impact of such work on musicians and participants, however little is known about what underpins the musicians’ actions in these settings. With this study, I sought to address this gap by investigating professional musicians’ emerging practices when devising co-creative musicking with elderly people. Three broad concepts were used as a theoretical background to the study: Theory of Practice, co-creative musicking, and Praxialism. Firstly, I used Theory of Practice to help understand the nature of emerging practices in a wider context of change in the field of music and habitus of musicians and participants. Theory of Practice enabled me to consider a practice as “a routinized type of behaviour which consists of several elements, interconnected to one another: forms of bodily activities, forms of mental activities, ‘things’ and their use, a background knowledge in the form of understanding, know-how, states of emotion, and motivational knowledge” (Reckwitz, 2002, p. 249). Secondly, I drew the knowledge from co-creative musicking, which is a concept I gathered from two existing concepts: co-creation and musicking. Musicking (Small, 1998), which considers music as something we do (including any mode of engagement with music), provided a holistic and inclusive way of looking at participation in music-making. The co-creation paradigm encompasses a view on enterprise that consists of bringing together parties to jointly create an outcome that is meaningful to all (Prahalad & Ramaswamy, 2004; Ramaswamy & Ozcan, 2014). The concept served as a lens to specify the jointness of the musicking and challenge issues of power in the engagement of participants in the creative-productive process. Thirdly, Praxialism considers musicking as an activity that encompasses “musical doers, musical doing, something done and contexts in which the former take place” (Elliott, 1995). Praxialism sets out a vision on music that goes beyond the musical work and includes the meanings and values of those involved (Silverman, Davis & Elliott, 2014). The concept allowed me to examine the work and emerging relationships as a result of devising co-creative musicking from an ethical perspective. Given the subject’s relative newness and rather unexplored status, I examined existing work empirically through an ethnographic approach (Hammersley & Atkinson, 2007). Four cases were selected where data was gathered through episodic interviewing (Flick, 2009) and participant observation. Elements of a constructivist Grounded Theory (Charmaz, 2014) were used for performing an abductive analysis. The analysis included initial coding, focused coding, the use of sensitizing concepts (Blumer 1969 in Hammersley, 2013) and memoing. I wrote a thick description (Geertz, 1973) for each case portraying the work from my personal experience. The descriptions are included in the dissertation as one separate chapter and foreshadow the exposition of the analysis in a next chapter. In-depth study of the creative-productive processes of the cases showed the involvement of multiple co-creative elements, such as a dialogical interaction between musicians and audience. However, participants’ contributions were often adopted implicitly, through the musicians interpreting behaviour and situations. This created a particular power dynamic and challenges as to what extent the negotiation can be considered co-creative. The implicitness of ‘making use’ of another person’s behaviour with the other not (always) being aware of this also triggered an ethical perspective, especially because some of the cases involved participants that were vulnerable. The imbalance in power made me examine the relationship that emerges between musicians and participants. As a result of a closer contact in the co-creative negotiation, I witnessed a contact of a highly personal, sometimes intimate, nature. I recognized elements of two types of connections. One type could be called ‘humanistic’, as a friendship in which there is reciprocal care and interest for the other. The other could be seen as ‘functional’, which means that the relationship is used as a resource for providing input for the creative musicking process. From this angle, I have compared the relationship with that of a relationship of an artist with a muse. After having examined the co-creative and relational sides of the interaction in the four cases, I tuned in to the musicians’ contribution to these processes and relationships. I discovered that their devising in practice consisted of a continuous double balancing act on two axes: one axis considers the other and oneself as its two ends. Another axis concerns the preparedness and unpredictability at its ends. Situated at the intersection of the two axes are the musicians’ intentionality, which is fed by their intentions, values and ethics. The implicitness of the co-creation, the two-sided relationship, the potential vulnerability of participants, and the musicians’ freedom in navigating and negotiation, together, make the devising of co-creative musicking with elderly people an activity that involves ethical challenges that are centred around a tension between prioritizing doing good for the other, associated with a eudaimonic intention, and prioritizing values of the musical art form, resembling a musicianist intention. The results therefore call for a musicianship that involves acting reflectively from an ethical perspective. Doctoral study by Karolien Dons
