Objective. To study the prevalence, nature and determinants of aggression among inpatients with acquired brain injury. Background. Patients with acquired brain injury often have difficulty in controlling their aggressive impulses. Design. A prospective observational study design. Methods. By means of the Staff Observation Aggression Scale-Revised, the prevalence, nature and severity of aggressive behaviour of inpatients with acquired brain injury was assessed on a neuropsychiatric treatment ward with 45 beds. Additional data on patient-related variables were gathered from the patients’ files. Results. In total, 388 aggressive incidents were recorded over 17 weeks. Of a total of 57 patients included, 24 (42%) patients had engaged in aggressive behaviour on one or more occasions. A relatively small proportion of patients (n = 8; 14%) was found to be responsible for the majority of incidents (n = 332; 86%). The vast majority of aggression incidents (n = 270; 70%) were directly preceded by interactions between patients and nursing staff. In line with this, most incidents occurred at times of high contact intensity. Aggressive behaviour was associated with male gender, length of stay at the ward, legal status and hypoxia as the cause of brain injury. Conclusion. Aggression was found to be highly prevalent among inpatients with acquired brain injury. The results suggest that for the prevention of aggression on the ward, it may be highly effective to develop individually tailored interventions for the subgroup with serious aggression problems. Relevance to clinical practice. Insight into the frequency, nature and determinants of aggressive behaviour in inpatients with acquired brain injury provides nurses with tools for the prevention and treatment of aggressive behaviour.
(‘Co’-)Designing for healthy behaviour greatly benefits from integrating insights about individual behaviour and systemic influences. This study reports our experiences in using insights about individual and systemic determinants of behaviour to inform a large co-design project. To do so, we used two design tools that encourage focusing on individual determinants (Behavioural Lenses Approach) and social / systemic aspects of behaviour (Socionas). We performed a qualitative analysis to identify 1) when and how the team applied the design tools, and 2) how the tools supported or obstructed the design process. The results show that both tools had their distinctive uses during the process. Both tools improved the co-design process by deepening the conversations and underpinnings of the prototypes. Using the Behavioural Lenses under the guidance of a behavioural expert proved most beneficial. Furthermore, the Socionas showed the most potential when interacting with stakeholders, i.c. parents and PPTs.
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Research conducted by Henk van den Hurk shows that teachers’ knowledge of effective instructional behaviour is of limited influence on their actual performance in daily teaching. Observing teachers within their own educational practice and the subsequent feedback in teacher training college, however, has shown to be effective in improving teacher instructional practice. Van den Hurk studied the effects of the application of a cyclic model for data-feedback in initial teacher training as well as in a master course for teachers. In the applied model, teachers are observed with standardised observational instruments, while teaching their own classes. Back in teacher training college they are supported in formulating specific points of improvement for their own instructional behaviour. Subsequently, in their own classroom, the students practice the skills they further have to develop. After a short while another classroom observation is scheduled. The use of this model has proven to lead to a substantial improvement of teacher instructional behaviour. It is remarkable that advances in the quality of teacher instructional behaviour are reached in a limited time-span of only several weeks.
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De afgelopen twee decennia is er veel meer aandacht ontstaan bij onderzoekers en beleidsmakers voor het begrip co-creatie. Bijna altijd wordt de rol van co-creatie als positief en essentieel gezien in een proces waarin maatschappelijke of publieke uitdagingen worden onderzocht en opgelost (zogenaamde sociale innovatie). Het meeste onderzoek naar deze twee begrippen is kwalitatief van aard en gebaseerd op ‘case studies’.In zijn promotieonderzoek kijkt Peter Broekema naar de rol van co-creatie binnen sociale innovatie in Europese samenwerkingsprojecten. In zijn eerste artikel heeft hij de begrippen co-creatie en sociale innovatie tussen 1995 en 2018 binnen de EU geanalyseerd en geconcludeerd dat beide begrippen steeds breder gebruikt worden en samen met het begrip impact zijn getransformeerd tot een beleidsparadigma.In het tweede artikel keek Peter Broekema hoe beide begrippen doorwerken in specifieke subsidieoproepen en hoe consortia deze begrippen toepassen en samenwerken. Hierbij bleek dat er weliswaar verschillende typen consortia bestaan, maar dat zij geen specifieke co-creatiestrategie hadden.In zijn laatste twee artikelen zal hij gedetailleerd kijken naar een aantal EU projecten en vaststellen hoe de samenwerking is verlopen en hoe tevreden de verschillende partners zijn met het resultaat. Peter Broekema maakt hiervoor gebruik van projecten waarin hij zelf participeert (ACCOMPLISSH, INEDIT en SHIINE).EU beleidsparadigma van sociale innovatie in combinatie met co-creatie en impact. Co-creatie vindt vaak binnen eigen type stakehodlers plaatsAbstractSocial innovation and co-creation are both relatively new concepts, that have been studied by scholars for roughly twenty years and are still heavily contested. The former emerged as a response to the more technologically focused concept of innovation and the latter originally solely described the collaboration of end-users in the development of new products, processes or services. Between 2010-2015, both concepts have been adapted and started to be used more widely by for example EU policymakers in their effort to tackle so called ‘grand societal challenges’. Within this narrative – which could be called co-creation for social innovation, it is almost a prerequisite that partners – especially citizens - from different backgrounds and sectors actively work together towards specific societal challenges. Relevance and aimHowever, the exact contribution of co-creation to social innovation projects is still unclear. Most research on co-creation has been focussing on the involvement of end-users in the development of products, processes and services. In general, scholars conclude that the involvement of end-users is effective and leads to a higher level of customer satisfaction. Only recently, research into the involvement of citizens in social innovation projects has started to emerge. However, the majority of research on co-creation for social innovation has been focusing on collaborations between two types of partners in the quadruple helix (citizens, governments, enterprises and universities). Because of this, it is still unclear what co-creation in social innovation projects with more different type of partners entails exactly. More importantly however, is that most research has been based on national case studies in which partners from different sectors collaborate in a familiar ‘national’ setting. Normally institutional and/or cultural contexts influence co-creation (for example the ‘poldermodel’in the Netherlands or the more confrontational model in France), so by looking at projects in a central EU and different local contexts it becomes clear how context effects co-creation for social innovation.Therefore this project will analyse a number of international co-creation projects that aim for social innovation with different types of stakeholders in a European and multi-stakeholder setting.With this research we will find out what people in different contexts believe is co-creation and social innovation, how this process works in different contexts and how co-creation contributes to social innovation.Research question and - sub questionsThe project will answer the following question: “What is the added value of co-creation in European funded collaboration projects that aim for social innovation?” To answer the main question, the research has been subdivided into four sub questions:1) What is the assumed added value of co-creation for social innovation?2) How is the added value of co-creation for social innovation being expressed ex ante and ex post in EU projects that aim specifically for social innovation by co-creation?3) How do partners and stakeholders envision the co-creation process beforehand and continuously shape this process in EU projects to maximise social innovation?4) How do partners and stakeholders regard the added value of co-creation for social innovation in EU projects that that aim for social innovation?Key conceptsThe research will focus on the interplay between the two main concepts a) co-creation and b) social innovation. For now, we are using the following working definitions:a) co-creation is a non-linear process that involves multiple actors and stakeholders in the ideation, implementation and assessment of products, services, policies and systems with the aim of improving their efficiency and effectiveness, and the satisfaction of those who take part in the process.b) social innovation is the invention, development and implementation of new ideas with the purpose to (immediately) relieve and (eventually) solve social problems, which are in the long run directed at the social inclusion of individuals, groups or communities.It is clear that both definitions are quite opaque, but also distinguish roughly the same phases (ideation/invention, development, implementation and assessment) and also distinguish different levels (products/services, policies and systems). Both concepts will be studied within the policy framework of the EU, in which a specific value to both concepts has been attributed, mostly because policymakers regard co-creation with universities and end-users almost as a prerequisite for social innovation. Based on preliminary research, EU policies seem to define social innovation in close reation with ‘societal impact’, which could defined as: “the long lasting effect of an activity on society, because it is aimed at solving social problems”, and therefore in this specific context social innovation seems to encompasses societal impact. For now, I will use this working definition of social innovation and will closely look at the entanglement with impact in the first outlined paper.MethodologyIn general, I will use a qualitative mixed method approach and grounded theory to answer the main research question (mRQ). In order to better understand the added value of co-creation for social innovation in an EU policy setting, the research will:SubRQ1) start with an analysis of academic literature on co-creation and social impact. This analysis will be followed by and confronted with an analysis of EU policy documents. SubRQ2) use a qualitative data analysis at nineteen EU funded projects to understand how co-creation is envisoned within social innovation projects by using the quintuple helix approach (knowledge flows between partners and stakeholders in an EU setting) and the proposed social innovation journey model. By contrasting the findings from the QDA phase of the project with other research on social innovation we will be able to find arachetypes of social innovation in relation with the (perceived) added value of co-creation within social innovation. SubRQ3) These archetypes will be used to understand the process of co-creation for social innovation by looking closely at behavioural interactions within two social innovation projects. This close examination will be carried out by carrying out interviews with key stakeholders and partners and participant observation.SubRQ4) The archetypes will also be used to understand the perceived added value by looking closely at behavioural interactions within two social innovation projects. This close examination will be carried out by carrying out interviews with key stakeholders and partners and participant observation.ImpactThe project will contribute to a better understanding of the relationship between co-creation and social innovation on different levels:a) Theoretical: the research will analyse the concepts of co-creation and social innovation in relation to each other by looking at the origins of the concepts, the adaptation in different fields and the uptake within EU policies;b) Methodological: a model will be developed to study and understand the non-lineair process of co-creation within social innovation, by focusing on social innovation pathways and social innovation strategies within a quintuple helix setting (i) academia, ii) enterprises and iii) governments that work together to improve iv) society in an v) EU setting);c) Empirical: the project will (for the first time) collect data on behavioural interactions and the satisfaction levels of these interactions between stakeholders and partners in an EU project.d) Societal: the results of the research could be used to optimize the support for social innovation projects and also for the development of specific funding calls.
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
Ruimte voor mij! Iedereen wil fijn wonen(Bijna) iedereen woont. Iedereen wil zich fijn voelen in zijn of haar thuis. Ook mensen met een verstandelijke beperking en moeilijk verstaanbaar gedrag willen dat. Moeilijk verstaanbaar gedrag betekent dat mensen soms agressief zijn naar zichzelf, anderen en spullen. Ze maken soms in hun omgeving spullen kapot. Dit doen ze bijvoorbeeld omdat ze gefrustreerd zijn, bang of omdat ze schrikken. Ze kunnen namelijk moeilijk vertellen wat zij belangrijk vinden om zich fijn te voelen. Daarom is het belangrijk om daar onderzoek naar te doen. Kan architectuur helpen? Architecten zijn de mensen die een gebouw ontwerpen. Zij bedenken hoe het gebouw eruit moet zien van binnen en van buiten. Zij bedenken bijvoorbeeld hoe een woning wordt ingedeeld en waar het licht vandaan komt. Daarvoor moeten ze goed weten voor wie ze het huis ontwerpen en wat de nieuwe bewoners nodig hebben. Wij willen graag dat architecten begrijpen wat mensen met moeilijk verstaanbaar gedrag nodig hebben om zich fijn te voelen. We willen onderzoeken hoe architectuur een bijdrage kan leveren dat zij zo fijn mogelijk kunnen wonen. Kan architectuur tegenwerken? Omdat deze bewoners weleens dingen kapot maken worden die dingen soms weggehaald. Of hun omgeving wordt zo gemaakt dat deze niet kapot kan. Dat klinkt best slim, maar het risico bestaat dat hun huis niet meer gezellig is. Wat ook wel gebeurt is dat hun thuis onhandig is ingedeeld. Dat er bijvoorbeeld veel gangen zijn die de hoek om gaan. Dan kunnen de bewoners niet zien wie eraan komt. Daardoor kunnen ze schrikken of bang zijn om de hoek om te gaan. Dat zijn dingen die misschien maken dat ze zich minder fijn voelen in hun thuis. Architectuur zou dus ook kunnen maken dat de bewoners zich juist niet fijn voelen. Misschien wel dat ze gefrustreerd of bang worden en daardoor agressief worden naar hun omgeving? Intensieve begeleidingSoms is het zo dat mensen met moeilijk verstaanbaar gedrag vastlopen in hun bestaande woning. Dan is het beter voor hen als ze voor een bepaalde tijd verhuizen naar een plek waar ze intensieve begeleiding krijgen en die speciaal gebouwd is voor mensen met moeilijk verstaanbaar gedrag. Een dergelijk gebouw wordt een ‘Very intensive care workhome’ genoemd. Een thuis, waar de bewoners in de buurt kunnen werken en ze in hele kleine groepen intensieve begeleiding krijgen. Hun thuis is ook een werkplek: de werkplek voor hun begeleiders. Het is dus ook belangrijk dat het gebouw die begeleiding ondersteunt. Maar wel zo dat het nog steeds een thuis is voor de bewoners. Wij gaan onderzoek doen in een ‘Very intensive care workhome’ van ’s Heeren Loo in Ermelo. Zo komen wij er hopelijk achter wat mensen met een verstandelijke beperking en moeilijk verstaanbaar gedrag nodig hebben om fijn te wonen. Wellicht kunnen we zo ook ontdekken hoe architectuur daar een bijdrage aan kan leveren. Bestaande informatieHoe doen we dat onderzoek? Het blijkt dat veel zorginstellingen waar deze mensen wonen al heel veel dingen opschrijven. Zo heeft elke bewoner een dossier waar in staat hoe het met hem of haar gaat. Er wordt opgeschreven als een bewoner agressief is naar een medewerker of als iets gerepareerd moet worden. Er is dus al heel veel kennis aanwezig, die wij kunnen gebruiken in ons onderzoek. Ook de medewerkers en de familieleden weten vaak al heel veel. Daarom hebben wij ze geïnterviewd. Omdat de bewoners zelf soms niet zo goed uit kunnen leggen wat ze fijn vinden of wat ze bang maakt hebben wij een week met hen geleefd. Hierdoor konden we zien hoe ze zich gedragen en ook met hen in gesprek raken, voor zover dat mogelijk was. Daardoor kunnen we ons beter in hen inleven. Verder hebben we ook veel foto’s gemaakt om te zien wat het gebouw zelf te vertellen heeft. We waren bijvoorbeeld op zoek naar sporen van agressie om te kijken of dit steeds op dezelfde plek gebeurt. Kijken vanuit verschillende perspectievenWe gaan onderzoeken of, en zo ja hoe, architectuur een bijdrage kan leveren aan de kwaliteit van bestaan van mensen met moeilijk verstaanbaar gedrag. Om deze vraag goed te beantwoorden is het belangrijk om deze vanuit verschillende perspectieven te onderzoeken. Zo is de kans het grootst dat we echt leren te begrijpen wat deze bewoners nodig hebben en hoe architectuur daarbij kan helpen. We kijken natuurlijk vanuit de bewoner, de medewerker, de familie, wat er opgeschreven is, wat het gebouw vertelt en ook wat de architect bedacht heeft. We hebben ook gekeken wat er in het verleden al is onderzocht over dit onderwerp en wat daarover is opgeschreven. Al die perspectieven samen geven een goed beeld en hopelijk een antwoord op onze vraag. Wie heeft hier wat aan?Als we dat antwoord dan hebben heeft dat voor verschillende groepen veel voordelen. De medewerkers, de familie en ook de bewoners kunnen dan beter vertellen wat er nodig is voor een fijn thuis. Dat helpt ook zorginstellingen die nieuwe gebouwen willen bouwen, omdat ze dan weten wat zij aan een architect moeten vragen. Die architect begrijpt hopelijk met ons antwoord ook beter hoe hij of zij een thuis moet ontwerpen voor mensen met een verstandelijke beperking en moeilijk verstaanbaar gedrag. Wie zijn wij? Wij zijn vertegenwoordigers van twee instellingen, namelijk van de Hanzehogeschool in Groningen en ’s Heeren Loo in Ermelo die voor dit project samenwerken. Maar we zijn vooral een groep mensen die de passie hebben om mee te werken aan een betere leefomgeving voor mensen met moeilijk verstaanbaar gedrag. Onze groep bestaat uit:• Berit Ann Roos, architect van het onderzochte gebouw, onderzoeker en directeur van de Academie van Bouwkunst aan de Hanzehogeschool• Mark Mobach, lector Facility Management aan de Hanzehogeschool en zeer geïnteresseerd in de relatie tussen mens en ruimte• Tineke Leussink, medewerker zorg en vastgoed bij ’s Heeren Loo en moeder van een zoon met moeilijk verstaanbaar gedrag. • We werken zeer nauw samen met de Professor architectuur Ann Heylighen van de KU Leuven, een universiteit in België. Challenging behaviour (CB), such as self-injury and aggression towards persons or objects, arises in interaction with the environment and is shown to increase attention, escape, adjust sensory stimulation, or receive a material reward. CB may prevent individuals from being included in society and enjoying a high quality of life (QoL). This raises the question of how architecture can contribute to creating environments that help reduce such behaviour, since literature shows that architects can be enablers of prevention, mitigating CB before rather than after its occurrence. This research explores how architecture may contribute to the QoL of intellectually impaired (and autistic) individuals showing CB with a scoping review and an empirical research at a ‘very intensive care’ facility in the Netherlands. For the review four databases were searched using four concepts: architecture, QoL, challenging behaviour, and intellectual impairment. Twelve articles were identified, none of which covered all four concepts. For the empirical research observations, interviews, and the study of files and reports have taken place. The combined results will provide a deeper understanding of the needs of individuals showing CB concerning environments that enhance their QoL for all members involved in the creation of these environments.Findings of the review suggest that individuals showing CB may possibly benefit from environments that promote independence, social participation, and well-being. This may be achieved by spaces providing access and understanding, offering a choice in various aspects, and by designing a home instead of an institution. Although differences exist between the needs of people showing CB and autistic individuals, the findings indicate many similarities. Future research is required to substantiate these similarities and differences and to investigate whether and how the built environment, designed for people showing CB, could be beneficial for all building users.Keywords: architecture, autism, challenging behaviour, intellectual impairment, quality of life
