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In this chapter, we propose that the democracy we wish to see out in the world is influenced by the quality of our own “inner democracies”—that is: the quality of the democracies among and between the selves or voices in the landscape of the self. We must find ways out of the I-prisons we experience and perpetuate. With this in mind, we propose that ”writing the self,” a method whereby creative, expressive, and reflective writing is used to cultivate an internal dialogue and construct a new identity narrative (Lengelle, 2014), can assist in reshaping our stories about ”the Other and ourselves” and can contribute to personal and cultural healing and reconciliation. The inner dialogue reconciled is foundational for the external dialogue at the heart of global citizenship within education. Indeed, as Schellhammer argues, we must cultivate the self in order to become inter-culturally competent, and this includes facing shadow aspects through truthful dialogues with the self and caring for the self. https://doi.org/10.1007/978-3-319-62861-5_6 LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/
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A critical reflection on the reconciliation process in Angola.
It was a landmark speech. On May 26, Angola’s president apologized and asked forgiveness for mass executions that occurred in 1977. He also announced the returning of victims’ remains to their families and the issuance of death certificates. But what does this mean for Angola’s wider reconciliation process? Other key demands and large groups of victims have still been left out, warn scholars Maarten van Munster and Joris van Wijk.
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Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
from Narcis: "What is known and objective Medication discrepancies are common at hospital discharge, and medication reconciliation is widely endorsed as a preventive strategy. However, implementation is difficult for instance due to the unreliability of patients medication histories. In the Netherlands, community pharmacies are well-informed about their patients’ pre-admission medication status which enables thorough post-discharge reconciliation. Our aim was to study the frequency and nature of medication discrepancies, missing patient's knowledge and administrative problems at admission to primary care. Methods A cross-sectional study was conducted in pharmacies belonging to the Utrecht Pharmacy Practice network for Education and Research in the Netherlands. Structured checklists were used to evaluate all discharge prescriptions presented by adult patients discharged from the hospital to their own home during the study period. The primary outcome was all possible problems with continuity of care, defined as (i) the number and type of medication discrepancies, (ii) administrative problems and (iii) the necessity for patient education. Results and discussion In forty-four pharmacies, checklists were completed for 403 patients. Most discharge prescriptions (92%) led to one or more problems with continuity of care (n = 1154, mean 2·9 ± 2·0), divided into medication discrepancies (31%), administrative problems (34%) and necessity for further education (35%). Medication discrepancies (n = 356) resulted mainly from missing pre-admission medication (n = 106) and dose regimen changes (n = 55) on the discharge prescription. Administrative problems (n = 392) originated mainly from administrative incompleteness (n = 177), for example missing reimbursement authorization forms, or supply issues (n = 150), for example insufficient pharmacy stock. The patients’ lack of medication knowledge post-discharge was illustrated by the high need for patient education (n = 406). What is new and conclusion Community pharmacists are still confronted with problems due to inadequate documentation at discharge which can inflict harm to patients if not properly addressed. To reduce these problems, a rigorous implementation of the medication reconciliation process at all transition points, standardized electronic transfer of all medication-related information and interdisciplinary collaboration are crucial."
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AimTo evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results.DesignA mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework.MethodsQuantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence.ResultsThe overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention.ConclusionAlthough involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population.ImpactIn addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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A tangible proof of the meaning and scope of human flourishing that can change not only organizations but also entire societies, is given by Robert Schuman, the French Minister of Foreign Affairs who launched the Schuman Declaration (1950) that gave birth to the EU. His leitmotiv was to be a faithful instrument in the hands of God in whichever circumstances. A strong personal relationship with God characterized his entire personal and professional life and implied the heroic practice of virtues. He strove for peace on the continent and therefore for reconciliation between France and Germany - countries that had been archenemies since the Treaty of Verdun (843). He previewed a peace project on coal and steel, former instruments of war. Schuman pursued a policy of reconciliation from the moment he became a member of the French Parliament (1919) and even during his captivity during the Second World War. His coherence of life was acknowledged by friend and foe and recognized also professionally. His profound Catholic faith brought human flourishing that changed not only French-German relationships, not only Europe, but the entire world. Schuman’s Europe would strive towards political unification through economic cooperation – as a means! – at the service of man and his transcendence so that man could flourish. These days man seems to be an instrument of the economy and politics instead of the other way round. A good moment to revive the person and thoughts of the Father of Europe.
With the EU struggling to maintain itself, it is highly relevant to look into the drive for and original vision on European unification of its principal architect, Robert Schuman, then French Minister of Foreign Affairs. The Schuman Declaration (1950) gave birth to the EU and procured the longest period of peace among its member states since the Treaty of Verdun (843). This article shows how Schuman’s Catholic faith influenced his life and therefore his politics. His drive to be a faithful instrument of Providence, supported by his origins from Alsace-Lorraine, made him strive towards peace on the European continent. He envisaged a European political integration through economic cooperation at the service of man and his transcendence and rooted in the common European spiritual and cultural heritage. This implied reconciliation, effective solidarity, subsidiarity and supranationality for European common interests through an integration in small steps.
Higher education is tasked with preparing students for a culturally diverse and globalizing world. Additionally, western nations have an increasingly diverse student population and know the success of their students will depend in part on being able to navigate diversity. There is therefore good reason for institutions of higher learning to promote and facilitate the development of ‘global citizens’ – people who can work and relate across borders and boundaries, both real and perceived. However, teachers are not necessarily equipped to foster this learning. Many teachers are used to a reproductive way of teaching while the learning that is needed here is identity learning, directed at dialogue, internally as well as externally. This chapter proposes the potential of creative, expressive and reflective writing as a way in which personal development – a form of a reflexive internal dialogue – can be fostered to promote cultural healing and global citizenship. The writing method will be described and a case study on cultural healing in the context of Canada’s reconciliation efforts with Aboriginal people will be used to illustrate the learning process involved. The processes of writing the self and re-narrating identity has several promising benefits for both students and teachers in higher education. First it allows us to learn more about ourselves and what blocks our learning (i.e. promotes self-reflection). Second, it allows us to change our story and our identifications and therefore choose differently (i.e. self-direction). Third, it is a companion on the road of life where we literally learn to talk and listen to ourselves and articulate the tacit knowledge that can be unearthed through narrative, journal, and poetic writing. Fourth, the method is playful and creative and although tears are frequently shed in the process, students report a great enjoyment in writing and sharing their stories with others. It is a meaningful dialogue about experience and also has the potential of promoting cultural (Lengelle, Jardine, & Bonnar, 2018) healing in the context of a very diverse student body (Banks, 2015). It also has the potential for creating new bonds in the classroom and allows teachers in higher education to engage in the difficult work of facilitating global citizenship learning. The internal dialogue described here also allows us to ‘clean up’ judgements and become aware of the need to reach out to others. Not only the actual sharing of vulnerable writing in a class or online setting shows us we are not alone, but ‘writing the self’ focuses deliberately on where we have become fearful about our own and others’ identities and allows us a learning process to unearth those things, heal them in order to reach out to others.
