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  • 1.
    Huber, M.
    et al.
    Louis Bolk Inst, Dept Healthcare & Nutr, Driebergen, Netherlands..
    van Vliet, Marja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Louis Bolk Inst, Dept Healthcare & Nutr, Driebergen, Netherlands.;Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Giezenberg, M.
    Vrije Univ Amsterdam, Policy Anal & Entrepreneurship Hlth & Life Sci, Amsterdam, Netherlands..
    Winkens, B.
    Maastricht Univ, Fac Hlth Med & Life Sci, Dept Methodol & Stat, NL-6200 MD Maastricht, Netherlands..
    Heerkens, Y.
    Dutch Inst Allied Hlth Care, Amersfoort, Netherlands..
    Dagnelie, P. C.
    Maastricht Univ, Fac Hlth Med & Life Sci, Dept Epidemiol, NL-6200 MD Maastricht, Netherlands..
    Knottnerus, J. A.
    Maastricht Univ, Dept Gen Practice, The Hague, Netherlands.;Maastricht Univ, Sci Council Govt Policy, The Hague, Netherlands..
    Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e010091Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate among stakeholders the support for the new, dynamic concept of health, as published in 2011: 'Health as the ability to adapt and to self-manage', and to elaborate perceived indicators of health in order to make the concept measurable. Design: A mixed methods study: a qualitative first step with interviews and focus groups, followed by a quantitative survey. Participants: Representatives of seven healthcare stakeholder domains, for example, healthcare providers, patients with a chronic condition and policymakers. The qualitative study involved 140 stakeholders; the survey 1938 participants. Results: The new concept was appreciated, as it addresses people as more than their illness and focuses on strengths rather than weaknesses. Caution is needed as the concept requires substantial personal input of which not everyone is capable. The qualitative study identified 556 health indicators, categorised into six dimensions: bodily functions, mental functions and perception, spiritual/existential dimension, quality of life, social and societal participation, and daily functioning, with 32 underlying aspects. The quantitative study showed all stakeholder groups considering bodily functions to represent health, whereas for other dimensions there were significant differences between groups. Patients considered all six dimensions almost equally important, thus preferring a broad concept of health, whereas physicians assessed health more narrowly and biomedically. In the qualitative study, 78% of respondents considered their health indicators to represent the concept. Conclusions: To prevent confusion with health as 'absence of disease', we propose the use of the term 'positive health' for the broad perception of health with six dimensions, as preferred by patients. This broad perception deserves attention by healthcare providers as it may support shared decision-making in medical practice. For policymakers, the broad perception of 'positive health' is valuable as it bridges the gap between healthcare and the social domain, and by that it may demedicalise societal problems.

  • 2.
    van Vliet, Marja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Integrative Medicine in the Dutch healthcare system: prerequisites and tools for implementation2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach.

    Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV).

    Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions & perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”.

    Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals.

  • 3.
    van Vliet, Marja
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Louis Bolk Institute, the Netherlands.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Busch, Martine
    van Praag Institute, Utrecht, The Netherlands.
    Meijer, Judith E M
    The Netherlands Foundation Health Centers, National Information and Knowledge Center for Integrative Medicine, Netherlands.
    von Rosenstiel, Inès A
    Slotervaart Hospital, National Information and Knowledge Center for Integrative Medicine, Netherlands .
    Jong, Miek C
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Louis Bolk Institute, the Netherlands.
    Attitudes, Beliefs, and Practices of Integrative Medicine Among Nurses in the Netherlands2015In: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 33, no 2, p. 110-121Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study assessed the attitude, beliefs, and practices of integrative medicine (IM) among nurses in the Netherlands.

    DESIGN: Subscribers of a Dutch nursing journal were asked to fill in an anonymous, structured, online survey related to the topic under study.

    RESULTS: A total of 355 people responded, of which 37% were familiar with the concept of IM in advance. On completion of the survey, the majority (83%) considered IM as a (very) important innovation in health care. Familiarity (odds ratio = 3.20; 95% confidence interval [1.48, 6.94]) and organization (nursing home compared to hospital (odds ratio = 5.98; 95% confidence interval [1.36, 26.23]) were characteristics associated with a positive attitude toward IM. Between 23% and 46% of respondents encountered obstacles regarding implementation of IM. The main obstacles were lack of support (69% to 78%), means (57% to 85%), and time (63% to 70%).

    CONCLUSIONS: Dutch nurses seem to have relatively positive attitudes and beliefs regarding IM. The outcome of this survey may contribute an increased awareness of the key role that nurses can play in the development and implementation of IM.

  • 4.
    van Vliet, Marja
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Jong, Miek
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A Barrier Opener for Personal Insights: Nursing and Medical Students Experiences of Participating in an Experiential Mind-Body Skills Program2014In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 20, no 5, p. A98-A99Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to obtain an in-depth understanding on how nursing-, and medical students participating in a Mind-Body Medicine Skills program experienced participation and what the program has meant to them on a personal and a professional level.

    Methods: Based on a qualitative approach, first and second year students were interviewed 3 months after completion of the program. Interviews were analyzed with a qualitative content analysis. As a part of a larger study evaluating the effects on stress, empathy and self-reflection, this qualitative sub-study included 10 nursing students from Mid Sweden University, Sweden, and 10 medical students from University of Utrecht, The Netherlands. The Mind-Body Medicine Skills program was adapted from the program developed at Georgetown University School of Medicine, Washington DC, and included 11 experiential sessions were the students were introduced to different mind-body techniques (mindfulness meditation, guided imagery, bio-feedback etc).

    Results: Data analysis is ongoing and more complete analysis will be presented at the conference. In preliminary analysis an overarching theme has been identified: The Mind-Body Medicine Skills program as a barrier opener of personal insights, and a starting point for a new journey in life. The participants describe how the course have made it possible for them obtain insights about themselves, both by self reflection in relation to experiences and through listening to the stories of the others. It is also described that they currently do not at all times explicitly use the direct techniques, but more separate personalized elements, which they have been able to incorporate in everyday situations: i.e. moments of mindfulness while walking, biking or eating, or taking a moment of breathing and relaxation before dealing with problematic situations with others.

    Conclusion: Participation in the Mind-Body Medicine Skills program can on an individual basis have a deep and profound meaning, stimulating to personal growth.

  • 5.
    van Vliet, Marja
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Jong, Miek C
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Effects of a Mind-Body Medicine Skills Program on Perceived Stress, Empathy and Self-Reflection Among Medicine and Nursing Students: A Quantitative Study2014In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 20, no 5, p. A99-A99Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to implement and quantitatively evaluate the Mind-Body Medicine (MBM) Skills program among Dutch medical and Swedish nursing students.

    Methods: The MBM Skills program was piloted among second year medical students at Utrecht University and first year nursing students at Mid Sweden University in the period 2011–2013. During the course, the participating students learned and practiced Mind-Body techniques such as relaxation, meditation, guided imagery, biofeedback, physical exercise, art, music and movement. The effects of the MBM skills program on perceived stress, empathy, and self-reflection were evaluated by the following validated scales: Perceived Stress Scale, Interpersonal Reactivity Index, and Groningen Reflection Ability Scale. Participating students and controls answer(-ed) the different questionnaires at baseline, at the end of the course, and 6 and 12 months later.

    Results: In total, 55 medical students and 49 nursing students have participated in the MBM skills program. Baseline analysis (age, gender, mind-body experience, perceived stress, four subscales of the IRI, and self-reflection) demonstrated that participating nursing students were significantly older (p<0.001), and had higher scores for empathetic concern (p<0.001) and self-reflection (p=0.001) than participating medical students. Further, baseline analysis showed no significant differences in baseline characteristics between intervention and control group for medical students, except from significantly higher levels of perceived stress among controls (p=0.008). Regarding nursing students, no differences were found between intervention and control group, except from significantly higher scores for empathetic concern among participants (p=0.023).

    Conclusion: We have successfully implemented the MBM Skills program for medical and nursing students. Baseline analysis showed that participants of the course were not a selected group, except from perceived stress among medical students and empathetic concern among nursing students. Data on the effects of the MBM skills program on perceived stress, empathic concern and self-reflection are currently being evaluated and will be presented at the conference.

  • 6.
    van Vliet, Marja
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Healthcare and Nutrition, Louis Bolk Institute, Driebergen, the Netherlan.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Jong, Miek C.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Healthcare and Nutrition, Louis Bolk Institute, Driebergen, the Netherlands; National Information and Knowledge Center Integrative Medicine (NIKIM), Amsterdam, the Netherlands.
    Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students2017In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 39, no 7, p. 710-719Article in journal (Refereed)
    Abstract [en]

    Background: A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind–body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

    Methods: The MBM course (consisting of experiential sessions of mind–body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

    Results: Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p = 0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p < 0.001], and decreased personal distress [−1.73 (95% CI −3.04, −0.35), p = 0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [−5.09 (95% CI −8.37, −1.82), p = 0.002] and decreased personal distress [−5.01 (95% CI −6.97, −3.06), p < 0.001] compared to controls until 12 months follow-up.

    Conclusions: This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.

  • 7.
    van Vliet, Marja
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Louis Bolk Inst, Bunnik, Netherlands.
    Jong, Miek C.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Louis Bolk Inst, Bunnik, Netherlands.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A Mind Body Skills Course Among Nursing and Medical Students: A Pathway for an Improved Perception of Self and the Surrounding World2018In: Global Qualitative Nursing Research, ISSN 2333-3936, Vol. 5Article in journal (Refereed)
    Abstract [en]

    Despite increased recognition of self-care and self-awareness as core competences for health care professionals, little attention is paid to these skills during their education. Evidence suggests that a Mind-Body (MB) skills course has the potential to enhance self-care and self-awareness among medical students. However, less is known about the meaning of this course for students and how it affects their personal and professional life. Therefore, we examined the lived experiences with an MB skills course among Dutch medical and Swedish nursing students. This course included various MB techniques, such as mindfulness meditation and guided imagery. Guided by a phenomenological hermeneutical method, three main themes were identified: "ability to be more present," "increased perception and awareness of self," and "connection on a deeper level with others." Overall, participation in the MB skills course served as a pathway to inner awareness and supported connecting with others as well as with the surrounding world.

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