BACKGROUND: The number of patients visiting emergency departments (ED) due to acute but less than urgent treatment needs is increasing. A deeper understanding of emergency perception and decision-making competencies of patients is fundamentally important for developing strategies to reduce ED utilization. The aim of this study was to assess ED patients\' subjective understanding of an emergency in general as well as relating to their own specific consultation. Additionally, the patients\' perspective on the ability to make appropriate decisions in acute situations should be explored.
METHODS: Seventeen qualitative semi-structured patient interviews were conducted and analyzed using qualitative content analysis.
RESULTS: The majority of participants attributed their ED consultation to a subjectively perceived emergency situation. Interviewees mostly understood an emergency as a serious or life-threatening constellation associated with impending long-term health damage. They believed that uncertainty concerning the interpretation of their symptoms and associated anxiety may particularly promote situations in which referring to an ED appears to be the only alternative. Patients\' health competencies were assessed negatively by a majority of interviewees with regard to assessment of complaints and decision-making in acute situations (\"insecure patients\"). In contrast, few patients, including those with chronic disease and experience in dealing with health problems, were considered to have a high level of competence (\"confident patients\").
CONCLUSIONS: Improving patients\' health literacy skills to strengthen their assessment of acute situations and their decision-making is important in order to promote appropriate ED utilization.

BACKGROUND: The benefits of patient education in bronchial asthma in terms of reducing hospitalization and incapacity to work are well documented. However, only about a quarter of patients take advantage of training offers. Therefore, this qualitative study with asthma patients examines how to sharpen the motivation to participate in training programs.
METHODS: In order to investigate narrative patterns of chronic illness in asthma patients, we conducted 14 problem-centered narrative (telephone) interviews. The collected data were evaluated in accordance with system-theoretical analysis. This methodology allows for the interviews to be examined for their narrative patterns. The central question was how the patients we interviewed succeeded in constructing normality in the interviews.
RESULTS: From the analysis of the interviews, we were able to develop four types of narrative patterns: the chronic illness as a crisis (1), as a passion (2), as an odyssey (3), and as homeostasis (4). Within these forms of narration, the transition from normal to pathological is told in a specific and exemplary manner. The results of our study can be seen as a contribution to the dynamization and differentiation of trajectories of chronic disease.
CONCLUSIONS: We identified significant differences in the experienced trajectories of the disease. Patients are dealing with chronic disease in different styles, which have individual \"pressure points\" where motivation for adherence is created in the first place. The results show that the patient\'s knowledge structures unfolding in the narrative patterns should not be viewed as health illiteracy.
CONCLUSIONS: These typologies of the normal and the pathological do not only provide a key to understanding the life-world (Lebenswelt) of chronically ill people, but also to the question of what motivates chronically ill patients to participate in patient trainings. This in-depth understanding could help us to improve motivational discussions with these patients.

BACKGROUND: Patient involvement in health research is an integral part of health care in many countries. It promotes the relevance and quality of research and increases the meaningfulness of research results. Meanwhile, the value of patient involvement has also been recognised in Germany. The lack of a common understanding of patient involvement and appropriate methods make implementation difficult. In Germany, patients are still rarely involved in the planning and conduct of health research. Vulnerable patient groups such as the elderly and the very old are considered particularly challenging for researchers in active patient involvement due to their special needs, which is why they are often neglected. Especially nursing home residents suffer from a variety of health impairments which are accompanied by a high number of prescription drugs and adverse events and can therefore make patient involvement more difficult. The present project aims to test the method of patient advisory boards for the involvement of nursing home residents. Using the design of a clinical trial to optimise medication for nursing home residents as a case study, we will assess the feasibility of the method for this target group. We will also install a patient advocate as moderator of the advisory board. The study plan is described in the present study protocol.
METHODS: Two patient advisory boards with nursing home residents will be established. With a patient advocate acting as moderator, the essential elements of a clinical trial to optimise medication will be discussed and passed on to the study planning team via the patient advocate. The overall topic of the clinical trial is the optimisation of medication in cardiovascular disease. The nursing home residents are informed about the contents and ideas of the study to be planned and the interests of the researchers, respectively, and will discuss the proposals of the study planning team. Nursing home residents\', the patient advocate\'s and the researchers\' expectations and experiences will be examined in individual interviews.
CONCLUSIONS: The study will provide a potentially suitable method to involve nursing home residents in the research process. The jointly developed study design will be incorporated into a new project proposal. The results will be used to inform the development of a German handbook on active public and patient involvement.

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual\'s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the \'Centre for research on the psychodynamics of personality\'. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re-authoring one\'s life narrative is accepted as part of a productive therapy as well as discovering one\'s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.
La recherche dans le domaine de la psychothérapie est un domaine d’étude en croissance rapide qui vise à étudier l’intégration des conditions intérieures et extérieures dans l’expérience d’une personne, l’interaction entre le subjectif et l’objectif, ainsi qu’entre l’individuel et le collectif. L’article aborde des questions concernant une perspective plus intégrative et la recherche qualitative en psychothérapie. L’auteur introduit des idées provenant d’études faites par un groupe de chercheurs à l’université de Vilnius sur l’efficacité de la psychothérapie. Ces chercheurs travaillent au « Centre for research on the psychodynamics of personality » (Centre de recherche sur les psychodynamiques de la personnalité). Ils sont docteurs en psychologie clinique ou doctorants dans le département de Psychologie à l’université de Vilnius. L’objet principal de ces recherches est la compréhension subjective d’épisodes de guérison et la construction de postulats de profondeur. Parmi différentes méthodes pour obtenir des données, les chercheurs ont utilisé celle consistant à faire un dessin d’un moment de guérison et celle consistant à raconter une histoire de psychothérapie telle que le client se la rappelle. Deux exemples de faire un dessin d’un moment de guérison ainsi qu’un exemple de raconter une histoire de psychothérapie sont analysés dans l’article. Les thèmes de l’expérience subjective du renouveau en psychothérapie, ainsi que la multiplicité d’expérience et de résultats en psychothérapie sont traités dans l’article et illustrés par des cas. Cette étude montre que de faire un dessin ouvre une dimension de plus dans la réflexion et que cela peut être un outil approprié pour le développement des récits individuels. Etre l’auteur de son récit de vie, ainsi que de sa réécriture, est considéré comme étant un aspect d’une thérapie productive. De même que découvrir sa capacité intérieure à « être auteur ». La capacité à suivre une succession de significations, ainsi qu’un lien avec la nature et la culture pourraient être une des manières d’actualiser une perspective intégrative dans la recherche en psychothérapie.
Psychotherapieforschung ist ein sich rasant entwickelndes Forschungsgebiet, das darauf abzielt, die Integration der inneren und äußeren Bedingungen einer individuellen Erfahrung, das Zusammenspiel von Subjektivem und Objektivem sowie von Individuellem und Kollektivem zu untersuchen. In diesem Beitrag werden Fragen diskutiert, die sowohl eine integrativere Sichtweise als auch qualitative Forschung in der Psychotherapie berücksichtigen. Die Autorin stellt einige Ideen aus Studien zur Wirksamkeit von Psychotherapie vor, die an der Universität Vilnius von einer Gruppe von Forschern durchgeführt wurden, die im \'Zentrum zur Erforschung der Psychodynamik der Persönlichkeit\' arbeiten. Zu dieser Forschergruppe gehören promovierte klinische Psychologen oder solche, die gegenwärtig am Institut für Psychologie der Universität Vilnius promovieren. Das subjektive Verständnis von Heilungsepisoden und die Entwicklung von Tiefenprämissen stellten die Hauptthemen dieser Studien dar. Neben anderen Methoden verwendeten die Forscher das Zeichnen eines Bildes eines Heilungsmomentes und das Erzählen einer Psychotherapiegeschichte, wie sie von Klienten erinnert wurde, um Daten zu sammeln. In der Arbeit werden zwei Beispiele für das Zeichnen eines Bildes eines Heilungsmomentes und ein Beispiel für das Erzählen einer Therapiegeschichte analysiert. Anhand von Falldarstellungen werden in dem Beitrag die Themen der subjektiven Erfahrung von Erneuerung in der Psychotherapie und die Vielzahl der Erfahrungen mit sowie die Ergebnisse von Psychotherapie diskutiert. Diese Studie hat gezeigt, daß das Zeichnen eines Bildes eine weitere Dimension der Reflexion eröffnet und ein geeignetes Werkzeug für die Entwicklung individueller Erzählungen sein kann. Das Verfassen und Neuverfassen der eigenen Lebenserzählung wird dabei als Teil einer produktiven Therapie und als Entdeckung der inneren Urheberschaft angesehen. Die Fähigkeit, einer Sukzession von Bedeutungen zu folgen sowie eine Verbindung zu Natur und Kultur herzustellen könnte eine der Möglichkeiten sein, eine integrative Sichtweise in der Psychotherapieforschung zu verwirklichen.
La ricerca in psicoterapia è un’area di studio in rapida evoluzione che tende ad esplorare l’integrazione tra le condizioni interne ed esterne dell’esperienza individuale, l’interazione tra soggettivo ed oggettivo tanto quanto tra individuale e collettivo. Nell’articolo vengono affrontate domande relative ad una visione più integrativa ed alla ricerca qualitativa in psicoterapia. L’Autrice introduce alcune idee prese dagli studi sull’efficacia della psicoterapia effettuati all’università di Vilnius da un gruppo di ricercatori, che lavorano nel ‘Center for Research on the psychodynamics of personality’. Psicologi clinici che hanno conseguito un dottorato o che lo stanno per conseguire presso il Dipartimento di Psicologia dell’Università di Vilnius fanno parte di questo gruppo di ricerca. La comprensione soggettiva degli episodi di guarigione e lo sviluppo di premesse profonde erano gli obiettivi principali di questi studi. Tra i tanti metodi utilizzati dai ricercatori per raccogliere informazioni vi è il disegno di un’immagine di un momento di guarigione e la narrazione di una storia terapeutica rammentata dal paziente. Due esempi del ‘disegno di un’immagine di un momento di guarigione’ e un esempio della ‘narrazione di una storia terapeutica’ sono analizzati nell’articolo. I temi dell’esperienza soggettiva del rinnovamento nella psicoterapia così come la molteplicità di esperienze e risultati vengono trattati nell’articolo con illustrazioni di casi. Questo studio ha mostrato che disegnare un’immagine apre un’ulteriore dimensione di riflessione e che può essere uno strumento appropriato per lo sviluppo di una narrazione individuale. Scrivere e riscrivere la narrazione della propria vita fa parte di una terapia produttiva tanto quanto la scoperta di esserne l’autore. L’abilità di seguire una successione di significati, così come una connessione con la natura e la cultura, potrebbe essere un modo per realizzare una prospettiva nella ricerca psicoterapeutica.
Исследование в психотерапии - это быстро развивающая область знаний, задачи которой состоят в изучении интеграции внутренних и внешних условий индивидуального опыта, взаимодействия между субъективным и объективным, индивидуальным и коллективным. В статье обсуждаются вопросы, связанные с интегративным подходом и качественными исследованиями в психотерапии. Автор представляет читателю некоторые идеи из работ по эффективности психотерапии, которые были проведены в университете Вильнюса группой ученых, работавших в «Центре исследования по психодинамике личности». Клинические психологи, имеющие докторскую степень или пишущие докторскую диссертацию на факультете психологии в университете Вильнюса, являются членами этой группы. Субъективное понимание моментов исцеления, а также предпосылки развития глубины терапии были основными задачами исследования. Среди прочих методов докторанты использовали рисунки моментов исцеления и рассказ психотерапевтической истории клиентом, которого приглашали для сбора данных. В статье анализируется два рисунка момента исцеления и одна терапевтическая история. Темы субъективного опыта обновления в психотерапии, а также многогранность опыта и результаты в психотерапии обсуждаются в статье вместе с клиническими иллюстрациями. Исследование показало, что рисунок открывает несколько измерений рефлексии, он может быть использован как адекватное средство для развития индивидуального нарратива. Авторское творение повторное сотворение нарратива своей жизни принимает как часть продуктивной терапии, а также позволяет открыть внутреннего автора. Способность прослеживать преемственность смыслов, а также связь между природой и культурой может быть одним из способов актуализации интегративного взгляда в исследовании в психотерапии.
La investigación en psicoterapia es un área de estudio en creciente desarrollo cuyo objetivo es explorar la integración entre las condiciones internas y externas de la experiencia de un individuo, el inter-juego entre lo subjetivo y lo objetivo, así como entre lo individual y lo colectivo. Se plantean consideraciones respecto a una perspectiva más integradora y a la investigación cualitativa. La autora introduce algunas ideas, a partir de estudios sobre la efectividad de la psicoterapia llevados a cabo en la Universidad de Vilnius, por un grupo de investigadores que trabajan en el ‘Centro de investigación en los procesos psicodinámicos de la personalidad’. Los miembros de este grupo de investigación son psicólogos clínicos que tienen un doctorado o están realizando un doctorado en el Departamento de Psicología en la Universidad de Vilnius. Las principales tareas de estos estudios fueron el desarrollo de premisas profundas y la comprensión subjetiva sobre los episodios de curación. Entre otros métodos, los investigadores para recoger data, utilizaban el dibujar un cuadro sobre un momento de curación y contar una historia de psicoterapia contada por el cliente. Dos ejemplos de dibujar un cuadro de un momento de curación y un ejemplo de contar una historia de terapia son analizados en el presente trabajo. Se da cuenta de la experiencia subjetiva de renovación en psicoterapia así como de la multiplicidad de experiencias y resultados a partir de la ilustración de casos. El estudio muestra que el dibujar un cuadro abre una nueva dimensión de reflexión y puede ser una herramienta apropiada para el desarrollo de narrativas individuales. Ser autor/a, y volver a ser autor/a de la propia narrativa de vida se acepta como parte de una terapia productiva así como del descubrimiento de la autoridad interna. La habilidad de dar cuenta de una sucesión de sentidos, así como una conexión con la naturaleza y la cultura podrían ser uno de los modos de actualizar una perspectiva integradora en la investigación en psicoterapia.
心理治疗研究是一个快速发展的领域, 它的目标是探索个体经验内在和外在状况的整合、主体与客体间以及个体与集体间的相互作用。这篇文章讨论的问题涉及心理治疗中更加整合的观点及定性的研究。作者介绍了来自维尔纽斯大学“人格心理动力研究中心”的一群研究者在进行心理治疗有效性研究时所发展出来的一些概念。这一研究团队的成员为具有博士学位的临床心理学家或是在维尔纽斯大学心理系在读的博士生。对治愈情节的主观理解, 以及作为治愈前提的深度发展是这些研究的主要任务。在研究者采用的诸多方法中, 还包括画出治愈时刻的图画, 以及来访者通过回忆而讲一个心理治疗的故事, 这些都作为研究所收集的数据。文章分析了两幅关于治愈时刻的绘画的案例, 以及一个治疗故事讲述的案例。治疗中更新的主体经验主题, 以及心理治疗中多样化的经验与结局都被作者以个案的形式进行了描绘。这一研究显示, 绘画可以带来更多层面的反思, 它可以是一个合适的工具用于个体叙述的发展。编著及再编著个体的生命叙述被当作为一种有益的治疗, 与此同时, 也有益于个体发现自己内在的著作者。有能力去跟随意义的演替, 以及去联系自然与文化, 可以是一种实行心理治疗研究的整合视角的途径。.

BACKGROUND: Internationally, efforts are underway to develop coordinated and standardized approaches for palliative care service delivery by improving service quality in hospice and palliative care networks. German legal regulations explicitly demand networking between hospice and palliative care providers. However, there is little research on models of cooperation and the building and development of hospice and palliative care networks. Research-based recommendations for network building and advancement are lacking.
OBJECTIVE: The study aim was to develop empirical recommendations for the building of new and advancement of existing hospice and palliative care networks in Bavaria, Germany.
METHODS: The project utilized a qualitative approach. The research project was structured in six sequential phases: 1) semi-structured individual interviews on status quo of networks, 2) a workshop including a focus group to develop definitions of key terms and prioritize major network themes, 3) semi-structured face-to-face interviews on factors enabling and inhibiting cooperation, 4) drafting of a recommendation for regional hospice and palliative care networks, 5) an online consensus survey questionnaire to rate relevance and feasibility of the draft recommendation and an internal consensus meeting to revise the draft, and 6) an expert workshop to develop examples of realization. Coordinators and chairpersons of 12 hospice and palliative care networks constitute the study population for study phases 1 to 3, 5, and 6. Network representatives partook in one (n=6), two (n=6), three (n=4), four (n=2), or all five (n=1) of the study phases 1, 2, 3, 5, and 6. Further experts participated in one (n=10) or both (n=1) of the phases 5 and 6.
RESULTS: Recommendations were drafted for six thematic fields: (i) missions and aims, (ii) roles and responsibilities, (iii) coordination, (iv) communication and information channels, (v) public visibility, and (vi) funding. The whole set of recommendations was rated by 90% of the participants to be fully or somewhat important for network building and development. A total of 22 recommendations was approved.
CONCLUSIONS: The call for establishing and developing standards for hospice and palliative care networks was situated within the current policy climate of Germany and the broader international community. The present recommendations can aid implementation of this request and have a strong relevance for practice.

Significant others are individuals representing family members or neighbors, friends, colleagues or members of the same household, who act as relatives or surrogates. Significant others play an important role when patients are transferred or discharged after hospitalization.
The objective of this review is to identify, appraise and synthesize the best available evidence exploring significant others\' experiences of the discharge or transfer of adult patients after hospitalization.
A qualitative comprehensive systematic review and meta aggregation.
Participants of this review are the \'significant other(s); persons who are important or influential to the patient\'s life.
How the significant others\' experience hospitalized patients\' transitions and the psychosocial and existential issues during transfer from hospital to home.
Studies that investigate the organizational culture during hospitalization.
Studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.
The search aimed at finding published and unpublished studies in English, German, Danish, Swedish and Norwegian, and was unrestricted by time. Eleven electronic databases and eleven websites were searched.
Methodological validity of the qualitative papers was assessed independently by two reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
Qualitative research findings were synthesized.
A total of 189 findings from twelve studies were aggregated into three categories. An aggregated finding was generated based on the primary studies: SOs existential strength is linked to preparations for the discharge including care planning meeting(s) and learning-by-doing care activities led by health care providers during hospitalizations.
The studies in this review provided useful and credible statements from caregivers\' voices that are not previously aggregated nor presented. The findings enlighten both positive and burdensome experiences in the everyday life of caring for a significant other after discharge.

The Need for Psychosocial Support in Parents of Chronically Ill Children Chronic illness in childhood and adolescence is associated with special requirements and demands on affected families. In particular, severe chronic diseases and rare diseases with a high level of health care needs or with progressive medical diagnoses permanently challenge the families\' resources. The aim of this study was to assess the need for psychological, nursing, legal and organisational support from a parent\'s perspective. Using qualitative content analysis according to Mayring, data from 96 parents of 68 chronically ill children were evaluated. The findings suggest an increased need for psychosocial support, but, the ideas, needs, and goals of parents are very versatile. However, family-based psychosocial support programs, which are adapted to the specific family situations, are unanimously judged to be useful. Interventions should be flexible as well as tailored to the affected families\' individual needs.

BACKGROUND: The consultation is at the heart of general practice. It is the central setting through which primary care is delivered. The competency requirements are laid down internationally by competency-based curricula for undergraduate and postgraduate education. So far, there is no competency-based vocational training to develop consultation skills in general practice in Germany. The study describes experiences with consultation skills training as an element of general practice training as reported by trainees and trainers in Germany.
METHODS: A qualitative and exploring approach was chosen because there is little experience with the German situation. We conducted structured focus group interviews with trainees and trainers, respectively. We recruited all participants by e-mail via the mail distributor \"Junge Allgemeinmedizin Deutschland\" (JADE, a trainee and junior GP organization) and the academic teachers of the Friedrich-Alexander University Erlangen-Nürnberg. Altogether, four focus group interviews with three to five participants were conducted, varying in length from 25 to 65minutes. All interviews were recorded digitally and transcribed verbatim. Then a qualitative content analysis was performed.
RESULTS: The statements of the ten trainees and five trainers mapped a system of four main categories: (a) association with the term consultation, (b) parts of a consultation, (c) competencies required for professional practice, (d) consultation skills training as an element of vocational training. Overall, all participants regarded the consultation as the most important element in general practice. Important content of consultations is to build a relationship with the patient, gather information, conduct physical examinations and achieve informed consent on further proceedings. All participants agreed that physicians need different sets of competencies: medical expertise, communication skills, examination skills and professionalism. Finally, there was a broad consensus that a competency-based general practice training to support the development of consultation skills is lacking in Germany. The majority acknowledged the need for change.
CONCLUSIONS: So far, the consultation skills development within the general practice training in Germany is regarded as deficient. Both trainees and trainers have stressed the importance of change in vocational training. With the new competency-based curriculum for general practice in Germany and the associated development of supporting tools important prerequisites have been provided.

Arrived in Germany: When Children Who have Fled Tell their Stories For this study, we listened to children who had fled with their families. We made a very conscious decision to focus on accompanied minors who have been displaced, because they go through the standard asylum system with their parent/guardian, which is why they often remain \"invisible\" as regards their own needs and their specific situation. We gave accompanied children who had fled a space where they could tell their stories and asked them to talk about their memories of their countries of origin, their experiences during their journey and on arrival in Germany, and their lives here, their concerns, but also their hopes and desires. The children presented here come from Afghanistan, Eritrea, Iran, Kosovo, Serbia and Syria. They therefore represent the countries from which people have set out on the always difficult, often life-threatening journey to Germany. And they represent the diversity of experiences of flight and arrival. Those responsible for this study come from various academic disciplines and areas of work. This was important to us in order to focus on the complexity of being a child and a child\'s everyday life under the conditions experienced while on the run. In view of the vulnerability of children, many challenges are regarded in a different light from previously, for example concerning the organisation of initial reception centres, education and care provisions, medical care, protected spaces and privacy. We want to encourage you to see these spaces, the bureaucratic procedures and coping with everyday life through the eyes of a child.

Culturally focused research has gained momentum in many disciplines, including psychology. However, much of this research fails to pay attention to the unconscious dynamics that underlie the study of culture and culturally influenced human beings. Such dynamics may be especially significant when issues of marginalization and oppression are present. Therefore, this paper seeks to contribute a framework for understanding cultural dynamics, especially unconscious cultural dynamics, within depth psychological qualitative research influenced by Jungian and post-Jungian scholarship. Inquiry that is approached with a commitment to making the unconscious conscious seeks to empower and liberate not only the subject/object studied but also the researchers themselves. Following a brief review of multiculturalism in the context of analytically informed psychology, this paper offers several case examples that focus on researchers\' integration of awareness of the cultural unconscious in their study of cultural beings and topics.