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We opened this volume with sobering stories of the dire global challenges before us. Indeed, one would not be hard pressed to find stories of the urgency of our various environmental and social crises. While we wrote this book, the COVID-19 pandemic raged, towns in the Arctic reached unprecedented temperatures, countless hectares of forests fell while fossil fuels continued to be violently extracted from the earth, and Black, Indigenous and people of colour continued to be exploited and oppressed. Yet, despite all this, or rather because of it, we wish to begin our conclusion with hope and determination. Drawing on Solnit (2016), we believe that there is a spaciousness in the uncertainties posed by the challenges before us in that they offer new possibilities for being, thinking and acting – for renewal and purposeful redirection in our trajectory – and it is through a reawakened awareness of our rich and dynamic relationships to place that we can find a better way forward.
It is now well established that humans are the most powerful influence on the environment. The scale, pace and intensity of human activity is fundamentally altering earth’s climate system (IPCC, 2014) and driving global biodiversity and ecosystem decline (IPBES, 2019). Simultaneously, new forms and patterns of mobility are emerging and accelerating in a world driven by globalised market forces, new technologies, media transformations and related cultural trends of late modernity (Stokols, 2018; Boccagni, 2017; Cresswell, 1996). Indeed, during the final stages of preparing this volume we are experiencing a global pandemic of COVID-19 that is reshaping society – from the way we travel to how we relate to one another (see the Preface). While many of the global challenges addressed in this volume are not new, they are accelerating to such a degree that they are challenging our sense of ‘ontological security’ in the world, a concept that has been useful in international relations research, and most recently climate change research, to articulate relationships between identity and security (Farbotko, 2019; Kinnvall, 2004). Our expectations for the stability and continuity of our habitats and lifestyles are increasingly being challenged.
Global challenges ranging from climate change and ecological regime shifts to refugee crises and post-national territorial claims are rapidly moving ecosystem thresholds and altering the social fabric of societies worldwide. This book addresses the vital question of how to navigate the contested forces of stability and change in a world shaped by multiple interconnected global challenges. It proposes that senses of place is a vital concept for supporting individual and social processes for navigating these contested forces and encourages scholars to rethink how to theorise and conceptualise changes in senses of place in the face of global challenges. It also makes the case that our concepts of sense of place need to be revisited, given that our experiences of place are changing. This book is essential reading for those seeking a new understanding of the multiple and shifting experiences of place.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.