How Can Home Care Patients and Their Caregivers Better Manage Fall Risks by Leveraging Information Technology?

Objectives: From the perspectives of home care patients and caregivers, this study aimed to (a) identify the challenges for better fall-risk management during home care episodes and (b) explore the opportunities for them to leverage health information technology (IT) solutions to improve fall-risk management during home care episodes. Methods: Twelve in-depth semistructured interviews with the patients and caregivers were conducted within a descriptive single case study design in 1 home health agency (HHA) in the mid-Atlantic region of the United States. Results: Patients and caregivers faced challenges to manage fall risks such as unmanaged expectations, deteriorating cognitive abilities, and poor care coordination between the HHA and physician practices. Opportunities to leverage health IT solutions included patient portals, telehealth, and medication reminder apps on smartphones. Conclusion: Effectively leveraging health IT could further empower patients and caregivers to reduce fall risks by acquiring the necessary information and following clinical advice and recommendations. The HHAs could improve the quality of care by adopting IT solutions that show more promise of improving the experiences of patients and caregivers in fall-risk management

Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa.

Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding

Rethinking Health Recommender Systems for Active Aging: An Autonomy-Based Ethical Analysis

Health Recommender Systems are promising Articial-Intelligence-based tools endowing healthy lifestyles and therapy adherence in healthcare and medicine. Among the most supported areas, it is worth mentioning active aging. However, current HRS supporting AA raise ethical challenges that still need to be properly formalized and explored. This study proposes to rethink HRS for AA through an autonomy-based ethical analysis. In particular, a brief overview of the HRS' technical aspects allows us to shed light on the ethical risks and challenges they might raise on individuals' well-being as they age. Moreover, the study proposes a categorization, understanding, and possible preventive/mitigation actions for the elicited risks and challenges through rethinking the AI ethics core principle of autonomy. Finally, elaborating on autonomy-related ethical theories, the paper proposes an autonomy-based ethical framework and how it can foster the development of autonomy-enabling HRS for AA

Inviting a Hospital Healthcare Team to Change : A Framework for Building Capacity to Provide Intersectional, Trauma-Informed Care

This Organizational Improvement Plan is designed for Open Doors (a pseudonym), a Canadian hospital invested in providing stigma-free, social, and structural determinants-based care to patients who are marginalized from healthcare vis-à-vis previous experiences of exclusion and institutional trauma at healthcare settings. In the context of deepening scrutiny on healthcare institutions for their role in perpetuating systemic oppression and for failure to mitigate inequitable health outcomes for marginalized populations, Open Doors’ commitment to justice-centered care offers a compelling case study in hospital-based strategies for addressing health inequity. The specific Problem of Practice (PoP) addressed is the hospital’s care team’s limited capacity for providing trauma-informed care for patients from diverse communities who face complex, intersecting, and systemic barriers to hospital-based care. Broader systemic failures and contextual factors shaping this PoP are discussed and situated using organizational theory and the recent groundswell in literature on socially conscious caregiving. The need to instigate transformative, adaptive third order change to address the PoP is highlighted using transformative and adaptive leadership theories. Critical appreciative inquiry and dialogic change models are blended to propose a change framework that can mobilize such change within Open Doors’ context. Guided by the change framework and an evaluation-driven design process, a specific solution is detailed, namely, a patient-centered design and learning hub. A detailed change plan is presented, whereby patients, staff, community representatives and leaders are invited into a knowledge-based, dialogic process of co-creating intersectional, trauma informed practices to address a high-priority intersectional area of need for Open Doors. Keywords: healthcare change management; transformative leadership; health professions education; critical reflexivity; critical appreciation; evaluative thinkin

Towards a Common Vision for Innovation: Making Sense of Complexity in a Health Sciences Program

The growing use of digital educational technologies in higher education has seen considerable change resulting in significant institutional energies directed towards maintaining currency with today’s emerging trends. The move to digital transformation is an inevitable assumption and generally positively accepted by academia. Despite this, technology integration has emerged in an ad hoc and reactive fashion rather than purposeful and strategic. This Organizational Improvement Plan (OIP) addresses the need for a shared vision for technology adoption across a health sciences program in a mid-sized institution. Although faculty participate enthusiastically in developing curricular initiatives, their roles and engagement with technology visioning are often void of their collective voices. The theoretical concepts of sensemaking and learning culture offer insight into the complexity of connecting technology to learning pedagogy. Central to developing capacity requires facilitating meaningful connections between users about the technology and the implications to practice. This OIP builds upon the need for a collaborative lens that acknowledges cultural nuances and individual empowerment. Key in the success of leading the process will be the enactment of adaptive and transformational leadership, where the approach for change is modelled in a collaborative and supportive manner. The change implementation plan of the proposed change is fostered by the dual application of Cawsey et al.’s (2016) Change Model and Kotter’s eight-stage process (2012). Ultimately, this OIP will result in an integrated visionary approach to technology adoption across a health science program

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development

Experience of nurse leaders in delivering care to youth victims of violence

Violence continues to take its toll on post-apartheid South Africa and the youth remain the most affected group in many communities. Research has either dealt with violence in isolation, or the youth affected by violence. Very little is known about the nurse leaders delivering healthcare to youth victims of violence. This study sought to explore and describe the experiences of nurse leaders in delivering care to youth victims of violence at a community health centre in Khayelitsha. A qualitative, descriptive, and contextual design was used. The accessible population was professional nurses (N = 40) taking the lead in influencing victims of violence in the community to wellness. Nine individual unstructured interviews were conducted until data saturation was reached. The findings of this study showed that nurse leaders experienced challenges in terms of under-preparedness, staff shortages, work load, verbal abuse, as well as victim-related factors. Participants also expressed some rewarding experiences, such as increased personal awareness, personal empowerment, victim empowerment, and job satisfaction. The study recommended that in-service training should be conducted for newly-appointed staff members with the purpose of preparing them for the challenges and expectations in the field of violence amongst youth in the community.Department of HE and Training approved lis

Unlocking the Future of Drug Development:Generative AI, Digital Twins, and Beyond

This article delves into the intersection of generative AI and digital twins within drug discovery, exploring their synergistic potential to revolutionize pharmaceutical research and development. Through various instances and examples, we illuminate how generative AI algorithms, capable of simulating vast chemical spaces and predicting molecular properties, are increasingly integrated with digital twins of biological systems to expedite drug discovery. By harnessing the power of computational models and machine learning, researchers can design novel compounds tailored to specific targets, optimize drug candidates, and simulate their behavior within virtual biological environments. This paradigm shift offers unprecedented opportunities for accelerating drug development, reducing costs, and, ultimately, improving patient outcomes. As we navigate this rapidly evolving landscape, collaboration between interdisciplinary teams and continued innovation will be paramount in realizing the promise of generative AI and digital twins in advancing drug discovery

Personal Cyber-Data Literacy Plurality in Routinized-Prescriptive and Relational-Holistic Cyber-Regimes

Ursula Franklin encouraged all who would listen to act in ways that are socially useful and personally satisfying. Over two decades ago, in her Massey Lectures on The Real World of Technology, she warned about the unsustainability of prescriptive bitsphere technology regimes determined by precisely routinized compliance. She advocated for alternative holistic regimes determined by care-full relational consideration. Cyber-data literacies are defined as allowing individuals to use and benefit from data associated with their digital practices. Routinized literacies are being mis-afforded by behaviour manipulation through learning systems built on cyber-surveillance and broken personal data markets. This critical essay calls for a re-imagining of cyber-data literacies as socially useful and personally satisfying relational digital practices rather than merely routinized digital media utilization skills. A meta-synthesis of neuro-cognitive and hermeneutic theory is used to frame a comparison of cyber-data literacies afforded by cyber-regimes of exclusive compliance and inclusive consideration. Inspired by Hanah Arendt’s concept of human plurality, the essay analyses how personal cyber-data literacies are constrained and afforded by human diversity. Personal cyber-data are conceptualized as lifeworld givens, entangled with personal knowledge and experience, oriented and determined by data cognitive artifact constraints and affordances, and filtered through individuated foresight and insight. Despite foresight plurality, a capacity for distributed cognition and intelligence arises from shared mind/brain architectures and bio-psycho-social-relational determinants of a shared human biology. The essay examines opportunities and benefits of promoting cyber-data literacy plurality, grounded in personal data made meaningful to both people and machines through meta-narratives constructed using personal cyber-data by people the data are about