The Performance of Dialysis Care: Routinization and Adaptation on the Floor

Previous studies of communication in dialysis centers primarily focused on communication between nurses and patients. In this study, ethnographic methods were used to explore the dominant communication performances enacted by dialysis staff members, including registered nurses, patient care technicians, technical aides, a social worker, and a dietitian. Findings suggest a dialectic between extreme routinization of care and continual adaptation. The dominant routine involved repeating the same preparation, treatment, and discharge process 3 shifts per day, thrice weekly for each patient. At the same time, near-constant adjustments to scheduling, coordination of tasks, and problem solving were needed to maintain the performance of repetition. The balancing of this dialectic has significant implications for new staff training and socialization, understanding the role of technology and routine in dialysis and in health care systems more generally, and in further theorizing the role of unbounded communication interactions in health care

Activity Theory Analysis of Heart Failure Self-Care

The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems

On preventive blood pressure self-monitoring at home

Self-monitoring activities are increasingly becoming part of people’s everyday lives. Some of these measurements are taken voluntarily rather than being referred by a physician and conducted because of either a preventive health interest or to better understand the body and its functions (the so-called Quantified Self). In this article, we explore socio-technical complexities that may occur when introducing preventive health-measurement technologies into older adults’ daily routines and everyday lives. In particular, the original study investigated blood pressure (BP) measurement in non-clinical settings, to understand existing challenges, and uncover opportunities for self-monitoring technologies to support preventive healthcare activities among older adults. From our study, several important aspects emerged to consider when designing preventive self-monitoring technology, such as the complexity of guidelines for self-measuring, the importance of interpretation, understanding and health awareness, sharing self-monitoring information for prevention, various motivational factors, the role of the doctor in prevention, and the home as a distributed information space. An awareness of these aspects can help designers to develop better tools to support people’s preventive self-monitoring needs, compared to existing solutions. Supporting the active and informed individual can help improve people’s self-care, awareness, and implementation of preventive care. Based on our study, we also reflect on the findings to illustrate how these aspects can both inform people engaged in Quantified Self activities and designers alike, and the tools and approaches that have sprung from the so-called Quantified Self movement

Technology as tool to overcome barriers of using fitness facilities: A health behavioural perspective

Underlying health conditions have been highlighted throughout the literature preventing several populations from engaging in physical activity. There have been little to no attempts made in addressing these populations directly in fitness facilities or indirectly using information technology (IT). The current research aimed at exploring current barriers and practices regarding IT and technological support in a fitness facility environment, using health behaviour theories (HBT) to explain member experiences. The sample was composed of 66 participants selected from 5 fitness facilities in Manchester, UK, of which there were 60.6% males and 39.4% females aged from 18-59. The instrument used was a survey. Health motives were reported by 71.2% of the participants, while ‘injury’ (reported by 70.2%), ‘lack of knowledge about exercise and health’ (reported by 42.4%), and ‘illness’ (reported by 28.1%) as main barriers to use the facilities. The main support mechanisms provided by the facilities management were staff support (59%), with online and technological support only accounting for 38.6% of facility support. The use of personal IT within the facilities were utilised by over half the participants (50.2%). The study revealed the need of additional IT support by fitness facilities in the form of applications and digital platforms. The findings are discussed with HBT as the theoretical underpinnings and suggestions are made for future research regarding IT advancements as support mechanisms

Patients' experiences with a welfare technology application for remote home care: A longitudinal study

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals.publishedVersio

Structural Estimation with a Randomized Trial of a Principal Agent Model of Medical Insurance with Moral Hazard

Despite the importance of principal-agent models in the development of modern economic theory, there are few estimations of these models. We contribute to fill this gap in a field where moral hazard has traditionally been considered important: the utilization of health care services. This paper presents a model where the individual decides to have treatment or not when she suffers an illness spell. The decision is taken on the basis of comparing benefits and out-of-pocket monetary costs of treatment. In the paper, we recover the estimates of the corresponding principal agent model and obtain an approximation to the optimal contract.

School ties: Keeping students with chronic illness connected to their school learning communities

Participation in their school community provides children and young people with opportunities for interaction and collaboration, benefiting them educationally and socially. Their involvement and sense of belonging can be disrupted significantly by the experience of chronic illness, not least because of prolonged or recurrent absence from school. Given that there are increasing incidence of and survival rates for chronic illness, schools are more likely to have students who are enrolled but are absent from lessons for significant periods of time owing to a chronic health condition. Helping these students stay connected to their school communities - strengthening their school ties - is essential, not only for psychosocial reasons, but to minimize their educational disadvantage and the impact on their quality of adult life and employment prospects. Although on-site hospital schools seek to address the educational needs of hospitalized children and young people, decentralized healthcare and improved medical treatment mean that they have less access to those students who are only hospitalized for short periods of time and receive treatment or recuperate at home. Out of the reach of hospital schools, these students also may not be attending their own schools, increasing the likelihood of disconnection and isolation. Children and young people themselves have indicated their social and academic concerns about absence from school and their desire for maintaining connections with their teachers and peers. Increasingly flexible communications technologies, such as videoconferencing, online whiteboarding, and interactive whiteboard (IWB) application sharing, provide opportunity for facilitating such connections. This paper describes the investigation of technology-mediated communication between students and their schools in the context of a research project funded by the Australian Research Council and in its third year of data collection across a number of schools in the state of Victoria. It explores some of the impediments to the successful implementation of technologies, highlighted by a collective case study of several students and their teachers. It presents a model for the linear and cyclic process of connection between students and teachers. Data suggest that ambiguity about their role and management of communications technologies in a school setting are significant challenges for teachers who have a student absent for significant periods owing to chronic illness

Promoting Patient-Centered Care in Chronic Disease

Nowadays, many people around the world are seeing their lives being shattered and even shortened due to one or more chronic conditions. Chronic illness is a dynamic ongoing process that is determined by a complexity of factors. Patient literacy, motivation, emotional well-being, and resources play an important role on patient adaption and are important challenges for healthcare providers. A systematic patient-centered approach that enables chronic patients to play an active role in their condition management and in the decision-making process on a day-to-day basis is required. However, some studies show that health professionals do not always guide their actions by Patient-centered orientation, either by personal issues or by professional and/or institutional barriers. The present chapter aimed to provide a comprehensive approach to patient-centered care in chronic disease and offer a structured guideline as a tool for formal academic education in chronic patient-centered care. This chapter is structured in five sections: (1) Chronic disease: the challenge of the twenty-first century, (2) The patient with a chronic disease, (3) Patient-centered care in chronic diseases, (4) Issues and barriers to achieve patient-centered care, and (5) Guide tool for health professionals’ training and education in patient-centered care