A poststructural rethinking of the ethics of technology in relation to the provision of palliative home care by district nurses

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative car

Quality care as ethical care:a poststructural analysis of palliative and supportive district nursing care

Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved

Collaboratively setting the priorities for health and social care research for older lesbian, gay, bisexual and trans* people

This paper reports on a novel approach to setting research priorities relevant to the needs of older LGBT people. Research is growing in this area and has recognised the negative impact of contemporary and historical discrimination towards non-normative genders and sexualities. The results of a symposium, survey and agreement analysis are presented to identify the levels of priority placed on sixty different research topics. Discussion focuses on the novelty and/or similarity to existing research patterns on LGBT ageing, as well as prioritising topics such as: how to include unheard voices; exploring trans* people’s experiences and preferences around long-term hormone use; and, embedding research findings into policy and practice

Enacting care amid power relations : The role of ‘veiled care’ in organisational life

Traditional understandings of care-giving assume care practices are clear to others and unambiguously altruistic, reflective of the selfless and humane bearing of care professionals. However, a range of organisational research has noted the complex and often contradictory ways in which enactments of care are interwoven into organisational relations of power and control. Through a narrative analysis of interview data, our paper focuses upon practices of inaction and concealment as ‘veiled’ care set within the power-laden complexities and contested meaning-making of organisational life. Our notion of veiled care extends debates about care as a social practice in everyday work relations in two ways. Firstly, it provides a greater focus on the less discernible aspects of care-giving which are significant but possibly overlooked in shaping subjectivities and meanings of care in work relations. Secondly, it develops the discussion of the situated ambiguities and tensions in enacting care that involves overcoming care-recipient resistance and an arguably less heroic but nonetheless important objective of non-maleficence, to avoid, minimise or repair damage

Dating Apps as Health Allies? Examining the Opportunities and Challenges of dating apps as partner in public health

In recent years, dating apps have become important allies in public health. In this paper, we explore the implications of partnering with dating apps for public health. We consider the opportunities and challenges inherent in these collaborations, paying special attention to privacy, trust, and user care in a digital environment.Despite their potential as targeted public health tools, dating apps raise significant ethical concerns, including the commodification of user data and privacy breaches, which highlight the complexities of blending healthcare initiatives with for-profit digital platforms. Furthermore, the paper delves into issues of discrimination, harassment, and unequal access within these apps, factors which can undermine public health efforts.We develop a nuanced critical reflexive approach, emphasizing the development of transparent data policies, the decoupling of content moderation from health initiatives, and a commitment to combat discrimination. We underscore the importance of embedding app-based health initiatives within broader care pathways, ensuring comprehensive support beyond the digital domain. This essay offers vital insights for public health practitioners, app developers, and policymakers navigating the intersection of digital innovation and healthcare

Prognostic factors associated with outcome following an epidural steroid injection for disc-related sciatica: a systematic review and narrative synthesis.

PURPOSE: Clinical guidelines recommend epidural steroid injection (ESI) as a treatment option for severe disc-related sciatica, but there is considerable uncertainty about its effectiveness. Currently, we know very little about factors that might be associated with good or poor outcomes from ESI. The aim of this systematic review was to synthesise and appraise the evidence investigating prognostic factors associated with outcomes following ESI for patients with imaging confirmed disc-related sciatica. METHODS: The search strategy involved the electronic databases Medline, Embase, CINAHL Plus, PsycINFO and reference lists of eligible studies. Selected papers were quality appraised independently by two reviewers using the Quality in Prognosis Studies tool. Between-study heterogeneity precluded statistical pooling of results. RESULTS: 3094 citations were identified; 15 studies were eligible. Overall study quality was low with all judged to have moderate or high risk of bias. Forty-two prognostic factors were identified but were measured inconsistently. The most commonly assessed prognostic factors were related to pain and function (n = 10 studies), imaging features (n = 8 studies), patient socio-demographics (n = 7 studies), health and lifestyle (n = 6 studies), clinical assessment findings (n = 4 studies) and injection level (n = 4 studies). No prognostic factor was found to be consistently associated with outcomes following ESI. Most studies found no association or results that conflicted with other studies. CONCLUSIONS: There is little, and low quality, evidence to guide practice in terms of factors that predict outcomes in patients following ESI for disc-related sciatica. The results can help inform some of the decisions about potential prognostic factors that should be assessed in future well-designed prospective cohort studies

Is monkeypox an STI? The societal aspects and healthcare implications of a key question

This letter explores the societal aspects and healthcare implications that underlie thinking about monkeypox, in the 2022 outbreak, as a sexually transmitted infection (STI). The authors examine what underlies this question, exploring what is an STI, what is sex, and what is the role of stigma in sexual health promotion. The authors argue that, in this specific outbreak, monkeypox is an STI among men who have sex with men (MSM). The authors highlight the need of critically thinking about how to communicate effectively, the role of homophobia and other inequalities, and the importance of the social sciences