Most people with dementia (PwD) are cared for by unpaid family carers, many of whom must balance caring with paid work. This regularly entails dealing with care-related emergencies (CRE). This study aims to explore the impact of carers’ autonomy at work regarding breaks, schedule, and place on their ability to manage CRE, and use technology to that end. We conducted interviews with 16 working carers of PwD in Scotland. Data were analysed thematically to identify key themes. Autonomy at work appeared on a spectrum from no to complete autonomy. Carers’ position on this spectrum was often dynamic and determined by the nature of their work, their workplace culture and regulations, and their line managers’ support – or clients in the case of self-employed carers. Break autonomy allowed carers to use technology to be notified of and delegate the CRE response. Schedule autonomy allowed for an in-person response to CRE. Place autonomy allowed carers to work and care simultaneously, which enabled them to manage CRE immediately but presented them with additional challenges. Distance between workplace and PwD’s residence impacted carers’ ability to manage CRE, despite having complete autonomy. Implications for healthcare professionals, service providers, employers, policymakers, and technology developers are presented.
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Introduction: The notion of autonomy in Self-Determination Theory is at the core of intrinsically motivated learning, and fulfilment of the need for autonomy is essential for thriving at school. Therefore teacher-provided autonomy support has grown into a key concern in educational research. In the present study into primary school music education, the notion of creative autonomy support is introduced. Research into autonomy support is typically focused on verbal interaction. However, from an enactive perspective, teachers’ gesturing, bodily movement, facial expression, and musical action form an integral part of the socially situated interaction in music lessons, inherently involving autonomy support. In the present study, a distinction is made between creative verbal autonomy support and creative musical and non-verbal autonomy support.Methods: Applying a process-based time-serial methodology, rooted in a Complex Dynamic Systems and Enactive perspective, the effects of an intervention with Video Feedback Coaching for teachers were investigated. Video data of 105 music lessons of 18 teachers (intervention and control condition) from six primary schools was gathered, to examine teachers’ creative autonomy support at both the individual and group level.Results: The findings show that teachers in the intervention condition, compared to the control group, achieved a meaningful increase in their ability to offer creative autonomy support verbally. Teachers also showed development for the non-verbal and musical aspects of offering creative autonomy support. However, particularly for offering higher-level creative autonomy support in the non-verbal and musical mode, significant results were found for less than half of the intervention teachers.Discussion: These results underline the importance of embracing and studying the bodily dimension as an integral part of teacher autonomy support, aimed at emergence of students’ musical creativity, in primary school music education and in teacher training. We explain how these results might be relevant for autonomy enhancing musical activities in vulnerable groups.
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The user’s experience with a recommender system is significantly shaped by the dynamics of user-algorithm interactions. These interactions are often evaluated using interaction qualities, such as controllability, trust, and autonomy, to gauge their impact. As part of our effort to systematically categorize these evaluations, we explored the suitability of the interaction qualities framework as proposed by Lenz, Dieffenbach and Hassenzahl. During this examination, we uncovered four challenges within the framework itself, and an additional external challenge. In studies examining the interaction between user control options and interaction qualities, interdependencies between concepts, inconsistent terminology, and the entity perspective (is it a user’s trust or a system’s trustworthiness) often hinder a systematic inventory of the findings. Additionally, our discussion underscored the crucial role of the decision context in evaluating the relation of algorithmic affordances and interaction qualities. We propose dimensions of decision contexts (such as ‘reversibility of the decision’, or ‘time pressure’). They could aid in establishing a systematic three-way relationship between context attributes, attributes of user control mechanisms, and experiential goals, and as such they warrant further research. In sum, while the interaction qualities framework serves as a foundational structure for organizing research on evaluating the impact of algorithmic affordances, challenges related to interdependencies and context-specific influences remain. These challenges necessitate further investigation and subsequent refinement and expansion of the framework.
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Abstract: Technological innovation in the healthcare sector is increasing, but integration of information technology (IT) in the care process is difficult. Healthcare workers are important agents in this IT integration. The purpose of this study is to explore factors that feed motivation to use IT. Self-determination theory (SDT) is applied to study how motivational factors impact effective IT use among frontline caregivers in residential care settings. As the team is very important to these caregivers, the team is our unit of analysis. In an embedded single case study design, interviews were conducted with all nine members of a team effectively using IT. All three basic psychological needs from SDT - autonomy, competence and relatedness - were found to have impact on effective IT use, though autonomy was primarily experienced at team level. Conversely, the effective use of an IT collaboration tool influences relatedness.
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Background The global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses’ work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic. Methods A descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding. Results We identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses’ stress and improved work conditions. Conclusions This study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.
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Background The global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses’ work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic. Methods A descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding. Results We identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses’ stress and improved work conditions. Conclusions This study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.
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Proper decision-making is one of the most important capabilities of an organization. Therefore, it is important to have a clear understanding and overview of the decisions an organization makes. A means to understanding and modeling decisions is the Decision Model and Notation (DMN) standard published by the Object Management Group in 2015. In this standard, it is possible to design and specify how a decision should be taken. However, DMN lacks elements to specify the actors that fulfil different roles in the decision-making process as well as not taking into account the autonomy of machines. In this paper, we re-address and-present our earlier work [1] that focuses on the construction of a framework that takes into account different roles in the decision-making process, and also includes the extent of the autonomy when machines are involved in the decision-making processes. Yet, we extended our previous research with more detailed discussion of the related literature, running cases, and results, which provides a grounded basis from which further research on the governance of (semi) automated decision-making can be conducted. The contributions of this paper are twofold; 1) a framework that combines both autonomy and separation of concerns aspects for decision-making in practice while 2) the proposed theory forms a grounded argument to enrich the current DMN standard.
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This article describes a European project which was aimed at improving the situation of persons with psychiatric or learning disabilities with regard to social participation and citizenship. The project took place in three countries (Estonia, Hungary and the Netherlands) and four cities (Tallinn, Budapest, Amersfoort and Maastricht). The project included research and actions at the policy level, the organizational level and the practice level. At the policy level, the framework of the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006) and the European Disability Strategy (European Commission, 2010) were used to look at national and local policies, at the reality of the lives of those with disabilities and at the support that professional services offer with regard to participation and inclusion. The project generated a number of insights, recommendations and methods by which to improve the quality of services and increase the number of opportunities for community engagement. In this article, we present some of the lessons learned from the meta-analysis. Although the circumstances in each country are quite different with regard to policy, culture and service systems, it is remarkable that people with disabilities face many of the same problems. The study shows that in all three countries, access to services could be improved. Barriers include bureaucratic procedures and a lack of services. The research identified that in every country and city there are considerable barriers regarding equal participation in the field of housing, work and leisure activities. In addition to financial barriers, there are the barriers of stigma and self-stigmatization. Marginalization keeps people in an unequal position and hinders their recovery and participation. In all countries, professionals need to develop a stronger focus on supporting the participation of their clients in public life and in the development of different roles pertaining to citizenship
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Aims: The aim of this study is to evaluate the nurses' experiences with the Nursing Crisis Meetings and to identify nurses' needs regarding the future governance structure. Design: Qualitative study. Methods: Two focus groups were conducted in February 2022 with participants of the Nursing Crisis Meetings (N= 15). We used thematic analysis to describe themes. Results: We identified five themes: opportunity to speak up, call for nursing leadership, call for control over practice and autonomy, development of a governance infrastructure and development of the professional nurse role. Conclusion: Nurses experienced the Nursing Crisis Meetings to be a positive and empowering infrastructure, which facilitates the unique opportunity to speak up and share experiences and concerns. This new infrastructure is a promising strategy to engage nurses during a pandemic and to build on a professional governance structure. Impact: This paper highlights the need for nurses to speak up and be engaged during the COVID-19 pandemic and gives a practical example of how to put this infrastructure into practice.
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In this chapter it is argued that self-direction is currently well above the head of the majority of youngsters and even of many adults. Evidence for this conclusion stems from developmental and brain research. However, for various reasons it is important that people develop the competences that are necessary for self-direction. To what degree is it possible to develop these competences? Are they 'learnable'? What can education contribute?
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