This paper outlines a methodology for making an educational technology ready for being embedded in classrooms. It presents the theoretical orientation and methodological principles that informed the innovation process of the ROSA project (Robot-supported Education for Autistic Children): an interdisciplinary, complex and longitudinal research and innovation initiative involving autistic pupils, teachers, parents, innovators, technologists/developers, school managers and researchers from different disciplines. Underpinned by social learning theory, practical ethics, participatory design and co-creation theory, it was situated in a special school in Norway. Based on theoretical underpinnings and rigorous cross-disciplinary dialogues, five methodological principles emerged as preconditions for successful user-centred innovation: (1) iterative ethical reflection; (2) participation and co-creation; (3) dyadic systems convening; (4) learning from the practitioners and (5) learning from the autistic pupils. The paper discusses how these principles were implemented through a cyclical process of awareness, identification, reflection and action. The principles emphasized human interaction over technology-driven instruction and real-world applicability over theory- or interest-driven solutions. The paper makes a significant contribution to the empirical research on the methodology of innovation of robot-mediated education, and it provides guidance for researchers and policymakers on methodological principles for participatory and ethically responsible research and innovation in the field.

Children with autism present some difficulties regarding social communication and emotional regulation. These difficulties are addressed by special education programs in several ways—for instance, peer-to-peer communication using pictograms or tablet-based games to rehearse social situations and learn about facial expressions. Social robots have shown potential as vehicles for these activities. They can be perceived as “safe” interaction partners, as well as entail a special motivation for children who are fascinated by technology. In this paper, we describe the experience of two pilot studies study using a NAO robot for social communication at a special education school in Norway involving five and fifteen (N1 = 5, and N2 = 15) children with autism, respectively. Each child used the robot for 1–2 sessions with the help of their main teacher and an additional teacher operating the robot. The teachers could select from a repertoire of activities that utilized the robot in various ways. The sessions were videotaped and analyzed by a multidisciplinary team composed of pedagogists, teachers, and researchers on ICTs, ethics, health, pedagogy and technology. The videos show that some children initiated and reciprocated communication with the robot in different contexts and with various degrees of support from the teachers. This paper describes design recommendations towards a longer study and pedagogical and ethical reflections on particular experiences observed in the pilot study.

Researchers and policymakers call for the development of ethical AI. Within Information Science, significant attention has been given to the responsible use and governance of AI. However, less focus has been given to building ethics into AI in the sense of making AI systems to act morally responsibly without human intervention. This cross-disciplinary systematic review examines empirical studies published in scientific journals between 2016 and 2024 to explore what characterizes the efforts of building ethics into AI. Using a comprehensive systematic review method, 6,752 articles were identified, of which 59 were selected and analysed by a multidisciplinary research team. Findings show that the practical development of ethical AI remains largely experimental. Most studies adopt a ‘thin’ conception of ethics, focused on technical operationalizations of a single moral principle or an aspect of ethical theory. This limited ethical scope may reflect the predominance of computer scientists in the field and a lack of sustained, iterative collaboration with ethicists and social scientists. The study concludes that if ethical AI is possible and justified, it will require a shift toward a more pluralistic and interdisciplinary approach to ethics.

AIMS:To explore in-depth nurses' use and further development of assessment skills in different nursing contexts in the first 2 years after graduation, and factors that influenced their use and development of assessment skills.DESIGN:The study had explorative qualitative design.METHODS:Eight nurses who previously had been interviewed about their learning of physical assessment skills in clinical rotation as students participated in this follow-up study. Individual in-depth interviews were conducted, where the nurses spoke freely about their experiences after graduation.RESULTS:Four prominent features influencing the nurses' use and development of assessment skills were identified: (a) assessment approaches and readiness for practice, (b) the primacy of communication, (c) recognition related to performing assessments, and (d) the influence of organizational factors on their assessment applications.CONCLUSION:Newly graduated nurses' use of assessment skills is an important part of providing holistic care. This study suggest that assessment skills is not only an assessment task but is central in relationship building and in supporting the professional development of nursing competence.PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution, due to study design.

Background In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in healthcare. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. Methods The TM elements were developed through a comprehensive participatory process, resulting in the decision to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. Results The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. Conclusions Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare.

BACKGROUND:The overall aim of this study was to explore third-year bachelor nursing students' stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students' use of physical assessment skills while in clinical rotation. There is a need to explore nursing students' learning processes related to the use of physical assessments.METHODS:Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students' physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students' performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews.RESULTS:Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice.CONCLUSIONS:This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students' learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students' learning of physical assessment skills-building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

Abstract eHealth and technology for older patients are expected to enhance healthcare services for older persons in the future. In a health communication perspective, what matters to the patient should be taken as the point of departure. Clinicians are also users of eHealth and technology as these tools should function to support their professional activities in order to provide the best possible healthcare to older persons. There are several challenges on the system and organizational level that need to be solved in order to have a sustainable digital‐supported healthcare system for older persons.

Background This study reports on a two-step service innovation project commissioned by the City Council of Oslo, coined as the Trust Model (TM). The aim was to develop a trust-based management model in municipal home care as an alternative to the purchaser-provider split (PPS), which has been the prevalent model in Norwegian and most European health services since the introduction of New Public Management in the 1990s. The TM was developed through a comprehensive participatory process.Methods The objectives were to a) identify important mechanisms facilitating or preventing the development and implementation of the trust model, and b) identify participants perceived outcomes. A realist informed process evaluation using mixed methods was performed in two iterations. The first (autumn 2016) included three districts, three teams and 80 patients. The second (2017) included four districts, eight teams and 160 patients.Results The TM was developed across the four districts. Team members, team leaders and managers found the TM promising, and no one wanted to return to the PPS. Patient satisfaction improved significantly during the first iteration. The TM iterations were complex, involving a series of agents interacting on different levels; interactions which in turn influenced the processes and ongoing interactions. The evaluation displayed a variety of interpretations of the TM and of trust as an organizational value. A series of needs for improvements were identified, including (1) develop a clear description of the model and its managerial principles, (2) develop a culture for trust-based management on all levels, (3) build team leaders’ competence, especially in trust-based management and coaching of team-members (4), clarify roles and responsibilities among team-members, (5) develop common procedures for allocation and distribution of services, and (6) build team-members communication competence in active listening and shared decision-making.Conclusions/implications Complex, values-based organizational innovation and change (like TM) challenge existing institutional logics (like NPM) and an organization’s ability to cope with institutional hybridization. The complexity of organizational innovation in home care and of researching this topic is understudied. The importance of recognizing the complexity of trust-building and the inherent slowness of radical service innovation should be further explored.

BACKGROUND:Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers' workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice.METHODS:In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data.RESULTS:The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service.CONCLUSION:Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.

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Chapter 2 Philosophical Perspectives on Person-Centredness for Healthcare Research Jan Dewing, Jan DewingSearch for more papers by this authorTom Eide, Tom EideSearch for more papers by this authorBrendan McCormack, Brendan McCormackSearch for more papers by this author Jan Dewing, Jan DewingSearch for more papers by this authorTom Eide, Tom EideSearch for more papers by this authorBrendan McCormack, Brendan McCormackSearch for more papers by this author Book Editor(s):Brendan McCormack, Brendan McCormack Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorSandra van Dulmen, Sandra van Dulmen NIVEL (Netherlands Institute for Health Services Research), Utrecht and Radboud University Medical Centre, Nijmegen, The NetherlandsSearch for more papers by this authorHilde Eide, Hilde Eide University College of Southeast Norway, Drammen, NorwaySearch for more papers by this authorKirsti Skovdahl, Kirsti Skovdahl University College of Southeast Norway, Drammen, NorwaySearch for more papers by this authorTom Eide, Tom Eide University College of Southeast Norway, Drammen, NorwaySearch for more papers by this author First published: 08 August 2017 https://doi.org/10.1002/9781119099635.ch2Citations: 4 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary This chapter provides an overview of the concept of person-centredness in order to theoretically contextualise research in person-centred healthcare. It draws on key philosophical ideas that have shaped the current thinking. The chapter aims to develop clear philosophical foundations for person-centred research and to show that coherent philosophical foundations are important for a number of reasons. It further sets out one possible set of ideas or concepts that a researcher might decide to use as a basis of person-centred research. There is an increasing number of so called person-centred studies being published that are supposedly underpinned by person-centred concepts and theories, but which continue to use research methods that do not match such concepts and theories and thus reinforce a disconnect between the reality of person-centred practice and research methods used to evaluate it. Citing Literature Person-Centred Healthcare Research RelatedInformation

This chapter considers person-centred leadership research as basically normative and action-oriented, as research with the overall aim of supporting and improving the leadership practice of making person-centred values live in the organisation. It presents some research projects as examples of how to go about doing research in order to support and improve person-centred leadership practice. These projects are participatory and action-oriented in design. Person-centred leadership can be studied at different levels: the macro or system level; the meso or organisation level; and the micro or practice level. The chapter also presents examples of how person-centred leadership research on these three levels may be performed. Many leadership theories and styles contain constructs congruent with a person-centred mindset and person-centred leadership. The leadership approaches most commonly attached to person-centredness are transformational leadership, relational leadership and ethical leadership.

BACKGROUND:Industrialized and welfare societies are faced with vast challenges in the field of healthcare in the years to come. New technological opportunities and implementation of welfare technology through co-creation are considered part of the solution to this challenge. Resistance to new technology and resistance to change is, however, assumed to rise from employees, care receivers and next of kin. The purpose of this article is to identify and describe forms of resistance that emerged in five municipalities during a technology implementation project as part of the care for older people.METHODS:This is a longitudinal, single-embedded case study with elements of action research, following an implementation of welfare technology in the municipal healthcare services. Participants included staff from the municipalities, a network of technology developers and a group of researchers. Data from interviews, focus groups and participatory observation were analysed.RESULTS:Resistance to co-creation and implementation was found in all groups of stakeholders, mirroring the complexity of the municipal context. Four main forms of resistance were identified: 1) organizational resistance, 2) cultural resistance, 3) technological resistance and 4) ethical resistance, each including several subforms. The resistance emerges from a variety of perceived threats, partly parallel to, partly across the four main forms of resistance, such as a) threats to stability and predictability (fear of change), b) threats to role and group identity (fear of losing power or control) and c) threats to basic healthcare values (fear of losing moral or professional integrity).CONCLUSION:The study refines the categorization of resistance to the implementation of welfare technology in healthcare settings. It identifies resistance categories, how resistance changes over time and suggests that resistance may play a productive role when the implementation is organized as a co-creation process. This indicates that the importance of organizational translation between professional cultures should not be underestimated, and supports research indicating that focus on co-initiation in the initial phase of implementation projects may help prevent different forms of resistance in complex co-creation processes.

Background: Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership. Objectives: The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants’ experience. Training programme and research design: A training programme was developed consisting of (1) a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at enhancing the ethical mindfulness of the organizational culture, and (2) a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants’ experiences with and the feasibility of the training. Participants and research context: Nine middle managers were recruited from a part-time master’s programme in leadership in Oslo, Norway. The research context was the participating leaders’ work situation during the 6 weeks of training. Ethical considerations: Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved. Findings: Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change. Discussion: The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation. Conclusion: The training programme seems feasible. It should be adjusted according to participants’ proposals and tested further in a large-scale study.

Background: Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time.Methods: As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients' need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach.Results: The thematic analysis revealed a pattern of patients' information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option.Conclusion: Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies.