Degree Of Autonomy Research Articles

Rural home care nurses’ experiences with continuing nursing education

Purpose: Rural home care nurses require access to continuing nursing education to address the increasing complexity of client care needs. There is currently limited literature on continuing nursing education for rural home care nurses. The purpose of this study was to explore the continuing nursing education experiences of rural home care nurses. Sample: Purposive and snowball sampling were used to recruit registered nurses who worked in publicly funded rural home care in one western Canadian province, in communities with a population of less than 10,000 people. Twenty rural home care nurses participated in semi-structured telephone interviews. Methods: This study used interpretive description as its method of inquiry and analysis. Data was collected between December 2020 and May 2021 and the analysis was supported using NVivo 12 software. Findings: Key findings from this study contribute to the description of western Canadian rural home care nursing roles and the degree of autonomy required to provide expert care in the home environment. Rural home care nurses’ experiences with continuing education are impacted by external factors including (1) Chameleonic Practice (One-Person Show, Professional Intersection, Becoming their Person), (2) Foundational Instability (Roadblocks to Learning, Stretched Thin, Rural Repatriation) and (3) Learning Leadership (Filling the Learning Bucket, Finding a Way, Learning Reciprocity). Conclusions: The findings of this study suggest that the continuing nursing education experiences of rural home care nurses is dependent on many factors. Significant policy changes and updated standards of practice are required to support safe client care through the delivery of evidence-informed continuing nursing education.

Educational Autonomy and the Holocaust: A Comparative Study of Teachers’ Freedom in European Narratives

ABSTRACT While Holocaust memory underscores the significance of freedom, the actual enactment of freedom varies across different countries, posing a vital question for educating about the Holocaust. How do educators navigate this dissonance? Do they serve as conduits for government perspectives, or do they exercise their teacher autonomy? As part of a comparative study examining shifts in Holocaust memory in Europe from 2020 to 2022, my colleagues and I conducted in-depth interviews with 75 Holocaust educators from Poland, Hungary, Germany, and England, inviting them to share their life stories and professional experiences. This article delves into a recurring theme found within these educators’ narratives: the appreciation of freedom and choice. To interpret the significance of this theme, I integrate educational theories on ‘difficult history’ and teacher autonomy with theories of psychological reactance and the freedom quotient (FQ). I draw on Isaiah Berlin's concepts of negative and positive liberty to bridge the personal and societal dimensions. The resulting model provides a framework for the study's findings. As expected, teachers from Poland and Hungary felt their negative liberty was constrained, while those from Germany and England reported a greater degree of autonomy. More surprisingly, limited negative liberty led many interviewees from Poland and Hungary to find powerful ways to express their inner freedom. These included resistance to authority, activism within and beyond the classroom, and the application of diverse and creative pedagogical approaches in EaH. The interviews also pointed to a connection between higher levels of negative liberty in Germany and England, and a plurality of content and goals in EaH within these countries. In light of these findings, I offer policy and educational recommendations.

On Robotic Surgery in Knee Arthroplasty: Beginning of a New Era

During the past two decades, the use of robotic arms in knee arthroplasty has changed from a concept to a reality. These systems promise precision and accuracy while shortening the required learning curve. Although still largely in the early stages, there are currently several commercially available platforms with varying degrees of flexibility. The available models can be classified into several categories based on their mode of operation (whether the system requires imaging input) and degree of autonomy. The present study aimed to review the existing body of literature and provide an outlook of the current landscape. The strengths and weaknesses of the implementation of such systems in knee arthroplasty are also discussed.

Civil liability for the actions of autonomous AI in healthcare: an invitation to further contemplation

There are already a number of autonomous robots that play a significant role in improving the quality of healthcare in different areas ranging from basic health diagnosis to complex surgeries. However, using robots and machine learning applications in the healthcare context poses concerns over liability for patient injury. This paper will thus attempt to investigate the potential legal problems that might arise if AI technology evolves or is commonly used in clinical practice. It also examines whether the traditional doctrines of liability can adequately address the liability for the injuries stemming from acts of autonomous robots. As such, this paper adopted both descriptive and analytical methodologies to explore the main focus of the study. while the descriptive methodology was used to spot light on various theories of liability, the analytical methodology was used to critically examine the main theories that have been advanced to deal with autonomous robots and predict the necessity of legal reform. Throughout this paper, the authors insist on the importance of distinguishing between robots in light of their degree of autonomy and then drafting liability rules depending on whether the action was done autonomously by an unattended robot or whether it was done automatically by an attended robot. Finally, the paper concludes with the proposal of a series of factors to be considered for the future regulation of AI Robots in the healthcare context.

The accountability of collaborative innovations in tax administration: A Dutch-US comparison

Analyzing a collaborative public management innovation in tax administration in the US and the Netherlands, this article investigates how differences in accountability systems affect senior public servants’ felt accountability, which itself appears critical to understanding why innovations evolve differently over time, even when sharing similar starting conditions. The article makes three key contributions. First, employing elite interviews, findings highlight how institutional factors critically shape public servants’ felt accountability, hereby expanding existing scholarship and its concentration on microlevel psychological determinants. Second, against expectations, findings illuminate that ministerial-based senior public servants may display a greater degree of autonomy in innovation design and implementation compared to agency-based officials. Third, the article demonstrates that the configuration of accountability systems can change significantly over time, thereby critically affecting the evolution of innovations. This underlines the relevance of taking a longitudinal research approach to analyzing senior public servants’ attitude to collaborative innovations.

Religion, Pluralism, and the Australian State after Same-Sex Marriage

Abstract Since the passing of same-sex marriage legislation in 2017, religious freedom has become a prominent feature of Australian public debate. Overwhelmingly, such debates are conducted within a human rights framework where principles such as individual autonomy and protection from discrimination are prioritized over the communal and associational elements of religious life. This in turn tends to augment the power of the state vis-à-vis religious communities and institutions. In important respects, the dominance of human rights represents a new manifestation of the kind of “liberal-statism”—a public philosophy of liberal individualism that accepts the primacy of the state in the management of cultural and religious diversity—that has been a central feature of Australian religion–state relations over time. After some historical discussion of Australian church–state practice, this article argues for a reconsideration of a largely overlooked approach deriving from the English pluralists of the early twentieth century, which promoted greater degrees of group autonomy in relation to a rapidly growing state. It is argued that this tradition has greater potential in responding to the religious diversity of our time than does the current human rights approach with its tendency to reinforce an individualistic or privatized conception of religion, diminish associational life, and thereby reinforce state power.

The autonomous word as a component of a compound predicate in European languages

The article is devoted to a typology of the compound predicate in a number of European languages (English, German, French, Spanish, Russian, Polish, Turkish and Bashkir), which goes a long way to building a theory of language in general and a theory of the sentence in particular. The method of our analysis is based on contrasting inductively selected verbal structures of some natural languages with a language etalon. The aim is to establish factors determining the positional and syntactic autonomy of the word. Positional autonomy is related to the word’s ability to change position in a sentence according to a certain degree of word order freedom, while syntactic autonomy suggests the ability of a word to function as an isolated one-word sentence. An ideal model characterized by absolute positional and syntactic word autonomy stands for the mentioned language etalon. It is assumed hypothetically that languages with a maximum possible free word order enjoy a marked word autonomy, unlike languages with a fixed word order being suggestive of reduced word autonomy. The hypothesis is verified on the basis of optional sampling of various types of the predicate in three temporal forms of the verb representing the category of person. The research ascertains dependence of word autonomy on agreement of grammatical form and meaning. The index of agreement determined as a ratio between the signifier and the signified in the paradigm of the verb conjugation enables to reveal the autonomy degree for each language of contrast. According to the decrement of autonomy the contrasted languages can be disposed in the following order: (Polish, Turkish, Bashkir) → (Russian) → (Italian) → (German) → (French) → (English).

Simulation-based mathematical learning for higher education students from heterogeneous backgrounds

ABSTRACT This paper explores the use of simulation-based training for mathematical learning in undergraduate and graduate mathematics, science, and engineering courses. Simulation-based training offers the advantages of active learning and inquiry-based learning techniques. Furthermore, it provides extensive flexibility, ranging from user-level usage of simulations to the modification or creation of new possibilities by the student, thus engaging different cognitive levels to achieve the learning objectives. This is particularly interesting in groups consisting of students from diverse backgrounds and levels, due to factors such as their international origin or varying prior education, especially in interdisciplinary Master’s degree programmes. Additionally, in online or blended environments (which have become widespread during the last years), simulation-based learning has the advantage of granting students a certain degree of autonomy, which can, to some extent, compensate for the absence of the instructor’s physical presence.

Quantification of finger grasps during activities of daily life using convolutional neural networks: A pilot study

AbstractQuantifying finger kinematics can improve the authors’ understanding of finger function and facilitate the design of efficient prosthetic devices while also identifying movement disorders and assessing the impact of rehabilitation interventions. Here, the authors present a study that quantifies grasps depicted in taxonomies during selected Activities of Daily Living (ADL). A single participant held a series of standard objects using specific grasps which were used to train Convolutional Neural Networks (CNN) for each of the four fingers individually. The experiment also recorded hand manipulation of objects during ADL. Each set of ADL finger kinematic data was tested using the trained CNN, which identified and quantified the grasps required to accomplish each task. Certain grasps appeared more often depending on the finger studied, meaning that even though there are physiological interdependencies, fingers have a certain degree of autonomy in performing dexterity tasks. The identified and most frequent grasps agreed with the previously reported findings, but also highlighted that an individual might have specific dexterity needs which may vary with profession and age. The proposed method can be used to identify and quantify key grasps for finger/hand prostheses, to provide a more efficient solution that is practical in their day‐to‐day tasks.

Breaking new ground: New Zealand Certificates of Steiner Education

The New Zealand Certificates of Steiner Education (CSE) are secondary qualifications at levels 1, 2 and 3, recognized by the New Zealand Qualifications Authority. They give access to tertiary education in New Zealand and beyond. The impulse for new qualifications grew from a wish to have important aspects of the taught Steiner curriculum recognized and valorized, that these aspects be credit bearing toward tertiary study, an option not offered by existing qualifications. The certificates were developed over an 18-month period and were implemented by the (then) four New Zealand Steiner schools with high school classes. The CSE are based on a suite of learning outcomes which give teachers a substantial degree of assessment autonomy, allowing them to tailor assessment modalities to the student or class being taught. Since 2012, the qualifications have been offered overseas and are now used as a pathway to university by Steiner schools in a growing number of countries. This article draws on the experiences of one of the developers of the qualification and two teachers in schools using the certificate in the UK, and outlines some of the challenges faced when breaking new ground in the advancement of Waldorf education internationally.

Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial.

We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2). A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected. Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians. Clinician's use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved. The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.

К вопросу о теории деконцентрации власти

This article examines the issues of the theory of deconcentration in the domestic and foreign scientific literature. In this context, the author consistently examines the existing positions regarding the understanding of the category “deconcentration” and its relationship with the concept of “decentralization”, and also studies the types of deconcentration. In particular, it is noted that in the Russian legal system, unlike other countries, this term is not used. Thus, deconcentration as one of the factors of the organization of power has been reflected in France and Cambodia. However, despite the absence of mention in Russian legislation, this mechanism is widely used within the framework of the territorial organization of public administration. As for the literature, most researchers point out that deconcentration is one of the forms of decentralization of public power. At the same time, among other manifestations of the latter, it is characterized by the least degree of autonomy of local government structures. The author understands by deconcentration the movement of the central government to the periphery through the formation of territorial subjects (or the empowerment of local subjects) as agents (representatives) of the central government, characterized by relations of power and subordination and not involving the creation of a separate level of public authority. The article also touches upon the issue of classification of the types of the analyzed legal phenomenon.

Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system

BackgroundThe widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care.MethodsA randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022.ResultsThe changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group.ConclusionThe results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.

State autonomy, economic reform & business elite influence in the GCC

ABSTRACT This study challenges traditional rentier state theory and contributes to a new generation of scholarship focused on state-business relations by evaluating the relationship between different degrees of state policymaking autonomy and business elite influences in political and economic institutions. The findings of this study address central policy questions about economic reform in the Gulf Cooperation Council countries. Using primary data from my case studies of Qatar and Kuwait, I posit two arguments. First, states with lesser business elite influence over political institutions have more autonomy to realise their economic reform goals; a less dominant and influential business elite circle will more likely submit to state-led economic reform initiatives. Greater business elite dominance, meanwhile, tends to create a powerful bloc undercutting economic change, such as labour reform or new regulatory frameworks, that would benefit the long-term stability of the state. Second, rentier states with higher degrees of state-led capitalism have more autonomy to conduct economic reforms; state-led capitalism produces more coherent and cohesive state apparatuses that can incentivize business elite cooperation.

Aotearoa New Zealand Climate and Environmental Journalists: Profiles, Practices, and Perspectives

This study investigates the profiles, practices, and perspectives of leading climate and environmental journalists from Aotearoa New Zealand. Based upon semi-structured interviews, this study discusses the state of national climate and environmental reportage, as well as possible and desired futures in the round, as responses to the rapidly emerging climate and biodiversity emergency. Within a comparatively small national media ecosystem, the interviews reveal a diversity of backgrounds and degrees of scientific expertise, a collegial relationship amongst the journalists, and a relatively high degree of autonomy in their respective newsrooms. The research notes the journalists believe climate and environmental reportage has increased in Aotearoa New Zealand in recent years although the level of coverage is still insufficient, and there are ongoing struggles to locate climate and environmental journalism within existing news frames. The interview discussion also explores features of reportage such as source relations, workload pressures, and audience engagement. This study explores how journalists negotiate their personal commitments to environmental change within the context of their professional practice. It also discusses the issue of advocacy reportage in climate and environmental journalism and possible critiques of existing journalistic practices and dominant news frames within the contexts of a climate and biodiversity emergency.

Definition and validation of the nursing diagnosis label “wish to die”: a research protocol

BackgroundEuthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care.This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis.MethodsA prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring’s diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases.DiscussionThe definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

Assessment of strategic healthcare purchasing and financial autonomy in Tanzania: the case of results-based financing and health basket fund.

Low-and middle-income countries (LMICs) are implementing health financing reforms toward Universal Health Coverage (UHC). In Tanzania direct health facility financing of health basket funds (DHFF-HBF) scheme was introduced in 2017/18, while the results-based financing (RBF) scheme was introduced in 2016. The DHFF-HBF involves a direct transfer of pooled donor funds (Health Basket Funds, HBF) from the central government to public primary healthcare-PHC (including a few selected non-public PHC with a service agreement) facilities bank accounts, while the RBF involves paying providers based on pre-defined performance indicators or targets in PHC facilities. We consider whether these two reforms align with strategic healthcare purchasing principles by describing and comparing their purchasing arrangements and associated financial autonomy. We used document review and qualitative methods. Key policy documents and articles related to strategic purchasing and financial autonomy were reviewed. In-depth interviews were conducted with health managers and providers (n = 31) from 25 public facilities, health managers (n = 4) in the Mwanza region (implementing DHFF-HBF and RBF), and national-level stakeholders (n = 2). In this paper, we describe and compare DHFF-HBF and RBF in terms of four functions of strategic purchasing (benefit specification, contracting, payment method, and performance monitoring), but also compare the degree of purchaser-provider split and financial autonomy. Interviews were recorded, transcribed verbatim, and analyzed using a thematic framework approach. The RBF paid facilities based on 17 health services and 18 groups of quality indicators, whilst the DHFF-HBF payment accounts for performance on two quality indicators, six service indicators, distance from district headquarters, and population catchment size. Both schemes purchased services from PHC facilities (dispensaries, health centers, and district hospitals). RBF uses a fee-for-service payment adjusted by the quality of care score method adjusted by quality of care score, while the DHFF-HBF scheme uses a formula-based capitation payment method with adjustors. Unlike DHFF-HBF which relies on an annual general auditing process, the RBF involved more detailed and intensive performance monitoring including data before verification prior to payment across all facilities on a quarterly basis. RBF scheme had a clear purchaser-provider split arrangement compared to a partial arrangement under the DHFF-HBF scheme. Study participants reported that the RBF scheme provided more autonomy on spending facility funds, while the DHFF-HBF scheme was less flexible due to a budget ceiling on specific spending items. Both RBF and DHFF-HBF considered most of the strategic healthcare purchasing principles, but further efforts are needed to strengthen the alignment towards UHC. This may include further strengthening the data verification process and spending autonomy for DHFF-HBF, although it is important to contain costs associated with verification and ensuring public financial management around spending autonomy.

Ongoing Peritoneal Dialysis Training at Home Allows for the Improvement of Patients' Empowerment: A Single Center Experience.

Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses. We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers.

Perception of helper's autonomous motivation increases recipient's prosocial behaviour intentions via feelings of gratitude

AbstractFour studies investigated the impact of a recipient's perception of a helper's motivation (autonomous vs. controlled) on the recipient's subsequent prosocial intentions, alongside testing a mediational mechanism. Study 1 employed a questionnaire method to assess the relationships between participants’ lay theories of helper's prosocial motivations (i.e., the degree of autonomy), their dispositional gratitude and their prosocial tendencies. Studies 2–4 manipulated a helper's autonomous versus controlled motivation within hypothetical scenarios (Studies 2 and 3) and within recalled events (Study 4), testing the effect of the helper's motivation on the recipient's prosocial intentions towards the helper (Studies 2–4), a bystander (Study 3) and others in general (Study 4) as well as the mediating role of gratitude. The findings consistently demonstrated that perceiving helpers as having autonomous motivation led to heightened intentions among recipients to engage in prosocial behaviour, which was mediated by increased feelings of gratitude. These effects remained robust after controlling for relevant factors including participants’ demographic information, social desirability bias and perceptions of egoism within helpers. Our findings highlight the role of perceived helper's autonomous motivation on recipient's prosocial behaviours, which enhances the knowledge regarding reciprocity and pay‐it‐forward behaviour.

Organizing Democracy: How International Organizations Assist New Democracies (by Paul Poast and Johannes Urpelainen)

Organizing Democracy: How International Organizations Assist New Democracies (by Paul Poast and Johannes Urpelainen)