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IPONS conference Abstracts.


Keynotes:
Nelly Oudshoorn - Professor of Technology Dynamics and Health Care
Department of Science, Technology and Policy Studies, University of Twente
e: n.e.j.oudshoorn@utwente.nl
w: www.utwente.nl/mb/steps/people/scientific/oudshoorn

Nelly Oudshoorn is a professor of Technology Dynamics and Health Care at the University of Twente,
the Netherlands. Her research interests and publications include the co-construction of technologies
and users, with a particular focus on medical technologies and information and communication
technologies. Her most recent book, Telecare Technologies and the Transformation of Healthcare
(Palgrave 2011), has received the Book of the Year Prize 2012 of the Foundation for the Sociology of
Health and Illness of the British Sociological Association.

ABSTRACT: How Spaces Matter in Telecare: a Techno-geographical Approach

In the last 15 years, the healthcare sector has witnessed the testing and introduction of an
increasing number of telecare applications that enable care at a distance. In this paper I will argue
that sociological and philosophical studies of telecare can be enriched by including a focus on place
to understand the dynamic interactions between people and things. Adopting insights of human
geographers, I will show how places in which technologies are used affect how technologies enable
or constrain human actions and identities. Whereas some places may facilitate the incorporation of
technologies, others may resist technologies. To capture, and further explore, this changing spatial
configuration of healthcare, I introduce the notion of techno-geography of care. This concept
provides a useful heuristic to study how spaces matter in healthcare.

Although telecare technologies introduce virtual encounters between healthcare providers and
patients, the use of telecare devices is always situated somewhere. In contrast to the rhetoric on
telecare, which emphasizes spatially unbounded care practices, telecare technologies still largely
depend on locally-grounded, situated care acts. Based on interviews with users of several cardiac
telecare applications, I will argue that patients home and public spaces are important places
involved in shaping the implementation and use of telecare technologies.


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Professor Davina Allen
School of Nursing and Midwifery Studies, Cardiff University
e: allenda@cardiff.ac.uk
w: www.cardiff.ac.uk/sonms/contactsandpeople/academicstaff/allen-davina-overview_new.html

Davina Allen is a sociologist of healthcare work and has a practice background in adult nursing. A
Professor in Cardiff School of Health Sciences, she is currently in receipt of a Health Foundation
Improvement Science Fellowship undertaking a programme of research focused on developing a
detailed understanding of healthcare coordination.

ABSTRACT: Rethinking holism, rethinking routines: Stretching old labels for a sustainable
professional future

The history of modern nursing is marked by a deep-seated tension between the clinical and
organisational components of the practice role. Over the last forty years, however, it is the former
that has been critical in shaping the professional mandate. Nursings claim to expertise is predicated
on a holistic model of patient care informed by a bio-psycho-social approach, with nursing theories
and models underlining the importance of therapeutic relationships as the foundation for practice.
Yet research demonstrates that nurses not only experience significant material constraints in
realising these ideals their contribution to healthcare extends far beyond direct work with patients.
Even a cursory glimpse inside healthcare organisations reveals that, for all their appearance of
laminated rationality, it is nurses who, in numerous ways, support and sustain the delivery and
organisation of health services and the demands and complexity of this work are increasing. In
recent history, however, this wider work has generally been regarded as at best an adjunct to the
core nursing function, and at worse, responsible for taking nurses away from their real work with
patients. Indeed, many of the new clinical governance and improvement technologies in healthcare
are promoted on the grounds that they will relieve nurses of such burdens and release time to care.

Arguments about the negative effects of nurses non-clinical functions on their work with patients
undoubtedly have credence and interventions which purport to support this activity have a self-
evident appeal. But there is a limit to how far organisation can be delegated to non-human actors
and the professions ambiguity about these elements of its function may not only be preventing
nursing from fulfilling its potential it might also be damaging for the profession and the public.
Buttressed by growing societal unease about fundamental care standards (Institute of Medicine
1999; The Mid Staffordshire NHS Foundation Trust Inquiry 2010) and a sense that the profession has
lost its way, there is a growing recognition that understanding nursing work exclusively in terms of
unmediated patient care is no longer serving the interests of the profession or the public (Chambliss
1997; 2004; Allen 2007; Maben and Griffiths 2008) and that a new model of professionalism is
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required which recasts the nursing role more widely to include nurses contribution to the whole
health system (Maben and Griffiths 2008). Studies of professional identity suggest this is highly
resilient however, which means it can be slow to change. Nevertheless, over its occupational history
the content of nursing work has been remarkably fluid, and the profession has a strong record of
accommodating new functions through the extension of old labels (Goodrick and Reay 2010).

Drawing on a wider ethnographic study of nurses organising work and actor network and practice-
based theories, in this presentation I consider how we might stretch two fundamental ideas within
nursing philosophy holism and routines to redefine the nursing mandate to accommodate the
challenges of contemporary healthcare systems.




















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Associate Professor Stephen Timmons
School of Health Sciences, The University of Nottingham
e: stephen.timmons@nottingham.ac.uk
w: www.nottingham.ac.uk/healthsciences/people/stephen.timmons

Stephen Timmons studied sociology at the universities of Cambridge and York. After working in the
NHS he did his PhD on nursing care planning systems at Anglia Ruskin University. He is now Associate
Professor in sociology in the School of Health Sciences, University Of Nottingham. In his research he
uses Science and Technology Studies, and sociology of professions to study a variety of issues in
healthcare. He is a member of Council of the Royal College of Emergency Medicine.

ABSTRACT: Is there such a thing as nursing technology?

The relationship between nursing and technology remains contested, despite (for instance)
Sandelowski and Burnard who show that this is in many ways a false distinction, and the work of
theorists like Haraway or Latour who would question whether such a distinction between the human
and non-human can ever be drawn. In this paper I will seek to address another issue in nursing and
technology. This is the question of whether the technologies that nurses use are distinctively nursing
technologies. Drawing on a broadly STS approach, I will argue that often nursing has technology
designed for it or imposed upon it. This is possible because of nursings subordinate status, and
because of the gendered status of technology. Its striking that neither doctors nor managers seem
to have this problem: It appears to be straightforward to know what medical technologies or
managerial technologies are.

I want to argue that nursing should seize control of the technology that it uses by thinking about
and designing new, distinctively nursing technologies. I will draw on the work of Cheryl Crocker and
her notion of technology transformed to show how this might be possible. I would contend that the
time is right to do this; designing and building new technologies has paradoxically never been easier.
As technology plays a key role in defining professions and their scope, this approach could prove
fruitful to the nursing profession more widely.




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Dr Alan Barnard
School of Nursing, Queensland University of Technology
e: a.barnard@qut.edu.au
w: http://staff.qut.edu.au/staff/barnard

Dr Alan Barnard is a nurse with a background in philosophy and psychology. Alan is a senior lecturer
at Queensland University of Technology, Australia and has extensive academic and clinical
experience. He is also a Research Fellow at a major Australian hospital, is the recipient of major
research grants and has published extensively on technology and nursing. He is interested in the
relationship between person-focused care, technology and nursing practice.

ABSTRACT: The Need for philosophic reflection on nursing, technology and the discourse of
difference

Technology is core business in nursing and it continues to impact directly upon nursing practice(s),
education and care. Technology is significant to the history and future of nursing yet as nurses we
have inadequately understood both its influence upon our practice and how to best address the
many challenges associated with it. This presentation will overview a model that broadens
explanation of technology to be more than machinery and artifact, in order to argue that technology
needs to be understood to include knowledge, skills and a specific way of thinking (technique).
Technique is the formation of a system of thinking aimed toward the absolute efficiency of methods
and means in every field of human endeavor.

The thesis of the paper is that development of philosophy(ies) of technology and nursing is
fundamental to discipline maturity and ultimately our role in enhancing person focused health care.
It will be argued that we must further our responsibility and interest in critiquing current and future
health care systems through philosophic inquiry into the experience, meaning and implications of
technology. Nurses are situated as important contributors to the use and integration of health care
technology yet we continue often to advance a discourse of difference between nurses and
technology as if we are in opposition to it. The paper argues for philosophy(ies) of technology and
nursing, and posits that the cause of experiences related to dehumanisation, or claims of inadequate
health care are less a result of the inclusion of machinery and artifacts, then they are about the goals
of technique, choices we make in practice, our thinking, and decisions about what is judged to be
important in care delivery. Interpretation highlights the influences of popular culture and
commonplace assumptions about technology, such as the primacy of progress and presumption of
neutrality, as central tenets influencing nursing literature and the construction of nursing evidence.

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The presentation concludes with practice examples of human focused care that occurs even in highly
technological environments. It will be demonstrated that what is required is explication of our
complicated and changing relationship with technology, which is more than simply about
dehumanisation as a logical outcome of technology. Technology is at any moment in time
increasingly understood to depend on the eye of the beholder, the hand of the user, and the
technological systems that influence integration and use.























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Dr Neema Sofaer
Centre of Medical Law & Ethics, King's College London
Fellow in Ethics and Health, Harvard University
w: www.kcl.ac.uk/prospectus/staff/index/id/1465
w: http://peh.harvard.edu/people/sofaer.html

Dr Neema Sofaer obtained a BA in English and Philosophy, and an M.Phil in Philosophy, from Trinity
College, Cambridge. After studying philosophy and classics at Harvard University as a Kennedy
Memorial Scholar, she obtained her PhD in Linguistics and Philosophy from Massachusetts Institute
of Technology. She then returned to Harvard as a Research Fellow, where she re-trained as a social
scientist and worked on some incredibly interesting projects. These included the drafting of
Massachusetts Department of Public Healths pandemic flu guidelines, a National Institutes of
Health study of people participating in clinical trials to obtain standard healthcare, and a Norwegian
government project to describe and evaluate the distribution of HIV drugs in Uganda.

Most recently, Neema was at Kings College London, where she managed her own Wellcome Trust
grant on the legal and ethical aspects of post-trial access to trial drugs. There, she designed and
carried out a three-year international consultation, which she used to first-author what is now the
current Health Research Authority Guidance on post-trial access to trial drugs. She also developed
and published (with Daniel Strech) a process for summarising complex debates in medical ethics for
medical professionals and policy makers. With Nir Eyal, she won her fields biennial, worldwide prize
for work on the ethics of translational health research.

ABSTRACT: Reasons Why Post-Trial Access to Trial Drugs Should, or Need not be Ensured to
Research Participants: A Systematic Review

Background: Researchers and sponsors increasingly confront the issue of whether participants in a
clinical trial should have post-trial access (PTA) to the trial drug. Legislation and guidelines are
inconsistent, ambiguous or silent about many aspects of PTA. Recent research highlights the
potential importance of systematic reviews (SRs) of reason-based literatures in informing decision-
making in medicine, medical research and health policy.

Purpose: To systematically review reasons why drug trial participants should, or need not be
ensured PTA to the trial drug and the uses of such reasons.

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Data sources: Databases in science/medicine, law and ethics, thesis databases, bibliographies,
research ethics books and included publications' notes/bibliographies.

Publication selection: A publication was included if it included a reason as above. See article for
detailed inclusion conditions.

Data extraction and analysis: Two reviewers extracted and analysed data on publications and
reasons.

Results: Of 2060 publications identified, 75 were included. These mentioned reasons based on
morality, legality, interests/incentives, or practicality, comprising 36 broad (235 narrow) types of
reason. None of the included publications, which included informal reviews and reports by official
bodies, mentioned more than 22 broad (59 narrow) types. For many reasons, publications differed
about the reason's interpretation, implications and/or persuasiveness. Publications differed also
regarding costs, feasibility and legality of PTA.

Limitations: Reason types could be applied differently. The quality of reasons was not measured.

Conclusion: This review captured a greater variety of reasons and of their uses than any included
publication. Decisions based on informal reviews or sub-sets of literature are likely to be biased.
Research is needed on PTA ethics, costs, feasibility and legality and on assessing the quality of
reason-based literature.









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Concurrent sessions
Transforming Caring into Bytes: An Institutional Ethnography examining the impact of the
Electronic Health Record on Care deliveryThe patient record has evolved greatly in the past century.
From its initial purpose of being a record of the individual patients health condition it has evolved to
a tool used for institutional risk management, financial, and quality assurance purposes. Even
though the Electronic Health Record (EHR) is widely being implemented and it has a become central
part of care delivery, little is known about how the work of everyday patient care and specifically the
patient provider relationship, has been impacted by the use of it. This Institutional Ethnography
examines how the electronic health record has impacted healthcare delivery. Findings of this study
included: This study demonstrated that the use of the electronic health record has led to a sense of
proletariatization and alienation of healthcare providers, particularly nurses. This study yielded a
large amount of data. These rich data offered a good insight in how the EHR is changing the
healthcare delivery system. Key findings included: The implementation of the EHR has led to
significant changes in care delivery. Healthcare providers work is being directed by the
documentation requirements. Institutions are aware of how they can change care delivery and use
this new gained capability readily. Caregivers have seen a proletariatization of their work. The work
of assessing a patients, meaning, that they try obtain comprehensive understanding of the condition
of the patient is being replaced with data collection. Data collection, in contrary to assessment, is
focused on pulling apart a patient in separate data points. E.g. level of pain, numeric value for the
level of falling. The move to the EHR has led to a sense of Alienation with the Care providers. This
study showed how Karl Marxs theory on the impact of technology is current. This study
demonstrates 4 levels of Alienation:
o Alienation of the product of the Caregivers labor
o Alienation of a sense of professional
o Alienation of personal identity.
o Alienation from others (Patients and Colleagues)
This findings of study are linked to the work of works of Martin Heidegger, Michel Foucault, Andrew
Feenberg and Albert Borgman .
Hans-Peter de Ruiter PhD, RN
Minnesota State University, Mankato
7700 France Ave S
Suite 360
Edina, MN 55435
507-389-6812
deruih@mnsu.ed
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____________________________________________________________________________

How should we search the literature? Evidence based practice and nurse education

Nursing dissertations often take the form of a literature review and post registration/licensure, it can
be argued that search and assessment skills are necessary prerequisites for the successful
performance of evidence based practice. To meet academic and professional requirements (and
putting assessment to one side), educators introduce literature searching skills to students and this
introduction makes use of texts that, it is argued, are problematic. Using work by Helen Aveyard to
illustrate recommended practice, this paper explores some of the assumptions that permeate
thinking about literature searching. It is proposed both that the number and types of sources that
need to be located remain indeterminate and open to contestation and, also, that an overly narrow
interpretation of the purpose and structure of nursing literature searches is frequently presumed.
Thus it is commonly supposed that the search process should and can begin with the formulation of
an answerable question and, to address the question posed, unhelpful or limiting conventions about
what counts as evidence are assumed. Students and registered nurses are however, properly and
legitimately interested in subjects that cannot easily be collapsed or framed in a way that allows
answerable questions to be set and targeted answering evidence sought. If the purpose of
literature searches is interpreted broadly rather than narrowly, alternative conceptions of search
construction deserve consideration. Thinking about how students are introduced to search
strategies provides a useful vehicle for investigating important aspects of evidence based practice
and nurse education. Unresolved questions about the meaning and purpose of evidence in or for
nursing practice underpin the way we approach and read the literature.
Martin Lipscomb PhD, RN
University of the West of England
Faculty of Health and Life Sciences
Department of Nursing and Midwifery
Alexandra Warehouse
West Quay Gloucester Docks
Gloucester
GL1 2LG

email: Martin.Lipscomb@uwe.ac.uk

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Clinical Labor Optimization: Managing Supply and Demand in a Dynamic Environment

Healthcare organizations continue to be challenged by the conflicting priorities of deploying scarce
nursing resources. Cost constrained organizations, shortages of professional nurses, and the need to
drive retention by meeting staffs schedule preferences are often in conflict as leaders strive to
create staffing and scheduling protocols. The traditional approaches to this activity are not systems
based and often involve a point solution whereby a single component of the system is improved,
often to the detriment of the system as a whole. Because the systems of staffing and scheduling are
dynamic, complex and non-linear, the traditional algebraic approaches serve a single dimension of
the system; i.e. staff preference or cost effectiveness. Optimization modeling, which has been
identified as best practice in other logistics intensive industries can be applied in the solution of
these problems in complex adaptive systems. These models find the best solution when balancing
complex work rules, union contracts, staff preference, budget requirements, and various models of
care.
Fitzpatrick will present several hospital case studies describing Two specific best practices from the
logistics industry have been applied to the system of staffing and scheduling; Lean production
operations strategies and the use of linear programming to model the complexities of the staffing
processes.
:
The quantitative as well as qualitative components of the model
The importance of interpretation and implementation of the staffing strategy
The need for process improvement to actualize the financial results
Achieving the business objectives of adequate coverage for demand, lowest cost solutions,
and satisfied staff
Therese Fitzpatrick, PhD, RN
Assistant Professor, The University of Illinois-Chicago, USA
Department of Health System Science, College of Nursing
Contact Information: 822 West Golf Road
Libertyville, Illinois 60048 USA
312.401.2738 (mobile)
Email: therese@uic.edu or ThereseAFitzpatrick@gmail.com
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Phenomenology, Evidence-Based Practice and the Study of Family Presence in Critical Care Units

Patient-centered care rather than disease-centered care with treatment recommendations and
decision making tailored to patients preferences and beliefs is emphasized in todays healthcare.
Guidelines for evidence-based best practices for support of families in the delivery of patient-
centered care in critical care have been established but only a number of institutions have policies
on family presence. Reliable, well-designed, high-quality research studies attending to family-
centered care will strengthen the level of evidence and document why family presence is not
incorporated in institutional polices. At the same time, evidence must extend beyond the current
emphasis on random controlled trials as the criterion standard in inquiry, which thereby devalues or
excludes qualitative studies. Qualitative studies like phenomenology are also most often ranked
lower in hierarchy of evidence, along with descriptive, evaluative, and case studies as weaker forms
of evidence compared with other research designs that examine interventions. From the findings of
two phenomenological studies, this paper aims to instill an evidence-based mindset into qualitative
research and a need to balance scientific knowledge gained through empirical research and evidence
from qualitative studies. The sheer proliferation of qualitative health research has made qualitative
findings difficult to dismiss and has generated urgent calls to incorporate them into the evidence-
based practice process. Qualitative questions are meaning questions influenced by a focus in
understanding of human experiences and the contexts of which the experiences occur. These types
of questions are asked to determine meaning, to provide insight and scope to a phenomenon, and to
appreciate a specific populations experience.
Brigitte S. Cypress, EdD, RN, CCRN (Assistant Professor)
Institutional affiliation: Lehman College, City University of New York
Contact address: P. O. Box 2205 Pocono Summit, PA 18346 USA
email: brigitte.cypress@lehman.cuny.edu






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What kind of robot might merit acceptance as an authentic companion?

Creating android and humanoid robots to furnish companionship in the nursing care of older people
continues to attract substantial development capital and research. Some people object, though, that
machines of this kind furnish human-robot interaction characterized by inauthentic relationships. In
particular, robotic and artificial intelligence (AI) technologies have been charged with substituting
mindless mimicry of human behavior for the real presence of conscious caring offered by human
nurses. When thus viewed as deceptive, these robots also have prompted corresponding concerns
regarding their potential psychological, moral, and spiritual implications for people who will be
interacting socially with the machines. Such objections and concerns can be assessed quite
differently, depending upon ones ambient culture and metaphysical presuppositions. The
complaints may be set aside as unnecessary, for example, within religious traditions for which robots
relying exclusively upon classical computation still can be viewed as presenting spiritual aspects.
Elsewhere, largely post-religious cultures may reject the misgivings simply as outdated superstition,
holding that the machines eventually will enjoy a consciousness described purely in behaviorist
terms. The present essay, in contrast, proposes that the heart of the foregoing objections and
concerns actually may be assessed scientifically and with results recommending fundamental
revisions in AI modeling of human mental life. Specifically, there now are considerations that favor
introduction of AI models using interactive classical and quantum computation. Development of
such hybrid computational architecture could provide credible reasons for people at least to
countenance accepting this advanced kind of robot as an authentic companion.
Dr. Ted Metzler
Oklahoma City University
Petree College of Arts and Sciences
2501 N. Blackwelder
Oklahoma City, Oklahoma 73106-1493 USA
(405) 208-5511
tmetzler@okcu.edu

Dr. Lundy Lewis
Department of Computer Information Technology
Southern New Hampshire University
2500 N. River Road
Manchester, New Hampshire 03106 USA
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(603) 668-2211 x3061
l.lewis@snhu.edu

The Rev. Linda Pope
Senior Pastor, Hunter & Garber United Methodist Churches
P.O. Box 137
Hunter, Oklahoma 74640 USA
(580) 684-7775
lindacpope@aol.com



Nursing as body care is precisely contradictory to a vision of nursing as a healing practice.
Our conference announcement begins with the following: Body care is at the centre of nursing
practice. For someone with my philosophical bent this represents a challenge and a contradiction.
There may be some caregivers who see themselves caring for bodies, but, with the exception of the
morgue, this is a limited and inadequate view. Even those who care for patients in a persistent
vegetative state do not just care for bodies. I would argue they are caring for persons; persons who
are matter/form unities in the language of Aristotle and Aquinas. The materials of their bodies may
not allow expression of their rational form (soul), but they are still persons within community. The
contemporary philosopher, Norris Clarke (Person and Being, 1993) will address the
phenomenological understanding of humans as substantial and relational, having transcendence.
This paper will consider(1) the meaning of being human within classical philosophy, (2) Descartes
distinction between humans and machines as he argues that we will always be able to tell the
difference, and (3) Nursing as a healing practice. Nursing as body care is precisely contradictory to
a vision of nursing as a healing practice. This later will address my own thought borrowing from the
work of William A. Wallace, Edmund Pellegrino and Imogene King.
Beverly J. Whelton, Ph.D. MSN
Associate Professor of Philosophy
Wheeling Jesuit University
316 Washington Avenue
Wheeling, Wv 26003
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Surveillance and the looking glass: a Foucaldian perspective on changing behaviours to promote
best practice in nursing

Traditionally defined as close observation (Marx, 2002:10), surveillance has long been used as a
powerful tool to protect social values (Dawson et al, 2005). However, in healthcare, as in wider
society, how surveillance is implemented is likely to be viewed negatively (Cooper, 2013). Whilst a
disembodied form of surveillance threads through peoples lives in the social world, the word still
implies a form of management control (Lyon, 2001).
This presentation will report on the findings from a nursing study, conducted in the United Kingdom,
which examined the impact of different intermediaries (a range of people who link between policy,
evidence and individuals in clinical areas) to promote best practice in infection control. The findings
showed that the ways in which intermediaries watched over practice meant that frontline staff were
stimulated through guilt or shame to practice correctly, so that evidence based habitual behaviours
were promoted. However, how intermediaries watched over practice also triggered staff to believe
they were being individually supported, and promoted an atmosphere of collegiality in clinical areas.
Being subjected to surveillance enhances self -awareness and influences behaviour (Henderson et al,
2010), and the theme observed in this study was constructive and caring, as opposed to the more
punitive connotations of surveillance.
The potential impact of promoting self-surveillance and amongst nursing and other clinical staff is
magnified by this study. To consider the implication for future policy and the organisation and
delivery of nursing and healthcare practice, the findings are explored in this presentation through a
Foucaldian lens.
Dr Lynne Williams
Cymrawd Ymchwil
Ysgol Gwyddorau Iechyd
lynne.williams@bangor.ac.uk
Prifysgol Bangor
Gwynedd, LL57 2EF


Dr Lynne Williams
Research Fellow, School of Healthcare Sciences
lynne.williams@bangor.ac.uk
Bangor University,Gwynedd, LL57 2EF
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Health technologiesfor better or for worse? A critical theory of standardization and instrumental
thinking within contemporary health care

The goal of market-oriented public health care reforms has been to find a balance between
affordability, high quality, and universal access. Health technologies, such as devices, techniques,
and procedures, are a great asset in achieving this. Undeniably, the quality of health care has
improved, to the extent that they have made earlier diagnosis, more effective and less invasive
treatments, and shorter hospital stays possible. However, for better or worse, the increasing use of
technologies also standardizes care. This raises the question whether there could be any adverse
effects on the ethical relationship between patients and professionals?

In their critique of culture industry, Horkheimer and Adorno argue that the adverse effects of
technology should not be attributed to their internal laws but rather to its function within the
economy today. From this I argue that the benefit of technology may turn against itself if the fiscal
conditions within public services do not allow sufficient time for professionals to properly consider
the use of technologies in each care situation. The intrinsic logic of making dissimilar things
comparable by reducing them to abstract quantities also validates technology use. If they are taken
for granted and applied blindly, merely as method and not as means towards understanding, they
become the sole instrument of thought: *t+he standardization of the intellectual function through
which the mastery of the senses is accomplished, the acquiescence of thought to the production of
unanimity, implies an impoverishment of thought no less than of experience; the separation of the
two realms leaves both damaged. This is bound to reflect the way the care relationship is
conceptualised.
Max Horkheimer and Theodor W. Adorno, Dialectic of Enlightenment (Stanford, CA: Stanford
University Press, 2002) 95.

Anna Ilona Rajala, MA, research student
Institutional affiliation: University College London / University of Brighton (from Oct 2014)
Contact address: 6 Cliff Close, Seaford, East Sussex, BN25 1BN, UK
email address: a.rajala.12@ucl.ac.uk


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Are patient care technologies impeding the therapeutic quality of nurse-patient relationships?

Increasingly, technologies are being used to facilitate care of patients in healthcare organisations
with the aim of controlling hospital costs, and improving professional staff performance and patient
safety. When used by nurses, technologies become part of the nurse-patient relationship and
intrinsic to the therapeutic context within which nursing practice takes place. It is important to
examine whether technologies, by virtue of their mechanical character, are impeding the
therapeutic quality of nurse-patient relationships. The purpose of this paper is to consider this issue
with regards to the use of medication dispensing technology.

This paper draws on findings from recent case study research in New Zealand that explores
professional nursing values in contemporary hospital practice. An argument will be presented using
interview and observation data from medical wards across three hospital sites together with
MacIntyres philosophical arguments of internal and external goods. It will be proposed that use of
medication dispensing technology (dispensing robots) requires nurses to spend significant time
away from the patients thereby impeding the therapeutic quality of nurse-patient relationships.
Taking the position of patient care technologies acting as barriers to, rather than enablers of, a
therapeutic nurse-patient relationship, MacIntyres arguments of excellence/internal goods and
effectiveness/external goods are used to understand how technological advances in healthcare
influence the therapeutic nurse-patient relationship. Tensions between organisational and
technological objectives good of effectiveness and the intentions of practice goods of excellence
will be demonstrated.

Helen Rook1, Kay De Vries2 and Therese Meehan3 4 5
Institutional affiliation
1 Lecturer, Programme Director, Graduate School of Nursing Midwifery and Health, Victoria
University of Wellington, Wellington New Zealand.
2 Senior Lecturer, Head of School, Graduate School of Nursing Midwifery and Health, Victoria
University of Wellington, Wellington New Zealand.
3Honorary Fellow of the Faculty of Nursing, Royal College of Surgeons in Ireland.
4Adjunct Senior Lecturer in Nursing at University College Dublin.
5Adjunct Professor, Graduate School of Nursing, Midwifery and Health, Victoria University of
Wellington, New Zealand.

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Contact Details
Helen Rook
Lecturer in Nursing, Programme Director MNS
Graduate School of Nursing, Midwifery & Health
Te Kura Tapuhi Hauora, Victoria University of Wellington,
PO Box 7625, Newtown, Wellington 6242. New Zealand.
Email: helen.rook@vuw.ac.nz

Making technology work for people: Self-testing technology and patient autonomy
This paper presents the empirical findings of a PhD study exploring the patient experience of
autonomy in engagement with self-testing technology. The proliferation of home-based self-testing
technology provides a contextualised example of an ideological shift towards greater patient
autonomy. The assumption underpinning these technologies is that they facilitate patient autonomy
through self-management. The study explored that assumption and the wider reverence to
autonomy in healthcare, in the clinical context of individuals with diabetes who self-test their blood
glucose levels.
Heideggerian phenomenology provided the overarching philosophy for the research. The study
adopted an empirical ethics research design that integrates philosophical analysis and empirical
enquiry in a cyclical fashion. Empirical data from key stakeholders: patients, healthcare professionals
and the scientific community was analysed collectively in accordance with a hermeneutic approach.
Empirical findings revealed an understanding of Autonomy as lived: The interdependent
phenomenon of autonomy in self-testing, whereby the patient experience of autonomy was
underpinned by three inter-reliant relationships - Relationship with self-testing device, Relationship
with illness and Relationship with healthcare provider. The paper explores the key implications of
this contextualised understanding of technology use for all stakeholders. While technology can
facilitate greater patient autonomy this can only occur in tandem with a variety of interdependent
factors and supporting structures. The value of reflection on the ethics of emerging healthcare
technologies is also explored. The paper concludes by introducing some normative implications of
the empirical work for operationalising autonomy, both in the context of technology use and in the
wider healthcare context.
Anna-Marie Greaney
RGN, RNT, MA
Department of Nursing and Healthcare Sciences Sls Building Institute of Technology Tralee Co.
Kerry
Email: Anna.Marie.Greaney@staff.ittralee.ie
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Athena Swan: Philosophy in Action

There are powerful philosophical reasons for fully embracing the recent Athena Swan initiative,
which go well beyond the usual utilitarian justifications. This paper argues that there is a deeper set
of values at issue, which, if not addressed, will expose our discipline to the possibility of embedding
bad science rather than nursing science.
Women in STEMM are under-represented, especially at senior levels. Even in Health Sciences and
Academic Nursing (where there is a much higher proportion of women than in many STEMM
subjects), there is a leaky pipeline feeding the upper echelons. The odds of rising (from
undergraduate to Professor) within Schools of Nursing are still much better for men (who are first
onto the glass lift). As well as a gender pay gap, there is unconscious bias against women at all levels,
and especially those in leadership roles.
Athena Swan is a national initiative to recognise organisational commitment to advancing womens
careers in STEMM. Prof Dame Sally Davies, Chief Medical Officer, has announced that NIHR and
CLAHRC funding bodies will no longer shortlist any NHS/University partnership unless the academic
department holds at least a Silver Award from the Athena Swan Charter for Women in Science. This
means Athena Swan now has a few teeth. All funding councils are following suit, and instantiating
a requirement for academic organisations to demonstrate a commitment to equality and diversity.
For many, this kind of initiative demonstrates a welcome, if belated, commitment to social justice.
Missing, so far, is a thorough-going commitment to equality and diversity, in combination with a full
recognition of the scientific importance of women as nurses and nurses as women.
Alison Edgley
Associate Professor of Social Sciences in Health
Room D87
Queen's Medical Centre
Nottingham
NG7 2UH
UK
Email: alison.edgley@nottingham.ac.uk


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Mixed methods in rehabilitation of the older person: a clinical and research paradigm

The demographic is aging and with this presents an increasingly nebulous and complex arrangement
of clinical problems. Clinical interventions have long been served by the reductionism of Descartes
and Newton: cause leads to a linear effect. This traditional positivistic model faces challenges within
rehabilitation of the older person. Conversely, these challenges can only be partially met through an
interpretivistic paradigm. Thus, Nurses and Allied Health Professionals need to progress away from
either a positivistic quantitative model or an interpretivistic qualitative model. A move toward the
mixed methods paradigm is justified in order that the strengths of both quantitative and qualitative
paradigms are integrated and embraced.

Further, when investigating low intervention adherence rates in the older population, clarity of the
underlying reasons is required. A critical realist worldview is set within the middle-ground:
phenomena are not reduced to a positivistic linear order (Reagon et al, 2009); truth values are not
placed on human behavioural perspectives (DeForge & Shaw, 2011). Critical realisms ontology is
stratified (Walsh & Evans, 2013): highly suited to impaired intervention adherence levels
investigations within older people.

An example is found in those who are at risk of injurious falls:
Empirical (the observed): Injurious falls rates
Actual (the known but unseen): Exercise adherence levels
Real (the hidden precondition): Bio-psychosocial phenomena (historical and contemporary)


The authors therefore argue that the philosophical stance point when performing clinical research
should be directed toward that of mixed methods.

Kevin Anthony MSc MCSP MA Research Methods Fellow,
University of Nottingham / Nottingham CityCare Partnership
Stephen Timmons PhD Associate Professor,
University of Nottingham

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Fatalism and the fundamental attribution error. On not trivialising social psychology

Philip Darbyshire has responded to my editorial in Nurse Education Today. He gained the impression,
he says, that I used social psychology to absolve poor or negligent practice from any hint of personal
responsibility and accountability. I propose to comment on this view.

The paper has two sections. First, I discuss the fundamental attribution error, an idea which
Darbyshire trivialises as the fundamental arrogance error, and a piece of linguistic puffery. In fact,
the evidence for correspondence bias, which is logically antecedent to the FAE, is rock solid. We
constantly invoke traits, attitudes and values, even when behaviour is manifestly constrained by
circumstance. We over-emphasise dispositions, and under-emphasise context. The FAE is a theory of
attribution. It says: we over-attribute behaviour to character. Darbyshire, however, imagines that it
is a theory of behaviour. He thinks it says: situations explain behaviour, character doesnt come into
it. He does not see the difference between saying situations matter (more than we think) and
only situations matter.

This error is compounded by a nave view of causation, discussed in the second section. According to
Darbyshire, claiming that behaviour is constrained by situations makes me a fatalist, unable to
account for nurses who do not all behave and respond identically. In the same way, not all those
who smoke develop cancer, a fact which on Darbyshires logic refutes the fatalistic claim that
cancer is caused by smoking. I explain why this conception of cause (as a sufficient condition) is
mistaken. However, I also argue that situations-as-causes do set limits to responsibility, even if
Darbyshire finds this morally inconvenient.
John Paley
8 Farm Place
Henton
Chinner
OX39 4AD
01844 351905



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Ways of improving health outcomes Antimicrobial resistance and Telehealth agendas
Within the health policy field we identified two generative socio-technical imaginaries Telehealth
and antimicrobial resistance (AMR) agendas that aim to reconfigure the existing socio-technical
regime its technologies, cultural practices, institutions in such a way as to improve health
outcomes. Each agenda tackles a specific wicked health problem: the increased burden on
healthcare resources presented by patients with chronic long term conditions (Telehealth), and the
challenge of managing and treating infectious disease against a backdrop of increased prevalence of
multi-drug resistant strains of pathogenic bacteria (AMR).
Although these diverse agendas occupy different territory within the health policy field they both
attend to wicked problems that impact on health outcomes. The purpose of this paper is to
interrogate the extent that these agendas are complementary and/or competing in terms of their
means and ends with regards to achieving improved health outcomes. For instance, whilst both
agendas introduce technological fixes, via closer monitoring for early detection of health
complications (Telehealth) and better diagnostic equipment for targeted antibiotic use (AMR), which
if responsive to each other could provide complementary means. The overarching Teleheath aim of
reducing emergency hospital admissions through measures such as increased prophylactic antibiotic
use may be unintentionally blind to the AMR agendas goal of preventing overuse of antibiotic
treatments. We conclude by highlighting the need for responsiveness between agendas to ensure
early co-operative agenda-shaping to ensure the emergence of compatible socio-technical
imaginaries, that once emerged and embedded socio-technical regimes, do not require costly retro-
manipulation to address potentially foreseeable conflicts.
Ms Josephine Go Jefferies Mr Richard Helliwell (presenter)
University of Nottingham
Nottingham University Business School University of Nottingham
Institute of Science and Society
School of Sociology and Social Policy
Room B42 Business School (South)
Jubilee Campus
Nottingham NG8 1BB
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Email: lixjg21@nottingham.ac.uk
Room B24 Law and Social Science
University Park
Nottingham NG7 2RD
Email: lqxrh2@nottingham.ac.uk



Productivity and professional identities in healthcare exploring governance and the governed

The performance of healthcare systems has come under increasing scrutiny as global trends mean
that both demand and costs escalate. Compounded by austere times, improving productivity is
deemed a universal challenge. In the UK a number of contemporary reforms and strategies have
advocated improved healthcare productivity as a political panacea for the long term future of the
NHS. As such, productivity improvement has been framed as a fundamental objective of both policy
and professional work. This study broadly aims to explore the ontological relationship between
professional healthcare work and identity. Specifically, it seeks to examine how austerity (in
particular the call for improved productivity) influences professional subjectivities, and how
Emergency Department (ED) nurses and doctors mediate their responses to dominant productivity
discourses and modes of governance.
Using empirical data from a longitudinal ethnographic case study conducted in one of the UKs
largest EDs, this work uses a theoretical framework based on Foucaults technologies of power and
technologies of the self to expose and explore two co-existing modes of professional productivity
governance one of authoritarian control and one of self-governance. The interplay between these
modes of governance is considered and the resultant professional subjectivity presented not as a
negotiated balance or hybrid position, but rather a complex and dynamic state characterised by near
continuous constitution and reconstitution. The significance of this state of flux is discussed with
reference to professionalism, practice and implications for future policy and productivity
improvement strategies.

Dr Fiona Moffatt
University of Nottingham
Division of Physiotherapy Education, University of Nottingham, Clinical Sciences Building, City
Hospital Campus, NG5 5PB
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fiona.moffatt@nottingham.ac.uk




Does blended learning need a third element for stabilisation within nurse education?
Blended learning offers not only face to face sessions within higher education, but the use of
technological interventions to provide a combined support for student learning (Driscoll, 2002;
Garison and Vaughan, 2008). Many forms of blended learning can be used to enable students to
supplement and support their learning journey. You tube, videos quizzes, reusable Learning objects,
exams, online discussion forums and debates were embedded into an existing course at the
University of Nottingham for post registration nurses. This provided an innovative blended learning
platform for nursing students (Kelly et al, 2009, Clifton and Mann, 2011; Blake, 2010). Lecturers and
students often remain reserved in supporting this approach and question if blended learning is the
new pedagogical breakthrough we hail it as.
Lecturers expectations of the use of such a course may not be supported by student engagement
within the process (Philips, 2005). The student acceptance of the virtual world may be considered as
removing them from the foundations of caring and compassion which is traditionally taught through
clinical exposure ( Meyer, 2005; Lopez-Perez et al., 2011 ) When reflecting upon the delivery of
blended learning courses, a third component should be considered. The introduction of clinical skills
would support existing blended learning courses, providing a triad of educational approaches in the
delivery of such an eclectic programme (Lenister, 209; Watson, 2001) Therefore, the development of
a three pronged approach to nurse education may offer a stabilisation from which further
educational innovations can be offered .

Nichola Ashsby
School of Health Sciences
Derby Education Centre
Royal Derby Hospital
Uttoxeter Road
Derby
DE22 3DT
UK
Email: Nichola.Ashby@nottingham.ac.uk
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Mill, advocacy and the tobacco endgame.

Though its stricture has not been universally followed in modern liberal states, Mills harm principle
remains important in public health ethics. Banning an individual from doing something because its
bad for him requires stronger reasons than banning it because it harms others. In England,
justification for smoking bans in enclosed spaces was firmly presented in terms of preventing harms
to others, even if its subsequent evaluation also included health gains to smokers. The legal ban did
not cover smoking outside where harms to others are less.
Care homes and hospices were granted exemption but in mental health units this was temporary, so
that when they expired, the ban became de facto a complete ban where patients cannot go outside.
During legal challenges in England, justification for the ban was sought in health gains for patients,
including regarding the habit as self-harm. Recent NICE guidelines recommend total smoking bans
inside and outside hospital for the benefit of smokers. For smokers, Mills principle has been
overturned.
The supremacy of personal autonomy is central to nursing ethics, though less so in public health
ethics. Smoking bans and their effect on individual patients is one area where these disciplines
collide. Nursing claims (or requires) a role for patient advocacy but this can be variously interpreted
and nursing can no longer prevaricate. It must choose to advocate for patients health (in favour of a
ban) or for patients choice (against a ban), and the direction it takes clearly identifies where the
professions values lie.

Paul Snelling
Senior Lecturer in Adult Nursing
University of Worcester
Institute of Health and Society
Henwick Grove
Worcester
WR2 6A
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p.snelling@worc.ac.uk

http://worc.academia.edu/PaulSnelling


Development and evaluation of a computer based e-learning tool to enhance knowledge of
workplace wellness in a healthcare setting
Background: Workplace health promotion is important for maintaining a healthy public health
workforce, and is an important settings approach to improving population health, yet is infrequently
included within formal training for healthcare professionals.
Aim: To develop an interactive e-learning tool on Workplace Wellness covering six key workplace
health promotion areas including work-related stress, musculoskeletal disorders, physical activity,
diet and nutrition, smoking and alcohol consumption. To assess the use of the tool in improving
knowledge of workplace health issues in NHS employees and healthcare students.
Methods: E-learning resource was developed by a nurse and health psychologist in an iterative peer-
reviewed process involving 14 expert reviewers. 194 participants (129 healthcare students, 91
healthcare employees; 26 of which-were both employee and student) completed the tool. Change in
knowledge was assessed using an online knowledge questionnaire before (n=188) and immediately
after (n=88) exposure to the e-learning tool. Participant perceptions towards use of the tool were
assessed (n=88).
Results: Baseline knowledge of workplace wellness was poor (n=188; mean accuracy 47.60%, s.d.
11.94%). Knowledge significantly improved from baseline to post-intervention (t(75)=-14.801, p <
0.0005, n=75, mean accuracy 77.96%, s.d. 14.08%), with improvements in knowledge evident for all
sub-topics. 90.5% of participants felt their knowledge of workplace wellness was improved, with
86.9% of participants stating they would recommend the resource to others.
Conclusion: E-learning has potential to improve knowledge of workplace wellness in healthcare staff
and students. The impact of improved knowledge on the health of employees, or their delivery of
patient care requires further exploration.

Ms Emily Gartshore RN MNurSci

51 Thorpe Road, Melton Mowbray, LE13 1SE
07507863988
emily.gartshore1@gmail.com
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The philosophical issues in the promotion of Financial Capability as a Public Health measure

The World Bank defines Financial Capability as people's internal capacity to act in their own best
financial interest given their socioeconomic conditions. The focus of this paper is on its association
with health. There is a well-established link between individuals' financial and health states (e.g.
Marmot Review). There is also evidence of beneficial effects on mental health and stress levels from
interventions that help people in financial difficulty. In the UK since the 1990s, various organisations
have attempted to enhance people's Financial Capability; some now do so with an explicit Public
Health aim. If successful, the interventions could help meet two objectives, improving Public Health
and reducing health inequality. However, those undertaking such interventions need to address a
number of philosophical issues, particularly relating to Political Philosophy. This short paper will
outline and defend an approach based on Sen and Nussbaum's Capability Approach to social justice.

Dr Peter Allmark
Centre for Health and Social Care Research
Sheffield Hallam University
32 Collegiate Crescent
Sheffield S10 2BP

0114 225 5727






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The Ontology of Spirituality: Implications for Nursing Practice

Spirituality is a domain of human experience which, while accounted for in many nursing models and
theories, is poorly addressed in practice. Many reasons have been suggested for this discrepancy,
largely focusing on the extent to which nurses are educated on, or feel comfortable engaging with,
spirituality. However, the obstacles to effective spiritual care run far deeper than this, stemming
from the long-standing obsession of nursing theory with the packaging and labelling of need-types
and the prescription of specific approaches to their fulfilment. This compulsion to 'define and
conquer', a flaw which pervades nursing theory through the evidence based practice movement and
its deification of quantitative research, forms fundamental barriers to nursing's engagement with
spirituality, and sets up healthcare professionals to fail where they might otherwise succeed.
This paper takes a critical view of the prevailing characterisations of spirituality in nursing theory. I
will challenge the assumptions upon which these characterisations are based and argue that they
have been a major contributing factor in the under-addressment of spiritual concerns and
underperformance in spiritual care within nursing. Finally, I will propose a different, more flexible
approach to defining spirituality which might remove some of the barriers to effective spiritual care
by allowing nurses to engage with spirituality on their own and their patients' terms.

Daniel Knight
Affiliation: University of Nottingham
Contact: E: ntyddkn@nottingham.ac.uk






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Believe and care. Study about Spanish midwives Evidence Based Nursing beliefs from Michel de
Certeau's anthropology of believe

Evidence-Based Nursing is the major scientific paradigm of our time in the field of nursing care and
perinatal care from midwives. However, their implementation by professionals is deficient, which
may have significant negative effects on the health of the population and the sustainability of the
Health System.
This paper proposes a research project on the Spanish midwives beliefs about Evidence Based
Nursing, from the fundamental premises of Michel de Certeaus anthropology of believe. Michel de
Certeau was a French jesuit thinker who wrote a large and amazing work in differents fields of
human sciences. His anthropology of believe have two key ideas: first, belief is one of the key drivers
of human action; second, beliefs affect both the epistemic dimension and the social dimension in
peoples life.
The aim of this research is to identify the core beliefs of Spanish midwives about this paradigm, in
order to design interventions which modify those beliefs, thus improving the implementation of
Evidence Based Nursing.
This research will be conducted in different centres of the Spanish Public Health System. Ad hoc
survey will be designed through expert consultation and will be pass to a sample of Spanish
midwives. Results may be an important aid in the evaluation of Evidence-Based Nursing
implementation in Spain, improving the correction of mistakes and generally the implementation of
Evidence Based Nursing.

Juan-Diego Gonzlez-Sanz, PhD, RM, RN.


Health Sciences Education Master (Subdirector)
Dp. 70, Fac. Enfermera
21071 Campus El Carmen
University of Huelva (Spain)
www.uhu.es/edusalud
www.uhu.es/juan.diego

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Please note that there will be a special issue of Nursing Philosophy based on the theme of this
conference: Details below.

Nursing Philosophy: Call for papers for Special Issue
Brave new world? Health, technology and evidence based practice
Guest Editor: Stuart Nairn
Submission deadline 1st June 2015
Body care is at the centre of nursing practice but the nature of that care has been extended beyond
the personal, human-to-human contact, and is increasingly refracted through the medium of
technological/scientific interventions. The way these technologies interact with the human
dimension does, and should, require critical analysis, particularly for nurses who are increasingly
expected to adopt methods and approaches that change the nature of the nurse patient relationship.
Added to this is the way that clinicians/academics/researchers interact with healthcare issues, locally
as well as globally.
There is an established debate and tension within the evidence based practice literature that
illustrates a deep ambivalence about how a holistic approach to clinical practice relates to, enhances,
or is undermined by the new health technologies. These include care pathways, systematic reviews
of knowledge, the enabling/disabling effects of technology and the putative implication of an
empiricist and dehumanising process inherent in these developments. For example, what happens
to the complexity of ethical debates when shaped in the form of arguments based on literature
reviews? These may wittingly or unwittingly serve as a means of translating complex moral issues
into usable clinical regimes that partially mimic meta-analyses. Furthermore we may ask what place
narrative knowledge and qualitative experiences may have in this new world of implementation
technologies? And how do the new interventions of telemedicine and other policy drivers that
emphasise the "hospital-at-home" impact on the ways that nurses carry out healthcare?
Papers are now invited for consideration for a special issue of Nursing Philosophy that develops this
theme. Manuscripts should be prepared and submitted in accordance with the journal author
guidelines and will be subject to the usual peer-review process. When submitting your manuscript
please state that the article is for the special issue: Brave new world? Health, technology and
evidence based practice. The deadline for submission of manuscripts is 1st June 2015.
Authors who would like to discuss their ideas for a paper to be considered for this themed issue are
welcome to contact stuart.nairn@nottingham.ac.uk

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