Older Individuals' Experiences of Medication Management and Care After Discharge from Hospital: An Interview Study

PURPOSE

To develop an in-depth understanding of older individuals' attitudes and perceptions of medication management and care after discharge from hospital-to-home.

PATIENTS AND METHODS

A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6-12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis.

RESULTS

Among the 15 respondents, mean age was 83.5 years (range 75-95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry).

CONCLUSION

The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.

Digitalization and school leadership: on the complexity of leading for digitalization in school

Purpose

Digitalization has permeated society and schools. In this process, focus has turned to the importance of school leaders in their leadership for digitalization. The purpose of this paper is to explore how school leaders understand digitalization and the digital competencies needed in leading for digitalization in Swedish schools.

Design/methodology/approach

Open questions from reflective learning journals (n=32) and interviews (n=8) conducted with school leaders were used to explore how school leaders understand digitalization and the digital competencies needed in leading for digitalization.

Findings

The findings show that school leaders see digitalization as a wide and complex concept including technical, pedagogical, administrational and organizational challenges at all levels of the school organization.

Practical implications

It appears that the role of the school leader, as a complex task, has become more complex as a result of digitalization. How time, resources and professional development are made available to support school leaders in their work with leadership for digitalization in order to support teachers’ and students’ learning.

Originality/value

This paper contributes to the area of school leadership and digitalization. The research contribution is of interest for school leaders and school organizers striving to implement and advance digitalization in schools. This also concerns the prioritization of digitalization as one of many important areas in schools as organizations.

Talking about digital textbooks. The teacher perspective

Purpose

An increasing amount of students’ and teachers’ work in the classroom involves digital technologies such as tablets and laptop computers. The purpose of this paper is to gain insight into the possibilities and challenges related to teachers’ use of digital textbooks and, through this work, the conditions for technology-enhanced learning (TEL).

Design/methodology/approach

This study was based on interviews with two teachers. In the analysis, The Ecology of Resources Model (Luckin, 2010) was used.

Findings

The findings of this study show that teachers see challenges in finding time to review digital textbooks and support the work with the textbooks in the classroom. However, the teachers in this study prioritize this work, seeing it as providing structure and improved accessibility for students.

Practical implications

The findings of this study point toward the need to support teachers in their work with reviewing and using digital textbooks, as well as other digitalized resources. How schools as organizations can support teachers’ activities, both individually and collaboratively, will be important. If this work is supported it may, in turn, have impact on TEL and promoting students’ use of digital textbooks and improving student outcomes.

Originality/value

This small study provides interesting insights into how teachers prioritize their work with digital textbooks to, despite challenges related to time, individualize and support students’ work with digital textbooks and other digital resources. Research on teachers’ use of digital textbooks in practice is limited.

Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.