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The aim of this study is to investigate why many immigrants end up in uncertain employment.

The paper describes a qualitative case study of three nursing homes in Oslo (Norway), which investigates immigrant employment and recruitment-related practices. Practice theory is used as the theoretical and methodological framework. The study takes an ethnographic approach and combines participant observation, semi-structured shadowing, qualitative interviews and document review.

The recruitment practice, as it is accomplished, is different from the practice that is prescribed in the formal recruitment policy. The configuration of the recruitment-related practices locks in the recruitment practice and reproduces the social order. The net effect of the recruitment-related practices is that immigrant employees remain in uncertain employment.

A practice-theoretical approach, analyzing organizational practices as they are accomplished in space and time and not as isolated activities defined by their purpose, provides a richer understanding of the complexity and connectedness of organizational practices. Combining practice theory and institutional perspectives, the paper demonstrates how normative and regulative mediators order and align related practices. The study demonstrates the importance of examining the configuration of practices to understand how the net effect of related practices affects those who dwell in them, in this case immigrants pursuing secure and stable employment.

This study contributes to the field of diversity management by using practice theory to explain why measures for enhancing immigrant employment may not have the intended effect because they are interwoven in a nexus of practices with conflicting interests that (un)intentionally undermine the measures.

This article proposes a new disruptive innovation in healthcare through the development of a physician assistant business model, which can be most readily applied in vulnerable rural health care settings.

This study reviews the current state of the health care system in terms of physician assistant utilization and primary care shortages in rural communities. The study proposes that the physician assistant-owned and -operated primary care business represents a disruptive innovation, via the application of the five principles of Clayton Christensen’s (1997) thesis on disruptive innovation.

Considering the current state of the health care industry, the study logically defends the proposed model as a disruptive innovation in that it: focuses on an underserved market, has lower costs, has few competitors, offers high quality and provides a sustainable competitive advantage.

The physician assistant business model is a viable solution for providing primary care for rural communities with educational, financial, transportation and other resource limitations.

This is a unique application of the theory of disruptive innovation, which illustrates how a new business model can solve a chronic shortage in primary care, especially in underserved populations.

As a result of demographic changes, older people are increasingly living at home, with multi-morbidity and complex care needs. This calls for enhanced integration of homecare nursing and social services. The purpose of this paper is to describe the clinical collaboration, scope and impact of integration from the perspective of staff in a setting identified as fully integrated.

In this qualitative study, data consisted of interviews with managers and care workers in social services and homecare nursing (n=14) in daily clinical collaboration, followed by five focus group discussions (n=28). Data were analysed using framework analysis.

Although the homecare services studied were ostensibly fully integrated, the study showed that the process of integration was incomplete. Interdisciplinary coordination between nursing and social services team managers was described as strong and efficient, but weaknesses were identified in collaboration between care workers. They lacked acquaintance with one another, opportunities for communication and knowledge of the contribution of members of other teams. They felt unclear about their own role in coordinated teamwork and lacked a shared vision.

This paper’s originality lies in the model of integrated care studied and its focus on actual care practices. The findings highlight that integration does not automatically permeate between different levels of service. Time and space must be allowed for conversations between health and social service teams to promote integration.

Following the development of a service that consisted of a “single point of contact” to coordinate end-of-life care (EoLC), including EoLC facilitators and an urgent response team, we aimed to explore whether the provision of coordinated EoLC would support patients being cared or dying in their preferred place and avoid unwanted hospital admissions.

Using a realist evaluation approach, the authors examined “what worked for whom, how, in what circumstances and why”. Multiple data were collected, including activity/performance indicators, observations of management meetings, documents, satisfaction survey and 30 interviews with service providers and users.

Advance care planning (ACP) increased through the first three years of the service (from 45% to 83%) and on average 74% of patients achieved preferred place of death. More than 70% of patients avoided an emergency or unplanned hospital admission in their last month of life. The mechanisms and context identified as driving forces of the service included: 7/7 single point of contact; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations.

This was a service evaluation and the outcomes are related to the specific context and mechanisms. However, findings can be transferable to similar settings.

“Single point of contact” services that offer coordinated EoLC can contribute in supporting people to be cared and die in their preferred place.

This paper provides an evaluation of a novel approach to EoLC and creates a set of hypotheses that could be further tested in similar services in the future.

The purpose of this paper is to present the findings of a study considering the application of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Practitioners from a range of professions were recruited to provide their views of how to respond to a variety of scenarios. GPs, nurses, social workers, physio/occupational therapists and care assistants were recruited to participate.

This study used the Delphi method to elicit participant views and generate consensus of opinion. The Delphi method recommends a large sample for heterogeneous groups, and round one had 98 participants from six different professional groups.

Participants did not respond consistently to the scenarios, but disagreed most significantly when patient decisions conflicted with clinical advice, and when to conduct a capacity assessment. These responses suggest that clinical responses vary significantly between individuals (even within settings or professions), and that the application of Mental Capacity Act (MCA) is complicated and nuanced, requiring time for reflection to avoid paternalistic clinical interventions.

Previous studies have not used a Delphi method to consider the application of MCA/DoLS. Because of this methods focus on developing consensus, it is uniquely suited to considering this practice issue. As a result, these findings present more developed understanding of the complexity and challenges for practitioner responses to some relatively common clinical scenarios, suggesting the need for greater clarity for practitioners.

This paper aims to discuss a new source of data detailing state level occupational licensing requirements for 50 professions.

This study's research team gathered state level licensing requirements for 50 profession in all 50 states and DC from 2022 to 2023. The authors include the type of regulation, entry requirements like fees, education, training, good moral character provisions and renewal requirements. The authors include Standard Occupational Classification industry codes to allow researchers to merge it with other publicly available data sources. Finally, the authors present descriptive statistics and provide a comparison of licensing requirements for audiologists, an occupation with variation in entry requirements.

The mean number of the 50 professions licensed in states is 36. On average, these professions require a bachelor's degree, $271 in licensing fees and 26 h of continuing education to renew. For the audiologist profession, there is considerable variation between states in entry requirements like fees and education.

Despite a large body of work on occupational licensing, data limitations still exist. Most analysis focuses on whether a profession is licensed or not. However, there is considerable variation between states for the same profession, providing an avenue for work estimating the effects of specific licensing requirements. A new source of data is introduced and discussed for researchers to use in future analyses of occupational licensing.

Health ambassadors are co-workers assigned to facilitate healthy choices amongst the ambassadors'' colleagues and are increasingly used in workplace health promotion. In a municipality in the southern region of Denmark, occupational health and safety (OHS) representatives were appointed as health ambassadors to facilitate the development of healthy lifestyle initiatives at the ambassadors' workplace and the uptake of various health offers from the municipality's workplace health programme amongst the ambassadors' colleagues. The aim of this study was to understand how employees and managers from the municipality experienced the health ambassador-facilitated implementation of the health programme.

The study was designed as an interview study with (n = 13) semi-structured interviews. Using purposeful sampling, the authors invited participants who held different positions (e.g. managers and regular employees) on two different work teams in the municipality. The work teams (a construction team and a healthcare team) differed in gender profile and work tasks but were both categorised as physically heavy work. Malterud's systematic text condensation was used to devise the strategy for the analysis.

The authors' findings show that the employees considered health a private matter that the workplace should not interfere with, and this challenged the implementation of the health programme. Secondly, the health ambassadors were not properly trained to facilitate health initiatives amongst the ambassadors' colleagues; instead, the managers were the driving force in the implementation of health initiatives.

The study provides useful insights into the processes of implementing health in the workplace and emphasises the importance of involving employees in design and planning of initiatives for workplace health promotion.

In many countries, schools move toward healthier canteen assortments by limiting the supply of unhealthy foods. The question arises whether this gives any undesirable side effects with students (e.g. compensation in purchases from school to outside retailers, reactance) and how to handle these so that operating school canteens remains financially viable. The purpose of this paper is to identify perspectives toward healthy school food assortments held by vocational education students and professionals within secondary and vocational schools with responsibility for school food policy (e.g. school canteen workers, teachers, school directors) in the Netherlands.

Four focus groups were conducted with students at a vocational school (n=25 in total). A semi-structured interview guide was used to conduct discussions. The interview guide also included three school canteen scenario’s (A: 100 percent healthy food, B: 50 percent healthy/50 percent unhealthy foods and C: 100 percent unhealthy food) and a set of nine intervention strategies. A brief survey included questions on the same three scenario’s and nine intervention strategies. A web-based survey was conducted among 68 professionals responsible for school food policy and included their evaluation of the same canteen scenarios and interventions. Survey data were analyzed using descriptive statistics and content analysis. Content analysis was done on the qualitative data.

School food professionals were highly supportive of Scenario A (100 percent healthy food), as this formed a better fit with their policies and was believed to stronger encourage healthy eating. They did worry about financial feasibility given lower affordability and student reluctance to accept the assortment. Students were less in favor of Scenario A. Students discussed getting value for money and remaining freedom to make unhealthy choices. The authors discuss implications for policy makers who aim to implement measures to improve young people’s eating habits.

This study contributes to the literature on creating healthier school food environments. This study uniquely examines a healthier school canteen from a viability perspective, including the views of students as primary customers. Given the need to progressively increase the number of foods complying to dietary guidelines in canteen assortments, this study provides insights into how and why assortment changes best can be implemented.

How to improve healthcare for the ageing population is attracting academia attention. Emerging technologies (i.e. robots and intelligent agents) look relevant. This paper aims to analyze the role of cognitive assistants as boundary objects in value co-creation practices. We include the perceptions of the main actors – patients, (in)formal caregivers, healthcare professionals – for a fuller network perspective to understand the potential overlap between boundary work and value co-creation practices.

We adopted a grounded approach to gain a contextual understanding design to effectively interpret context and meanings related to human–robot interactions. The study context concerns 21 health solutions that had embedded the Watson cognitive platform and its adoption by the youngest cohort (50–64-year-olds) of the ageing population.

The cognitive assistant acts as a boundary object by bridging actors, resources and activities. It enacts the boundary work of actors (both ageing and professional, caregivers, families) consisting of four main actions (automated dialoguing, augmented sharing, connected learning and multilayered trusting) that elicit two ageing value co-creation practices: empowering ageing actors in medical care and engaging ageing actors in a healthy lifestyle.

We frame the role of cognitive assistants as boundary objects enabling the boundary work of ageing actors for value co-creation. A cognitive assistant is an “object of activity” that mediates in actors' boundary work by offering novel resource interfaces and widening resource access and resourceness. The boundary work of ageing actors lies in a smarter resource integration that yields broader applications for augmented agency.

Purpose: As specific emotional arenas, hospitals are characterized by the interweaving of various emotional requirements, arising from different sources of norms, rules, or guidelines. This study aims to highlight an often-overlooked dimension of emotional labor in healthcare by describing the coexistence of emotional rules (i.e. feeling and/or display rules) through a multilevel perspective (institutional level, cluster/department level, service level, ward level, professional level). Study Design/Methodology/Approach: These emotional requirements for nurses and nursing assistants are investigated through three sets of data (observation, interviews, and internal documents) in a French public hospital, focusing on two hospital services: three long-term care units (primary field of investigation), and five adult medical emergency wards (secondary field of investigation). Findings: The results of the analysis show the pervasive nature of emotional requirements which are intertwined and more or less implicit/explicit according to the level analyzed. In addition to organizational rules, professional and social emotional rules contribute to shaping emotional requirements, particularly through rules of “empathetic expression” and those of retenue bienveillante. Research Limitations/Implications: This research has contributed to showing the dynamic nature of emotional requirements and their appropriation and modulation by healthcare professionals. The qualitative methodology used allows for unique insights but limits the generalization of results. Originality/Value: This research has addressed various gaps in the existing literature by describing emotional requirements through a multilevel analysis, by outlining a set of rules that had not been previously described (retenue bienveillante) and by including the population of nursing assistants as well as nurses in a study on hospital emotional labor. Future research could envisage spatial analysis of emotional labor to help better understand emotional requirements' variability according to emotionalized zones.