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This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.

To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.

Hospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.

Pre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.

The analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.

This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.

An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.

The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.

The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution?

The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment.

The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made.

The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.

The complexity and uncertainty of healthcare operations increasingly require agility to safeguard a high quality of care. Using a microfoundations of dynamic capabilities perspective, this study investigates the effects of nurses' implicit voice theories (IVTs) on the behaviors that influence their individual agility.

This research uses quantitative survey data collected from 2,552 Canadian nurses during the fourth wave of the Covid-19 pandemic in the fall of 2021. Structural equation modeling is used to test a conceptual model that hypothesizes the effects of three different IVTs on nurses' creativity, spontaneity, agility and the quality of care they deliver to patients.

The results reveal that voice-inhibiting cognitions (like “suggestions are criticisms for higher-ups”, “I first need a solution or solid data”, and “speaking up has negative repercussions”) negatively impact nurses' creativity and spontaneity in crafting solutions to problems they face daily. In turn, this affects nurses' individual agility as they attempt to adapt to changing circumstances and, ultimately, the quality of care they provide to their patients.

Even if organizations have little control over employees' pre-held beliefs regarding voice, they can still reverse them by developing and nurturing a voice-welcoming culture to boost their workers' agility.

This study combines two theoretical frameworks, voice theory and dynamic capabilities theory, to study how individual-level factors (cognitions and behaviors) contribute to nurses' individual agility and the quality of care they provide to their patients. It answers the recent calls of scholars to study the mechanisms through which healthcare operations can develop and sustain dynamic capabilities, such as agility, and better face the “new normal”.

Various health systems are challenged by a multifaceted crisis of increased service demand and workforce shortages. The effects are devastating and may end up in decreased access to care, poor quality of patient care and extreme demands on the workforce. The introduction of the physician assistant (PA) profession provided an avenue to address such challenges in several countries. In Germany, the integration of PAs has been proceeding slowly.

To understand the integration of the profession in Germany, we conducted 15 expert interviews to reveal how the PA profession is perceived among healthcare experts as well as the barriers and facilitators of integration in inpatient care.

Our results highlight a generally positive perception of PAs, particularly in terms of workload relief and bridging the gap between healthcare professionals. Nonetheless, barriers include resistance from healthcare workers unfamiliar with the PA role, while workforce shortages and collaborative teamwork facilitate integration.

These findings lay the groundwork for potential integration-enhancing strategies in Germany.

This paper aims to explore virtual simulations, merging artificial intelligence with real-world simulations, supporting Canadian armed forces (CAF) junior military leaders (JMLs) leadership development. Our research questions are: (1) How do virtual simulations support CAF junior military leadership development within a globalized and complex environment in the 21st century? (2) Could virtual simulations support a leadership culture change through efficacious “soft skills” training? In this paper, we explore the efficacy of virtual simulations for enhancing or developing leadership in JMLs in the CAF through a four-day pilot project with twenty JMLs (n = 20).

To assess the efficacy of virtual simulations for leadership development, we designed and studied a four-day leadership workshop for JMLs in the CAF using several virtual artificial intelligence leadership role-play simulations developed by McGraw Hill in their smart book textbook (Manning & Curtis, 2022) and several non-virtual in-class simulations for comparison. We selected four twenty to thirty-minute virtual role-play simulations that synergized with the in-person morning leadership workshop. We facilitated the three-hour leadership workshops and virtual/in-class simulations over four consecutive days. We emulated the ELESS model (De Freitas & Routledge, 2013) to assess soft and leadership skills.

The participants (JMLs) reported beneficial learning utility associated with the virtual simulations. Participants also expressed that further utility might be leveraged through virtual simulations incorporating greater complexity with multiple potential outcomes. They also suggested that leadership simulations designed around military situations would prove highly beneficial, something that was outside of the scope of this small pilot project.

Since this phase of our research is a pilot project, we secured a small amount of funding to test our hypothesis that simulations enhance leadership development for JMLs. These funding limitations resulted in several constraints in the research, such as the availability of virtual simulations articulating leadership from a military perspective. However, we believed the assigned organizational leadership simulations in the McGraw Hill Smart Book ecosystem would approximate generic leadership situations enough to test the hypothesis with the JMLs. As a pilot project, our sample size was relatively small (n = 20 JMLs) since participation was voluntary amidst a busy spring season for the JMLs. Since this is a pilot project, we suggest that twenty JMLs are an adequate sampling to test the hypothesis that simulations enhance JML leadership development. We will expand the sample size in the next phase of our research as we work with the CAF to expand the pool of participants to at least forty JML participants (n = 40). We also plan to secure further funding to collaborate with subject matter experts to design virtual simulations based on Canadian military leadership scenarios.

The CAF host robust simulations capabilities for combat training, but have not exploited the potential training and analytical capacity of virtual leadership simulations for leadership development within the CAF. We believe that virtual simulations provide an opportunity for the CAF to effect desired culture change through leadership development that leverages the substantial pedagogical benefits of simulations.

The CAF encountered several detrimental leadership scandals that eroded the reputational capital of the CAF. In the current geo-political climate of an expanding North American Treaty Organization (NATO) and threats from several international actors, the CAF seeks to expand its capabilities by adding and enhancing its human capital. However, the CAF currently experiences a significant gap in its human capital aspirations. There is a unanimous consensus that the endemic traditional culture of the CAF, as expressed in the recent explosive leadership scandals, is a deterrent to recruitment and thus weakens the CAF’s capability. The CAF targets leadership development with new leadership paradigms as pivotal to culture change. The CAF suggests that by enhancing leadership development in the CAF the new cadre of leadership will change the culture of the CAF and thereby enhance the reputational capital of the CAF. It is believed that this rejuvenated culture will lead to greater recruitment and retention, leading to a strengthened military. A strengthened military is important to provide effective support and protection for the Canadian people in these volatile and uncertain times. This expanded capacity will enable the CAF to address external military threats more effectively and also the increasing operations other than war (OOTW), such as the military support of long-term care facilities during COVID-19 or the military’s support in fighting record wildfires and the military’s support in climate change related disasters such as flooding.

The satisfaction measures indicated by the participants are typical evaluative measures of leadership development (Noe, 2023). These satisfaction ratings do not, however, indicate whether training has produced a change in behaviour (Brown, 2022). The implications of these outcomes for leadership education are that role-player simulations are useful leadership education and development tools because they provide a theatre of practice in which mistakes are not detrimental and serve as learning moments (Moore, 2012; Piro and O’Callaghan, 2021; Riotto, 2021). Further, the importance of role-player simulations that closely approximate the sector where leadership is experienced and practiced is perceived to enhance the experience. While the CAF invest in combat related simulations, but leadership development simulations are not as evident in the training and development array. This study seeks to assess their potential value as a leadership development tool within the wider context of character development as a leadership competency.

The purpose of this study is to advance a novel evaluation index system and evaluation approach for ability of older adults in China.

This study constructed a comprehensive older adult ability evaluation index system with 4 primary indicators and 17 secondary indicators. Grey clustering analysis and entropy weight method are combined into a robust evaluation model for the ability of older adults.

The result demonstrates that the proposed grey clustering model is readily available to calculate the disability level of elderly individuals. The constructed index system more comprehensively considers all aspects of the disability of the elderly.

This study provides a quantitative method and a more reasonable index system for the determination of the disability level of the elderly.

Ireland’s ageing population has resulted in an increasing number of older adults living with frailty. Despite growing attention towards older adults’ and health professionals’ perspectives of frailty, occupational therapy research is limited. This study aims to explore occupational therapists’ perceptions of frailty and how their perceptions impact their approach to the assessment and management of frailty.

Using qualitative descriptive design, 19 occupational therapists working with older adults participated in online focus groups. Data were analysed using thematic analysis.

Perceptions of occupational therapists were constructed into three main themes: conceptualising frailty; management of frailty; and advancing frailty practice. Findings indicate that occupational therapists perceived frailty as a multidimensional concept but highlight a reluctance to use frailty terminology with patients. Findings also suggest that although occupational therapists are involved in provision of care for older adults living with frailty, the profession’s scope is not optimised in the assessment and management of frailty.

Findings provide insight into occupational therapists’ perceptions of frailty. Development of a shared understanding of frailty between clinicians and patients and enhancement of undergraduate frailty education are recommended to progress occupational therapy’s role in frailty management.