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Garratt S, Dowling A, Manias E. Medication administration in aged care facilities: A mixed-methods systematic review. J Adv Nurs 2024. [PMID: 38973246 DOI: 10.1111/jan.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024]
Abstract
AIM(S) To synthesize aged care provider, resident and residents' family members' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident-centredness in aged care facilities. DESIGN A mixed-methods systematic review. PROSPERO ID CRD42023426990. DATA SOURCES The AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023. REVIEW METHODS Included studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta-analysis were performed. RESULTS One hundred and twenty-eight studies were included (33 qualitative, 85 quantitative and 10 mixed-methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication-related decision-making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28-0.50, p < .001). CONCLUSIONS Medication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents' autonomy and input by aged care workers and providers is needed to address medication administration's interpersonal and psychosocial aspects. New directions for future research should examine the decision-making behind dose form modification, aged care workers' definitions of medication omission and practical methods to support residents' and their family members' engagement during medication administration. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE It is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision-making, particularly concerning dose form modification, covert administration and medication omissions. Resident-centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care. IMPACT What Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident's family members to understand the challenges, interpersonal opportunities and risks during medication administration. What Were the Main Findings? There is a lack of empirical evidence around resident-centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision-making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident-centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care. REPORTING METHOD This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to this systematic review.
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Affiliation(s)
- Stephanie Garratt
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Alison Dowling
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
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Yoshimi T, Kato K, Tsuchimoto S, Mizuguchi N, Aimoto K, Itoh N, Kondo I. Investigating proficiency using a lift-type transfer support device for effective care: comparison of skilled and unskilled nursing homes. Disabil Rehabil Assist Technol 2024; 19:841-850. [PMID: 36178527 DOI: 10.1080/17483107.2022.2128444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/22/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of the study was to investigate whether the sustained use of the "Hug," a "hugging" type robotic transfer support device, could increase the level of quality of care. METHODS The effect of proficiency on using the device was examined in terms of time spent for transfer, ratio of transfers using the device, and range of targets. The results were compared between skilled care facilities that had used the device for >24 months and unskilled facilities. RESULTS The time spent for transfer at the unskilled facility was 4.6 min (2nd week after introduction), was reduced to 3.0 min (5th week), and 1.5 min at the skilled facility. The usage ratio at the unskilled facility was 13% and 30% (2nd and 5th week, respectively), while it was 97% in the skilled facility. Further, we identified wider in the range of target care recipients in the skilled facility. CONCLUSION It takes time to master the use of Hug; however, its use was associated with many positive aspects, especially from the perspective of care recipients, e.g., better care, use of their own legs, and reduced time for transfers. These findings suggest that the widespread use of Hug would improve the quality of care.IMPLICATIONS FOR REHABILITATIONLess physically burdened on the caregivers using Hug, they can afford to talk to the care recipients.Using recipient's own legs during transfers, it prevents leg muscle disuse.As reduced time for transfers, recipients will have more opportunities to get out of bed.
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Affiliation(s)
- Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shohei Tsuchimoto
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nobuaki Mizuguchi
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keita Aimoto
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
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Kang YJ, Mueller CA, Gaugler JE, Mathiason Moore MA, Monsen KA. Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system. J Am Med Inform Assoc 2023; 30:1837-1845. [PMID: 37352394 PMCID: PMC10586029 DOI: 10.1093/jamia/ocad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. METHODS An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. RESULTS Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. CONCLUSIONS Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.
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Affiliation(s)
- Yu Jin Kang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Twin Cities, Minnesota, USA
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Ausserhofer D, Tappeiner W, Wieser H, Serdaly C, Simon M, Zúñiga F, Favez L. Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study. BMC Geriatr 2023; 23:347. [PMID: 37268879 DOI: 10.1186/s12877-023-04022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/06/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes. PURPOSE The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession). METHODS This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. RESULTS Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession. CONCLUSION This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession.
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Affiliation(s)
- Dietmar Ausserhofer
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Waltraud Tappeiner
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
| | - Heike Wieser
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
| | - Christine Serdaly
- Serdaly&Ankers Snc, 210 Route de Florissant, 1231, Conches, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Lauriane Favez
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland.
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, Yverdon-les-Bains, Switzerland.
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Nelson Chang NC, Leecaster M, Fridkin S, Dube W, Katz M, Polgreen P, Roghmann MC, Khader K, Li L, Dumyati G, Tsay R, Lynfield R, Mahoehney J, Nadle J, Hutson J, Pierce R, Zhang A, Wilson C, Haroldsen C, Mulvey D, Reddy SC, Stone ND, Slayton RB, Thompson ND, Stratford K, Samore M, Visnovsky LD. Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions. J Am Med Dir Assoc 2023; 24:735.e1-735.e9. [PMID: 36996876 DOI: 10.1016/j.jamda.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities. DESIGN 2 cross-sectional visits. SETTING AND PARTICIPANTS Four CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care. METHODS Room-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use). RESULTS We recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates. CONCLUSIONS AND IMPLICATIONS Resident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns.
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Bail K, Merrick E, Gibson D, Hind A, Strickland K, Redley B. A co-designed health information system implementation into residential aged care: A mixed-method evaluation. J Nurs Scholarsh 2023; 55:521-535. [PMID: 36366792 DOI: 10.1111/jnu.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. METHODS Three-stage, mixed-methods participatory action research, concurrent with the natural experiment of a co-designed health information system implementation into a 169-bed aged care home in Australia. Data were collected pre-, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. RESULTS Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident-focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the 'delicacies of dignity'. CONCLUSION Implementation of a health information system into a residential aged care facility was associated with improved resident-focused care and staff efficiency. CLINICAL RELEVANCE Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co-design strategies can enhance both effectiveness and success of technology implementation into residential aged care.
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Affiliation(s)
- Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Eamon Merrick
- Auckland University of Technology, Auckland, New Zealand
| | - Diane Gibson
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Alicia Hind
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Karen Strickland
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research, Institute for Health transformation, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Bail K, Gibson D, Hind A, Strickland K, Paterson C, Merrick E, Gibson J, Kozlovskaia M, O'Dea A, Smith B, Redley B. 'It enables the carers to see the person first': Qualitative evaluation of point-of-care digital management system in residential aged care. J Clin Nurs 2023; 32:174-190. [PMID: 35285557 PMCID: PMC10078649 DOI: 10.1111/jocn.16285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). BACKGROUND Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. DESIGN Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation. METHODS Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. RESULTS 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. CONCLUSION A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care. RELEVANCE TO CLINICAL PRACTICE Nurses, carers, administrators, and advocates can support the co-design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision.
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Affiliation(s)
- Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Diane Gibson
- University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Alicia Hind
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Karen Strickland
- University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Eamon Merrick
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jo Gibson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Maria Kozlovskaia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Amy O'Dea
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Bridget Smith
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Gibson D, Willis E, Merrick E, Redley B, Bail K. High demand, high commitment work: What residential aged care staff actually do minute by minute: A participatory action study. Nurs Inq 2022:e12545. [PMID: 36529955 DOI: 10.1111/nin.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
This article explores staff work patterns in an Australian residential aged care facility and the implications for high-quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector.
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Affiliation(s)
- Diane Gibson
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Eileen Willis
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Eamon Merrick
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, Australia
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Kalne PS, Mehendale AM. The Purpose of Time-Motion Studies (TMSs) in Healthcare: A Literature Review. Cureus 2022; 14:e29869. [DOI: 10.7759/cureus.29869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
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Kalne PS, Kalne PS, Mehendale AM. Acknowledging the Role of Community Health Workers in Providing Essential Healthcare Services in Rural India-A Review. Cureus 2022; 14:e29372. [PMID: 36304347 PMCID: PMC9584634 DOI: 10.7759/cureus.29372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
In underserved communities, the community health worker (CHW) concept has been employed to improve health and lessen unfavourable health consequences. In India's rural healthcare delivery system, auxiliary nurse midwives (ANMs), accredited social health activists (ASHA workers), and Anganwadi workers (AWWs) are the primary field-level frontline officials who come into direct contact with the population. They bear a large portion of the burden of carrying out health services. This review investigated the various contributions made by these CHWs, ANMs, ASHA workers, and AWWs to the advancement of basic healthcare in Indian rural areas. The goal of reviewing this paper was to learn more about what CHWs do to provide the target demographic with high-quality healthcare. A thorough literature search was conducted using crucial databases including PubMed, Google, and Google Scholar. Recent studies were examined to determine how well CHWs perform essential healthcare services in low and middle-income nations. Numerous studies demonstrate how their work has a good effect on society. The length of time CHWs spend at work each day and how well they perform as a whole depends on several variables. This review study showed that, globally, there is a growing interest in CHWs' performance. In terms of incentives, pay, and training expenses, CHWs are thought to be a more affordable option than other types of health workers. They are recognised as the main factors in providing promotive, preventive, curative and rehabilitative healthcare services, achieving enhanced neonatal and maternal health and the development of children and adolescents. The current review also examined previous studies on the work done by CHWs and their potential benefits for enhancing primary healthcare in rural India. It focused on the routine work done by these health workers to increase service accessibility and access to high-quality healthcare, particularly for individuals living in rural areas. Hence, it is necessary to evaluate the functions and general status of community health workers (CHWs), as well as recognise their role, to improve their efficiency in providing basic healthcare services to society and make necessary changes in the future.
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Kato K, Yoshimi T, Aimoto K, Sato K, Itoh N, Kondo I. Reduction of multiple-caregiver assistance through the long-term use of a transfer support robot in a nursing facility. Assist Technol 2022:1-8. [PMID: 35320681 DOI: 10.1080/10400435.2022.2039324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The long-term use of transfer support robots in nursing facilities is an important option for improving the efficiency of care work. The "Resyone" transfer support robot is a combination of an electric care bed and a wheelchair, and the wheelchair half of the bed can be detached at the touch of a button. The purpose of this study was to investigate how the long-term use of Resyone would improve the performance of transfer assists, such as reducing the need for multiple caregivers. One Resyone was installed in a nursing facility in Japan and 17 caregivers used it for more than 11 months. The time and number of caregivers required for each transfer assist were surveyed for three 1-week periods: 1 week before (Phase 1) and at 3 weeks (Phase 2) and 11 months (Phase 3) after the introduction of Resyone. In Phase 1, approximately 60% of all transfer assists were performed by two caregivers, but in Phase 2, this was reduced to approximately 20%, and finally, in Phase 3, all transfer assists were performed by a single caregiver. These results suggested that the long-term use of Resyone was associated with improved work efficiency in transfer assistance in a nursing facility.
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Affiliation(s)
- Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keita Aimoto
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Sato
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
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Kato K, Yoshimi T, Tsuchimoto S, Mizuguchi N, Aimoto K, Itoh N, Kondo I. Identification of care tasks for the use of wearable transfer support robots - an observational study at nursing facilities using robots on a daily basis. BMC Health Serv Res 2021; 21:652. [PMID: 34225718 PMCID: PMC8256590 DOI: 10.1186/s12913-021-06639-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce the physical burden of caregivers, wearable transfer support robots are highly desirable. Although these robots are reportedly effective for specific tasks in experimental environments, there is little information about their effectiveness at nursing care facilities. The aim of this study was to identify care tasks and operations suitable for the use of these robots among caregivers in nursing facilities where these robots have been in use on a daily basis. METHODS A 1-min observational time-motion analysis was conducted to examine care tasks and operations in two nursing facilities where wearable transfer support robots, namely Muscle Suit or HAL® Lumbar Type for Care Support, have been used routinely on a daily basis for more than 24 months. RESULTS Analysis of the care tasks and their time ratio while wearing the equipment revealed that both robots were used conspicuously for direct care in over 70% of transits, especially during transfer assistance and toileting care. Furthermore, these robots were used intensively in the morning along with wake-up calls to care recipients, where pre-assigned wearers used them as part of their "routine work." CONCLUSIONS We found that these wearable transfer support robots enabled effective performance of care tasks and operations in nursing facilities where these robots have been used on a daily basis for an extended period of time. These results may lead to the effective implementation and sustained operation of other types of care robots in the future. TRIAL REGISTRATION UMIN Clinical Trials Registry no. UMIN000039204 . Trial registration date: January 21, 2020. Interventional study. Parallel, non-randomized, single blinded.
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Affiliation(s)
- Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan.
| | - Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Shohei Tsuchimoto
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Nobuaki Mizuguchi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Keita Aimoto
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Naoki Itoh
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan.,Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
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13
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So KH, Ting CW, Lee CP, Lam TTN, Chiang SC, Cheung YT. Medication Management Service for Old Age Homes in Hong Kong Using Information Technology, Automation Technology, and the Internet of Things: Pre-Post Interventional Study. JMIR Med Inform 2021; 9:e24280. [PMID: 33565993 PMCID: PMC7904397 DOI: 10.2196/24280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Innovation in technology and automation has been increasingly used to improve conventional medication management processes. In Hong Kong, the current practices of medication management in old age homes (OAHs) are time consuming, labor intensive, and error prone. To address this problem, we initiated an integrated medication management service combining information technology, automation technology, and the Internet of Things in a cluster network of OAHs. Objective This pilot study aimed to evaluate the impact of the medication management program on (1) medication management efficiency, (2) medication safety, and (3) drug wastage in OAHs. We compared the time efficiency and the reductions in medication errors and medication wastage in OAHs before and at least 2 weeks after the implementation of the program. Methods From November 2019 to February 2020, we recruited 2 OAHs (serving 178 residents) in Hong Kong into the prospective, pre-post interventional study. The interventional program consisted of electronic medication profiles, automated packaging, and electronic records of medication administration. Using 3-way analysis of variance, we compared the number of doses prepared and checked in 10-minute blocks before and after implementation. We received anonymous reports of medication errors from OAH staff and analyzed the results with the Fisher exact test. We also calculated the quantity and cost of wasted medications from drug disposal reports. Results The number of doses prepared and checked in 10-minute blocks significantly increased postimplementation (pre: 41.3, SD 31.8; post: 70.6, SD 22.8; P<.001). There was also a significant reduction in medication errors (pre: 10/9504 doses, 0.1%; post: 0/5731 doses; P=.02). The total costs of wasted medications during January 2020 in OAH 1 (77 residents) and OAH 2 (101 residents) were HK $2566.03 (US $328.98) and HK $5249.48 (US $673.01), respectively. Conclusions Our pilot study suggested that an innovative medication management program with information technology, automation technology, and Internet of Things components improved the time efficiency of medication preparation and medication safety for OAHs. It is a promising solution to address the current limitations in medication management in OAHs in Hong Kong.
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Affiliation(s)
- Kei Hong So
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China).,Hong Kong Pharmaceutical Care Foundation, Hong Kong, Hong Kong (China)
| | - Cheuk Wun Ting
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Chui Ping Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Teddy Tai-Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Sau Chu Chiang
- Hong Kong Pharmaceutical Care Foundation, Hong Kong, Hong Kong (China)
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
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14
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Chen EYH, Bell JS, Ilomäki J, Corlis M, Hogan ME, Caporale T, Van Emden J, Westbrook JI, Hilmer SN, Sluggett JK. Medication administration in Australian residential aged care: A time-and-motion study. J Eval Clin Pract 2021; 27:103-110. [PMID: 32285584 DOI: 10.1111/jep.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE/AIM Medication administration is a complex and time-consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. METHOD A time-and-motion study was conducted in three South Australian RACFs. A representative sample of 57 scheduled medication administration rounds in 14 units were observed by a single investigator. The rounds were sampled to include different times of day, memory support units for residents living with dementia and standard units, and medication administration by registered and enrolled nurses. Medications were administered from pre-prepared medication strip packaging. The validated Work Observation Method By Activity Timing (WOMBAT) software was used to record observations. RESULTS Thirty nurses were observed. The average time spent on scheduled medication administration rounds was 5.2 h/unit of average 22 residents/day. The breakfast medication round had the longest duration (1.92 h/unit). Resident preparation, medication preparation and provision, documentation, transit, communication, and cleaning took an average of 5 minutes per resident per round. Medication preparation and provision comprised 60% of overall medication round time and took significantly longer in memory support than in standard units (66 vs 49 seconds per resident per round for preparation, 79 vs 58 for provision; P < .001 for both). Almost half (42%) of tablets/capsules were crushed in memory support units. The time taken for medication administration was not significantly different among registered and enrolled nurses. CONCLUSIONS Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed.
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Affiliation(s)
- Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | | | | | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
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Yoshimi T, Kato K, Tsuchimoto S, Mizuguchi N, Kondo I. Increase of verbal communication by long-term use of transfer-support robots in nursing facilities. Geriatr Gerontol Int 2020; 21:276-277. [PMID: 33331112 DOI: 10.1111/ggi.14113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shohei Tsuchimoto
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nobuaki Mizuguchi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
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Sluggett JK, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Keen C, Hopkins R, Ooi CE, Hilmer SN, Hughes GA, Luu A, Nguyen KH, Comans T, Edwards S, Quirke L, Patching A, Bell JS. Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1114-1120.e4. [PMID: 32179001 DOI: 10.1016/j.jamda.2020.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities. DESIGN A nonblinded, matched-pair, cluster randomized controlled trial. SETTING AND PARTICIPANTS Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs). METHODS The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models. RESULTS Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (-0.36, 95% confidence interval -0.63 to -0.09, P = .01). No significant changes in secondary outcomes or harms were observed. CONCLUSIONS AND IMPLICATIONS One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities.
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Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Claire Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Ria Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Georgina A Hughes
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Andrew Luu
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kim-Huong Nguyen
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Tracy Comans
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Susan Edwards
- Drug & Therapeutics Information Service, GP Plus Marion, South Australia, Australia
| | - Lyntara Quirke
- Consumer Representative, Dementia Australia, Scullin, Australian Capital Territory, Australia
| | - Allan Patching
- Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Qian S, Yu P, Bhattacherjee A. Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study. Int J Nurs Stud 2019; 98:9-18. [PMID: 31238234 DOI: 10.1016/j.ijnurstu.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity. OBJECTIVES This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work. DESIGN Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor. SETTING Eight care units in two long-term care facilities in Australia. PARTICIPANTS Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study. METHODS Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review. RESULTS Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility. CONCLUSIONS Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.
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Affiliation(s)
- Siyu Qian
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales 2522, Australia; Digital Health and Digital Aged Care, Smart Infrastructure, University of Wollongong, Wollongong, New South Wales 2522, Australia.
| | - Ping Yu
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales 2522, Australia; Digital Health and Digital Aged Care, Smart Infrastructure, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - Anol Bhattacherjee
- Information Systems & Decision Sciences, Muma College of Business, University of South Florida, Tampa, FL 33620, USA
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