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Martin D, Ivanova D, Simonsen TPH. Moving Beyond Clinical Imaginaries: Technogeographies of the Everyday Urban. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-024-09872-y. [PMID: 39002097 DOI: 10.1007/s10912-024-09872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
In this paper, we analyse the intersections between care and place in mundane spaces not explicitly designed for the provision of care, and where digital technologies are used to mediate ecologies of distress in the city. We locate our analysis alongside studies of how digital technologies impact the experience of care within non-clinical spaces, whilst noting that much research on the use of technologies for care remains haunted by clinical imaginaries. Bringing together ideas of multi-sited therapeutic assemblages, technogeographies of care, and how places-by-proxy can act as conduits for care, we explore an example of an online app being used in public space to manage experiences of anxiety in an everyday urban environment. We reflect on this illustrative example to trace the movement of care as it is mediated through digital technologies-out of the clinic, beyond the home, and into the ordinary spaces of the city. We conclude that the entanglements of digital technologies and ordinary urban places prompt us to entirely reconsider questions of the where of care.
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Affiliation(s)
| | - Dara Ivanova
- Department of Architecture, TU Delft, Delft, The Netherlands
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2
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Dunham M, Bacon L, Cottom S, McCrone P, Mehrpouya H, Spyridonis F, Thompson T, Schofield P. Chronic pain through COVID. FRONTIERS IN PAIN RESEARCH 2022; 3:937652. [PMID: 36341152 PMCID: PMC9629777 DOI: 10.3389/fpain.2022.937652] [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: 05/06/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To identify good practice in the community management of chronic pain, and to understand the perspective of a group of healthcare service users towards the management of chronic pain using technology during the COVID-19 pandemic. Methods Forty-five people, recruited via social media and Pain Association Scotland, participated in three focus groups hosted over Zoom. Focus groups were conducted using semi-structured questions to guide the conversation. Data were analysed using Ritchie / Spencer's Framework Analysis. Results The participants shared observations of their experiences of remotely supported chronic pain services and insights into the potential for future chronic pain care provision. Experiences were in the majority positive with some describing their rapid engagement with technology during the COVID pandemic. Conclusion Results suggest there is strong potential for telehealth to complement and support existing provision of pain management services.
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Affiliation(s)
- M. Dunham
- School of Health / Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Correspondence: M. Dunham
| | - L. Bacon
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - S. Cottom
- Pain Association Scotland, Perth, United Kingdom
| | - P. McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - H. Mehrpouya
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - F. Spyridonis
- Department of Computer Science, Brunel University London, Uxbridge, United Kingdom
| | - T. Thompson
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - P. Schofield
- University of Plymouth, Plymouth, United Kingdom
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Winkler M. Rhoads Research Lecture-Reflections from a clinician scientist: The power of patient voice. JPEN J Parenter Enteral Nutr 2022; 46:1751-1760. [PMID: 35880830 DOI: 10.1002/jpen.2433] [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: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/07/2022]
Abstract
Qualitative research is a scientific method that systematically examines a phenomenon with the purpose of understanding and describing human experiences, exploring meanings and patterns, and illuminating the patient's lived experience. The Rhoads Research Lecture will highlight the power of patient voice and its importance to clinicians and researchers in addressing key clinical needs that are most relevant to patients receiving nutrition support. The subjective experience of patients who are dependent on home parenteral nutrition (HPN) will be shared, including how patients view HPN, define their quality of life (QOL), and describe the meaning of food in the context of being intravenously fed. As a result of these exploratory studies, the HPN patient-reported outcome questionnaire (HPN-PROQ) was developed and validated. Incorporating the HPN-PROQ in practice empowers patients to identify and communicate QOL and HPN therapy goals and clinicians to delve deeper in the provision of holistic and empathetic care.
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Affiliation(s)
- Marion Winkler
- Department of Surgery/Nutritional Support Service, Rhode Island Hospital, Providence, Rhode Island, USA.,The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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4
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Cantin-Garside KD, Nussbaum MA, White SW, Kim S, Kim CD, Fortes DMG, Valdez RS. Understanding the experiences of self-injurious behavior in autism spectrum disorder: Implications for monitoring technology design. J Am Med Inform Assoc 2021; 28:303-310. [PMID: 32974678 DOI: 10.1093/jamia/ocaa169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/21/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Monitoring technology may assist in managing self-injurious behavior (SIB), a pervasive concern in autism spectrum disorder (ASD). Affiliated stakeholder perspectives should be considered to design effective and accepted SIB monitoring methods. We examined caregiver experiences to generate design guidance for SIB monitoring technology. MATERIALS AND METHODS Twenty-three educators and 16 parents of individuals with ASD and SIB completed interviews or focus groups to discuss needs related to monitoring SIB and associated technology use. RESULTS Qualitative content analysis of participant responses revealed 7 main themes associated with SIB and technology: triggers, emotional responses, SIB characteristics, management approaches, caregiver impact, child/student impact, and sensory/technology preferences. DISCUSSION The derived themes indicated areas of emphasis for design at the intersection of monitoring and SIB. Systems design at this intersection should consider the range of manifestations of and management approaches for SIB. It should also attend to interactions among children with SIB, their caregivers, and the technology. Design should prioritize the transferability of physical technology and behavioral data as well as the safety, durability, and sensory implications of technology. CONCLUSIONS The collected stakeholder perspectives provide preliminary groundwork for an SIB monitoring system responsive to needs as articulated by caregivers. Technology design based on this groundwork should follow an iterative process that meaningfully engages caregivers and individuals with SIB in naturalistic settings.
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Affiliation(s)
- Kristine D Cantin-Garside
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Susan W White
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Sunwook Kim
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Chung Do Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Diogo M G Fortes
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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5
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Factors Influencing Usability of Rehabilitation Robotic Devices for Lower Limbs. SUSTAINABILITY 2020. [DOI: 10.3390/su12020598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, there has been a sharp increase in the number of elderly people in South Korea; this has led to rising costs and concerns on the quality of physical therapy treatment involving rehabilitation robotic devices. Therefore, the government has asked academia to expand its research scope to evaluate the usability of these devices. Hence, this study aimed to identify the major factors influencing the usability of a rehabilitation robotic device for lower limbs and the reasons for involving several diverse user groups for a more comprehensive evaluation. To measure usability as perceived by three primary user groups of user experience (UX) professionals, rehab professionals, and lay people, this study collected 196 survey. The results of an EFA showed that among three general quality factors and five device specific factors, visual pertinence, use confidence, and safety were the critical factors influencing usability, and the results of ANOVA offered that there was discrepancy in the influential factors, namely visual pertinence, transferring, and holding the body. These findings indicate that the necessity of employing a posture-centered approach and multiple user groups in assessing the usability of rehabilitation devices. Given these findings, it is suggested that the industry and design community should move toward implementing a more explorative perspective to enable a more human-centered and posture-concerned approach to provide better usability to the diverse users of medical devices.
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Don't look at it as a miracle cure: Contested notions of success and failure in family narratives of pediatric cochlear implantation. Soc Sci Med 2019; 228:117-125. [DOI: 10.1016/j.socscimed.2019.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022]
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Patient Perceptions of the Adequacy of Supplemental Oxygen Therapy. Results of the American Thoracic Society Nursing Assembly Oxygen Working Group Survey. Ann Am Thorac Soc 2019; 15:24-32. [PMID: 29048941 DOI: 10.1513/annalsats.201703-209oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Pulmonary clinicians and patients anecdotally report barriers to home supplemental oxygen services including inadequate supply, unacceptable portable options, and equipment malfunction. Limited evidence exists to describe or quantify these problems. OBJECTIVES To describe the frequency and type of problems experienced by supplemental oxygen users in the United States. METHODS The Patient Supplemental Oxygen Survey, a self-report questionnaire, was posted on the American Thoracic Society Public Advisory Roundtable and patient and health care-affiliated websites. Respondents were invited to complete the questionnaire, using targeted e-mail notifications. Data were analyzed using descriptive statistics, paired t tests, and χ2 analysis. RESULTS In total, 1,926 responses were analyzed. Most respondents reported using oxygen 24 h/d, for 1-5 years, and 31% used high flow with exertion. Oxygen use varied, with only 29% adjusting flow rates based on oximeter readings. The majority (65%) reported not having their oxygen saturation checked when equipment was delivered. Sources of instruction included the delivery person (64%), clinician (8%), and no instruction (10%). Approximately one-third reported feeling "very" or "somewhat" unprepared to operate their equipment. Fifty-one percent of the patients reported oxygen problems, with the most frequent being equipment malfunction, lack of physically manageable portable systems, and lack of portable systems with high flow rates. Most respondents identified multiple problems (average, 3.6 ± 2.3; range, 1-12) in addition to limitations in activities outside the home because of inadequate portable oxygen systems (44%). Patients living in Competitive Bidding Program areas reported oxygen problems more often than those who did not (55% [389] vs. 45% [318]; P = 0.025). Differences in sample characteristics and oxygen problems were noted across diagnostic categories, with younger, dyspneic, high-flow users, and respondents who did not receive oxygen education, relating more oxygen problems. Respondents reporting oxygen problems also experienced increased health care resource utilization. CONCLUSIONS Supplemental oxygen users experience frequent and varied problems, particularly a lack of access to effective instruction and adequate portable systems. Initiatives by professional and patient organizations are needed to improve patient education, and to promote access to equipment and services tailored to each patient's needs.
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Jeffs L, Jamieson T, Saragosa M, Mukerji G, Jain AK, Man R, Desveaux L, Shaw J, Agarwal P, Hensel JM, Maione M, Onabajo N, Nguyen M, Bhatia R. Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study. JMIR Hum Factors 2019; 6:e9720. [PMID: 30990460 PMCID: PMC6488957 DOI: 10.2196/humanfactors.9720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 11/29/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. Methods This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. Results The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.
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Affiliation(s)
- Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- St. Michael's Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Geetha Mukerji
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Arsh K Jain
- London Health Sciences Centre, London, ON, Canada
| | - Rachel Man
- London Health Sciences Centre, London, ON, Canada
| | - Laura Desveaux
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Hensel
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - R Bhatia
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
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Alami H, Gagnon MP, Fortin JP. Involving Citizen-Patients in the Development of Telehealth Services: Qualitative Study of Experts' and Citizen-Patients' Perspectives. J Particip Med 2018; 10:e10665. [PMID: 33052126 PMCID: PMC7434098 DOI: 10.2196/10665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 08/04/2018] [Accepted: 09/18/2018] [Indexed: 01/08/2023] Open
Abstract
Background Decisions regarding telehealth services in Quebec (Canada) have been largely technocratic by nature for the last 15 years, and the involvement of citizen-patients in the development of telehealth services is virtually nonexistent. In view of the societal challenges that telehealth raises, citizen-patient involvement could ensure more balance between evidence from traditional research methodologies and technical experts and the needs and expectations of populations in decisions about telehealth services. Objective This study aimed to explore the perception of various stakeholders (decision makers, telehealth program and policy managers, clinicians, researchers, evaluators, and citizen-patients) regarding the involvement of citizen-patients in the development of telehealth services in Quebec. In particular, we explored its potential advantages, added value, obstacles, and challenges it raises for decision making. Methods We used a qualitative research approach based on semistructured individual interviews, with a total of 29 key actors. Respondents were identified by the contact network method. Interviews were recorded and transcribed verbatim. A pragmatic content thematic analysis was performed. To increase the capacity for interpretation and analysis, we were guided by the principle of data triangulation. Results Citizen-patient involvement in decision making is perceived more as a theoretical idea than as a practical reality in health care organizations or in the health system. There is very little connection between citizen involvement structures or patient and user groups and telehealth leaders. For the respondents, citizen-patient involvement in telehealth could increase the accountability and transparency of decision making and make it more pragmatic within an innovation-driven health system. This involvement could also make citizen-patients ambassadors and promoters of telehealth and improve the quality and organization of health services while ensuring they are more socially relevant. Challenges and constraints that were reported include the ambiguity of the citizen-patient, who should be involved and how, claimant citizen-patient, the risk of professionalization of citizen-patient involvement, and the gap between decision time versus time to involve the citizen-patient. Conclusions This study provides a basis for future research on the potential of involving citizen-patients in telehealth. There is a great need for research on the issue of citizen-patient involvement as an organizational innovation (in terms of decision-making model). Research on the organizational predisposition and preparation for such a change becomes central. More efforts to synthesize and translate knowledge on public participation in decision making in the health sector, particularly in the field of technology development, are needed.
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Affiliation(s)
- Hassane Alami
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec, QC, Canada.,Research Center of Quebec City University Hospital Center, Hôpital St-François d'Assise, Quebec, QC, Canada
| | - Marie-Pierre Gagnon
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec, QC, Canada.,Research Center of Quebec City University Hospital Center, Hôpital St-François d'Assise, Quebec, QC, Canada.,Faculty of Nursing Science, Laval University, Quebec, QC, Canada
| | - Jean-Paul Fortin
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
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Larsen T. Nurses' elicitation of patient error as a practice in training end-stage renal patients in automated home peritoneal dialysis. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:807-827. [PMID: 29573433 DOI: 10.1111/1467-9566.12721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As part of a reorganisation of the delivery of health care in Denmark therapies for chronic medical conditions are moved out of hospitals and disease-specific patient education programmes instituted to train patients to assume responsibility for treating their disease at home, that is, perform tasks and functions traditionally done by healthcare professionals. Drawing on video-recordings (90:25h) from a programme for self-management of end-stage renal disease through automated home peritoneal dialysis, the study employs conversation analysis to examine nurses' instructional practices for providing patients with the necessary knowledge, skill and competences. Showing training to rely on an error-based monitoring strategy, the study demonstrates that rather than solely waiting for random errors to emerge, nurses on occasion steer patients towards specific errors to bring about particular instructional opportunities. Surprising given the seriousness of the therapy, this elicitation of error is shown to reflect a deliberate instructional choice; nurses promote select errors to impart patients with an understanding of the procedural logic behind the therapy and medical technology. The study argues that training patients for chronic disease self-management and providing them with a proficiency level, normally associated with certified professionals, necessitates pushing patients beyond what is strictly accurate and exposing them to medically delicate events.
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Affiliation(s)
- Tine Larsen
- Department of Design and Communication, University of Southern Denmark, Denmark
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11
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Will CM. Editorial: Beyond behavior? Institutions, interactions and inequalities in the response to antimicrobial resistance. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:E1-E9. [PMID: 29574948 DOI: 10.1111/1467-9566.12735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Catherine M Will
- School of Law, Politics and Sociology, Freeman Building G44, University of Sussex, BN1 9QE
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12
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Ten Haken I, Ben Allouch S, van Harten WH. The use of advanced medical technologies at home: a systematic review of the literature. BMC Public Health 2018; 18:284. [PMID: 29482550 PMCID: PMC6389044 DOI: 10.1186/s12889-018-5123-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background The number of medical technologies used in home settings has increased substantially over the last 10–15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. Methods The study focused on advanced medical technologies that are part of the technical nursing process and ‘hands on’ processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. Results The review identified 87 relevant articles, 62% was published in the period 2011–2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic ‘user experiences’ (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Conclusions Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.
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Affiliation(s)
- Ingrid Ten Haken
- Saxion University of Applied Sciences, Research Group Technology, Health & Care (TH&C), P.O. Box 70.000, 7500, KB, Enschede, The Netherlands.
| | - Somaya Ben Allouch
- Saxion University of Applied Sciences, Research Group Technology, Health & Care (TH&C), P.O. Box 70.000, 7500, KB, Enschede, The Netherlands
| | - Wim H van Harten
- Department Health Technology & Services Research (HTSR), University of Twente, Faculty Behavioural, Management and Social Sciences (BMS), Ravelijn 5246, P.O. Box 217, 7500, AE, Enschede, The Netherlands.,Rijnstate General Hospital, Arnhem, The Netherlands
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13
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Campling NC, Pitts DG, Knight PV, Aspinall R. A qualitative analysis of the effectiveness of telehealthcare devices (i) are they meeting the needs of end-users? BMC Health Serv Res 2017; 17:455. [PMID: 28676054 PMCID: PMC5496164 DOI: 10.1186/s12913-017-2408-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/05/2017] [Indexed: 11/21/2022] Open
Abstract
Background There are many telehealthcare devices currently available ranging from personal alarms, automated pill dispensers and fall detectors through to monitoring devices for blood sugar, blood pressure and heart rate. Many devices remain unused once acquired or shortly after a period of initial use. Methods The study used a qualitative design involving focus groups and interviews. End users’ opinions of telehealthcare devices were examined through focus groups along with the views of market experts and key supply chain players through telephone interviews to ascertain their views on the devices. The data were recorded, transcribed and analysed thematically. Results Amongst the wide range of user issues associated with telehealthcare devices two themes merited particular attention: design characteristics and the lack of focus on end-user needs. Our findings suggested that few telehealthcare devices appear to be developed based on the principles of user-centred design. Consequently, many were non-intuitive to use, with the majority of the focus group participants not recognising the purpose of the devices from their appearance alone. Conclusions Greater input from real end-users rather than “proxy” users such as carers, professional users or technologists is required when developing telehealthcare devices or systems. Design should be focussed on intuitive use to enable the user to successfully achieve what is required from the devices. This may require the existing supplier—driven market focus to be challenged, but could improve the contribution of technology to improving healthcare.
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Affiliation(s)
- Natasha C Campling
- Faculty of Health Sciences Building 67, University of Southampton, Southampton, UK
| | - David G Pitts
- Cranfield Biotechnology Centre, Cranfield University, Bedford, UK
| | - Paul V Knight
- Cranfield Biotechnology Centre, Cranfield University, Bedford, UK
| | - Richard Aspinall
- Health and Wellbeing Academy, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK.
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14
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Larsen T. Nurses' instruction of patients in the use of INR-monitors for self-management of cardio-vascular conditions: Missed instructional opportunities. PATIENT EDUCATION AND COUNSELING 2017; 100:673-681. [PMID: 27839890 DOI: 10.1016/j.pec.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the effectiveness of a patient education programme for chronic disease self-management in terms of whether (a) patients are taught to perform the medical procedure and (b) nurses have evidence of patients' proficiency when they start self-management. METHODS Patients were followed through an education programme for oral anticoagulation therapy, involving the use of INR-monitors. Training sessions were video-recorded and analyzed using Conversation Analysis. 55 instructional opportunities were identified, and the relationship between instructional response and patients' subsequent (un)successful demonstration of the procedure traced. RESULTS Patient errors provide the most frequent type of instructional opportunity, but not all are addressed; a significant number is allowed to pass uncorrected. Consequently, patients are not given the opportunity to learn. In the majority of cases where instructional opportunities are missed, patients subsequently do not demonstrate a correct understanding of the procedure. CONCLUSION Patients are allowed to start self-management although nurses do not have evidence that they are capable of performing all aspects of the medical procedure correctly. PRACTICE IMPLICATIONS Effective practice suggests that nurses take measures to minimize the amount of missed instructional opportunities that arise and ensure that errors are pursued until patients demonstrate proficiency in all aspects of the procedure.
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Affiliation(s)
- Tine Larsen
- Department of Design and Communication, University of Southern Denmark, Universitetsparken 1, DK-6000 Kolding, Denmark.
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15
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Munck B, Sandgren A. The impact of medical technology on sense of security in the palliative home care setting. Br J Community Nurs 2017; 22:130-135. [PMID: 28252328 DOI: 10.12968/bjcn.2017.22.3.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The increase in the use of medical devices in palliative home care requires that patients and next-of-kin feel secure. Therefore, the aim was to describe medical technology's impact on the sense of security for patients, next-of-kin and district nurses. Deductive content analysis was conducted on data from three previous studies, using the theoretical framework 'palliative home care as a secure base'. The use of medical technology was shown to have an impact on the sense of security for all involved. A sense of control was promoted by trust in staff and their competence in managing the technology, which was linked to continuity. Inner peace and being in comfort implied effective symptom relief facilitated by pain pumps and being relieved of responsibility. Health care professionals need to have practical knowledge about medical technology, but at the same time have an awareness of how to create and maintain a sense of security.
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Affiliation(s)
- Berit Munck
- District Nurse, Senior Lecturer, Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Anna Sandgren
- Senior Lecturer, Co-director, Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Sweden
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Winkler MF, Ross VM, Piamjariyakul U, Gajewski B, Smith CE. Technology Dependence in Home Care: Impact on Patients and Their Family Caregivers. Nutr Clin Pract 2016; 21:544-56. [PMID: 17119161 DOI: 10.1177/0115426506021006544] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL). METHODS A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care. RESULTS Technology dependence influences health-related QOL. Patients and their family caregivers must balance the positive aspects of being in the home environment with the challenges of administering complex therapies at home. Patients and caregivers need additional support to reduce the physical, emotional, social, and financial burdens they experience. CONCLUSIONS More research is needed to address effective interventions to reduce patient and caregiver burdens and to improve outcomes for technology-dependent individuals. A greater level of preparedness for managing home technology and technology-related problems may improve quality of life.
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Affiliation(s)
- Marion F Winkler
- Rhode Island Hospital, 593 Eddy Street, NAB218, Providence, RI 02903, USA.
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Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A, Marano G, Marchetti M, Midolo E, Minacori R, Refolo P, Romano F, Ruggeri M, Sacchini D, Spagnolo AG, Urbina I, Vaglio S, Grazzini G, Liumbruno GM. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:287-386. [PMID: 27403740 PMCID: PMC4942318 DOI: 10.2450/2016.0065-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.
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Affiliation(s)
- Americo Cicchetti
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Alexandra Berrino
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Marina Casini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Codella
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Alessandra Fiore
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Marco Marchetti
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Midolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Minacori
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Refolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Romano
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Irene Urbina
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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Lundin M, Mäkitalo Å. Co-designing technologies in the context of hypertension care: Negotiating participation and technology use in design meetings. Inform Health Soc Care 2016; 42:18-31. [PMID: 26890491 DOI: 10.3109/17538157.2015.1113176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research Interest: In this article, we take an interest in the new kind of relation that has been claimed to be urgently required between health services and patients. Co-production of health services implies fundamental changes in the ways medical care is organized and delivered. Usually, technologies are put forth as potential solutions to problems that might occur when establishing such new relations. AIMS The aim of this study is to scrutinize how different perspectives were brought into the discussions as the concrete design and use of a mobile phone application were introduced, and how participants anticipated and negotiated their own participation in the design project. METHODS This article reports results from an explorative study of a co-design project in hypertension care wherein health professionals and patients were invited to co-design some features of the application they were later to use. RESULTS/CONCLUSIONS The study shows that new practices of self-treatment are not likely to take place without the cooperation of patients, since they are to provide the observational data necessary for the professionals' work. The negotiations are needed to balance patients' concerns of being monitored by technology and their needs of being in control of their everyday lives and activities.
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Affiliation(s)
- Mona Lundin
- a Department of Education, Communication and Learning , University of Gothenburg , Göteborg , Sweden
| | - Åsa Mäkitalo
- a Department of Education, Communication and Learning , University of Gothenburg , Göteborg , Sweden
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Maniatopoulos G, Procter R, Llewellyn S, Harvey G, Boyd A. Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology. Soc Sci Med 2015; 131:98-106. [DOI: 10.1016/j.socscimed.2015.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maria Piras E, Zanutto A. “One day it will be you who tells us doctors what to do!”. Exploring the “Personal” of PHR in paediatric diabetes management. INFORMATION TECHNOLOGY & PEOPLE 2014. [DOI: 10.1108/itp-02-2013-0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Personal Health Record (PHR) systems make possible to integrate data from different sources and circulate them within the illness care and management network. The new arrangements prefigure a redefinition of the relations among healthcare practitioners, patients, and caregivers. The purpose of this paper is to consider the role and the meanings attributed to information when a technical artifact enables new forms of communication within the healthcare management network.
Design/methodology/approach
– The authors adopted a qualitative research design, conducting a pre-post analysis on a theoretical sample of patients and of a paediatrics department. The authors selected 12 patients (six females and six males) aged between four and 20 years old.
Findings
– The patients were willing to act as “stewards of their own information” (Halamka et al., 2008), but they interpreted this role in terms of restricting access to their information, rather than facilitating its dissemination. In fact, the PHR was symbolized as an instrument to support personal diabetes management but the patients want to preserve their own competence and independent management on the information regarding their “Personal” diseases.
Originality/value
– This work highlights two connotation of “Personal” information. The first is the dimension of the right to the privacy of information when it is believed that it may be used to pass judgement on the patient. The second connotation of “Personal” is the assertion by patients of their competence and autonomy in interpreting the information on the basis of personal knowledge about their diabetes.
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Procter R, Greenhalgh T, Wherton J, Sugarhood P, Rouncefield M, Hinder S. The Day-to-Day Co-Production of Ageing in Place. Comput Support Coop Work 2014; 23:245-267. [PMID: 26321795 PMCID: PMC4551166 DOI: 10.1007/s10606-014-9202-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report findings from a study that set out to explore the experience of older people living with assisted living technologies and care services. We find that successful ‘ageing in place’ is socially and collaboratively accomplished – ‘co-produced’ – day-to-day by the efforts of older people, and their formal and informal networks of carers (e.g. family, friends, neighbours). First, we reveal how ‘bricolage’ allows care recipients and family members to customise assisted living technologies to individual needs. We argue that making customisation easier through better design must be part of making assisted living technologies ‘work’. Second, we draw attention to the importance of formal and informal carers establishing and maintaining mutual awareness of the older person’s circumstances day-to-day so they can act in a concerted and coordinated way when problems arise. Unfortunately, neither the design of most current assisted living technologies, nor the ways care services are typically configured, acknowledges these realities of ageing in place. We conclude that rather than more ‘advanced’ technologies, the success of ageing in place programmes will depend on effortful alignments in the technical, organisational and social configuration of support.
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Affiliation(s)
| | | | - Joe Wherton
- Queen Mary University London, 58 Turner Street, London, E1 2AB UK
| | - Paul Sugarhood
- Barts Health NHS Trust, Newham University Hospital, London, E13 8SL UK
| | | | - Sue Hinder
- Warwick University, Coventry, CV4 7AL UK
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Affiliation(s)
- Darlene G. Kelly
- Emeritus Member, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kelly A. Tappenden
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Marion F. Winkler
- Department of Surgery/Nutrition Support, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Siewers V, Holmøy T, Frich JC. Experiences with using mechanical in–exsufflation in amyotrophic lateral sclerosis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.834513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
In this article I argue that attention to the spatial and material dimensions of chronic disease management and its place-making effects is necessary if we are to understand the implications of the increased mobilisation--technologically or otherwise--of the home in chronic disease management. Analysing home treatment in asthma and haemophilia care, I argue that in relation to chronic disease management the home is not only always connected to the clinic but moreover, what the home is in part depends on the specificities of these attachments. Drawing primarily on the work of Susan Leigh Star and scholars of human geography I propose the concept of chronic care infrastructures designating the often inconspicuous socio-material elements (such as medication, control visits, phone calls, doses and daily routines), which are embedded in everyday life (of both the clinic and the home) and participate in producing the effect of treatment but also the effect of home. These chronic care infrastructures demand the emplacement of various objects and activities in everyday life and thus relate to negotiations of 'keepings'--hat to keep and care for and where to grant it room vis á vis other 'keepings'.
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Affiliation(s)
- Henriette Langstrup
- Centre for Medical Science and Technology Studies, University of Copenhagen, Denmark
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26
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Welch JL, Thomas-Hawkins C, Bakas T, McLennon SM, Byers DM, Monetti CJ, Decker BS. Needs, Concerns, Strategies, and Advice of Daily Home Hemodialysis Caregivers. Clin Nurs Res 2013; 23:644-63. [DOI: 10.1177/1054773813495407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improved patient outcomes have led to increased international interest in daily home hemodialysis as a kidney replacement therapy. Daily home hemodialysis often requires the assistance of a caregiver during and between treatments. Understanding the needs and concerns of caregivers of persons on daily home hemodialysis will inform the design of supportive interventions to improve caregiver retention and maintain their health and well-being. Using a descriptive qualitative design, the purpose of this study was to identify and describe the needs, concerns, strategies, and advice of family caregivers. Twenty-one caregivers were interviewed; five of these individuals were former caregivers of patients who had returned to outpatient hemodialysis. Data were collected via audio-recorded telephone interviews following a semistructured interview guide with five open-ended questions. A content analysis approach was used to code and analyze the data. Caregivers described needs, concerns, and strategies and offered advice in five predetermined major categories. Major findings included a need for respite services and a need for interventions to manage the emotional responses to caregiving. This study provides valuable information about relevant areas to consider when developing an intervention program for daily home hemodialysis caregivers.
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Affiliation(s)
- Janet L. Welch
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Tamilyn Bakas
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Doris M. Byers
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Brian S. Decker
- Indiana University School of Medicine, Indianapolis, IN, USA
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Mort M, Roberts C, Callén B. Ageing with telecare: care or coercion in austerity? SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:799-812. [PMID: 23094945 DOI: 10.1111/j.1467-9566.2012.01530.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. 'Telecare' technologies are heavily promoted to assist ageing-in-place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the 'telehome' as the solution to the problem of the 'age dependency ratio'. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of 'technogenarians' and 'shared work' to illuminate our analysis of telecare in use. Drawing on European-funded research we argue that home-monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non-use and 'misuse' in daily practice. We propose that re-imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co-production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.
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Affiliation(s)
- Maggie Mort
- Department of Sociology, Lancaster University, UK Fundación Española para la Ciencia y la Tecnología, Barcelona, Spain
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28
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Palmier-Claus JE, Rogers A, Ainsworth J, Machin M, Barrowclough C, Laverty L, Barkus E, Kapur S, Wykes T, Lewis SW. Integrating mobile-phone based assessment for psychosis into people's everyday lives and clinical care: a qualitative study. BMC Psychiatry 2013; 13:34. [PMID: 23343329 PMCID: PMC3562160 DOI: 10.1186/1471-244x-13-34] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/02/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients' perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. METHOD 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants' perceptions and experiences of the devices, and thematic analysis was used to analyse the data. RESULTS Three themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. CONCLUSIONS The feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care, and that the technology can be successfully integrated into everyday routine. However, it also suggests that it is important to demonstrate to patients the personal, as well as theoretical, benefits of the technology. In the future it will be important to establish whether clinical practitioners are able to use this technology as part of a personalised mental health regime.
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Affiliation(s)
- Jasper E Palmier-Claus
- Division of Clinical Psychology, School of Psychological Sciences, the University of Manchester, Oxford Road, Manchester, United Kingdom.
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - John Ainsworth
- Institute of Population Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Matt Machin
- Institute of Population Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Christine Barrowclough
- Division of Clinical Psychology, School of Psychological Sciences, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Louise Laverty
- Department of Sociology, Social Policy and Criminology, the University of Liverpool, Liverpool, United Kingdom
| | - Emma Barkus
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, Australia
| | - Shitij Kapur
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
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Mair M, Kierans C. Patients' uses of information as researchable domains of social practice. Health Informatics J 2012; 18:271-83. [PMID: 23257057 DOI: 10.1177/1460458212445400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article we argue that research into information for patients has to extend beyond an evaluation of particular information resources to studies of how those resources are engaged with, made sense of and used in practice. We draw on empirical data collected in the course of a study of a patient information resource designed for breast cancer patients in Liverpool and Newcastle in order to demonstrate the limitations of a restricted focus on information resources alone - namely, that it does not take into account the specific ways in which information is incorporated within what patients do as the grounds of 'further inference and action'. Our interest is less in discussing the strengths and weaknesses of this particular resource than in explicating some neglected aspects of the commonplace ways in which patients 'work' with information. We conclude by sketching some broad features of those 'reading' and 'linking' practices, the study of which, we believe, would help us as researchers to explicate the 'problem of information' as it is actually encountered and resolved by patients in realworld settings for their own practical purposes. Taking our lead from ethnomethodological studies and related research in various fields, we argue patients' uses of information are social practices that can and should be treated as researchable phenomena.
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Affiliation(s)
- Michael Mair
- Sociology, Social Policy and Criminology, University of Liverpool, UK.
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Tong A, Lesmana B, Johnson DW, Wong G, Campbell D, Craig JC. The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies. Am J Kidney Dis 2012. [PMID: 23177729 DOI: 10.1053/j.ajkd.2012.08.045] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most patients with end-stage renal disease require dialysis to survive because they are unable to access kidney transplantation. Peritoneal dialysis (PD) is recommended by some clinical practice guidelines as the dialysis treatment of choice for adults without significant comorbid conditions or those with residual kidney function. This study aims to synthesize published qualitative studies of patients' experiences, beliefs, and attitudes about PD. METHODS We conducted a systematic review and thematic synthesis of qualitative studies of adult perspectives of living with PD. Databases (MEDLINE, Embase, PsycINFO, and CINAHL), theses, and reference lists were searched to November 2011. RESULTS 39 studies involving 387 participants were included. We identified 7 themes: resilience and confidence (determination and overcoming vicissitudes), support structures (strong family relationship, peer support, professional dedication, social abandonment, and desire for holistic care), overwhelming responsibility (disruptive intrusion, family burden, and onerous treatment regimen), control (gaining bodily awareness, achieving independence and self-efficacy, and information seeking), freedom (flexibility and autonomy, retaining social functioning, and ability to travel), sick identity (damage to self-esteem and invisible suffering), and disablement (physical incapacitation and social loss and devaluation). CONCLUSIONS PD can offer patients a sense of control, independence, self-efficacy, and freedom. However, holistic and multidisciplinary care is needed to mitigate the risks of impaired self-esteem, physical incapacitation, reduced social functioning, and poor sense of self-worth. Strategies that aim to strengthen social support and promote resilience and confidence in patients are integral to achieving positive adjustment, improved psychosocial outcomes, and treatment satisfaction.
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Affiliation(s)
- Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
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Sanders C, Rogers A, Bowen R, Bower P, Hirani S, Cartwright M, Fitzpatrick R, Knapp M, Barlow J, Hendy J, Chrysanthaki T, Bardsley M, Newman SP. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC Health Serv Res 2012; 12:220. [PMID: 22834978 PMCID: PMC3413558 DOI: 10.1186/1472-6963-12-220] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/10/2012] [Indexed: 01/18/2023] Open
Abstract
Background Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial. Methods Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes. Results Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued. Conclusions These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.
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Affiliation(s)
- Caroline Sanders
- Health Sciences Research Group (Primary Care), The University of Manchester, 5th Floor, Williamson Building, Oxford Rd, Manchester, UK.
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Munck B, Sandgren A, Fridlund B, Mårtensson J. Next-of-kin’s conceptions of medical technology in palliative homecare. J Clin Nurs 2012; 21:1868-77. [DOI: 10.1111/j.1365-2702.2012.04123.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oudshoorn N. How places matter: telecare technologies and the changing spatial dimensions of healthcare. SOCIAL STUDIES OF SCIENCE 2012; 42:121-142. [PMID: 22530385 DOI: 10.1177/0306312711431817] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and patients. I argue that science and technology studies (STS) research on telecare, as well as other technologies, can be enriched by including a focus on place to understand the dynamic interactions between people and things. Adopting insights of human geographers, I show how places in which technologies are used affect how technologies enable or constrain human actions and identities. Whereas some spaces may facilitate the incorporation of technologies, others may resist technologies. A focus on how places matter is important for understanding how telecare technologies reorder and redefine healthcare. Although other healthcare technologies are also important actors in transforming healthcare, telecare technologies do this in a very specific way: they redefine the spatial dimensions of healthcare. To capture and further explore this changing spatial configuration of healthcare, I introduce the notion of technogeography of care. This concept provides a useful heuristic to study how places matter in healthcare. Although telecare technologies introduce virtual encounters between healthcare providers and patients, the use of telecare devices still largely depends on locally grounded, situated care acts. Based on interviews with users of several cardiac telecare applications, including healthcare professionals and patients in Germany and The Netherlands, the paper shows how patients' homes and public spaces are important for shaping the implementation and use of telecare technologies, and vice versa. Last, but not least, telecare devices are implicated as well. The paper emphasizes the place-dependency of the use and meaning of technical devices by showing how the same technological device can do and mean different things in different places.
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Affiliation(s)
- Nelly Oudshoorn
- Department of Science,Technology and Policy Studies, University of Twente, Enschede, The Netherlands.
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Hall H, Côté J, McBean A, Purden M. The experiences of patients with pulmonary arterial hypertension receiving continuous intravenous infusion of epoprostenol (Flolan) and their support persons. Heart Lung 2011; 41:35-43. [PMID: 21784527 DOI: 10.1016/j.hrtlng.2011.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 05/10/2011] [Accepted: 05/14/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Little is known about the day-to-day experiences of patients and their support persons during the course of epoprostenol treatment for pulmonary arterial hypertension (PAH). The study objective was to describe the experiences of patients and their support persons adjusting to PAH and continuous intravenous epoprostenol. METHODS A qualitative descriptive design with semistructured interviews was conducted jointly with the patient and his/her support person. Seven patients and their support persons (spouse, child, friend) were included. RESULTS Patients demonstrated personal growth and resilience as they adapted to PAH. Four patient themes emerged: initial shock, figuring it out, giving life, and ongoing struggles. Themes specific to the support person included "their life is in my hands," pressure to perform, and continuation of my role. CONCLUSION Nurses may assist these patients and support persons by teaching technical skills, problem-solving and troubleshooting strategies, mobilizing social support, and providing opportunities to reflect on lifestyle changes and long-term adjustment to PAH.
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Affiliation(s)
- Heather Hall
- Jewish General Hospital, School of Nursing, McGill University, Montreal, Quebec, Canada.
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Fex A, Flensner G, Ek AC, Söderhamn O. Self-care agency and perceived health among people using advanced medical technology at home. J Adv Nurs 2011; 68:806-15. [DOI: 10.1111/j.1365-2648.2011.05781.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Domestic practice, situated contingency and adherence to medical directives: A call for research. SOCIAL THEORY & HEALTH 2011. [DOI: 10.1057/sth.2011.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Palacios-Ceña D, Losa-Iglesias ME, Alvarez-López C, Cachón-Pérez M, Reyes RAR, Salvadores-Fuentes P, Fernández-de-Las-Peñas C. Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. J Adv Nurs 2011; 67:2537-50. [PMID: 21615459 DOI: 10.1111/j.1365-2648.2011.05694.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. BACKGROUND An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. DATA SOURCES A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. REVIEW METHODS Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. FINDINGS People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. CONCLUSION Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.
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Abstract
In 2010, the Infusion Nurses Society began work to identify research priorities for infusion nursing. Nurses need to understand the research process and become proficient in collaboration to promote research in their specialty. One of the most important components of conducting research is the written research proposal. A poorly written proposal may result in denial of funding, rejected publications, and prolonged discussion and revision at the institutional or ethics review board. This article provides an overview of the elements needed in a research proposal, identifies institutional review board requirements, and highlights important criteria for recruitment and consent of subjects.
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Rogers A, Kirk S, Gately C, May CR, Finch T. Established users and the making of telecare work in long term condition management: Implications for health policy. Soc Sci Med 2011; 72:1077-84. [DOI: 10.1016/j.socscimed.2011.01.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 12/06/2010] [Accepted: 01/23/2011] [Indexed: 12/11/2022]
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Palacios-Ceña D, Losa ME, Fernández-de-las-Peñas C, Salvadores-Fuentes P. Living with life insurance: a qualitative analysis of the experience of male implantable defibrillator recipients in Spain. J Clin Nurs 2011; 20:2003-13. [DOI: 10.1111/j.1365-2702.2010.03508.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bodies in Context: Potential Avenues of Inquiry for the Sociology of Chronic Illness and Disability Within a New Policy Era. HANDBOOK OF THE SOCIOLOGY OF HEALTH, ILLNESS, AND HEALING 2011. [DOI: 10.1007/978-1-4419-7261-3_25] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pipkin M, Eggers PW, Larive B, Rocco MV, Stokes JB, Suri RS, Lockridge RS. Recruitment and training for home hemodialysis: experience and lessons from the Nocturnal Dialysis Trial. Clin J Am Soc Nephrol 2010; 5:1614-20. [PMID: 20576829 DOI: 10.2215/cjn.02440310] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We assessed perceived barriers and incentives to home hemodialysis and evaluated potential correlates with the duration of home hemodialysis training. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS Surveys were sent to the principal investigator and study coordinator for each clinical center in the Frequent Hemodialysis Network Nocturnal Trial. Baseline data were obtained on medical comorbidities, cognitive and physical functioning, sessions required for home hemodialysis training, and costs of home renovations. RESULTS The most commonly perceived barriers included lack of patient motivation, unwillingness to change from in-center modality, and fear of self-cannulation. The most common incentives were greater scheduling flexibility and reduced travel time. The median costs for home renovations varied between $1191 and $4018. The mean number of home hemodialysis training sessions was 27.7 +/- 10.4 (11-59 days). Average training time was less for patients with experience in either self-care or both self-care and cannulation. The number of training sessions was unrelated to the score on the Modified Mini Mental Status or Trailmaking B tests or patient's education level. Training time also did not correlate with the SF-36 Physical Function subscale but did with the modified Charlson comorbidity score and older patient age. CONCLUSIONS Lack of patient or family motivation and fear of the dialysis process are surmountable barriers for accepting home hemodialysis as a modality for renal replacement therapy. Formal education and scores on cognitive function tests are not predictors of training time.
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Affiliation(s)
- Mary Pipkin
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
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Mathar T. Managing health(-care systems) using information health technologies. HEALTH CARE ANALYSIS 2010; 19:180-91. [PMID: 20390452 DOI: 10.1007/s10728-010-0150-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany’s and England’s healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective values, actors’ and institutions’ organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they tend to affect practitioners’ practices more dramatically in England. The conclusion is drawn that with the usage of IHTs, healthcare systems reproduced existing patterns of health provision while also enabling a sort of convergence. Future research should investigate whether the new concept of patienthood emerging in both welfare states actually suits patients and professionals needs and requirements.
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Affiliation(s)
- Thomas Mathar
- Institut für Europäische Ethnologie, Humboldt-Universität zu Berlin, Mohrenstrasse, Berlin, Germany.
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Timmons S, Crosbie B, Harrison-Paul R. Displacement of death in public space by lay people using the automated external defibrillator. Health Place 2010; 16:365-70. [DOI: 10.1016/j.healthplace.2009.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 11/04/2009] [Accepted: 11/11/2009] [Indexed: 11/28/2022]
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Briscoe WP, Woodgate RL. Sustaining self: the lived experience of transition to long-term ventilation. QUALITATIVE HEALTH RESEARCH 2010; 20:57-67. [PMID: 20019349 DOI: 10.1177/1049732309356096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Long-term mechanical ventilation (LTMV) is used to support growing numbers of children and adults who develop chronic respiratory failure. The purpose of this hermeneutic phenomenological study was to explore the subjective meaning of the experience of transition from spontaneous breathing to reliance on LTMV. In-depth, audiorecorded interviews of 11 ventilated individuals living in a western Canadian province were transcribed and analyzed. The transition journey was revealed to be a time of psychological, physical, and spiritual challenge. "Sustaining self " was revealed as the essence of ventilator users' transition experience. Findings underscore the complex nature of transition to technological reliance, illuminating the need for increased health professional knowledge and understanding of the symptom experience and management options for individuals living with chronic respiratory failure. Strategies to support individuals' sense of self as they journey to a life reliant on LTMV are required.
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Affiliation(s)
- Winnifred P Briscoe
- Red River College of Applied Arts, Science and Technology, Winnipeg, Manitoba, Canada.
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Fex A, Ek AC, Söderhamn O. Self-care among persons using advanced medical technology at home. J Clin Nurs 2009; 18:2809-17. [DOI: 10.1111/j.1365-2702.2009.02861.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr 2009; 28:467-79. [PMID: 19464089 DOI: 10.1016/j.clnu.2009.04.001] [Citation(s) in RCA: 255] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/01/2009] [Indexed: 12/28/2022]
Abstract
Home parenteral nutrition (HPN) was introduced as a treatment modality in the early 1970s primarily for the treatment of chronic intestinal failure in patients with benign disease. The relatively low morbidity and mortality associated with HPN has encouraged its widespread use in western countries. Thus there is huge clinical experience, but there are still few controlled clinical studies of treatment effects and management of complications. The purpose of these guidelines is to highlight areas of good practice and promote the use of standardized treatment protocols between centers. The guidelines may serve as a framework for development of policies and procedures.
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Cafazzo JA, Leonard K, Easty AC, Rossos PG, Chan CT. Patient-perceived barriers to the adoption of nocturnal home hemodialysis. Clin J Am Soc Nephrol 2009; 4:784-9. [PMID: 19339408 DOI: 10.2215/cjn.05501008] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Nocturnal home hemodialysis (NHHD) has been shown to improve clinical outcomes, although adoption has been limited. Given the known benefits, an understanding of the barriers to adoption is needed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patient-perceived barriers were studied through a cross-sectional survey of prevalent hemodialysis patients using validated instruments, study-specific questions, and ethnographic interviews. Fifty-six of 66 NHHD patients and 153 of 199 conventional hemodialysis (CHD) patients were included in the survey. Twenty interviews were conducted with NHHD, CHD, and predialysis patients. RESULTS Compared with CHD patients, NHHD patients had higher perceived physical health scores (Short Form 12 [SF-12]: 41.47 +/- 10.9 versus 34.73 +/- 10.6, P < 0.0001), but had similar mental health scores (47.30 +/- 11.1[NHHD] versus 45.27 +/- 11.3[CHD]), P = 0.25). Despite having similar measures of education and perceived social support as NHHD patients, CHD patients had a low interest (1.68 [out of 5] +/- 1.26) in adopting NHHD. The major barriers perceived by CHD patients were lack of self-efficacy in performing the therapy, lack of confidence in self-cannulation, and length of time on current therapy. Similar themes emerged from the qualitative analysis as well as: burden on family members and fear of a catastrophic event. CONCLUSIONS Patient-perceived barriers are primarily fears of self-cannulation, a catastrophic event, and the burden on family. These findings should form the basis of screening patients for interest in NHHD and serve to mitigate these concerns.
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Affiliation(s)
- Joseph A Cafazzo
- Centre for Global eHealth Innovation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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50
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Moreira T. Continuous positive airway pressure machines and the work of coordinating technologies at home. Chronic Illn 2008; 4:102-9. [PMID: 18583447 DOI: 10.1177/1742395308092481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Research on the use of health technology at home has consistently reported that it is underpinned by users' evaluations of the technology in relation to their illness trajectory, their social network, and the place where it is used. Recent studies have also revealed that the efficacy of health technologies depends upon users' work that is largely invisible to professionals, managers and designers. This paper draws on the most widely used therapy for the management of sleep apnoea, continuous positive airway pressure (CPAP), to show how users maintain workable relationships between it and other technological elements of the domestic environment. METHODS Qualitative analysis was performed of an archive of messages sent to a web-based support group for sleep disorders between 1994 and 2007. RESULTS Users describe two related techniques: first, drawing on their embodied knowledge of using domestic technologies to imagine potential, alternative environments for CPAP; and second, using their body as an instrument to assess the ;fit' of each of the attempted arrangements. The interaction between these two techniques entails frequent shifts in users' understandings of their illness and those involved in its management. CONCLUSION Strategies of implementation of health technologies at home should acknowledge and incorporate the embodied knowledge processes of users.
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Affiliation(s)
- Tiago Moreira
- School of Applied Social Sciences, Durham University, Durham, UK.
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