Staff members’ perceptions of a ICT support package in dementia care during the process of implementation

A systematic review of electronic assistive technology within supporting living environments for people with dementia

Health and social care provision needs to change in order to meet the needs of an increase in the number of people living with dementia. Environmental design, technology and assistive devices have the potential to complement care, help address some of the challenges presented by this growing need and impact on the lived experience of this vulnerable population. This systematic review was undertaken to identify the research on the use of electronic assistive technology within long-term residential care settings. A total of 3229 papers published from the inception of each of the databases up until May 2016 were retrieved from searches in four major databases. Sixty-one were identified to be included in the review. The inclusion criteria were: original peer reviewed journals; an electronic assistive technology intervention; with residents or tenants living with dementia or their family or paid caregivers; in supported living environments or residential care. The data extracted from the included studies focused on the methodology, technology, outcomes and the role of people living with dementia within the research. Overall, an extensive variety of technical interventions were found, with a broad range of methodological heterogeneity to explore their effect. Additionally, wide-spanning outcomes to support the potential of technology solutions and the challenges presented by such intervention were found.

Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care

Background

Use of monitoring technologies (e.g. wearable or environmental sensors) in long-term care generates extensive ethical debate, primarily about their potential to enhance resident safety weighed against concerns about their impacts upon resident autonomy. There are a number of other ethical aspects which are far less debated, including questions about the monitoring of the workforce, and equality of access to technologies. In this paper, we explore the extent to which remote monitoring of the workforce, and equality of access to technologies, were seen to influence the implementation of monitoring technologies within long-term care facilities.

Methods

An embedded multiple-case study design was used with three dementia-specialist care facilities in England that had experience using a range of monitoring technologies. Data were collected through 175 h’ observation of daily practice, semi-structured interviews with 36 staff, residents and relatives, and examination of organisational documentation and technology manufacturer literature. Data were analysed using Framework Analysis.

Results

Use of technologies for workforce monitoring was understood in relation to the ethical obligations to fulfil a duty of care to residents. There was little recognition of any negative implications for the workforce, but staff were susceptible to rumours that technologies were being used for performance management even when this was not the case. There were questions about how far data collected by monitoring technologies could constitute ‘evidence’ of appropriate care delivery. Equality and access to technologies involved a need to compromise between generic designs that were not universally suitable, but were more affordable than bespoke designs. Contracts with suppliers imposed limitations on product choice.

Conclusions

There is an urgent need for greater consideration of the ethical and legal implications that remote technological monitoring might have upon workforce morale, recruitment and retention. Ensuring variety of technological design to facilitate equitable access for residents is financially extremely challenging. It is possible that considerations of equitable access are not deemed a priority due to the current generation of residents’ low levels of technological familiarity and expectation. It might be overstated and unrealistic to view expensive technologies as the pinnacle of innovative practice in care homes.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1155-6) contains supplementary material, which is available to authorized users.

Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI.

They Don't Care About Us! Care Personnel's Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study

Background

Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts.

Objective

The objective of our study was to investigate professional caregivers’ AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies.

Methods

A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people’s caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage.

Results

The care context significantly impacted the evaluations of AAL technologies (F_14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F_2,118=4.570; P=.01) and specific technologies (F_2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F_2,118=4.073, P=.02) that are allowed to be gathered.

Conclusions

AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional’s needs and concerns (“care about us”). The results contribute to a broader understanding of professional caregivers’ needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts.

Exploring attitudes of healthcare professionals towards ICT-based interventions for nursing home residents with dementia: a mixed-methods approach

BACKGROUND

Information and Communication Technologies (ICTs) could be useful for delivering non-pharmacological therapies (NPTs) for dementia in nursing home settings.

AIMS

To identify technology-related expectations and inhibitions of healthcare professionals associated with the intention to use ICT-based NPTs.

DESIGN

Cross-sectional multi-method survey.

METHODS

N = 205 healthcare professionals completed a quantitative survey on usage and attitudes towards ICTs. Additionally, N = 11 semi-structured interviews were conducted.

RESULTS

Participants were classified as intenders to use ICTs (53%), non-intenders (14%) or ambivalent (32%). A MANCOVA revealed higher perceived usefulness for intenders compared to non-intenders and ambivalent healthcare professionals (V =.28, F(12, 292)= 3.94, p <.001). Qualitative interviews revealed generally high acceptance of ICTs in the workplace. Furthermore, benefits for residents emerged as a key requirement.

CONCLUSION

Staff trainings should stress specific benefits for residents and healthcare professionals to facilitate successful implementation and acceptance of ICTs in nursing home settings.

Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies

The aim of the study was to synthesise the best available research evidence on nursing professionals' experiences of the facilitators and barriers to the use of online telehealth services in nursing practice. Telehealth is used to deliver healthcare services and health-related information by means of information and communication technology (ICT). The systematic review of qualitative studies was conducted using thematic synthesis of previous studies. International electronic databases PubMed, CINAHL, Eric, Web of Science/Web of Knowledge and Scopus, and Finnish databases Medic and Ohtanen were searched in spring 2013. In addition, the search was complemented in fall 2015. Following critical appraisal, 25 studies from 1998 to fall 2015 were reviewed and the findings were synthesised. Both facilitators and barriers were grouped into five main categories which were related to nurses' skills and attitudes, nurses' work and operations, organisational factors, patients and technology. The highest number of facilitators and barriers was found in the category focusing on nurses' work and operations. Based on the findings, nurses' skills and attitudes are preventing factors in the implementation of telehealth. There is also a need to focus on patients' role in telehealth usage although the findings support positive adoption of ICT tools among patients. The findings call for further development of technological tools used in nursing practice and healthcare services. The change from traditional face-to-face nursing to the use of telehealth calls for local agreements and further discussions among professionals on how this change will be accepted and implemented into practice. In addition, organisations need to make sure that nurses have enough resources and support for telehealth use.

Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

Background

Ageing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits.

Objective

This study explored facilitators and barriers to the implementation of monitoring technologies in care homes.

Design

Embedded multiple-case study with qualitative methods.

Setting

Three dementia-specialist care homes in North-West England.

Participants

Purposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents.

Methods

36 semi-structured interviews with staff, relatives and residents; 175 h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis.

Results

Findings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice.

Conclusion

Implementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.

Nurses' experiences of the use of an Internet-based support system for adolescents with depressive disorders

BACKGROUND

Internet-based applications are potentially useful and effective interventions to reach and support adolescents with mental health problems. Adolescents' commitment to the use of a new Internet-based intervention is closely related to the support they receive from healthcare professionals. This study describes nurses' experiences of the use of an Internet-based support system for adolescents with depressive disorders.

METHOD

Qualitative descriptive study design including individual interviews with nine nurses at two psychiatric outpatient clinics. The Technology Acceptance Model (TAM) was used as the theoretical background of the study.

RESULTS

Nurses described several benefits of using the Internet-based support system in the care of adolescents with depressive disorders if the nurses integrate it into daily nursing practices. As perceived disadvantages the nurses thought that an adolescent's mental status might be a barrier to working with the support system. Perceived enablers could be organizational support, nurses' attitudes, and technology-related factors. Nurses' attitudes were identified as a barrier to supporting adolescents' use of the Internet-based support system.

CONCLUSION

The findings suggest that the implementation plan and support from the organization, including that from nurse managers, are crucial in the process of implementing a technology-based support system.

Digital support for medication administration--a means for reaching the goal of providing good care?

PURPOSE

The purpose of this paper is to describe staffs' perceptions of digital support for medication administration (DSM) and out of the perceptions interpret underlying values.

DESIGN/METHODOLOGY/APPROACH

In total, 22 persons working in elder care participated in the study. The study had a qualitative approach and focus group interviews were used to collect data. To analyze the manifest content a phenomenographic method was used. An interpretation of perceptions was then undertaken aimed at identifying underlying values.

FINDINGS

Three descriptive categories, "utility," "impact on working environment" and "economic impact" were the result of the manifest analysis. The values of having a "good working environment," "benefits" and "good economy" were interpreted as guidance for staffs' acceptance or rejection of the DSM.

SOCIAL IMPLICATIONS

The care-giving process and its challenges from the perspective of the staffs need consideration. Staffs in this study sometimes expressed strong emotions as a sign of frustration for losing prerequisites to perform their work well. In big complex organizations where economy and effectiveness are often discussed, knowledge of power relations in innovation and implementation processes would be beneficial. Although moral distress is a well-known phenomenon, future research may be needed to find solutions that diminish this negative trend in more economic focussed organizations.

ORIGINALITY/VALUE

This study had a twofold approach with the intention of going beyond descriptions. To gain a deeper understanding a normative interpretation was completed. Ethical conflicts are frequently characterized as conflicts between at least two values. In this study staffs expressed fear of losing prerequisites needed to perform their work well. Prerequisites that were identified as values and these values were threatened by the DSM.

A technology roadmap of assistive technologies for dementia care in Japan

The number of elderly people in Japan is growing, which raises the issue of dementia, as the probability of becoming cognitively impaired increases with age. There is an increasing need for caregivers, who are well-trained, experienced and can pay special attention to the needs of people with dementia. Technology can play an important role in helping such people and their caregivers. A lack of mutual understanding between caregivers and researchers regarding the appropriate uses of assistive technologies is another problem. A vision of person-centred care based on the use of information and communication technology to maintain residents’ autonomy and continuity in their lives is presented. Based on this vision, a roadmap and a list of challenges to realizing assistive technologies have been developed. The roadmap facilitates mutual understanding between caregivers and researchers, resulting in appropriate technologies to enhance the quality of life of people with dementia.

Professional Caregivers' Perceptions on how Persons with Mild Dementia Might Experience the Usage of a Digital Photo Diary

Cognitive impairments influence the possibility of persons with dementia to remember daily events and maintain a sense of self. In order to address these problems a digital photo diary was developed to capture information about events in daily life. The device consisted of a wearable digital camera, smart phone with Global Positioning System (GPS) and a home memory station with computer for uploading the photographs and touch screen. The aim of this study was to describe professional caregiver's perceptions on how persons with mild dementia might experience the usage of this digital photo diary from both a situation when wearing the camera and a situation when viewing the uploaded photos, through a questionnaire with 408 respondents. In order to catch the professional caregivers' perceptions a questionnaire with the semantic differential technique was used and the main question was "How do you think Hilda (the fictive person in the questionnaire) feels when she is using the digital photo diary?". The factor analysis revealed three factors; Sense of autonomy, Sense of self-esteem and Sense of trust. An interesting conclusion that can be drawn is that professional caregivers had an overall positive view of the usage of digital photo diary as supporting autonomy for persons with mild dementia. The meaningfulness of each situation when wearing the camera and viewing the uploaded pictures to be used in two different situations and a part of an integrated assistive device has to be considered separately. Individual needs and desires of the person who is living with dementia and the context of each individual has to be reflected on and taken into account before implementing assistive digital devices as a tool in care.