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Chang F, Östlund B, Kuoppamäki S. Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses. J Med Internet Res 2023; 25:e44692. [PMID: 37145835 DOI: 10.2196/44692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/07/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. OBJECTIVE Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. METHODS We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. RESULTS During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. CONCLUSIONS Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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Mathijssen E, de Lange W, Bleijenberg N, van Houwelingen T, Jaarsma T, Trappenburg J, Westland H. Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey. J Med Internet Res 2023; 25:e41768. [PMID: 36892935 PMCID: PMC10037173 DOI: 10.2196/41768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. OBJECTIVE The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. METHODS A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. RESULTS We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. CONCLUSIONS Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care.
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Affiliation(s)
- Elke Mathijssen
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wendela de Lange
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nienke Bleijenberg
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Innovations in Healthcare, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Tiny Jaarsma
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jaap Trappenburg
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen Westland
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Frennert S. Moral distress and ethical decision-making of eldercare professionals involved in digital service transformation. Disabil Rehabil Assist Technol 2023; 18:156-165. [PMID: 33151763 DOI: 10.1080/17483107.2020.1839579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Technology affects almost all aspects of modern eldercare. Ensuring ethical decision-making is essential as eldercare becomes more digital; each decision affects a patient's life, self-esteem, health and wellness. METHODS We conducted a survey and interviews with eldercare professionals to better understand the behavioural ethics and decision making involved in the digital transition of eldercare. CONCLUSION Our qualitative analysis showed three recurrent roles among eldercare professionals in regard to digital service transformation; makers, implementers and maintainers. All three encountered challenging and stressful ethical dilemmas due to uncertainty and a lack of control. The matter of power relations, the attempts to standardize digital solutions and the conflict between cost efficiency and if digital care solutions add value for patients, all caused moral dilemmas for eldercare professionals. The findings suggest a need for organizational infrastructure that promotes ethical conduct and behaviour, ethics training and access to related resources.Implications for rehabilitationThe transition to digital care service is not neutral, but value-laden. Digital transformation affects ethical behaviour and decision-making.The decision as to which digital services should be developed and deployed must include eldercare professionals and not lay solely in the hands of managers, technologists and economists.We must move away from attempting to fit standardized solutions to a heterogenous group of older patients; accommodating the pluralism of patients' needs and wants protects their dignity, autonomy and independence.As digital care practices evolve, so too must organizational structures that promote ethical conduct.
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Affiliation(s)
- Susanne Frennert
- Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmo, Sweden
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Hjalmarsson A, Östlund G, Asp M, Kerstis B, Holmberg M. A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services. Int J Qual Stud Health Well-being 2022; 17:2082062. [PMID: 35703409 PMCID: PMC9225717 DOI: 10.1080/17482631.2022.2082062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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Affiliation(s)
- Anna Hjalmarsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Gunnel Östlund
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Ambulance Services, Region Sörmland, Eskilstuna, Sweden
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5
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Stranz A, Tishelman C, Westerlund B, Nilsson F, Hilton R, Goliath I. The call-bell in residential care homes: Experiences of residents and staff. J Aging Stud 2022; 62:101056. [DOI: 10.1016/j.jaging.2022.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
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Hirvonen H, Tammelin M, Hämäläinen A, Taipale S. Group‐based instant messaging in Finnish residential elder care work: Taming the technology or vice versa? NEW TECHNOLOGY WORK AND EMPLOYMENT 2022. [DOI: 10.1111/ntwe.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helena Hirvonen
- Centre of Excellence in Research on Ageing and Care University of Jyväskylä Jyväskylä Finland
| | - Mia Tammelin
- Jyväskylä University of Applied Sciences Jyväskylä Finland
| | - Antti Hämäläinen
- Centre of Excellence in Research on Ageing and Care University of Jyväskylä Jyväskylä Finland
| | - Sakari Taipale
- Centre of Excellence in Research on Ageing and Care University of Jyväskylä Jyväskylä Finland
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Glomsås HS, Knutsen IR, Fossum M, Christiansen K, Halvorsen K. Family caregivers' involvement in caring for frail older family members using welfare technology: a qualitative study of home care in transition. BMC Geriatr 2022; 22:223. [PMID: 35303816 PMCID: PMC8932075 DOI: 10.1186/s12877-022-02890-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Demographic, economic and organisational changes challenge home care services. Increased use of welfare technology and involvement of family members as co-producers of care are political initiatives to meet these challenges. However, these initiatives also involve ethical aspects. METHOD The aim of this qualitative study was to explore family caregivers' experience of involvement and possible ethical aspects of caring for frail older family members receiving home care services supported by welfare technology. This study used a qualitative explorative and descriptive design within a phenomenological-hermeneutical approach. Sixteen interviews with eighteen family caregivers were conducted. The participants were sons, daughters, siblings and spouses of frail older people receiving home care services with the support of welfare technology. Data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes. First, the family caregivers' experienced caring as meaningful but increasingly demanding concerning the changes in home care services. Second, they experienced a change in relationships, roles, tasks, and responsibilities related to more family involvement and the use of welfare technology. This also challenged their sense of autonomy. However, welfare technology helped them deal with responsibilities, especially safety. The family caregivers requested early involvement, dialogue for care decisions, more cooperation and support from health professionals. Third, the participants experienced that health professionals decided the conditions for co-production without discussion. Their need for information and knowledge about welfare technology were not met. Fourth, the family caregivers felt that the health professionals did not adequately recognise their unique knowledge of the care receiver and did not use this knowledge for customising the welfare technology to the care receiver and their families. Fifth, the family caregivers expressed concern about service and welfare technology inequality in home care services. CONCLUSIONS Co-production in the involvement of family caregivers in care is still not an integral part of home care service. Welfare technology was appreciated, but the family caregivers called for early involvement to ensure successful and safe implementation and use. More attention needs to be given to ethical concerns about the change in relations, transfer of tasks and responsibility, and risk of inequality.
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Affiliation(s)
- Heidi Snoen Glomsås
- grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Ingrid Ruud Knutsen
- grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Mariann Fossum
- grid.23048.3d0000 0004 0417 6230Faculty of Health and Sport Sciences, Institute of Health and Nursing Science, University of Agder, Postboks 422, N-4604 Kristiansand, Norway
| | - Karin Christiansen
- grid.460119.b0000 0004 0620 6405Faculty of Health Sciences, Research Centre for Health and Welfare Technology, VIA University College, Hedeager 2, DK-8200 Aarhus, Denmark
| | - Kristin Halvorsen
- grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
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Chang F, Kuoppamäki S, Östlund B. Technology scripts in care practice: A case study of assistant nurses’ use of a social alarm system in Swedish nursing homes. Digit Health 2022; 8:20552076221089077. [PMID: 35355808 PMCID: PMC8958713 DOI: 10.1177/20552076221089077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Technologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses’ care practices in nursing homes. Methods The paper draws on observations of assistant nurses’ daily tasks (32 h) and semi-structured interviews with assistant nurses ( n = 12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses’ technology-mediated care practices, while interviews were used to deeply understand assistant nurses’ perceptions of the system, their care practices, and which aspects they considered during the provision of care. Findings We show the complexities involved in integrating a social alarm system into care practices based on assistant nurses’ situational and personal interpretations of both technology scripts and quality of care. The technology-mediated care practices consist of receiving alarms from residents, checking alarms via alarm phones, responding to alarms via alarm phones, checking specific residents’ situations in person, documenting all finished alarms, and documenting some finished alarms. In these practices, the assistant nurses defined technology scripts according to their expected requirements and outcomes, and meanwhile considered the quality of care by evaluating the priority of practical, moral or relational care in the situations at hand. Through further negotiations with the defined scripts and the considered quality of care, the assistant nurses decided on the final way of following (or not following) specific scripts in practice. Conclusion Results from our study portray the complexity of technology in care practices. The findings contribute to increased understanding of technology-mediated care practices in nursing homes, and research on technology scripts in institutional settings.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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Stokke R, Melby L, Isaksen J, Obstfelder A, Andreassen H. A qualitative study of what care workers do to provide patient safety at home through telecare. BMC Health Serv Res 2021; 21:553. [PMID: 34090450 PMCID: PMC8180066 DOI: 10.1186/s12913-021-06556-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. METHODS The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis. RESULTS We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. CONCLUSIONS We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.
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Affiliation(s)
- Randi Stokke
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway.
| | - Line Melby
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Jørn Isaksen
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Gudbrandsdalsvegen 350, 2624, Lillehammer, Norway
| | - Aud Obstfelder
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Hege Andreassen
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
- Centre for Women and Gender Research, UiT, The Arctic University of Norway, P.O Box 6050 Langnes, 9037, Tromsø, Norway
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. 'They just came with the medication dispenser'- a qualitative study of elderly service users' involvement and welfare technology in public home care services. BMC Health Serv Res 2021; 21:245. [PMID: 33740974 PMCID: PMC7977566 DOI: 10.1186/s12913-021-06243-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people's involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users' experience of user involvement in the implementation and everyday use of welfare technology in public home care services. METHOD This qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. RESULTS Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible. CONCLUSION The results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Postboks 509, N-4898, Grimstad, Norway
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. User involvement in the implementation of welfare technology in home care services: The experience of health professionals-A qualitative study. J Clin Nurs 2020; 29:4007-4019. [PMID: 33463827 DOI: 10.1111/jocn.15424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study is to learn more about factors that promote or inhibit user involvement among health professionals when implementing welfare technology in home care services. BACKGROUND It is a health policy goal to increase the use of welfare technology in order to address some of the challenges that healthcare services are facing. Health professionals' involvement is important for the successful implementation of welfare technology in home care services. DESIGN The study has an explorative and descriptive longitudinal design based on a qualitative approach. Five focus group interviews were conducted with 16 nurses and assistant nurses from three different municipalities over a period of 2 years. The data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes: competence a critical component, information and information lines, new ways of working, choice of welfare technology and change in patient services. From health professionals' perspective, there appeared to be a lack of preparedness for the change in the implementation of welfare technology entailed for home care services. The respondents experienced limited facilitation and opportunities for user involvement. CONCLUSION Health professionals want to be more involved but emphasised that competence, information and collaborative arenas are necessary factors if involvement in the process is to be increased. Competence affected some of the respondents' attitudes and willingness to use the technology. The respondents also experienced that the managements' focus on facilitation and interest in user involvement in addition to infrastructures that functioned in various ways had an impact on user involvement. RELEVANCE TO CLINICAL PRACTICE The knowledge gained from this study about factors that promote or inhibit user involvement among health professionals could contribute to better preparedness for further implementation of welfare technology in the field of home care.
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Affiliation(s)
- Heidi Snoen Glomsås
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
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Chang F, Eriksson A, Östlund B. Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4245. [PMID: 32545871 PMCID: PMC7344572 DOI: 10.3390/ijerph17124245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-142 58 Stockholm, Sweden; (A.E.); (B.Ö.)
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Holthe T, Halvorsrud L, Thorstensen E, Karterud D, Laliberte Rudman D, Lund A. Community Health Care Workers' Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia. J Multidiscip Healthc 2020; 13:447-458. [PMID: 32547050 PMCID: PMC7245453 DOI: 10.2147/jmdh.s246180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D. Participants and Methods Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke. Results Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities. Conclusion This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D. Trial registration NSD project number 47996.
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Affiliation(s)
- Torhild Holthe
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Norway
| | - Liv Halvorsrud
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Erik Thorstensen
- Oslo Metropolitan University, Work Research Institute, Centre for Welfare and Labour Research, Oslo, Norway
| | - Dag Karterud
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Debbie Laliberte Rudman
- University of Western Ontario, School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, London, Canada
| | - Anne Lund
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Norway
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Alnes RE, Berg H, Krøvel B, Blindheim K. «Du har på en måte hatt besøk, vet du!». TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2019-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Helen Berg
- NTNU, Institutt for samfunnsmedisin og sykepleie, Trondheim
| | | | - Kari Blindheim
- NTNU, Institutt for helsevitenskap, Ålesund og Senter for omsorgsforskning
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15
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Stokke R, Hellesø R, Sogstad M. Hvorfor er det så vanskelig å integrere velferdsteknologii omsorgstjenesten? TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-03-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Ragnhild Hellesø
- Senter for omsorgsforskning, øst, NTNU i Gjøvik
- Avdeling for sykepleievitenskap, Institutt for helse og samfunn, Universitetet i Oslo
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Stokke R. Older People Negotiating Independence and Safety in Everyday Life Using Technology: Qualitative Study. J Med Internet Res 2018; 20:e10054. [PMID: 30341049 PMCID: PMC6234346 DOI: 10.2196/10054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/28/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Due to demographic changes with an aging population, there is a demand for technology innovations in care services. However, technology innovations have proven difficult to implement in regular use. To understand the complexity of technology innovations in care practices, we need a knowledge base of the complex and diverse experiences of people interacting with established technologies. Objective This paper addresses the research gap in relation to understanding the microcontext of co-production of care involving established technologies integrated into care practices. The paper also aims to provide a framework for exploring what really happens when different actors use technology in care practices. Methods Participant observations and 22 interviews with actors using social alarms were conducted employing the critical incident technique. A stepwise deductive-inductive analysis was then performed. Results The results reveal how co-production of care assumes different meanings according to how actors use the technology. The results also show how technology innovation changes the dynamics between the actors and rearranges care practices. Independent and safe living is co-produced through performing bricolages and optimizing practice. Additionally, this opens up for unexpected results and bricolages as an integrated part of technology innovations. Conclusions This study illustrates how care services are always co-produced between the actors involved. By using aspects from science and technology studies, this paper provides a framework for exploring technology in use in care practices. The framework provides tools to unpack and articulate the process of co-producing services.
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Affiliation(s)
- Randi Stokke
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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