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de Ruiter HP, Clisbee D, Houston R, Skärsäter I. The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study. JMIR Hum Factors 2023; 10:e47586. [PMID: 37921843 PMCID: PMC10656666 DOI: 10.2196/47586] [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: 03/27/2023] [Revised: 08/12/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. OBJECTIVE The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. METHODS A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. RESULTS This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. CONCLUSIONS Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers.
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Affiliation(s)
- Hans-Peter de Ruiter
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - David Clisbee
- Department of Computer Information Science, Minnesota State University, Mankato, MN, United States
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Piau A, Steinmeyer Z, Mattek N, Lindauer A, Sharma N, Bouranis N, Wild K, Kaye J. Caregiving in Older Adults; Experiences and Attitudes toward Smart Technologies. J Clin Med 2023; 12:jcm12051789. [PMID: 36902576 PMCID: PMC10003197 DOI: 10.3390/jcm12051789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: The development of assistive technologies has become a key solution to reduce caregiver burden. The objective of this study was to survey caregivers on perceptions and beliefs about the future of modern technology in caregiving. (2) Methods: Demographics and clinical caregiver characteristics were collected via an online survey along with the perceptions and willingness to adopt technologies to support caregiving. Comparisons were made between those who considered themselves caregivers and those who never did. (3) Results: 398 responses (mean age 65) were analyzed. Health and caregiving status of the respondents (e.g., schedule of care) and of the care recipient were described. The perceptions and willingness to use technologies were generally positive without significant differences between those who ever considered themselves as caregivers and those who never did. The most valued features were the monitoring of falls (81%), medication use (78%), and changes in physical functioning (73%). For caregiving support, the greatest endorsements were reported for one-on-one options with similar scores for both online and in-person alternatives. Important concerns were expressed about privacy, obtrusiveness, and technological maturity. (4) Conclusions: Online surveys as a source of health information on caregiving may be an effective guide in developing care-assisting technologies receiving end users' feedback. Caregiver experience, whether positive or negative, was correlated to health habits such as alcohol use or sleep. This study provides insight on caregivers' needs and perceptions regarding caregiving according to their socio-demographic and health status.
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Affiliation(s)
- Antoine Piau
- Internal Medicine and Gerontology, University Hospital of Toulouse, Université Paul Sabatier, 31062 Toulouse, France
| | - Zara Steinmeyer
- Internal Medicine and Gerontology, University Hospital of Toulouse, Université Paul Sabatier, 31062 Toulouse, France
- Correspondence: ; Tel.: +33-561322392
| | - Nora Mattek
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
| | - Allison Lindauer
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
| | - Nicole Sharma
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
| | - Nicole Bouranis
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
| | - Katherine Wild
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR 97239, USA
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Predel C, Timmermann C, Ursin F, Orzechowski M, Ropinski T, Steger F. Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis. JMIR Mhealth Uhealth 2022; 10:e32910. [PMID: 35737429 PMCID: PMC9264133 DOI: 10.2196/32910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/27/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns.
Objective
This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities.
Methods
On the basis of a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles.
Results
We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients.
Conclusions
The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access.
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Affiliation(s)
- Christopher Predel
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Cristian Timmermann
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Frank Ursin
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Timo Ropinski
- Visual Computing Group, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Ghafurian M, Hoey J, Dautenhahn K. Social Robots for the Care of Persons with Dementia. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2021. [DOI: 10.1145/3469653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Intelligent assistive robots can enhance the quality of life of people with dementia and their caregivers. They can increase the independence of older adults, reduce tensions between a person with dementia and their caregiver, and increase social engagement. This article provides a review of assistive robots designed for and evaluated by persons with dementia. Assistive robots that only increased mobility or brain-computer interfaces were excluded. Google Scholar, IEEE Digital Library, PubMed, and ACM Digital Library were searched. A final set of 53 articles covering research in 16 different countries are reviewed. Assistive robots are categorized into five different applications and evaluated for their effectiveness, as well as the robots’ social and emotional capabilities. Our findings show that robots used in the context of therapy or for increasing engagement received the most attention in the literature, whereas the robots that assist by providing health guidance or help with an activity of daily living received relatively limited attention. PARO was the most commonly used robot in dementia care studies. The effectiveness of each assistive robot and the outcome of the studies are discussed, and particularly, the social/emotional capabilities of each assistive robot are summarized. Gaps in the research literature are identified and we provide directions for future work.
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Affiliation(s)
- Moojan Ghafurian
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Jesse Hoey
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Kerstin Dautenhahn
- Departments of Electrical and Computer Engineering/Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Ali H, Ahmed A, Cole A. Capturing nurses' perception of communicative technologies in nursing facilities: Survey instrument development. Int J Older People Nurs 2021; 16:e12404. [PMID: 34231958 DOI: 10.1111/opn.12404] [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: 10/06/2020] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the common perception of the call light system as crucial for patient safety, there are usability gaps between what features staff in nursing facilities need to address an alarm quickly and how the call system is designed. A survey instrument was developed to investigate nursing home staff experiences in using call light technology. METHODS A survey instrument was developed and distributed to staff in two nursing facilities in Up-State, New York (N = 278). The strength and direction of relationships between pairs of variables were measured using Pearson correlation and analysis of variance to investigate the perceived effect of staff's perception of the call light system on the work system's elements, process and staff outcomes. RESULTS The study found correlations between the job-level workload and the noise in the unit (r = 0.272, p = .000), between job-level workload and the ease of locating call lights (r = 0.154, p = .023), and between job stress and burnout (r = 0.176, p = .009). Only 64% of nursing home staff believed that the call light system reflected urgent needs, with younger staff relating to this group. The staff gave the work environment a high score, which corresponds to excessive noises caused by the call light alarm, according to 74% of the staff. These associations stem from gaps caused by a lack of user feedback in the design and acquisition process, leading to usability issues that reduce performance and satisfaction over time. CONCLUSION The study found that the type of call light system used is associated with usability challenges that often impeded the performance of the nursing home staff's response to residents. These insights can improve the selection of a new call light system that avoids usability issues and challenges identified by end-users.
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Affiliation(s)
| | - Abdulaziz Ahmed
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Astin Cole
- Political Science Department, Auburn University, Auburn, Alabama, USA
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Keenan AJ, Tsourtos G, Tieman J. The Value of Applying Ethical Principles in Telehealth Practices: Systematic Review. J Med Internet Res 2021; 23:e25698. [PMID: 33783366 PMCID: PMC8044738 DOI: 10.2196/25698] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/04/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can lead to reduced effectiveness, noncompliance, and harm, undermining the best intentions of governments and clinicians. Objective Our aim was to explore how ethical considerations or impacts may be different, greater, or more variable in information and communication technology methods versus face-to-face health care delivery models, and how they may be applied in practice. Methods We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. Six databases were searched between March 2016 to May 2016 and again in December 2020 to provide the benefit of currency. A combination of broad terms (“ethics,” “ethical,” “health,” and “care”) with the restrictive terms of “telehealth” and “telemedicine” was used in keyword searches. Thematic analysis and synthesis of each paper was conducted, aligned to the framework developed by Beauchamp and Childress. Results From the 49 papers reviewed, authors identified or discussed the following ethical principles in relation to telehealth practice: autonomy (69% of authors, 34/49), professional–patient relationship (53% of authors, 26/49), nonmaleficence (41% of authors, 20/49), beneficence (39%, of authors, 19/49), and justice (39% of authors, 19/49). Conclusions Although a small number of studies identified ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated into clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there was little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice.
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Affiliation(s)
- Amanda Jane Keenan
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Jennifer Tieman
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Fares N, Sherratt RS, Elhajj IH. Directing and Orienting ICT Healthcare Solutions to Address the Needs of the Aging Population. Healthcare (Basel) 2021; 9:147. [PMID: 33540510 PMCID: PMC7912863 DOI: 10.3390/healthcare9020147] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With an aging population, it is essential to maintain good health and autonomy for as long as possible. Instead of hospitalisation or institutionalisation, older people with chronic conditions can be assisted in their own home with numerous "smart" devices that support them in their activities of daily living, manage their medical conditions, and prevent fall incidents. Information and Communication Technology (ICT) solutions facilitate the monitoring and management of older people's health to improve quality of life and physical activity with a decline in caregivers' burden. METHOD The aim of this paper was to conduct a systematic literature review to analyse the state of the art of ICT solutions for older people with chronic conditions, and the impact of these solutions on their quality of life from a biomedical perspective. RESULTS By analysing the literature on the available ICT proposals, it is shown that different approaches have been deployed by noticing that the more cross-interventions are merged then the better the results are, but there is still no evidence of the effects of ICT solutions on older people's health outcomes. Furthermore, there are still unresolved ethical and legal issues. CONCLUSION While there has been much research and development in healthcare ICT solutions for the aging population, ICT solutions still need significant development in order to be user-oriented, affordable, and to manage chronic conditions in the aging wider population.
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Affiliation(s)
- Nada Fares
- Department of Biomedical Engineering, School of Biological Sciences, University of Reading, Berkshire RG6 6AY, UK;
| | - R. Simon Sherratt
- Department of Biomedical Engineering, School of Biological Sciences, University of Reading, Berkshire RG6 6AY, UK;
| | - Imad H. Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut 1107 2020, Lebanon;
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Wild K, Sharma N, Mattek N, Karlawish J, Riley T, Kaye J. Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study. J Med Internet Res 2021; 23:e18806. [PMID: 33439144 PMCID: PMC7840292 DOI: 10.2196/18806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.
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Affiliation(s)
- Katherine Wild
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nicole Sharma
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nora Mattek
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas Riley
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
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Baudin K, Gustafsson C, Frennert S. Views of Swedish Elder Care Personnel on Ongoing Digital Transformation: Cross-Sectional Study. J Med Internet Res 2020; 22:e15450. [PMID: 32543444 PMCID: PMC7327600 DOI: 10.2196/15450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/18/2020] [Accepted: 03/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges. Objective The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession. Methods Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations. Results The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as “too slow” (4/4, 100%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the “right pace” (4/7, 57%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2%) (P<.001). Conclusions Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel’s resistance to welfare technology and patients’ participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care.
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Affiliation(s)
- Katarina Baudin
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Christine Gustafsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Susanne Frennert
- Internet of Things and People Research Center, Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden
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Tsertsidis A. Challenges in the provision of digital technologies to elderly with dementia to support ageing in place: a case study of a Swedish municipality. Disabil Rehabil Assist Technol 2020; 16:758-768. [PMID: 31913734 DOI: 10.1080/17483107.2019.1710774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this paper is to identify structural problems and challenges for the delivery of digital technologies for ageing in place to elderly with dementia. METHODS To that end, I conducted a case study in a Swedish municipality. RESULTS The results showed that elderly with dementia are not exploiting their full potential of receiving help in the form of technology, since the four conditions of the Consumer Direction (Control and Direct services - Variety of digital technologies for ageing in place options - Information and Support - Participation in systems design) were met to a very low degree. CONCLUSIONS I propose that the municipality in question creates a proper knowledge-sharing platform so that occupational therapists are well informed about digital technologies for ageing in place, to allow them to provide accurate information and support to elderly with dementia, resulting in a possible increase in use of technology and subsequently support the empowerment goal of Consumer Direction. I also believe, according to the findings of this study, that the module of Information and Support should be treated as the most important condition for achieving increased Consumer Direction.Implications for rehabilitationElderly with dementia and their relatives do not receive sufficient information about digital technologies for ageing in place (DTAP). There is not enough information regarding the available options and their use. This often denies elderly with dementia and their relatives the services they are entitled.Occupational therapists knowledge about DTAP affects the variety of options presented to elderly with dementia and their subsequent use.Once a person is diagnosed with dementia, physicians tend to suggest medicinal solutions, overlooking the dissemination of DTAP information. Thus hindering their early access to DTAP.
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Sundgren S, Stolt M, Suhonen R. Ethical issues related to the use of gerontechnology in older people care: A scoping review. Nurs Ethics 2019; 27:88-103. [PMID: 31113266 DOI: 10.1177/0969733019845132] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Demographic trends indicate growth of population aged 65 and older in Western countries. One of the greatest challenges is to provide high-quality care for all. Technological solutions designed for older people, gerontechnology, can somewhat balance the gap between resources and the increasing demand of healthcare services. However, there are also ethical issues in the use of gerontechnology that need to be pointed out. PURPOSE To describe what ethical issues are related to the use of gerontechnology in the care of community-dwelling older people. METHODS A scoping review was performed to identify and analyse studies concerning ethical issues when using gerontechnology in the home care of older people. The literature search was limited to studies published after 1990 and addressed to the electronic databases CINAHL, PubMed, Cochrane, Medic, IEEE Explore and Web of Science. The search was performed in July-August 2018. Data from empirical studies were analysed using thematic analysis. ETHICAL CONSIDERATIONS This scoping review was conducted in accordance with good scientific practice. The work of other researchers was respected and cited appropriately. RESULTS A total of 17 studies were identified. Two main themes were found. 'Balancing between the benefits of using gerontechnology and the basic rights of older people', consisted of the subthemes safety, privacy and autonomy. The other main theme, 'Gerontechnology as a risk of insecurity for older people', included the subthemes fear of losing human contact and concern and fear. Surveillance and monitoring technologies were mainly studied. CONCLUSION These results suggest that there may be ethical issues related to the use of gerontechnology and they must therefore be taken into consideration when implementing technology in the care of community-dwelling older people.
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Affiliation(s)
| | | | - Riitta Suhonen
- University of Turku, Finland; Turku University Hospital, Finland; City of Turku, Welfare Division, Finland
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Abstract
PurposeThe purpose of this paper is to review marketing materials of surveillance products for people with dementia and their carers in three ageing countries, as part of a dementia-technology media analysis.Design/methodology/approachAn online environmental scan was conducted using search terms for surveillance technologies (STs) and dementia through a Google search focussed on the UK, Sweden and the Netherlands. Data were extracted on the products’ and websites’ marketing messages from consumer and marketer perspectives.FindingsInformation was gathered for 382 product websites, of which 242 met eligibility criteria. The majority of products come from the UK. In the UK and Sweden, the companies behind the websites appeared to be mainly “cottage industries” which focus on selling ST. In contrast, sellers in the Netherlands included a more balanced mixture of small, medium and large companies. In all three countries, the website messaging focussed on the need to manage safety concerns, without considering privacy or consent.Social implicationsContrary to the perception of future dependence on technology, the ST sector seems to be a niche market. The media messages, equating people with dementia with animals and children, are at odds with initiatives that strive for dignity and dementia friendliness.Originality/valueNo previous study is known to have explored media messages from websites that market ST for people with dementia.
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Dockweiler C, Diedrich L, Palmdorf S, Beier D, Ilic J, Kibbert M, Kirsch J, Hannemann N, Prisett F, Schmitke V, Schmidt C, Spindeler T, Sommer L, Sommer S, Stark AL, Steinkühler C, Stolte J, Hornberg C. [Telematics in ambulatory care: Exploring the nurses' perspective]. Pflege 2018; 32:87-96. [PMID: 30265200 DOI: 10.1024/1012-5302/a000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Telematics in ambulatory care: Exploring the nurses' perspective Abstract. BACKGROUND In the context of demographic change, the use of information and communications technology in home care has the aim of ensuring the quality of nursing care in the future. The acceptance of telematic applications by all users is crucial in this regard. AIM The aim of this study was to assess the subjective attitudes and intentions of nursing staff on telematic applications in home care. METHODS Based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT), an online survey was conducted in which nursing staff as well as nursing students throughout Germany were surveyed. 371 questionnaires have been included in the analysis. RESULTS Nursing students as well as nurses stated inadequate information and insufficient technical competence. Referring to performance expectations, both groups hope for improving care process transparency and communication inside and outside sectors. For effort expectancy, higher costs, training efforts and technology dependency were named. CONCLUSIONS The results show the relevance of the attitudes and demands of users for a successful implementation. In the future, training and further education should increasingly promote the technological competence of nursing staff.
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Affiliation(s)
| | - Leonie Diedrich
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Sarah Palmdorf
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Dina Beier
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Jonas Ilic
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Marius Kibbert
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Joeline Kirsch
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Niels Hannemann
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | | | | | | | | | - Lara Sommer
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Samira Sommer
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Anna Lea Stark
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | | | - Johanna Stolte
- 1 Fakultät für Gesundheitswissenschaften, Universität Bielefeld
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Kolltveit BCH, Thorne S, Graue M, Gjengedal E, Iversen MM, Kirkevold M. Telemedicine follow-up facilitates more comprehensive diabetes foot ulcer care: A qualitative study in home-based and specialist health care. J Clin Nurs 2018; 27:e1134-e1145. [PMID: 29193527 DOI: 10.1111/jocn.14193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To investigate the application of a telemedicine intervention in diabetes foot ulcer care, and its implications for the healthcare professionals in the clinical field. BACKGROUND Contextual factors are found to be important when applying technology in health care and applying telemedicine in home-based care has been identified as particularly complex. DESIGN AND METHODS We conducted field observations and individual interviews among healthcare professionals in home-based care and specialist health care in a diabetes foot care telemedicine RCT (Clin.Trial.gov: NCT01710774) during 2016. This study was guided by Interpretive Description, an inductive qualitative methodology. RESULTS Overall, we identified unequal possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. Different circumstances and possibilities in home-based care made the application of telemedicine as intended more difficult. The healthcare professionals in both care contexts perceived the application of telemedicine to facilitate a more comprehensive approach towards the patients, but with different possibilities to enact it. CONCLUSIONS Application of telemedicine in home-based care was more challenging than in the outpatient clinic setting. Introducing more updated equipment and minor structural adjustments in consultation time and resources could make the use of telemedicine in home-based care more robust. RELEVANCE TO CLINICAL PRACTICE Application of telemedicine in diabetes foot ulcer follow-up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer as well as the patient's total situation. Access to adequate equipment and time, particularly in home-based care, is necessary to capitalise on this new technology.
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Affiliation(s)
- Beate-Christin Hope Kolltveit
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Marit Graue
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Faculty of Health and Social Care, Molde University College, Molde, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Section of Endocrinology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Marit Kirkevold
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Moyle W, Jones C, Murfield J, Dwan T, Ownsworth T. 'We don't even have Wi-Fi': a descriptive study exploring current use and availability of communication technologies in residential aged care. Contemp Nurse 2017; 54:35-43. [PMID: 29185380 DOI: 10.1080/10376178.2017.1411203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There has been significant growth in communication technologies. However, it is unknown to what extent RACFs accommodate such technologies. AIM To explore the use and availability of communication technologies for use by residents within RACFs in Queensland, Australia. METHODS A descriptive, structured telephone survey. Every 10th alphabetically listed facility from a total sample of n = 462 were telephoned and staff were invited to complete the survey. RESULTS Forty-one out of a total of 93 RACFs completed the survey. The telephone was by far the primary form of communication used by residents to communicate with family and friends (n = 40; 97.6%). Conversely, the use of web-connection communication software (Skype or similar) was uncommon. CONCLUSION The use and availability of communication technologies is limited within RACFs, highlighting a significant lag in the uptake within the sector.
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Affiliation(s)
- Wendy Moyle
- a Menzies Health Institute QLD, Griffith University , Nathan, Brisbane , Australia.,b School of Nursing and Midwifery, Nathan Campus , Griffith University , Nathan, Brisbane , Australia
| | - Cindy Jones
- a Menzies Health Institute QLD, Griffith University , Nathan, Brisbane , Australia.,b School of Nursing and Midwifery, Nathan Campus , Griffith University , Nathan, Brisbane , Australia
| | - Jenny Murfield
- a Menzies Health Institute QLD, Griffith University , Nathan, Brisbane , Australia
| | - Toni Dwan
- a Menzies Health Institute QLD, Griffith University , Nathan, Brisbane , Australia.,c School of Applied Psychology, Mt Gravatt Campus , Griffith University , Mt Gravatt, Brisbane , Australia
| | - Tamara Ownsworth
- a Menzies Health Institute QLD, Griffith University , Nathan, Brisbane , Australia.,c School of Applied Psychology, Mt Gravatt Campus , Griffith University , Mt Gravatt, Brisbane , Australia
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Cerdan J, Catalan-Matamoros D, Berg SW. Online communication in a rehabilitation setting: Experiences of patients with chronic conditions using a web portal in Denmark. PATIENT EDUCATION AND COUNSELING 2017; 100:2283-2289. [PMID: 28698033 DOI: 10.1016/j.pec.2017.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/10/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To gain insight into the experiences of patients with long-term conditions enrolled in an online rehabilitation programme using a web portal. METHODS Danish outpatients were recruited from a rehabilitation department and were granted access to a web portal which included an online rehabilitation programme with key information, clinical advice, and self-management activities. After two weeks, patients were invited to participate in focus groups. A topic guide was used to explore this new online rehabilitation programme in relation to participants' experiences. RESULTS Fourteen participants, ranging from 42 to 72 years old, were allocated into three focus groups. Participants mainly reported negative experiences by the following four themes: 'patients' experiences', 'technical aspects', 'areas for improvement', and 'digitalization added value'. CONCLUSION Participants mainly reported negative experiences and suggested combining both face-to-face consultations with online care by user-friendly web portals. This will ensure a positive contribution from digital communication tools to rehabilitation. PRACTICE IMPLICATIONS Patients' experiences should be considered in the design of web portals in rehabilitation which could help healthcare organizations when developing online rehabilitation programmes.
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Affiliation(s)
- Jose Cerdan
- Physio- and Occupational Therapy Department, Hvidovre Hospital, Hvidovre, Denmark; Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Catalan-Matamoros
- Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain; Research group for Health Sciences CTS-451, University of Almeria, Almeria, Spain.
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Øyen KR, Sunde OS, Solheim M, Moricz S, Ytrehus S. Understanding attitudes toward information and communication technology in home-care: Information and communication technology as a market good within Norwegian welfare services. Inform Health Soc Care 2017; 43:300-309. [PMID: 28506095 DOI: 10.1080/17538157.2017.1297814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to better understand nurses' and other staff members' attitudes toward the usefulness of information and communication technology in home-care settings. Research has found that beliefs about the expected benefits of information and communication technology impact the use of technology. Furthermore, inexperience with using information and communication technology may cause negative attitudes. This article is based on a questionnaire to 155 nurses and other staff members in home-care in Sogn og Fjordane county in Norway. The results revealed minimal use of information and communication technology at work; however, participants had positive attitudes regarding the potential benefits of information and communication technology use in home-care. Individuals' extensive use of and familiarity with different solutions in private lives could be an important context for explaining employees' attitudes. Given that information and communication technology is both a welfare service and a market good, this may explain individuals' positive attitudes toward information and communication technology despite their lack of experience with it at work. Experiences with information and communication technology as a market good and the way new technologies can affect work routines will affect the implementation of information and communication technology in home-care.
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Affiliation(s)
| | - Olivia Sissil Sunde
- a Faculty of Health Studies , Sogn og Fjordane University College , Førde , Norway
| | - Marit Solheim
- a Faculty of Health Studies , Sogn og Fjordane University College , Førde , Norway
| | - Sara Moricz
- a Faculty of Health Studies , Sogn og Fjordane University College , Førde , Norway
| | - Siri Ytrehus
- a Faculty of Health Studies , Sogn og Fjordane University College , Førde , Norway
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Information technologies for active and assisted living—Influences to the quality of life of an ageing society. Int J Med Inform 2017; 100:32-45. [DOI: 10.1016/j.ijmedinf.2017.01.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 10/06/2016] [Accepted: 01/14/2017] [Indexed: 11/24/2022]
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Guise V, Wiig S. Perceptions of telecare training needs in home healthcare services: a focus group study. BMC Health Serv Res 2017; 17:164. [PMID: 28231852 PMCID: PMC5324329 DOI: 10.1186/s12913-017-2098-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals’ perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Methods Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. Results The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients’ perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Conclusion Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills and attitudes required for new ways of working and enable quality and safety in telecare practice, staff should be provided with training as part of telecare implementation processes. Telecare training should be hands-on and encourage an overall patient-centred approach to care to ensure good patient-professional relationships at a distance.
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Affiliation(s)
- Veslemøy Guise
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
| | - Siri Wiig
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway
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Ienca M, Fabrice J, Elger B, Caon M, Scoccia Pappagallo A, Kressig RW, Wangmo T. Intelligent Assistive Technology for Alzheimer’s Disease and Other Dementias: A Systematic Review. J Alzheimers Dis 2017; 56:1301-1340. [DOI: 10.3233/jad-161037] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Marcello Ienca
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
| | - Jotterand Fabrice
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bernice Elger
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
- University Center for Legal Medicine, University of Geneva, Switzerland
| | - Maurizio Caon
- Department of Computer Science, HumanTech Institute, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | | | - Reto W. Kressig
- University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
- Chair of Geriatrics, University of Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
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Virtual visits in home health care for older adults. ScientificWorldJournal 2014; 2014:689873. [PMID: 25506616 PMCID: PMC4258330 DOI: 10.1155/2014/689873] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/01/2014] [Accepted: 11/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. DESIGN An integrative literature review. METHOD Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. RESULTS Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. CONCLUSIONS The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.
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Marchesoni MA, Axelsson K, Lindberg I. Digital support for medication administration--a means for reaching the goal of providing good care? J Health Organ Manag 2014; 28:327-43. [PMID: 25080648 DOI: 10.1108/jhom-11-2012-0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Hofmann B. Ethical challenges with welfare technology: a review of the literature. SCIENCE AND ENGINEERING ETHICS 2013; 19:389-406. [PMID: 22218998 DOI: 10.1007/s11948-011-9348-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many kinds of welfare technology break with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner.
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Affiliation(s)
- Bjørn Hofmann
- Center for Medical Ethics, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway.
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Abstract
Research indicates the essentiality of dignity as a vital component for quality of life, reconfirming the emphasis on dignity preservation in the international code of nursing ethics. Applying Noblit and Hare’s meta-ethnography, the aim of the study was to develop a theory model by synthesizing 10 qualitative articles from various cultural contexts, exploring nurse and allied healthcare professional perception/practice concerning dignity-preserving dementia care. “Advocating the person’s autonomy and integrity,” which involves “having compassion for the person,” “confirming the person’s worthiness and sense of self,” and “creating a humane and purposeful environment,” was identified as a primary foundation for dignity-preserving dementia care. “Balancing individual choices among persons no longer able to make sound decisions, against the duty of making choices on behalf of the person,” which involves “persuasion” and/or “mild restraint,” was considered a crucial aspect in certain situations. “Sheltering human worth—remembering those who forget” was identified as a comprehensive motive and core value within dignity-preserving dementia care.
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Affiliation(s)
- Oscar Tranvåg
- University of Bergen, Norway; Oslo and Akershus University College, Norway
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Yueh HP, Lin W, Lu TY, Chou YL. Examining older users’ performance on and preference for menu designs of digital photo frames. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2013. [DOI: 10.1080/1463922x.2011.617113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Gaskin S, Georgiou A, Barton D, Westbrook J. Examining the role of information exchange in residential aged care work practices--a survey of residential aged care facilities. BMC Geriatr 2012; 12:40. [PMID: 22856585 PMCID: PMC3463451 DOI: 10.1186/1471-2318-12-40] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 06/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals. METHODS A survey of staff (n = 119), including managers, health informatics officers (HIOs), quality improvement staff, registered nurses (RNs), enrolled nurses (ENs)/endorsed enrolled nurses (EENs) and assistants in nursing (AINs) was carried out in four residential aged care facilities in New South Wales and Victoria, Australia. Sites varied in size and displayed a range of information technology (IT) capabilities. The survey investigated how and by whom information is collected, retrieved and exchanged, and the frequency and amount of time devoted to these tasks. Descriptive analysis was performed using SPSS, and open responses to questions were coded into key themes. RESULTS Staff completed a median of six forms each, taking a median of 30 min per shift. 68.8% of staff reported transferring information from paper to a computer system, which took a median of 30 min per shift. Handover and face-to-face communication was the most frequently used form of information exchange within facilities. There was a large amount of faxing and telephone communication between facility staff and General Practitioners and community pharmacists, with staff reporting sending a median of 2 faxes to pharmacy and 1.5 faxes to General Practitioners, and initiating 2 telephone calls to pharmacies and 1.5 calls to General Practitioners per shift. Only 38.5% of respondents reported that they always had information available at the point-of-care and only 35.4% of respondents reported that they always had access to hospital stay information of residents after hospital discharge. CONCLUSIONS This survey identified a high volume of information exchange activities, as well as inefficient procedures, such as the transfer of information from paper to computer systems and the reliance upon faxes for communication with external providers. These findings contribute to evidence for the need for interoperable IT systems to allow more efficient and reliable information exchange between facilities and external providers.
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Affiliation(s)
- Sarah Gaskin
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Donna Barton
- Sir Moses Montefiore Jewish Home, Randwick, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
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Harrefors C, Sävenstedt S, Lundquist A, Lundquist B, Axelsson K. Professional Caregivers' Perceptions on how Persons with Mild Dementia Might Experience the Usage of a Digital Photo Diary. Open Nurs J 2012; 6:20-9. [PMID: 22509232 PMCID: PMC3322432 DOI: 10.2174/1874434601206010020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | - Stefan Sävenstedt
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | | | | | - Karin Axelsson
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Finnbakk E, Skovdahl K, Blix ES, Fagerström L. Top-level managers’ and politicians’ worries about future care for older people with complex and acute illnesses - a Nordic study. Int J Older People Nurs 2012; 7:163-72. [DOI: 10.1111/j.1748-3743.2012.00312.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Drawing on interviews with 76 older people (aged 60 years and older) receiving telecare services at home and in housing with care and 16 family caregivers in West Lothian, Scotland, the authors consider how far telecare can support older people’s citizenship goals of independence, participation, and identity. They conclude that although these goals are to some extent supported by telecare, they are also supported by the model of care being applied and limited by aspects of the wider environment, such as ageism. The authors argue that in every case, contextual factors beyond the intrinsic capacities of a technological system and beyond the models of care developed and promoted by a service delivery organization must be explored if the impact of telecare is to be fully understood. Thus, the human use of technology and its moral context are critical to its success or limitation.
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Wälivaara BM, Andersson S, Axelsson K. General practitioners' reasoning about using mobile distance-spanning technology in home care and in nursing home care. Scand J Caring Sci 2011; 25:117-25. [PMID: 20518865 DOI: 10.1111/j.1471-6712.2010.00800.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The trend for health care and nursing care turns from hospital to health care and nursing care at home. Studies have shown that health care professionals have no access to patient records in home and nursing home settings. Technological development creates opportunities for a host of mobile technology solutions. The aim of this study was to describe the reasoning among general practitioners (GPs) about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes. Seventeen GPs were divided in five groups for a group interview. The interviews were tape-recorded and transcribed verbatim. The qualitative content analysis resulted in four areas about the MDST, MDST has an impact on GPs' work, the nurses' profession, and the patient and the family, with nine adherent categories. The findings were interpreted and formulated in the theme: MDST should be used with caution. The results show quite a few expressions about the MDST as useful and valuable in health care at home and in nursing home settings; however, in every category, there were text that we interpreted as caution when using the MDST. The MDST cannot be used in all situations and cannot replace human meetings in health care and nursing care at home and in nursing homes. The MDST should primarily be a tool for the profession, and understanding the professions' reasoning about technology use in health care at home and in nursing home settings must be the base for implementing MDST.
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Affiliation(s)
- Britt-Marie Wälivaara
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Zwijsen SA, Niemeijer AR, Hertogh CMPM. Ethics of using assistive technology in the care for community-dwelling elderly people: an overview of the literature. Aging Ment Health 2011; 15:419-27. [PMID: 21500008 DOI: 10.1080/13607863.2010.543662] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This article provides an overview of the international literature on the most important ethical considerations in the field of assistive technology (AT) in the care for community-dwelling elderly people, focused on dementia. METHOD A systematic literature review was performed. RESULTS A total of 46 papers met the inclusion criteria. Three main themes were found. The first theme, personal living environment, involves the subthemes privacy, autonomy and obtrusiveness. The second theme, the outside world, involves the subthemes stigma and human contact. The third theme, the design of AT devices, involves the subthemes individual approach, affordability and safety. The often referred to umbrella term of 'obtrusiveness' is frequently used by many authors in the discussion, while a clear description of the concept is mostly absent. CONCLUSION When it comes to AT use in the care for elderly people living at home, ethical debate appears not to be a priority. The little discussion there relies heavily on thick concepts such as autonomy and obtrusiveness which seem to complicate the debate rather than clarify it, because they contain many underlying ambiguous concepts and assumptions. Most encountered ethical objections originate from the view that people are, or should be, independent and self-determinant. It is questionable whether the view is correct and helpful in the debate on AT use in the care for (frail) elderly people. Other ethical approaches that view people as social and reciprocal might be more applicable and shed a different light on the ethical aspects of AT use.
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Affiliation(s)
- Sandra A Zwijsen
- Department of Nursing Home Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature. Int Psychogeriatr 2010; 22:1129-42. [PMID: 20199699 DOI: 10.1017/s1041610210000037] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Technology has emerged as a potential solution to alleviate some of the pressures on an already overburdened care system, thereby meeting the growing needs of an expanding population of seriously cognitively impaired people. However, questions arise as to what extent technologies are already being used in residential care and how ethically and practically acceptable this use would be. METHODS A systematic literature review was conducted to explore what is known on the moral and practical acceptability of surveillance technologies in residential care for people with dementia or intellectual disabilities, and to set forth the state of the debate. RESULTS A total of 79 papers met the inclusion criteria. The findings show that application and use of surveillance technologies in residential care for vulnerable people generates considerable ethical debate. This ethical debate centers not so much around the effects of technology, but rather around the moral acceptability of those effects, especially when a conflict arises between the interests of the institution and the interests of the resident. However, the majority of articles lack in depth analysis. Furthermore, there are notable cultural differences between the European literature and American literature whereby in Britain there seems to be more ethical debate than in America. Overall however, there is little attention for the resident perspective. CONCLUSION No ethical consensus has yet been reached, underlining the need for clear(er) policies. More research is thus recommended to determine ethical and practical viability of surveillance technologies whereby research should be specifically focused on the resident perspective.
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Harrefors C, Axelsson K, Sävenstedt S. Using assistive technology services at differing levels of care: healthy older couples’ perceptions. J Adv Nurs 2010; 66:1523-32. [DOI: 10.1111/j.1365-2648.2010.05335.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
ABSTRACTDementia is one of the greatest contemporary health and social care challenges, and novel approaches to the care of its sufferers are needed. New information and communication technologies (ICT) have the potential to assist those caring for people with dementia, through access to networked information and support, tracking and surveillance. This article reports the views about such new technologies of 34 carers of people with dementia. We also held a group discussion with nine carers for respondent validation. The carers' actual use of new ICT was limited, although they thought a gradual increase in the use of networked technology in dementia care was inevitable but would bypass some carers who saw themselves as too old. Carers expressed a general enthusiasm for the benefits of ICT, but usually not for themselves, and they identified several key challenges including: establishing an appropriate balance between, on the one hand, privacy and autonomy and, on the other: maximising safety; establishing responsibility for and ownership of the equipment and who bears the costs; the possibility that technological help would mean a loss of valued personal contact; and the possibility that technology would substitute for existing services rather than be complementary. For carers and dementia sufferers to be supported, the expanding use of these technologies should be accompanied by intensive debate of the associated issues.
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Suhonen R, Stolt M, Launis V, Leino-Kilpi H. Research on ethics in nursing care for older people: A literature review. Nurs Ethics 2010; 17:337-52. [DOI: 10.1177/0969733010361445] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this review was to analyse the empirical studies that focus on ethics in nursing care for older people, scoping the need and areas for further study. A search of the MEDLINE and CINAHL databases (earliest to August 2009) was conducted using the the keywords: ethic* and nursing or care or caring and elderly or aged or older. After a four-stage process, 71 empirical articles were included in the review, with informants ranging from elderly people to relatives, caregivers, managers and students in care settings. The review focusses on the concepts, contexts, methods and validity of these studies. Based on the analysis, the reviewed research seems to be fragmented and multifaceted, focussing on selected issues such as autonomy, self-determination and informed consent. No large research programs or research traditions were found so it was not possible to draw any conclusions about suitable methods, study designs or instruments of measurement for use in this research area.
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Affiliation(s)
| | | | | | - Helena Leino-Kilpi
- University of Turku, Turku, Finland & Hospital District of South-Western Finland
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Calvert JF, Kaye J, Leahy M, Hexem K, Carlson N. Technology use by rural and urban oldest old. Technol Health Care 2009; 17:1-11. [PMID: 19478400 DOI: 10.3233/thc-2009-0527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Technologies designed to optimally maintain older people as they age in their desired places of residence are proliferating. An important step in designing and deploying such technologies is to determine the current use and familiarity with technology in general among older people. The goal of this study was to determine the extent that community-dwelling elderly at highest risk of losing independence, the oldest old, use common electronic devices found in residential urban or rural settings. METHODS We surveyed 306 nondemented elderly age 85 or over; 144 were part of a rural aging study, the Klamath Exceptional Aging Project, and 181 were from an urban aging cohort in Portland. RESULTS The most frequently used devices were televisions, microwave ovens, and answering machines. Persons with mild cognitive impairment were less likely to use all devices than those with no impairment. Higher socioeconomic status and education were associated with use of more complicated devices. Urban respondents were more likely than rural ones to use most devices. CONCLUSION Technology use by very old community-dwelling elderly is common. There are significant differences in use between rural and urban elderly.
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Affiliation(s)
- James F Calvert
- Department of Family Medicine, Oregon Health & Science University, Cascades East Family Medicine, Klamath Falls, OR, USA.
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Harrefors C, Sävenstedt S, Axelsson K. Elderly people’s perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden. Scand J Caring Sci 2009; 23:353-60. [DOI: 10.1111/j.1471-6712.2008.00629.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Or CK, Valdez RS, Casper GR, Carayon P, Burke LJ, Brennan PF, Karsh BT. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. Work 2009; 33:201-9. [PMID: 19713630 PMCID: PMC2819983 DOI: 10.3233/wor-2009-0867] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.
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Affiliation(s)
- Calvin K.L. Or
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Rupa S. Valdez
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Gail R. Casper
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | | | - Patricia Flatley Brennan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Ben-Tzion Karsh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
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Nilsson C, Skär L, Söderberg S. Swedish district nurses' attitudes to implement information and communication technology in home nursing. Open Nurs J 2008; 2:68-72. [PMID: 19319223 PMCID: PMC2600856 DOI: 10.2174/1874434600802010068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 11/22/2022] Open
Abstract
The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses' attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses' from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses' attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses' work situation.
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Affiliation(s)
- Carina Nilsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Or CK, Valdez RS, Casper GR, Carayon P, Burke LJ, Brennan PF, Karsh BT. Human Factors and Ergonomic Concerns and Future Considerations for Consumer Health Information Technology in Home Nursing Care. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/154193120805201219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home care patient, which can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-management. Currently, a variety of consumer health information technologies (CHITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This article reviews the HFE considerations for information access, communication, and patient self-management, discusses how CHIT can potentially mitigate current problems, and explains how the design and implementation of CHIT itself requires careful HFE attention.
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Affiliation(s)
- Calvin K.L. Or
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Rupa S. Valdez
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Gail R. Casper
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | | | - Patricia Flatley Brennan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Ben-Tzion Karsh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
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