Informational ecology and care workers: Safety alarm systems in Finnish elderly-care organizations

Information ecology in digitalising welfare services: a multi-level analysis

Purpose

The purpose of this paper is to examine and reinterpret information ecology in the context of the changing environment of services, which has been strongly affected by digitalisation and increasing citizen engagement. Here, information ecology refers to the interaction and co-evolution of technologies, human beings and the social environment.

Design/methodology/approach

The data consist of 25 thematic interviews conducted in a public Finnish organisation responsible for organising welfare services, and in its collaborating organisations. The interviews were analysed qualitatively. The analytical framework is based on Nardi and O'Day's five components of information ecology: system, diversity, co-evolution, keystone species and locality.

Findings

The analysis shows that these basic components still exist in the digitalisation era, but that they should be interpreted and highlighted differently, for example, stressing the openness of the information system instead of closed systems, as well as emphasising the increasing meaning of diversity amongst digitalisation, and the dynamic co-evolution between the elements of the system. New capabilities, such as the ability to combine various kinds of information and knowledge, are needed in this adaptation.

Research limitations/implications

The study illustrates a wider, updated information-ecology concept with the help of empirical research. Technology affects care organisations' information ecologies in numerous – often invisible – ways, which this study brings into light.

Originality/value

So far, information-ecology research has overlooked social and healthcare, but this study provides findings concerning this societally important sector.

Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes

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.

eHealth Services in the Near and Distant Future in Swedish Home Care Nursing

Sweden and other developed countries are putting deliberate efforts into eHealth and digitalization of home care nursing. eHealth services have big potential in this area because they can provide mobile access to healthcare information. This study explores the eHealth services that home care nursing providers in Sweden currently use, plan to use, and have discarded. It also investigates their eHealth visions for the future. We sent a survey to the 264 Swedish municipalities responsible for home care nursing and received 144 responses (55%). The results show a large diversity of eHealth services in use. A few can be considered core services since they are broadly implemented or will be in the near future. Trials are also being carried out with more specialized services. The respondents envision more automation and remote monitoring services, while technical and usability issues are the main obstacles to implementation today. Much knowledge can be gained from proper evaluation of the ongoing work. More research is needed regarding (1) what eHealth can offer home care nursing, (2) the effects of using eHealth in home care nursing, and (3) if and how home care nursing organizations need to adapt to best make use of eHealth.

Safety for older adults using telecare: Perceptions of homecare professionals

AIM

The aim of this study was to explore homecare professionals' perceptions of safety related to the use of telecare by older adults.

DESIGN

An exploratory qualitative design was employed.

METHODS

Two focus group interviews with ten female homecare professionals (nine Registered Nurses and one occupational therapist) were carried out between June-December 2017. The participants were recruited from six community homecare services in two Norwegian municipalities. Data were analysed using qualitative content analysis.

RESULTS

The participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also stated that the use of telecare involves challenges that could lead to harm to older adults due to technological limitations and difficulties managing and understanding the technology. Although telecare can enhance safety, it is necessary to develop reliable technology and adapt it to the user's abilities, skills and resources.

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review

Background

Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support “aging safely in place.”

Objective

This integrative review examines how research literature describes use of the PERS focusing on the users’ perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices.

Methods

The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted.

Results

The search resulted in 33 included studies describing different actors’ experiences with the PERS in use. The overall focus was on the end users’ experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors.

Conclusions

The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices.