Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions.

PURPOSE: Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function. METHODS: In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users. RESULTS: The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs' potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders' engagement, skills and teamwork.IMPLICATIONS FOR REHABILITATIONThis proof-of-concept study tested the feasibility of a home care delivery system using sensors and remote communication device for those with dementia and disabilities.A home care delivery system was successfully created for 12 weeks by collaborative efforts among care professionals, care recipients and family caregivers in their private home environment.The introduction of in-home passive remote monitoring system increased the possibility of the older adults being able to live independently, and enabled rehabilitation at home.The users had favourable views regarding the system's preventive and interactive nature and highlighted a greater need for better integration of improved assistive technology in long-term care and rehabilitation.

Bridging the gap between healthcare professions' regulation and practice: the "lived experience" of community pharmacists in Ireland following regulatory change.

BACKGROUND: Reforms to models of health and care regulation internationally have adapted to address the challenges associated with regulating healthcare professionals. Pharmacists in Ireland entered a new era of regulation with the enactment of the Pharmacy Act in 2007 which significantly updated the law regulating pharmacy in Ireland and expanded the regulatory scope considerably. An earlier study in 2017 examined the experiences of 20 community pharmacists of the Act. This follow-up study aimed to expand the scope of the original study to all community pharmacists in Ireland, to report their "lived experience" of the regulatory model introduced by the Act, assessing its impact on their professional practice using the principles of "better regulation". METHODS: Survey methodology was used to assess the perception of all community pharmacists registered with the Pharmaceutical Society of Ireland of the Act, as implemented, on their practice using an experimental design based on the seven principles of "Better Regulation". Descriptive statistics analyzed quantitative responses while answers from open-ended questions were analyzed using a combination of a modified framework analysis and a qualitative content analysis. RESULTS: Respondents agreed that the Act was necessary, although its implementation by the regulator was largely not viewed as fulfilling the remaining "Better Regulation" principles of being effective, proportional, consistent, agile, accountable and transparent. In particular, its proportionality was questioned. This resulted in pharmacists perceiving that their professional competency to act in the best interests of their patients was not appropriately acknowledged by the regulator, which in turn compromised their ability to provide optimal care for their patients. CONCLUSION: While healthcare professional regulation must primarily be concerned with public protection, it must also have regard to its impact on those delivering healthcare services. The findings highlight the challenge internationally of balancing rigidity and flexibility in professional health and care regulation, and the importance of a regulatory conversation occurring between those regulating and those regulated. This would serve to promote mutual learning and understanding to create a responsive approach to regulation, underpinned by mutual trust, effective risk assessment and adherence to the principles of "Better Regulation".

How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study.

BACKGROUND: Patient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective has been reported as an effective way of learning from incident data in a multidisciplinary team, the level of adaptability of this perspective to a different cultural context has not been widely explored. The primary aim of the study, therefore, was to investigate how healthcare practitioners in Japan perceive the reporting systems and utilize a systems perspective in learning from incident data in acute care and mental health settings. METHODS: A non-experimental, descriptive and exploratory research design was adopted with the following two data-collection methods: 1) Sixty-one semi-structured interviews with frontline staff in two hospitals; and 2) Non-participatory observations of thirty-seven regular incident review meetings. The two hospitals in the Greater Tokyo area which were invited to take part were: 1) a not-for-profit, privately-run, acute care hospital with approximately 500 beds; and 2) a publicly-run mental health hospital with 200 beds. RESULTS: While the majority of staff acknowledge the positive impacts of the reporting systems on safety, the observation data found that little consideration was given to systems aspects during formal meetings. The meetings were primarily a place for the exchange of practical information, as opposed to in-depth discussions regarding causes of incidents and corrective measures. Learning from incident data was influenced by four factors: professional boundaries; dealing with a psychological burden; leadership and educational approach; and compatibility of patient safety with patient-centered care. CONCLUSIONS: Healthcare organizations are highly complex, comprising of many professional boundaries and risk perceptions, and various communication styles. In order to establish an optimum method of individual and organizational learning and effective safety management, a fine balance has to be struck between respect for professional expertise in a local team and centralized safety oversight with a strong focus on systems. Further research needs to examine culturally-sensitive organizational and professional dynamics, including leader-follower relationships and the impact of resource constraints.

Assessing the Impact of an Original Soft Communicative Robot in a Nursing Home in Japan: Will Softness or Conversations Bring more Smiles to Older People?

It has been reported that robotics-aided care can contribute to enhancing older people's social participation and quality of life in nursing homes, while simultaneously reducing the burden on care professionals at nighttime. Due to increasing demand for social care and the relative workforce shortage, it is likely that a greater number and variety of robots will be introduced and implemented in the future. While the benefits of applying robots and assistive technologies are recognized, the current limitations and weaknesses have also been identified. One of these is the difficulty associated with a user-centered design, involving older adults with impaired cognitive and sensory abilities in nursing homes. In order to overcome this challenge, a project was carried out to develop a soft and compact bedside communication robot with an input/output device, connected to existing technologies (e.g. monitoring camera, biological sensor). Drawing on the principle of gemba (deference to frontline professionals' experience, expertise and skills), users' feedback was reflected in the iterative steps of robot development. The original soft and communicative robot was introduced and its effectiveness was tested by measuring older people's reactions and changes in their behaviors and engagement levels. The article reports the development process and results of a small-scale evaluation study, comparing the impact of this original soft-type robot with and without its communicative functions. The human-robot interactions were captured on video, and the analysis revealed that while communicative robots reduced the psychosocial burden on older adults, positive emotional, verbal, visual and behavioral engagement was generated with the help of the non-verbal plush toy.

Home-care robots - Attitudes and perceptions among older people, carers and care professionals in Ireland: A questionnaire study.

Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home-care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home-care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland and Japan. This study reports findings from the Irish cohort (114 older people [OP], 8 family carers and 56 Health and Social Care Professionals [HSCPs]). Seventy per cent of the total respondents (N = 178) reported being open to the use of home-care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home-care robots, while stressing the importance of 'privacy protection' and 'guaranteed access to human care'. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home-care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user-centred design, ethical aspects and national care policy.

Exploring perceptions toward home-care robots for older people in Finland, Ireland, and Japan: A comparative questionnaire study.

PURPOSE: To clarify potential users' perceptions toward the development and social implementation of home-care robots in Japan, Ireland, and Finland. METHODS: Unsigned, self-administered questionnaires were distributed to adults aged 65 or older, family caregivers, and home-care/health and social care professionals (HSCPs). A total of 1004 responses were collected. RESULTS: In Japan, many people were already familiar with robots in their daily lives. The most notable finding about their perspectives on home-care robots was related to safety. Moreover, 93.7 % of the Japanese respondents said, "If the user cannot decide whether to use a home-care robot, family members who know the user well should decide," followed by 76.4 % in Ireland and 83.1 % in Finland (p < .001). In Ireland, 81.8 % of the respondents said, "I want to help other people and society by participating in the research and development of home-care robots" (Japan: 69.9 %; Finland: 67.5 %) (p = .006). In Finland, many people had a negative impression of robots compared to the other two countries. Finland had the highest percentage (75.4 %) of respondents who said, "Health care professionals should be allowed to use secondary information collected by a home-care robot" (Japan and Ireland: 64 %) (p = .024). Moreover, Ireland and Finland emphasized the need to guarantee the entitlement to receive human care. CONCLUSIONS: Devising optimal strategies for the development and social implementation of home-care robots by incorporating various perspectives while valuing human dignity will require examination of each country's characteristics with respect to history, culture, policies, and values related to robots.

Measuring the impact of age, gender and dementia on communication-robot interventions in residential care homes.

AIM: The primary aim of this study was to examine the impact of age, gender and the stage of dementia on the results of an assistive technology intervention that make use of communication robots (com-robots). The intervention was designed to improve the social participation and interactions of nursing home residents. While our previous study showed that the overall effects of com-robot intervention were positive, it was unknown what impact age, gender and the stage of dementia of participants had on such an intervention. METHODS: This was a non-randomized, multicenter quasi-experimental intervention study conducted in residential care homes in Japan. Two types of com-robots were introduced for 8 weeks after baseline evaluation. The World Health Organization's ICF was used for evaluating any changes present after the 8-week intervention. In total, 78 residents (68 women, 10 men, 86.5 ± 7.7 years old) participated in the study. The Degree of Daily Life Independence Score for People with Dementia (DDLIS-PD) was employed for measuring the stage of dementia. RESULTS: The results showed that the older participants aged ≥80 benefited more from the intervention than the younger cohort did (P < 0.05). A greater improvement was shown among those with a more advanced stage of dementia than those at a less advanced stage (P < 0.05), when using DDLIS-PD. CONCLUSIONS: The overall findings support the use of com-robots within the context of a care team for older people with moderate dementia, and those who are aged ≥80 years. Geriatr Gerontol Int 2020; 20: 373-378.

Professional practice following regulatory change: An evaluation using principles of "Better Regulation".

BACKGROUND: The provisions in place internationally to regulate the practice of healthcare professionals have undergone significant change. However, this changing regulatory environment as experienced by healthcare professionals in the practice setting has not to date been widely researched. OBJECTIVE: To describe the "lived experience" of pharmacists in community practice in Ireland of the model of regulation introduced by the Pharmacy Act 2007 and their perception of it as fulfilling the seven principles of "better regulation": Necessity; Effectiveness/Targeted; Proportionality; Transparency; Accountability; Consistency and Agility. METHOD: 20 community pharmacists purposively selected, shared their lived experiences of the Act, as implemented in a semi-structured interview. A qualitative content analysis incorporating a framework analysis based on the seven principles of better regulation was used to analyze the data. RESULTS: The Act and its implementation by the Pharmaceutical Society of Ireland (PSI) was not perceived by community pharmacists overall as fulfilling the principles of better regulation. While there was agreement that the Act was necessary, its implementation by the PSI was not viewed as being effective, targeted, proportional and consistent. The PSI was considered to act as a deterrence regulator that is not adequately transparent or accountable. The Act is not sufficiently agile to respond to changes in pharmacy practice. CONCLUSION: Community pharmacists acknowledge the need for the Pharmacy Act but perceive that the PSI needs to adopt a more responsive approach to implementation if the Act is to be considered a model of better regulation. The study findings are of interest as there is little published research on how regulation is experienced by healthcare professionals who are subject to its provisions. The principles of better regulation provide an effective qualitative methodology to examine models of professional regulation based on the "lived experience" of regulatees.

How do nurses and midwives perceive their preparedness for quality improvement and patient safety in practice? A cross-sectional national study in Ireland.

BACKGROUND: Although patient safety and quality are cornerstones of healthcare practice, evidence is limited of the knowledge, skills and competence of practicing nurses and midwives in Ireland. OBJECTIVES: To investigate the perceptions of nurses and midwives regarding their continuing professional development-based preparedness for, and participation in quality and safety in the clinical setting. DESIGN: A cross-sectional survey was undertaken across the Republic of Ireland in 2016 examining nurses and midwives' perceptions of their knowledge and skills in quality and safety methods and tools, their views of competence in this field using the domains from the Quality and Safety Education for Nurses (QSEN) framework (person-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), and their participation in practice related to their access to quality and safety data. SETTINGS: 12 Health Service Executive (HSE) Centers of Nursing and Midwifery Education (CNMEs) in Ireland PARTICIPANTS: Practicing nurses and midwives (n = 654) working in acute hospitals and community healthcare organizations who were undertaking continuing professional development (CPD) education at the time of data collection (March-April 2016). METHODS: Survey methodology. 1787 surveys were distributed. Data were analyzed by IBM Statistical Package for the Social Sciences. RESULTS: A response rate of 37% (n = 654/1787) was achieved. While respondents were highly trained academically, many reported a lack of confidence in quality and safety methods and tools and QSEN competencies. Frontline staff nurses and midwives reported they were less prepared than their mid and senior level colleagues. Significant numbers indicated they were not engaged in quality and safety in practice. CONCLUSIONS: This first nationwide study in Ireland has discovered that nurses and midwives perceive gaps in their preparedness to engage in quality improvement and patient safety in practice. To safeguard patient care, priority should be given to ensuring front-line staff are appropriately educated, have access to data, and time to competently participate in the continuous improvement of patient care.

Understanding the state of health information in Ireland: A qualitative study using a socio-technical approach.

OBJECTIVES: The objective of this paper is to add to the broader literature on socio-technical theory and its value and/or relevance to health information in Ireland. The paper focuses on three factors that can impact on health information; those of policy, infrastructure and people (PIP) and examines how Ireland compares with other countries in relation to these factors. MATERIALS AND METHODS: Qualitative methods (documentary analysis and semi-structured interviews) were used. Key policy and strategy documents, and original research articles from Australia, Canada, Ireland, the UK and the US were analysed from a comparative perspective. The dimensions of policy, infrastructure and people were then explored through semi-structured interviews with health information experts in Ireland. Their perceptions were compared with and contrasted against the findings from the documentary analysis, and examined thematically. FINDINGS: The views of health information experts support the findings of the review of Ireland's development in this area compared with other countries and that Ireland lags behind others in policy and practice terms. CONCLUSIONS: The paper concludes that the three dimensions of policy, infrastructure and people do indeed help to frame the understanding of health information in Ireland and that a socio-technical perspective, combined with a comparative approach, can also help both policy makers and practitioners in identifying the scope for improvement in health information.

Bringing the Family in through the Back Door: the Stealthy Expansion of Family Care in Asian and European Long-Term Care Policy.

In the era of global ageing, amid political concerns about increasing care needs and long-term sustainability of current care regimes, most high-income economies are seeking to minimise the use of institutional care and to expand formal home care for their older populations. In long-term care reforms, concerns about public funding, formal providers and the paid care workforce are foremost. However, an integral yet hidden part of all these reforms is the stealthily growing role of family carers. This article aims to identify and spell out how developments in formal home care bring about different modes of increasing, encouraging and necessitating family care inputs, across welfare states. Using secondary sources, three different modes were identified, and the article outlines the logic of each mechanism, drawing on illustrative examples of policy dynamics in both European and Asian countries. Family care inputs have increased through policy changes that are not explicitly or primarily about family care, but rather about expansion or changes in formal care. In some cases, this is explicit, in other cases something that happens 'through the back door'. Nonetheless, in all cases there are implications for the family caregivers' time, health and employment options. Future studies are needed to examine longitudinal trends from a comparative perspective to confirm our findings and elucidate how government commitments to formal home care provision and financing interact with the changing nature and volume of family caregiving.

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting.

OBJECTIVE: Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. DESIGN: Qualitative research design using documentary analysis and semi-structured interviews. SETTING: Two large teaching hospitals in London; one providing acute and the other mental healthcare. PARTICIPANTS: Sixty-two healthcare practitioners with experience of reporting and analysing incidents. RESULTS: Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. CONCLUSION: Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education.

INTRODUCTION: This paper describes the evaluation of a 2-day simulation training programme for staff designed to improve teamwork and inpatient care and compassion in an older persons' unit. OBJECTIVE: The programme was designed to improve inpatient care for older people by using mixed modality simulation exercises to enhance teamwork and empathetic and compassionate care. METHODS: Healthcare professionals took part in: (a) a 1-day human patient simulation course with six scenarios and (b) a 1-day ward-based simulation course involving five 1-h exercises with integrated debriefing. A mixed methods evaluation included observations of the programme, precourse and postcourse confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training. RESULTS: Observations showed enjoyment of the course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human patient simulation (t=9; df=56; p<0.001) and ward-based exercises (t=9.3; df=76; p<0.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients. Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons. CONCLUSIONS: The study demonstrated that simulation is an effective method for encouraging dignified care and compassion for older persons by teaching team skills and empathetic and sensitive communication with patients and relatives.

Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: a qualitative interview study.

BACKGROUND: Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression. OBJECTIVE: This study aimed to gain an in-depth understanding of staff experience of, and attitudes towards, the identification and monitoring of interferon-alpha-induced-depression and the decision-making process concerning the use of liaison psychiatry and other clinical services. DESIGN: A qualitative interview study was conducted among clinical staff involved in the care of patients with hepatitis C, using the perspective of naturalistic decision making. SETTINGS: Outpatient liver clinics in three large teaching hospitals in South London, the United Kingdom. PARTICIPANTS: All clinical nurse specialists from the three outpatient liver clinics were included. All were involved directly in the care of patients receiving interferon-alpha treatment and had at least one year experience (mean 6.4 years, range 1-11 years) in this field. METHODS: Semi-structured face-to-face interviews were conducted between 2010 and 2011. Data collection and analysis were carried out iteratively to ensure the reliability of the analysis using the constant comparison method. RESULTS: Staff used verbal and non-verbal cues when assessing risks of patients developing depression before and during IFN-α treatment. Major sources of uncertainty were patient engagement and familiarity, referrals to psychiatrists, language barriers, and distinguishing between psychological and physical symptoms. Good rapport with patients and good communication among multidisciplinary professional groups were key strategies identified to reduce uncertainty. CONCLUSION: Current methods of identifying vulnerable patients rely on the availability of clinical experts and good communication within a multidisciplinary team. Detection and management of depression in this population is complex, however, various strategies are employed by nurses to overcome difficulties when making decisions regarding patient welfare. Current clinical practices should be taken into account when developing new tools and methods.

The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies.

OBJECTIVE: Dentofacial emergencies are a common presentation to the emergency department (ED) but there is little recent data on physicians' knowledge, confidence and attitudes in handling these cases. METHOD: A questionnaire was administered to 103 ED physicians. The sample was primarily drawn from London hospitals as well a smaller contribution from around the UK and included physicians with a range of experience and at different grades. RESULTS: The majority of the 102 participants (76.5%) did not receive any formal training in managing dentofacial emergencies. The percentage of participants who were happy to manage common dentofacial emergencies is as follows: dental trauma (20.4%); major facial trauma (39.8%); interpreting facial X-rays (68.0%); and facial suturing (85.4%). When questioned 12.1% of the participants felt that ED physicians should be responsible for managing dental emergencies compared to 22.4% who felt that ED physicians should manage maxillofacial emergencies. Only 3.9% of the participants would opt to be treated by an ED doctor in the event of them presenting to the ED with a dental injury. The remaining 72.5% would prefer to be seen by a maxillofacial surgeon, 23.5% by a dentist and none of the participants opted to be seen by the emergency nurse practitioner. CONCLUSION: ED physicians do not feel confident in managing some dentofacial emergencies. This may be attributed to a lack of training in this area as well as exposure to these types of emergencies. There is a need for greater awareness, validated guidelines and training resources for ED physicians to treat dentofacial emergencies as well more research in this field of emergency medicine.