Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses.

BACKGROUND: New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. OBJECTIVE: Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. METHODS: We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. RESULTS: During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. CONCLUSIONS: Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group.

A qualitative study of what care workers do to provide patient safety at home through telecare.

BACKGROUND: In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. METHODS: The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis. RESULTS: We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. CONCLUSIONS: We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.

Utility of a Medical Alert Protection System compared to telephone follow-up only for home-alone elderly presenting to the ED - A randomized controlled trial.

OBJECTIVE: Medical Alert Protection Systems (MAPS) are a form of assistive technology designed to support independent living in the care of elderly patients in the community. We aimed to investigate the utility of using such a device (eAlert! System) in elderly patients presenting to an Emergency Department (ED). METHODS: Elderly patients presenting to an ED were randomized to receive MAPS or telephone follow-up only (control arm). All patients were followed up at one-week, one-month and six-month post-intervention. A confidence scale (at 1week, 1month and 6months) and EQ-5D score (at 6months) were also administered. RESULTS: 106 and 91 participants enrolled in the MAPS and control arms respectively. Within both individual arms, there were significant reductions in the median number of ED visits and median number of admissions in the six month periods before, compared to after intervention (p<0.01 for both). However, the reductions were not significantly different between the two arms. Among participants who have had one or more admissions during the six months period post intervention, the MAPS arm had significantly lower median total length of stay (8days, Interquartile Range [IQR]=(4, 14)) compared to the control arm (15days, IQR=(3, 25), p=0.045). The median health state score for health state was significantly higher in the MAPS arm (70 IQR=(60,80) versus 60 IQR=(50,70), p=0.008). CONCLUSION: In this population of elderly ED patients, the use of a MAPS decreased length of stay for admissions and improved quality of life measures.

Older People Negotiating Independence and Safety in Everyday Life Using Technology: Qualitative Study.

BACKGROUND: Due to demographic changes with an aging population, there is a demand for technology innovations in care services. However, technology innovations have proven difficult to implement in regular use. To understand the complexity of technology innovations in care practices, we need a knowledge base of the complex and diverse experiences of people interacting with established technologies. OBJECTIVE: This paper addresses the research gap in relation to understanding the microcontext of co-production of care involving established technologies integrated into care practices. The paper also aims to provide a framework for exploring what really happens when different actors use technology in care practices. METHODS: Participant observations and 22 interviews with actors using social alarms were conducted employing the critical incident technique. A stepwise deductive-inductive analysis was then performed. RESULTS: The results reveal how co-production of care assumes different meanings according to how actors use the technology. The results also show how technology innovation changes the dynamics between the actors and rearranges care practices. Independent and safe living is co-produced through performing bricolages and optimizing practice. Additionally, this opens up for unexpected results and bricolages as an integrated part of technology innovations. CONCLUSIONS: This study illustrates how care services are always co-produced between the actors involved. By using aspects from science and technology studies, this paper provides a framework for exploring technology in use in care practices. The framework provides tools to unpack and articulate the process of co-producing services.

"Maybe we should talk about it anyway": a qualitative study of understanding expectations and use of an established technology innovation in caring practices.

BACKGROUND: Technological innovations are strongly promoted to meet the demands posed by increased pressure on home care services and to assist ageing in place in western societies. Although heavily advocated as plug and play solutions, technologies have proven difficult and unpredictable when integrated into home care services. We need greater insight into what happens when technologies are integrated into caring practices. All technologies come with expectations as to their function. This study explores how actors who are involved with the social alarm, which is an established technology innovation, relate to, perceive and articulate these expectations of the technology in everyday living. METHODS: The article presents results from a two-case study, using a triangulation of qualitative methods in order to gain an in-depth understanding of technology in use in home care services through "thick descriptions". The study was conducted in Norway and data were analysed using a stepwise deductive-inductive analysis. RESULTS: The empirical findings demonstrate that expectations regarding the social alarm, even though it represents a simple and well-established technology, are complex and multidimensional. The notion of script and domestication provided relevant tools for exploring these expectations and for understanding how actors interpret and adapt their practices of using the technology. This enabled a more comprehensive understanding of how technology opens up for different interpretations and puts values in play. CONCLUSIONS: This article suggests exploring technology in use as scripted in multidimensional script, and offers a frame for doing so. It also reveals how technology scripts and articulation prove important for understanding the complex reality when integrated into home care practices, thus identifying how using the technology leads to the taming and unleashing of both technology and actors. The study offers an increased understanding of how and why technology is unpredictable and works differently in different contexts. Moreover, it stresses the importance of avoiding expectations of plug-and-play in a reality of complex interactions between different actors.

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.

Access to, use of, and experiences with social alarms in home-living people with dementia: results from the LIVE@Home.Path trial.

Background: Social alarms are considered an appropriate technology to ensure the safety and independence of older adults, but limited research has been conducted on their actual use. We, therefore, explored the access, experiences, and use of social alarms among home-bound people with dementia and their informal caregivers (dyads). Methods: From May 2019 to October 2021, the LIVE@Home.Path mixed-method intervention trial collected data from semi-quantitative questionnaires and qualitative interviews conducted among home-dwelling people with dementia and their informal caregivers in Norway. The study focused on data from the final assessment at 24 months. Results: A total of 278 dyads were included, and 82 participants reached the final assessment. The mean age of the patients was 83 years; 74.6% were female; 50% lived alone; and 58% had their child as a caregiver. A total of 62.2% of subjects had access to a social alarm. Caregivers were more likely to answer that the device was not in use (23.6%) compared to patients (14%). Qualitative data revealed that approximately 50% of the patients were not aware of having such an alarm. Regression analyses assessed that access to a social alarm was associated with increasing age (86-97 years, p = 0.005) and living alone (p < 0.001). Compared to their caregivers, people with dementia were more likely to answer that the device gave them a false sense of security (28% vs. 9.9%), while caregivers were more likely to answer that the social alarm was of no value (31.4% vs.14.0%). The number of social alarms installed increased from 39.5% at baseline to 68% at 24 months. The frequency of unused social alarms increased from 12 months (17.7%) to 24 months (23.5%), and patients were less likely to feel safe during this period (60.8% vs. 70%). Conclusion: Depending on their living situation, patients and family members experienced the installed social alarm differently. There is a gap between access to and the use of social alarms. The results indicate an urgent need for better routines in municipalities with regard to the provision and follow-up of existing social alarms. To meet the users' changing needs and abilities, passive monitoring may help them adapt to declining cognitive abilities and increase their safety.Clinical Trial Registration: https://ClinicalTrials.gov, NCT04043364.

Indoor and outdoor social alarms: understanding users' perspectives.

The elderly population is increasing and there is a need to provide care and safety at a high level with limited resources. New social alarm solutions may contribute to safety and independence for many elderly. However, it is important to understand the needs within the user group. This work studied social alarms in a broad sense and from several user perspectives. In the first study, social alarm use and its aspects were investigated. To understand where there may be problems and weaknesses, users, caregivers, managers of municipalities, and personnel at alarm centers were interviewed. The interviews helped identify a number of problems. For municipalities, the processes of procuring new alarms and managing their organization were found to be complex. The effect of this was that the same social alarm systems had been ordered over and over again without taking into account new user needs or new technical solutions. For alarm users, one large problem was that the alarms had very limited reach and were designed for indoor use only. This has resulted in users hesitating to leave their homes, which in turn has negative effects due to lack of physical activity and fewer social contacts. One important result from the first study was the need for a social alarm solution that worked outdoors. In a second study, needs regarding outdoor social alarms were investigated. The results from this study showed that wearable outdoor alarms must be easy to use, provide communication, and be well designed. Finally, these alarms must work both indoors and outdoors, and the user should not have to worry about where he/she is or who is acting on an alarm.