Stakeholder's experiences of living and caring in technology-rich supported living environments for tenants living with dementia.

BACKGROUND: Technology innovation provides an opportunity to support the rising number of people living with dementia globally. The present study examines experiences of people who have dementia and live in technology enriched supported care models. Additionally, it explores caregiver's attitudes towards technology use with the housing scheme. METHODS: A qualitative research design was adopted, and eight housing schemes consented to take part in the study. A technology audit was undertaken in addition to participant interviews and caregiver survey. Seven peer researchers conducted semi-structured interviews with 22 people living with dementia. Interviews were analysed using thematic analysis. Informal and formal caregivers were invited to complete a survey to capture their attitudes towards technology use. A total of 20 informal and 31 formal caregiver surveys were returned. All surveys were input into Survey Monkey and downloaded into excel for analysis. Closed questions were analysed using descriptive statistics and open-ended questions were organised into themes and described descriptively. RESULTS: The technology audit identified that technologies were in place from as early as 2002. Technology heterogeneity of, both passive and active devices, was found within the housing schemes. Technologies such as wearable devices were reportedly used according to need, and mobile phone use was widely adopted. The themes that developed out of the tenant interviews were: Attitudes and Engagement with Technology; Technology Enhancing Tenants Sense of Security; Seeking Support and Digital Literacy; and Technology Enabled Connection. A lack of awareness about living alongside technology was a major finding. Technologies enabled a sense of reassurance and facilitated connections with the wider community. The interaction with technology presented challenges, for example, remembering passwords, access to Wi-Fi and the identification of its use in an emergency. The caregiver survey reported a range of facilitators and barriers for the use of technology within care. Both types of caregivers held relatively similar views around the benefits of technology, however their views on issues such as privacy and consent varied. Safety was considered more important than right to privacy by family caregivers. CONCLUSIONS: The present study provides new insight into stakeholder's experiences of living, working and caregiving alongside technology in supported living environments. As the generation of people living with dementia become more tech savvy, harnessing everyday technologies to support care could enable holistic care and support the transition through the care continuum. Advance care planning and technology assessments are at the very core of future technology provision. It is evident that a paternalistic attitudes towards technology use could impact the multitude of benefits technology can play in both health and leisure for people living with dementia and their caregivers.

Palliative and end-of-life educational interventions for staff working in long-term care facilities: An integrative review of the literature.

BACKGROUND: Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE: To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS: The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS: A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS: Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE: Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.

Working in a storied way-Narrative-based approaches to person-centred care and practice development in older adult residential care settings.

AIMS AND OBJECTIVES: To evaluate the effects of the implementation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings. BACKGROUND: Care in long-term residential settings for older people is moving away from the biomedical approach and adopting a more person-centred one. Narrative can help shape the way care is planned and organised. The provision of person-centred care that is holistic and that takes account of resident's beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework. DESIGN: The chosen methodology was participatory action research. METHODS: Between 2010-2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation. RESULTS: Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing). CONCLUSION: The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur. RELEVANCE TO CLINICAL PRACTICE: Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co-constructed plan of care.

An exploratory study of web-enhanced learning in undergraduate nurse education.

AIM: The aim of the study was to explore undergraduate nursing students' views of web-enhanced learning and to examine issues relating to their pattern of access to a rehabilitation nursing module website. BACKGROUND: As information technology is an integral component of western health care, all nurses are expected to have the necessary knowledge, skills and attitudes to be competent in its use. METHODS: In phase 1, a focus group interview was conducted with students (n = 6) who had not logged onto a similar module website. In phase 2, a questionnaire was administered to students undertaking the web-enhanced module. In phase 3, each student's (n = 231) pattern of access to the module was identified and compared with the student's performance as evidenced by their module assignment mark. RESULTS: Students held favourable attitudes towards web-enhanced learning but some students experienced difficulties. There was a significant positive association between the students' assignment mark and the number of times logged onto the module website. Significant negative correlations were found between mark and week of first log on, and week of first log on and number of hits onto the module site. This suggests that students who logged onto the module in the first few weeks were more likely to achieve higher marks. CONCLUSIONS: This study's findings suggest that students who accessed the module website early and often were more likely to produce more comprehensive nursing assessments and consequently achieve higher assignment marks than their colleagues. RELEVANCE TO CLINICAL PRACTICE: The findings have relevance to all nurses as lifelong learning is a mandatory requirement for maintaining clinical competence and electronic learning can provide students (regardless of registration status) with the flexibility to gain access to course content at a time and place convenient to them. The role of electronic learning in promoting a more holistic nursing assessment is also discussed.