Leaders' experiences of successfully implementing health and welfare technology in sparsely populated Nordic areas.

PURPOSE: This study examines the effective implementation of health and welfare technology (HWT) in sparsely populated Nordic regions within healthcare and social care settings. MATERIALS AND METHODS: Through re-analysing 12 semi-structured interviews conducted in 2020 across three successfully implementing Nordic regions, the research utilised inductive thematic analysis with a reflexive approach to uncover key experiences. RESULTS: It identifies five critical success factors: Positive attitudes towards and understanding of digital transformation, Consensus on changing care delivery through HWT, Leadership and organisational readiness for change, Effective feedback mechanisms, and Trust and engagement in the learning process. Highlighting the significance of positive mindsets, leadership, collaboration, and adaptability, the findings underscore the theoretical underpinnings of Weiner's organisational readiness for change and Bronfenbrenner's ecological system theory for planning and understanding HWT implementation. Addressing challenges of adapting to HWT necessitates a comprehensive approach, including tailored training, robust support systems, strategic user engagement, feedback integration, and fostering open communication, ultimately ensuring technology serves the user's needs effectively. CONCLUSION: In conclusion, successful HWT adoption in these areas hinges on fostering a culture of learning, strong leadership, and collaborative efforts. It suggests further research with a larger cohort to validate these insights, offering vital considerations for organisations navigating digital transformation in healthcare and social services.

Encourage a positive attitude towards technological advancements and digital transformation among healthcare and social care organisations to facilitate the successful implementation of health and welfare technology (HWT).Invest in leadership training to equip leaders with the skills needed to effectively guide teams through the adoption of HWT.Foster interdisciplinary collaboration among stakeholders, including healthcare providers, therapists, and technology experts, to seamlessly integrate HWT into the rehabilitation process.Promote staff adaptability to evolving technologies by providing training and support for adapting to new tools and practices in HWT implementation.

Implementation of welfare technology: a state-of-the-art review of knowledge gaps and research needs.

PURPOSE: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers. MATERIALS AND METHODS: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles. RESULTS: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself. CONCLUSIONS: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations.IMPLICATIONS FOR REHABILITATIONWhen planning for the implementation of welfare technology for older people and persons with disabilities, it is important to be aware that necessary evidence and guidance may not always be available in peer-reviewed scientific literature but considerable knowledge gaps and research needs remain.Actors implementing welfare technology are encouraged to include researchers in their projects to study, document and report experiences made, and thereby contribute to building the evidence base and supporting evidence-based implementation.

Longing to Belong: Hard of Hearing Young Adults' Experiences of Social Identity and Group Membership.

Studies on hard of hearing (HH) individuals have focused mostly on children's experiences in school. However, their lives as young adults have not received much attention. The present study therefore examined HH young adults' experiences of social identity and group membership. Semistructured interviews were conducted with 16 individuals (10 males, 6 females) with severe to profound hearing loss. They were from diverse cultural backgrounds. A qualitative content analysis was performed with a manifest analysis. Two categories emerged: Belonging to a Social Environment and Engaging in Important Communication. The results indicate that the HH individuals, either deliberately or unconsciously, chose to be with other HH individuals because of their longing for group membership and desire to avoid being misunderstood. The participants longed for inclusion, acceptance, and opportunities to create an inclusive social environment and to communicate with others.

No thank you to humanized robots: attitudes to care robots in elder care services.

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

Significant challenges when introducing care robots in Swedish elder care.

INTRODUCTION: Care robots are machines, operating partly or completely autonomously, that are intended to assist older people and their caregivers. Care robots are seen as one part of the solution to the aging population, allowing fewer professional caregivers to provide the necessary assistance and care. Despite the potential benefits, the dissemination of care robots, and welfare technology in general, is limited in Swedish elder care. PURPOSE: To explore the challenges of introducing welfare technology, particularly care robots, in elder care. MATERIALS AND METHODS: Twenty-one individual interviews with key actors at the societal level, analysed by thematic analysis. RESULTS: The challenges, from the societal actors' perspectives, were related to; the beliefs in technology, attitudes, ethics, collaboration, and the need for knowledge and skills regarding care robots (individual and group challenges). Challenges of a national character were: national governance, infrastructure, laws and regulations, economics, and procurement (systemic and societal challenges). In addition, the necessary preconditions for successful introduction were revealed as: the utility of the technology, implementation, evaluation and safety, security, and integrity (preconditional challenges). CONCLUSIONS: The introduction of care robots in elder care services seems to be more challenging than that of welfare technology in general, given the context and prevailing attitudes and preconceptions about robotics. Significant challenges need to be managed, at all levels of the society, before care robots can become an integral part of daily care and assist older people and their caregivers in activities and rehabilitation.IMPLICATION FOR REHABILITATIONThe challenges described by the societal actors', are partly similar to those of the end users', in terms of attitudes, ethics, knowledge and skills, and collaboration. This consensus should provide a solid foundation for the conceptualization and introduction of care robots in elderly care.The challenges follow the pattern of an ecosystem involving all sections of society, which are intertwined and require consideration before the expected benefits can be realised.A user-centred approach is necessary to support the design, implementation, and usefulness of care robots and their suitability for meeting the real needs of older persons and professional caregivers.

Implementation of welfare technology: a systematic review of barriers and facilitators.

PURPOSE: Although studies addressing barriers to and facilitators of implementation of welfare technology have been published, no systematic review synthesising evidence on such factors has been found. The purpose of this study was therefore to identify and synthesise existing primary research on facilitators and barriers that influence the implementation of welfare technology for older people, people with disabilities and informal caregivers. MATERIALS AND METHODS: A systematic search in 11 databases was performed using predefined inclusion and exclusion criteria to identify empirical studies that assess the implementation of welfare technology for older people, people with disabilities or informal caregivers. The search identified 33 publications with quantitative, qualitative and mixed method designs. The reported findings were thematically synthesised and conceptualised into themes. RESULTS: Six themes of facilitators and barriers that influence the implementation of welfare technology emerged: capacity, attitudes and values, health, expectations, participation and identity and lifestyle. These were presented from five perspectives: older persons and persons with disabilities, informal caregivers, health and care personnel, organisation and infrastructure and technology. The findings may be used as a means to structure the planning and evaluation of implementation processes of welfare technologies for older persons and persons with disabilities and to understand the complexities of implementation. CONCLUSIONS: This knowledge generates deepened insights and structures to guide and evaluate the implementation processes of welfare technologies and engenders an understanding of the complexities of implementation.Implications for rehabilitationWhen planning for the implementation of welfare technology for older people and persons with disabilities, it is important to consider capacity, attitudes and values, health, expectations, participation, and identity and lifestyle.Using the result from the study facilitates deepened insights and structures for evaluation of implementation processes of welfare technologies and brings an understanding of the complexities of implementation.Welfare technology should be available, safe, usable and fit the user's daily lives.Implementable welfare technology should focus on needs, but also consider design and possible experienced stigma related to the identity of being a welfare technology user.

Decision-Making Is in the Making! Aspects of Decision-Making in the Area of Assistive and Welfare Technology-A Qualitative Study.

Assistive and welfare technology (AT/WT) has been introduced as a way of facing an ageing population and providing support for older adults in their daily lives. There is much research concerning the assessment and recommendation of AT/WT to individual end-users. However, few studies have explored AT/WT decision-making from a managerial perspective. This study explores what aspects influence decision-making in assistive technology organizations concerning new technology procurements. The study is based on interviews with 24 managers engaged in assistive technology organizations, representing 13 of 21 regions in Sweden. The interview data consisted of the participants' experiences deciding on AT/WT procurement. A reflexive inductive thematic analysis was used to identify aspects that influenced decision-making. The main findings show that decision-making is in the making, meaning that decision-making is a constant on-going managerial process. Furthermore, the findings show that managers experience uncertainty in the decision-making, sometimes make ad hoc decisions and request an evidence-based, person-centred approach to improve decision-making. The study concludes that supportive, technology, patient, and knowledge aspects influence managers' decisions.

Participation in daily life for adults with profound intellectual (and multiple) disabilities: How high do they climb on Shier's ladder of participation?

Participation is the goal of Swedish disability policy, but it is difficult to achieve for adults with profound intellectual (and multiple) disabilities (PI(M)D). Since these adults are dependent on others in every aspect of their lives, others control their ability to participate in everyday life decisions. This study used observations, analyzed with Shier's ladder of participation, to elucidate and describe participation in daily life for adults with PI(M)D living in a group home. The results showed that the adults often reached the first three levels of Shier's ladder, one adult reached the fourth level once, and no one reached the fifth level. Participation on a higher level, therefore, seems hard to reach for adults. Staff members' attitudes toward the adults' capability can also be a barrier to participation. Applying Shier's ladder of participation can provide valuable information that might lead to increased participation in daily life for adults with PI(M)D.

Views of Swedish Elder Care Personnel on Ongoing Digital Transformation: Cross-Sectional Study.

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.

Staff members and managers' views of the conditions for the participation of adults with profound intellectual and multiple disabilities.

BACKGROUND: Participation is a central aspect of quality of life, and it is indicative of high-quality outcomes for people with intellectual disabilities. However, participation is difficult to achieve for adults with profound intellectual and multiple disabilities. AIM: To describe staff members' perceptions of what participation means for adults with profound intellectual and multiple disabilities. METHOD: Using a phenomenographic approach, 27 interviews were analysed resulting in variations in the conditions for participation. RESULTS: The interviews revealed conditions for participation at individual, staff and organisational levels. CONCLUSION: Participation appears to be an un-reflected phenomenon, and several conditions must be met to achieve it. The conditions are experienced being fundamental for adults within the target group to achieve any kind of participation. The staff members and managers' perceptions of participation as conditional can make it more difficult for adults within the target group to achieve the Swedish disability policy goal of participation.

Staffs' documentation of participation for adults with profound intellectual disability or profound intellectual and multiple disabilities.

PURPOSE: This study investigated what areas of International Classification of Functioning, Disability and Health were documented in implementation plans for adults with profound intellectual disability or profound intellectual and multiple disabilities with focus on participation. METHODS: A document analysis of 17 implementation plans was performed and International Classification of Functioning, Disability and Health was used as an analytic tool. RESULTS: One hundred and sixty-three different codes were identified, especially in the components Activities and participation and Environmental factors. Participation was most frequently coded in the chapters Community, social and civic life and Self-care. Overall, the results showed that focus in the implementation plans concerned Self-care and Community, social and civic life. The other life areas in Activities and participation were seldom, or not at all, documented. CONCLUSIONS: A deeper focus on participation in the implementation plans and all life areas in the component Activities and participation is needed. It is important that the documentation clearly shows what the adult wants, wishes, and likes in everyday life. It is also important to ensure that the job description for staff contains both life areas and individual preferences so that staff have the possibility to work to fulfill social and individual participation for the target group. Implications for rehabilitation There is a need for functioning working models to increase participation significantly for adults with profound intellectual disability or profound intellectual and multiple disabilities. For these adults, participation is achieved through the assistance of others and support and services carried out must be documented in an implementation plan. The International Classification of Functioning, Disability and Health can be used to support staff and ensure that information about the most important factors in an individual's functioning in their environment is not omitted in documentation.

eHomecare and safety: The experiences of older patients and their relatives.

The study's aim was to extend descriptions of how older patients with granted eHomecare and their relatives understand safety, and further to describe how they experience safety in everyday life. The study was conducted in Sweden. The participants were 12 older patients who had been provided with eHomecare and 8 relatives. Data were collected by semi-structured individual interviews. A conceptual framework of safety was used and a qualitative content analysis was conducted in a deductive and an inductive phase. The deductive results are presented in predefined categories: perceived sense of safety, disturbance and threats, re-establishing safety, and new safety. The inductive analysis resulted in two main categories: safety as part of everyday life and eHomecare as safety. The results show that eHomecare can promote safety for older patients and their relatives. Existing doubts and ethical concerns about the service can be minimized by providing adequate information.

Experiences of using Bestic, an eating aid for people with intellectual disabilities.

This article reports on the results of a pilot study exploring whether and how the meal situations of persons with intellectual disabilities (PWIDs) in need of help and support during meal situations were affected by an eating aid. This article also analyzes how PWIDs and their assistants perceived their experiences of using an eating aid during meal situations. Data for the study were collected in interviews with PWIDs and their assistants. The results are presented in five themes: independence in the meal situation, motivation to use the eating aid, functions of the eating aid, social aspects of using the eating aid, and design corresponding to intellectual disability. The eating aid's function, user-friendliness, and the assistants' attitudes appear to be crucial for using the eating aid. Another important aspect is the introductory and training phase, which must be fundamentally adapted to suit the PWIDs ability to learn and understand. When these aspects are controlled, the eating aid can be a tool for increased independence during meal situations for PWIDs who are unable to move their arms or hands.

Using a Robotic Cat in Dementia Care: A Pilot Study.

The current study aimed to explore (a) reactions of individuals with dementia to an interactive robotic cat and their relatives' and professional caregivers' experiences, and (b) to measure usability in developing the care/treatment of individuals with dementia using interactive robotic pets. An intervention design in a pilot study using mixed methods was conducted in two stages: a quantitative single-case study (n = 4) and a qualitative interview study (n = 14). Results indicated less agitated behavior and better quality of life for individuals with dementia. Interviews showed positive effects by providing increased interaction, communication, stimulation, relaxation, peace, and comfort to individuals with dementia. The tested interactive robotic cat was also considered easy to use. There is an increased need for alternative/complementary forms of care to meet an increasing number of individuals with dementia. For some individuals with dementia, an interactive robot, such as a robotic cat, can increase well-being and quality of life.

The meaningful encounter: patient and next-of-kin stories about their experience of meaningful encounters in health-care.

This study focuses on the meaningful encounters of patients and next of kin, as seen from their perspective. Identifying the attributes within meaningful encounters is important for increased understanding of caring and to expand and develop earlier formulated knowledge about caring relationships. Caring theory about the caring relationship provided a point of departure to illuminate the meaningful encounter in healthcare contexts. A qualitative explorative design with a hermeneutic narrative approach was used to analyze and interpret written narratives. The phases of the analysis were naïve interpretation, structure analysis on two different levels (narrative structure, and deep structure through metaphors) and finally a dialectic interpretation. The narratives revealed the meaning of the meaningful encounter as sharing, a nourishing fellowship, common responsibility and coming together, experienced as safety and warmth, that gives, by extension, life-changing moments, a healing force and dissipated insight. The meaningful encounter can be seen as a complex phenomenon with various attributes. Understanding the meaningful encounter will enable nurses to plan and provide professional care, based on caring science, focusing on patient and next-of-kin experiences.

Patients' and caregivers' attributes in a meaningful care encounter: similarities and notable differences.

In today's healthcare system, there is an imbalance between what patients expect of caregivers' care and their perception of the care they get. How is it possible to reduce this imbalance? The aim of this paper was to describe attributes associated with meaningful encounters in the Swedish healthcare system based on patients' and caregivers' written narratives and to note the differences and similarities between the attributes identified by the two groups. This paper is a qualitative descriptive study. The analysis was guided by qualitative content analyses. Based on patients' narratives, attributes associated with a meaningful encounter fell into four categories: the kind-hearted caregiver, the thoughtful caregiver, the mutually oriented caregiver, and the helpful caregiver. Based on caregivers' narratives, the attributes were categorized as being humane, caring through physical contact, caring by nurturing communication, joy and laughter in care, and a sense of mutuality. The results show that there are both similarities and differences in patients' and caregivers' opinions about the attributes of a meaningful encounter. Knowing more about the attributes associated with meaningful encounters makes it possible for caregivers to individualize care for patients and makes it easier to help and support patients in what they most need support with.

Supportive leadership in Swedish community night nursing.

AIM: The aim of the present study was to examine the support night nurses' give to staff in community night nursing. BACKGROUND: Studies have shown that support given to staff is one of night registered nurses' (RNs') experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described. METHODS: All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. RESULTS: The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership. CONCLUSIONS: Out of 'concern for the staff' the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs' awareness that by giving support to staff this affects the staffs' caring for older people. IMPLICATIONS FOR NURSING MANAGEMENT: The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

Dependency in autonomous caring--night nurses' working conditions for caring in nursing.

Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

Municipal night nurses' experience of the meaning of caring.

The aim of this study was to elucidate municipal night registered nurses' (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs' experience of caring is interpreted as meanings in paradoxes: 'being close at distance', the condition of 'being responsible with insignificant control', and 'being interdependently independent'. The RNs' experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding to vocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.