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Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

BACKGROUND: Ageing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, an...

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Autores principales: Hall, Alex, Wilson, Christine Brown, Stanmore, Emma, Todd, Chris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Pergamon Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490779/
https://www.ncbi.nlm.nih.gov/pubmed/28494333
http://dx.doi.org/10.1016/j.ijnurstu.2017.04.008
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author Hall, Alex
Wilson, Christine Brown
Stanmore, Emma
Todd, Chris
author_facet Hall, Alex
Wilson, Christine Brown
Stanmore, Emma
Todd, Chris
author_sort Hall, Alex
collection PubMed
description BACKGROUND: Ageing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits. OBJECTIVE: This study explored facilitators and barriers to the implementation of monitoring technologies in care homes. DESIGN: Embedded multiple-case study with qualitative methods. SETTING: Three dementia-specialist care homes in North-West England. PARTICIPANTS: Purposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents. METHODS: 36 semi-structured interviews with staff, relatives and residents; 175 h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis. RESULTS: Findings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice. CONCLUSION: Implementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.
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spelling pubmed-54907792017-07-12 Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory Hall, Alex Wilson, Christine Brown Stanmore, Emma Todd, Chris Int J Nurs Stud Article BACKGROUND: Ageing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits. OBJECTIVE: This study explored facilitators and barriers to the implementation of monitoring technologies in care homes. DESIGN: Embedded multiple-case study with qualitative methods. SETTING: Three dementia-specialist care homes in North-West England. PARTICIPANTS: Purposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents. METHODS: 36 semi-structured interviews with staff, relatives and residents; 175 h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis. RESULTS: Findings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice. CONCLUSION: Implementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies. Pergamon Press 2017-07 /pmc/articles/PMC5490779/ /pubmed/28494333 http://dx.doi.org/10.1016/j.ijnurstu.2017.04.008 Text en © 2017 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hall, Alex
Wilson, Christine Brown
Stanmore, Emma
Todd, Chris
Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title_full Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title_fullStr Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title_full_unstemmed Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title_short Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory
title_sort implementing monitoring technologies in care homes for people with dementia: a qualitative exploration using normalization process theory
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490779/
https://www.ncbi.nlm.nih.gov/pubmed/28494333
http://dx.doi.org/10.1016/j.ijnurstu.2017.04.008
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