57 research outputs found
Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study
Background:
Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care.
Objective:
We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care.
Methods:
Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis.
Results:
A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach.
Conclusions:
Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources.publishedVersio
From “Plug” to “play” : Making established technology innovations work in caring services
The overall aim of this article-based thesis is to develop the knowledge base of public
service innovations as a way of understanding established technology innovation in
municipal caring services. More precisely, the objective is to increase our understanding
of the complex reality of technology in use in caring practices by focusing on the
interactions between the technology and humans involved.
Policy documents describe a demand for increased technology innovations in community
care services to meet perceived challenges in the services caused by a “silver tsunami” and
to facilitate independent living. However, the integration of technologies has proven
to be difficult, and many projects never integrate into regular use after the pilot stage.
Research in the wake of these pilots seeking to identify drivers and barriers to technology
innovations in caring practices does not capture the technology innovations that
are actually integrated and used in regular caring practices, and what it takes to make
them work. To understand these public service innovations we need a knowledge base
incorporating the complex and diverse experiences with established technologies, and
an understanding of the interactions between people and the technology involved. This
thesis contributes towards a more comprehensive understanding of the “workings” of
technology innovations when exploring the social alarm, which is a widely established
and adopted technology innovation in caring practices.
Public service innovation is a developing field of exploring public services. More recent
public service innovation has mainly studied public innovations on an organisational
level. However, this thesis utilises the concept of co-production to explore the practice
of the social alarm in use on a micro level. The concept of co-production is further
developed by utilising aspects of science and technology studies as theoretical tools for
exploring public service innovations.
A systematic integrated review was conducted aiming to scope the research history of
the social alarm in use from a user perspective. Furthermore, a combination of participant
observations, 22 in-depth interviews and a study of documents related to the use
of the social alarm were conducted within the home care service in two municipalities
in Norway. Consequently, the thesis is based on descriptive and explorative qualitative
designs. The empirical data were analysed using a stepwise, deductive, inductive
method.
Through empirical analysis, the overall findings indicate the need to add theoretical
tools for understanding these innovations. By utilising the metaphor of script and
domestication from science and technology studies, this thesis contributes a theoretical
framework for exploring the co-production of expectations and experiences related to technology in use in caring practices. Thereby it further develops the understanding of
the field of public service innovation within caring practices.
This thesis demonstrates empirically how people involved with the social alarm utilise
the technology. The results describe complex and multiple caring practices with divergent
results related to its use. This promotes an increased understanding of how even
rather simple and well-established technologies are unpredictable and work differently
in different contexts when interacting with different people.
The focus is directed to efforts to make it work and to enable older people to live
independently and safely at home. The study also illustrates how technology innovations
change the dynamics between the people involved, rearranging caring practices, and
opening up for bricolages as an integrated part of established technology innovations
Forming Nursing Home Practices That Support Quality of Care for Residents. A Qualitative Observational Study
Background: Residents of nursing homes are increasingly frail and dependent. At the same time, there are increased demands for quality of care and social life for individual residents. In this article, we explore how care workers contribute to quality of care and social life in shared living rooms in nursing homes.
Methods: An ethnographically inspired design was applied, and a purposive sample of six units for long-term care in three nursing homes in Norway was included in the study. Data were collected by participant observation, including informal conversations with the staff and residents, and the data were analyzed using thematic analysis.
Results: The analysis identified three main themes: working within the given context, creating care practices and organizing activities. The empirical findings demonstrate that care work focuses on meeting both the residents’ physical and social needs and aiming for high-quality care and social life for the residents in nursing homes.
Conclusion: The results of this study illustrate that nursing home practices are focused on residents as a group. However, care workers take advantage of personal skills and resources to work towards person-centred care within the given context. The quality of care is recognized in terms of how care workers meet individual residents’ needs. The quality of care seems highly related to the capability and skills of individual care workers.publishedVersio
Shared patient information and trust: a qualitative study of a national eHealth system.
Background In Norway, as in other countries, national eHealth systems, such as the Summary Care Record
(SCR), have been implemented to improve the collaboration around patients by sharing patient information
between health professionals across healthcare institutions and administrative levels. Although widely implemented
across the health and care services in Norway, evaluations of the SCR indicate less use than expected. There is a need
for analysis that lays out the visions and expectations of the SCR and contrasts these with detailed observations of use
in everyday health professional work. This study adds to the eHealth research field by exploring this reality.
Method This paper has a qualitative design with an ethnographic approach, including participant observation, qualitative interviews, and a document review. Qualitative individual interviews with 22 health professionals and six weeks
of participant observation were conducted, and eight documents were reviewed. The field notes and the interviewtranscriptions were analyzed following a stepwise-deductive induction analysis.
Results The document review identified the expectations and visions of the SCR, including an underlying assumption of trust in shared patient information. However, this assumption is implicit and not recognized as a crucial
element for success in the documents. In our observation and interview data, we found that health professionals
do not necessarily trust information in the SCR. In fact, several procedures and routines to assess the trustworthiness
of SCR information were identified that complicate and disturb the expected use. In our analysis, two main themes
characterize the health professionals’ handling of the SCR: adapting to workflow and dealing with uncertainty.
Conclusion Our study illustrates that unconditional trust in shared patient information is an implicit assumption in SCR policy documents, but in their everyday work health professionals do not necessarily unconditionally
trust shared patient information. Rather, sharing patient information through technology, such as the SCR, requires
of health professionals to critically assess the digital information. The information in the SCR, as all sources of information presented to health professionals, becomes an item for their constant trust-work. Our study is of value to policymakers, health information systems developers, and the field of practice both nationally and internationally
Forvaltning og tildeling av kommunalt tjenesteutviklingstilskudd – sett fra et Statsforvalter- og kommuneperspektiv
Denne forprosjektrapporten er skrevet på oppdrag fra Helsedirektoratet og omhandler forvaltning og tildeling av kommunalt tjenesteutviklingstilskudd fra et Statsforvalter- og kommuneperspektiv. Rapporten er basert på et forskningsprosjekt som er gjennomført av Senter for omsorgsforskning (SOF), øst i perioden august 2023 til januar 2024.
BAKGRUNN OG PROBLEMSTILLINGER
Målet med forprosjektet har vært å innhente informasjon om forvaltningen og tildelingen av kompetanse- og tjenesteutviklingstilskuddet, tidligere kalt kompetanse- og innovasjonstilskuddet, i de kommunale helse- og omsorgstjenestene. Det er SF som forvalter tilskuddsordningen på vegne av Helsedirektoratet.
Etter avtale, og i samarbeid med Helsedirektoratet, er forprosjektet avgrenset til å gjelde innovasjons-/tjenesteutviklingsdelen av tilskuddet. Dette er fordi Helsedirektoratet primært har vært interessert i å få kunnskap om de innovative løsningene fra innovasjons-/tjenesteutviklingsprosjektene i helse- og omsorgstjenestene. Videre er forprosjektet avgrenset til året 2022.
I samarbeid med Helsedirektoratet har følgende problemstillinger blitt utarbeidet og vært styrende for forprosjektet:
1. Hvordan har Statsforvalteren prioritert tildeling av innovasjons-/tjenesteutviklingstilskudd?
2. Hva er førende for tildelingen av tilskuddet hos Statsforvalteren?
3. Hvilke prosjekter har fĂĄtt kompetanse- og innovasjonstilskudd i kommunale helse- og omsorgstjenester i 2022?
4. Hva beveger seg innenfor de ulike rapporteringskategoriene, er det satsninger som gĂĄr igjen pĂĄ tvers av kommuner?
5. Hvilke aktører har vært delaktige i prosjektene
Enhancement of cranial nerves in Lyme neuroborreliosis: incidence and correlation with clinical symptoms and prognosis
Purpose
Symptoms of cranial neuritis are a common presentation of Lyme neuroborreliosis (LNB). Imaging studies are scarce and report contradictory low prevalence of enhancement compared to clinical studies of cranial neuropathy. We hypothesized that MRI enhancement of cranial nerves in LNB is underreported, and aimed to assess the prevalence and clinical impact of cranial nerve enhancement in early LNB.
Methods
In this prospective, longitudinal cohort study, 69 patients with acute LNB were examined with MRI of the brain. Enhancement of cranial nerves III–XII was rated. MRI enhancement was correlated to clinical findings of neuropathy in the acute phase and after 6 months.
Results
Thirty-nine of 69 patients (57%) had pathological cranial nerve enhancement. Facial and oculomotor nerves were most frequently affected. There was a strong correlation between enhancement in the distal internal auditory canal and parotid segments of the facial nerve and degree of facial palsy (gamma = 0.95, p < .01, and gamma = 0.93, p < .01), despite that 19/37 nerves with mild-moderate enhancement in the distal internal auditory canal segment showed no clinically evident palsy. Oculomotor and abducens nerve enhancement did not correlate with eye movement palsy (gamma = 1.00 and 0.97, p = .31 for both). Sixteen of 17 patients with oculomotor and/or abducens nerve enhancement had no evident eye movement palsy.
Conclusions
MRI cranial nerve enhancement is common in LNB patients, but it can be clinically occult. Facial and oculomotor nerves are most often affected. Enhancement of the facial nerve distal internal auditory canal and parotid segments correlate with degree of facial palsy.publishedVersio
Assessment of cognitive function, structural brain changes and fatigue 6Â months after treatment of neuroborreliosis
publishedVersionPaid Open Acces
Are white matter hyperintensities associated with neuroborreliosis? The answer is twofold
Purpose
Many consider white matter hyperintensities (WMHs) to be important imaging findings in neuroborreliosis. However, evidence regarding association with WMHs is of low quality. The objective was to investigate WMHs in neuroborreliosis visually and quantitatively.
Materials and methods
Patients underwent brain MRI within one month of diagnosis and six months after treatment. Healthy controls were recruited. WMHs were counted by visual rating and the volume was calculated from automatic segmentation. Biochemical markers and scores for clinical symptoms and findings were used to explore association with longitudinal volume change of WMHs.
Results
The study included 74 patients (37 males) with early neuroborreliosis and 65 controls (30 males). Mean age (standard deviation) was 57.4 (13.5) and 57.7 (12.9) years, respectively. Baseline WMH lesion count was zero in 14 patients/16 controls, 20 in 13/11, with no difference between groups (p = 0.90). However, from baseline to follow-up the patients had a small reduction in WMH volume and the controls a small increase, median difference 0.136 (95% confidence interval 0.051–0.251) ml. In patients, volume change was not associated with biochemical or clinical markers, but with degree of WMHs (p values 0.002–0.01).
Conclusion
WMH lesions were not more numerous in patients with neuroborreliosis compared to healthy controls. However, there was a small reduction of WMH volume from baseline to follow-up among patients, which was associated with higher baseline WMH severity, but not with disease burden or outcome. Overall, non-specific WMHs should not be considered suggestive of neuroborreliosis.publishedVersio
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
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