Using Technologies with Care : Notes on Technology Assimilation Processes in Home Care

Elderly care is currently undergoing a phase of development in which new technologies are anticipated to increase efficiency, secure quality of services and give care assistants more time with the elderly people. This thesis reports on a study of how people involve technologies in everyday home care work. It focuses on assimilation processes associated with people’s use of information and communication technologies (ICT) and other technologies. The main problem addressed in the thesis is how do care assistants assimilate new emerging technologies in their work practice? The aim of this study is to gain an understanding of assimilation processes and the ways that people learn and select different features of technologies in practice. Technology assimilation processes are in this work assumed being part of people’s everyday use and exploration of the technologies they have at hand. The underpinning fieldwork commenced 2001 and ended 2006 and comprises ethnographical workplace studies in three different home care organisations. When new technologies are brought into an organisation they are not introduced into a vacuum; the thesis shows they are introduced into an existing ecology of work, where links between technologies and resources are tightly associated with ways people deal with contingencies and coordination. The result of the study show that when individuals and workgroups configure their own web of supporting technologies they also reconfigure their workplace. In this work it is revealed that the home care geography holds two main activity domains which provide radically different conditions for technology use. How people effectively manage to balance their work in the two domains is seen as a crucial component in how we can understand use of new technologies. It is also concluded that the involvement of new technologies effect the structure of work as the care assistants either loose or are given a strengthened autonomy and control in their work. This is a relationship that is effected by and dependent on the different ways new technologies are involved and used. Assimilation processes are in this work understood as an ongoing orchestration of tools and technologies. They are catalysed through the conflict between new and established routines and the provision of a social space of innovation, which call for the ability to detect aspects in current practices that could be sorted out, retained and selected to be part of innovation. In home care, an example such innovation is found in innovative ways managing technologies and their involvement in practice. The challenge is to grasp how everyday assimilation processes can strategically advance practice as a whole. The perspective offered by - using technologies with care - suggests a different view on innovation. Such a view focuses on innovative use and workplace configurations, as it is aware of novel technical configurations

Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care : Qualitative Study on Using eHealth Services for Self-Management Support

Background: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services. Objective: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care. Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D. Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty. Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care

Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care : Qualitative Study on Using eHealth Services for Self-Management Support

BACKGROUND: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services. OBJECTIVE: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care. METHODS: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D. RESULTS: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty. CONCLUSIONS: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients' involvement in their own care

Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study

Background: Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective: This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods: This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results: From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions: Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalize Background: Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective: This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods: This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results: From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions: Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs

Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management

BackgroundNurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. AimThe aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. MethodsFocus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. ResultsThree themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. Conclusion and relevance to clinical practiceThe results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care