Technology and good dementia care. A study of technology and ethics in everyday care practice

Avhandling (ph.d.) - Universitetet i Oslo, 2009publishedVersio

Prosjekteriets dilemma. Mellom avgrenset prosjekt og muligheter for læring i teleomsorg og velferdsinnovasjon

OrginalartikkelHva er forutsetningene for vellykket teleomsorgsinnovasjon? Dette spørsmålet er et sentralt tema for denne artikkelen. Utgangspunktet er våre erfaringer med det vi opplever som et «snevert prosjekteri» innenfor dette feltet. I Norge i dag gjennomføres og igangsettes det et stort antall prosjekter som involverer ny teknologi, i form av velferdsteknologiske løsninger. Og felles for mange av disse prosjektene er at de forblir avgrensede og «interne», med et, i vår mening, for ensidig og snevert fokus på dokumentasjon av effekt i forhold til utprøving av enkeltteknologier

Prosjekteriets dilemma: Mellom avgrenset prosjekt og muligheter for læring i teleomsorg og velferdsinnovasjon

Hva er forutsetningene for vellykket teleomsorgsinnovasjon? Dette spørsmålet er et sentralt tema for denne artikkelen. Utgangspunktet er våre erfaringer med det vi opplever som et «snevert prosjekteri» innenfor dette feltet. I Norge i dag gjennomføres og igangsettes det et stort antall prosjekter som involverer ny teknologi, i form av velferdsteknologiske løsninger. Og felles for mange av disse prosjektene er at de forblir avgrensede og «interne», med et, i vår mening, for ensidig og snevert fokus på dokumentasjon av effekt i forhold til utprøving av enkeltteknologier. Resultatet er at det er liten utveksling av erfaringer, læring og utvikling både innad og på tvers av prosjektene. Som en konsekvens av dette er det få prosjekter som «overlever» fra prosjekt til ordinær drift. Dette utgjør en betydelig utfordring, slik vi ser det, for den varslede storsatsingen på velferdsteknologi i Norge de kommende årene.Artikkelen er basert på empiri fra en studie av telemonitorering av kolspasienter. Dette er et sykehusinitiert prosjekt, kalt «kols-kofferten», som på mange måter er et suksessprosjekt, ettersom det har «overlevd» i mer enn tre år, har ekspandert og har mange tilfredse brukere. Gjennom mobilisering av teoretiske og analytiske ressurser fra det tverrfaglige forskningsfeltet studier av vitenskap, teknologi og samfunn (STS), viser vi at denne «suksessen» henger sammen med at prosjektet, i alle fall til en viss grad, har evnet å åpne opp og innrette seg i den sammenhengen tjenesten inngår i. I artikkelen benytter vi oss av Madeleine Akrichs «skript-begrep» for å vise hvordan kols-kofferten i utgangspunktet definerte aktører, roller og oppgaver i prosjektet. Og videre, hvordan både aktører, roller og ansvar ble utfordret, reforhandlet og redefinert gjennom møtet med praksis.Prosjektets dilemma ligger i at teleomsorgsprosjekter ikke blir for snevert definert og avgrenset til utprøving av enkeltteknologier, men fokuserer bredere og mer fleksibelt på tjenesten og velferden som skal utvikles, og, som en del av dette, involverer ulike aktører og brukergrupper i dette utviklingsarbeidet.The dilemma of project organization: between well-defined projects and prospects of learning in telecare and welfare innovation:The aim of this article is twofold: one; to discuss the consequences of a limited project focus in development of telecare and welfare innovation, and the prospects of flexible and dynamic development and learning under such conditions, and, two; to contribute to the debate about the potential role of technologies in future health- and social care services, and about the necessary conditions for technologies to contribute to good care and strengthened welfare. For this we draw on empirical data from a study of the development and implementation of a hospital initiated home care service involving telemonitoring of COPD-patients. The study is based on ethnographic observation and interviewing. We use excerpts of empirical data and analytical resources from STS to develop an argument about the importance of focusing on in-service innovation and innovation as a longitudinal, multilinear and involving learning process. This is a demanding process conditioned by dialogue, involvement and negotiation as well as flexible and adjustable solutions

Embodied meaning-making in the experiences and behaviours of persons with dementia

Background: The aim of the study was to explore and articulate how meaning-making appears and how meaningfulness is experienced in persons with severe dementia. Although there is little knowledge about meaning-making and experience of meaningfulness for this group, this article assumes that persons with dementia are as much in need of meaningfulness in life as any others, and hence, that they are involved in the process of meaning-making. Methods: The study was conducted using a qualitative method with exploratory design. Ten patients with severe dementia at a specialized dementia ward at an old age psychiatric department in hospital were observed through participant observation performed over four months. The field-notes from the observation contained narratives carrying with them a dimension of meaning played out in an everyday setting and thus named Meaning-making dramas. The narratives were analyzed looking for expressions where experiences of meaning-making and meaningfulness could be identified. Results: The narratives demonstrate that persons with severe dementia are involved in processes of meaning-making. The narratives include expressions of meaning-making, and of interactions that include apparent crises of meaning, but also transitions into what may be interpreted as meaningfulness based on experiences of significance, orientation and belonging. The role of the body and the senses has proved significant in these processes. The findings also suggest that experiences of meaning contribute to experience of personhood. Conclusions: The relevance to clinical practice indicates that working from a person-centred approach in dementia care also includes paying attention to the dimension of meaning. This dimension is important both for the person living with dementia and for the people caring for them. Acknowledging meaning as a central human concern, it is crucial to seek understanding and knowledge about the significance of meaning in vulnerable groups such as persons with dementia.Sykehuset Innlandet HF 150332publishedVersio

Smarthusteknologi. Planlegging og drift i kommunale tjenester

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Etikkarbeid i praksisnær forskning. Bofellesskap som forskningsarena

I denne artikkelen diskuterer forfatterne forskningsetiske utfordringer i empirisk forskning i bofellesskap for mennesker med nedsatt funksjonsevne og omfattende tjenestebehov. Disse menneskene defineres i forskningsetisk sammenheng som sårbare. Særlige hensyn må tas, og overordnede forskningsetiske retningslinjer må fortolkes til anvendt etikk gjennom etisk refleksjon og vurdering av handlingsvalg i praktiske øyeblikk. Gjennom empiriske eksempler bidrar artikkelen til debatten om kvalitet i forskning ved å belyse prosesser og sensitive situasjoner som synliggjør kompleksiteten i forskningsetikk og behovet for skjønnsutøvelse i praksisnær forskning.publishedVersio

Cross-National Study of Mental Health and Employment Status Nine Months Post Social Distancing Implementation Practices

This cross-national study examined the mental health between those individuals working and those not working nine months post initial COVID-19 social distancing implementation. Respondents (N = 3,474) were recruited through social media (e.g. Facebook, Twitter) and completed an online survey in October/November 2020. The respondents were from Norway, the UK, the USA and Australia. The mental health of those working and not working were analysed using t tests and socio-demographics were compared using one-way analysis of variance. Respondents who were working were significantly more likely to experience better mental health, were younger, report higher levels of education, and significantly less likely to worry about their own situation, health or financial situation than respondents who were not employed. Respondents who were retired reported better mental health than respondents who were not working for other reasons (laid off/dismissed, receiving benefits, studying, other). These findings raise the importance for social workers and other health service providers to monitor the overall mental health of individuals especially when social distancing protocols are in place and as countries begin to recover from the pandemic.publishedVersio

Loneliness and its association with social media use during the COVID-19 outbreak

Social distancing rules during the COVID-19 pandemic changed social interaction for many and increased the risk of loneliness in the general population. Social media use has been ambiguously related to loneliness, and associations may differ by age. The study aimed to examine loneliness and its association with social media use within different age groups during the COVID-19 pandemic. A cross-sectional online survey was conducted in Norway, the United Kingdom, the United States, and Australia during April/May 2020, and 3,810 participants aged 18 years or above were recruited. Multiple regression analyses were conducted to examine associations between social media use and social and emotional loneliness within separate age groups. Emotional loneliness was higher among young adults and among those who used social media several times daily. Adjusting by sociodemographic variables, using more types of social media was associated with lower social loneliness among the oldest participants, and with higher emotional loneliness among the youngest participants. Among middle-aged participants, using social media more frequently was associated with lower social loneliness. We found that the associations between social media use and loneliness varied by age. Older people’s engagement on social media may be a resource to reduce loneliness during the COVID-19 pandemic. We observed higher levels of loneliness among high-frequent social media users of younger age.publishedVersio

Cross-national study of worrying, loneliness, and mental health during the COVID-19 pandemic: a comparison between individuals with and without infection in the family.

Objective: The objective of this study was to examine differences in worry, loneliness, and mental health between those individuals infected by COVID-19 or having someone their family infected, and the rest of the population. Methods: A cross-sectional online survey was conducted in Norway, UK, USA, and Australia during April/May 2020. Participants (n = 3810) were recruited via social media postings by the researchers and the involved universities. Differences between those with and without infection in the family were investigated with chi-square tests and independent t-tests. Multiple regression analyses were used to assess associations between sociodemographic variables and psychological outcomes (worry, loneliness, and mental health) in both groups. Results: Compared to their counterparts, participants with infection in the family reported higher levels of worries about themselves (p < 0.05) and their family members (p < 0.001) and had poorer mental health (p < 0.05). However, the effect sizes related to the differences were small. The largest effect (d = 0.24) concerned worries about their immediate family. Poorer psychological outcomes were observed in those who were younger, female, unemployed, living alone and had lower levels of education, yet with small effect sizes. Conclusions: In view of the small differences between those with and without infection, we generally conclude that the mental health effects of the COVID-19 situation are not limited to those who have been infected or have had an infection within the family but extend to the wider population

Employment Uncertainty and Mental Health during the COVID-19 Pandemic Initial Social Distancing Implementation: A Cross-national study

Background Social distancing during the COVID-19 pandemic has resulted in changes in the work environment and employment uncertainty. This paper reports on a cross-national comparison of four countries (Norway, UK, USA and Australia) and examines the differences in mental health between those individuals employed and those not employed during the social distancing implementation. Methods Participants (N = 3,810) were recruited through social media in April/May 2020 and were invited to complete a self-administered electronic survey over a 3-week period. Differences between those employed and those not employed with regard to their sociodemographic characteristics and mental health were investigated with chi-square tests, independent t tests, and one-way analysis of variances (ANOVAs). Results Compared with their counterparts, participants who were employed reported lower levels of mental health distress (p < 0.001), higher levels of psychosocial well-being (p < 0.001), better overall quality of life (p < 0.001), and lower levels of overall loneliness, social loneliness, and emotional loneliness (p < 0.001). Small to medium but consistent differences (Cohen’s d = 0.23–0.67) in mental health favor those with employment or those who were retired. Conclusion Further study is needed to assess mental health over time as the COVID-19 pandemic and employment uncertainty continues.publishedVersio