eHealth in Care Coordination for Older Adults Living at Home: Scoping Review

Background: The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing. Objective: This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals. Methods: We used a scoping review methodology. We searched four databases—MEDLINE, CINAHL, Academic Scoping Premier, and Scopus—from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis. Results: A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients’ health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults’ use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication. Conclusions: We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support.publishedVersio

A qualitative study of living with the burden from heart failure treatment: Exploring the patient capacity for self-care.

Aim To explore how patients with heart failure perceive their capacity to manage treatment and self‐care. Design A qualitative descriptive study. Methods Patients (N = 17) were recruited from a nurse‐led heart failure outpatient clinic from May–August 2017. Data were collected through individual semi‐structured interviews and analysed using systematic text condensation. Results Three main themes were identified as follows: “Personal characteristics,” “Coping strategies” and “Emotional and informative support.” The first main theme contained the subthemes “inherent strength” and “maintenance of a positive attitude.” The second main theme included the subthemes “selective denial,” “ability to adapt by setting new goals” and “careful selection of information.” The third main theme contained the subthemes “support from health professionals enhancing patient capacity,” “support from next of kin in patients' self‐care” and “practical support and hope from peers.”publishedVersio

A methodological framework for capturing relative eyetracking coordinate data to determine gaze patterns and fixations from two or more observers

While physical activity during cancer treatment is found beneficial for breast cancer patients, evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms. This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy, on cancer-related fatigue, physical fitness, and activity level. Sixty-seven women were randomized to an exercise intervention group (n=33, performed strength training 3x/week and 30 minutes brisk walking/day) and a control group (n=34, performed their regular physical activity level). Data collection was performed at baseline, at completion of chemotherapy (Post1), and 6-month postchemotherapy (Post2). Exercise levels were slightly higher in the scheduled exercise group than in the control group. In both groups, cancer-related fatigue increased at Post1 but returned to baseline at Post2. Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2. Significant differences between intervention and control groups were not found. The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy, although one cannot rule out that results reflect diminishing treatment side effects over time

Designing a future eHealth service for posthospitalization self-management support in long-term illness: Qualitative interview study

Background: For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users’ supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. Objective: This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. Methods: A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. Results: In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. Conclusions: This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients’ supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs.publishedVersio

Coordinating mental health services for people with serious mental illness: A scoping review of transitions from psychiatric hospital to community

Effective coordination as people with serious mental illness (SMI) move between care settings is essential. We aimed to review challenges to care coordination for people with SMI and identify approaches for improving it. Sixteen articles were identified. Two main challenges emerged: people with SMI facing adjustment challenges during transitions and services struggling to provide continuity of care. Effective approaches addressed coordination challenges and resulted in better improvements in service utilization, social functioning and quality of life. Future interventions may benefit from shared decision-making, support for caregivers, and addressing the challenges associated with complicated medication regimes and accessing medications.acceptedVersio

A digital educational resource to support and enhance effective mentorship practices of nursing students in nursing homes: a qualitative study

There is a grooving body of evidence emphasising the need to support and enhance effective mentorship practices for nursing students in nursing home placements, including strengthening of the pedagogical competence of registered nurse mentors. Owing to the necessity for multifaceted mentoring competence and the challenges of workload registered nurses are facing, the use of flexible digital educational resources has been suggested. However, current knowledge on the effectiveness of digital educational resources in enhancing mentorship practices in nursing homes is scarce. This study aimed to explore the perception of registered nurse mentors regarding the effectiveness of a digital educational resource, particular its usability and value-in-use in supporting and enhancing mentorship practices in nursing homes. The study applied an exploratory descriptive qualitative design. Pre- and post-mentoring semi-structured focus group interviews were conducted among a total of 23 registered nurse mentors across three Norwegian nursing homes. The transcribed interviews were thematically analysed. Standards for reporting qualitative research were followed. The analysis yielded one pre-mentoring theme: (1) predominant enthusiasm and satisfaction and three post-mentoring themes: (2) enhanced confidence and motivation, (3) enhanced mentoring competence in supporting the nursing students’ learning process, and (4) factors influencing the value-in-use of the digital educational resource. Digital educational resources support effective mentorship practices by enhancing the confidence and motivation in the mentor role and by enabling more goal-oriented supervision and assessment tailored to the learning goals of students. The implementation of digital educational resources to support and enhance effective mentorship practices is an important avenue for further research towards achieving high-quality learning environments in clinical nursing education in general and nursing homes. Based on the study findings, nursing educational institutions should consider offering digital educational resources to develop, support, and advance mentorship training, which may more effectively impact and improvepublishedVersio

Factors influencing treatment burden in colorectal cancer patients undergoing curative surgery: A cross-sectional study

Objective To describe the severity of treatment burden in surgically treated colorectal cancer (CRC) patients and examine associations between treatment burden and demographic and clinical variables. Methods This cross-sectional study recruited 134 patients diagnosed with Dukes’ stage A-C CRC between 2016 and 2018 who underwent curative surgery. The Patient Experience with Treatment and Self-management (PETS) questionnaire assessed treatment burden domains of ‘workload’, ‘stressors’ and ‘impact’ between 6 weeks and 18 months after primary surgery. Results Highest scores were observed for difficulty with healthcare services (median score 33.3), physical and mental fatigue (median score 30.0) and medical information (median score 26.8). Younger age, low education level or no cohabitants were significantly associated with higher workload PETS scores (p < 0.05, 0.013, p = 0.047, respectively). Higher PETS stressors scores were significantly associated with younger age (p = 0.006), lower education level (p = 0.016), and high comorbidity (p = 0.013). Higher PETS impact scores were significantly associated with the female sex (p = 0.050), younger age (p = <0.001–0.003), lower education (p = 0.003), no cohabitants (p = 0.003), high comorbidity (p = 0.003) and cancer stage Dukes A (p = 0.004). Conclusions A seamless and supportive healthcare system beyond hospitalisation targeting CRC subpopulations in danger of high treatment burden may improve patients’ self-management experience.publishedVersio

Initiation and maintenance of lifestyle changes among participants in a healthy life centre: a qualitative study

Background Since the early 2000s, Healthy Life Centres have been established in Norway to promote physical and mental health. Yet to date, little is known about the efficacy of Healthy Life Centres in promoting health behaviour change and maintenance or the factors that underlie these processes. Accordingly, the aim of the current study was to examine the factors that participants in a Healthy Life Centre perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet. Method Participants were purposely recruited from among adherers in a 12-month multi-method research project at a Healthy Life Centre. Individual, semi-structured interviews were conducted with 8 women and 6 men who were between the ages of 20 and 61 years old. Data were analysed using Systematic Text Condensation. Results Three main themes were derived from this analysis. The first theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. The second theme focused on strategies for coping with the challenges and potential pitfalls that were associated with various unpleasant experiences and life events. The third theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes. Conclusion The current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants’ experiences. In line with self-determination theory, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritizations in order to balance healthy lifestyle behaviours with the routines of “daily life” while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways.publishedVersio

Supporting the nurse educator in clinical education – A qualitative evaluation of a digital educational resource DigiVIS

Despite the increased use of technology for teaching and learning in clinical nursing education, relatively little attention seems to be directed toward the usefulness of digital educational resources (DERs) to support nurse educators’ educational role in clinical nursing education. An interpretive descriptive qualitative study design was conducted to evaluate the usefulness of a DER to support nurse educators in clinical nursing education. Data were collected through two focus group interviews with part-time and novice educators (n = 5) and full-time, more experienced educators (n = 5), after they had overseen student nurses in nursing home placements. Data were analyzed using thematic analysis and Standards for Reporting Qualitative Research guidelines were used for this study. The analysis identified three themes related to nurse educators’ experiences of the usefulness of a DER to support their educational role while overseeing first-year students on clinical placements in nursing homes: (1) Provides academic support and a sense of security (2) promotes pedagogical efficacy, and (3) represents a flexible resource for educational planning. This study shows that a digital educational resource can be an efficient and useful supplementary strategy to support the nurse educator’s role in clinical nursing education. Future research is required to systematize knowledge about the impact of DERs on orientation and training, as well as motivation and facilitators for, and barriers to, their use to enhance quality and strengthen the nurse educator’s role in clinical nursing education.publishedVersio

Exploring social innovation (SI) within the research contexts of higher education, healthcare and welfare services : a scoping review

ntroduction: Nordic countries face societal challenges for which social innovation may represent solutions. The aim of this scoping review is to explore the concept of social innovation within the research contexts of higher education, ealthcare, and welfare services. Method: A scoping review methodology was used, including a literature search and the identification of eligible studies published between 2007 and 2019, in addition to data extraction and synthesis. Forty-three studies were included in this review. Results: Across the research contexts, social innovation is conceptualized as a set of novel, creative, human-centred, and value-driven processes aiming to bring about change. Qualitative research methods dominate social innovation research. In welfare services, social innovation concerns the relationship between policy and praxis, new forms of leadership and management, and the promotion of societal inclusion and cohesion. Social innovation in healthcare comprises the use of technology to digitalize service, enhance patients’ well-being, and improve service quality. In higher education, social innovation research focuses on educational reforms involving non-profit stakeholders. Discussion: Social innovation is a multifaceted concept related to change at the organizational or societal level, often with various stakeholders working together to create improvements. The lack of a common definition and framework of social innovation makes this concept difficult to measure or quantify, reflecting the dominance of qualitative research methods in the selected research contexts. Across these research contexts, social innovation can be defined and used for various research purposes, which are often political and value-based, with the latter connected to the common good and people’s well-being. Moreover, few social innovation studies have been performed in Nordic countries.publishedVersio