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

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          Abstract

          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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          Most cited references 30

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          In search of a few good apps.

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            PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia.

            There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE.
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              Defining the outcomes of community care: the perspectives of older people with dementia and their carers

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                Author and article information

                Contributors
                Journal
                Int J Nurs Stud
                Int J Nurs Stud
                International Journal of Nursing Studies
                Pergamon Press
                0020-7489
                1873-491X
                1 July 2017
                July 2017
                : 72
                : 60-70
                Affiliations
                [a ]School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
                [b ]School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, Australia
                [c ]Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, UK
                [d ]University Hospital of South Manchester NHS Foundation Trust, and Manchester Academic Health Science Centre, UK
                Author notes
                [* ]Corresponding author. alex.hall@ 123456manchester.ac.uk
                Article
                S0020-7489(17)30094-9
                10.1016/j.ijnurstu.2017.04.008
                5490779
                28494333
                © 2017 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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