Patient safety and feeling of safety when telecare is used among home-dwelling older adults : A qualitative study

Abstract

Background The use of telecare technologies is regarded as an important measure in meeting future healthcare challenges, and is a major focus area both in Norway and internationally. With the help of telecare, older individuals with chronic illnesses and impaired functioning shall better master their illness and everyday life and be able to live at home for as long as possible. Home-dwelling older adults are an important target - and user group. An important intention for the implementation and use of telecare technologies is to contribute to increased patient safety and feeling of safety. However, there is a lack of research concerning patient safety and feeling of safety when telecare is used among older adults in a municipal context. Aim The overarching aim of this thesis was to contribute to more insight and knowledge regarding patient safety and feeling of safety when telecare is used among home-dwelling older adults, by exploring the perceptions and experiences of homecare professionals, managers, and older telecare users. Methodology This qualitative study has an exploratory, inductive design. A total of 29 participants from a total of ten Norwegian municipalities participated in the study. The participants had practical and/or administrative experience within a total of 12 different telecare devices. Data were collected using focus groups and individual interviews. All data were analyzed using qualitative content analysis. The collected data formed the basis for three research papers (Paper I, II, and III). Findings Paper I presents the findings from focus group interviews with in total 10 homecare professionals (nine registered nurses and one occupational therapist). The research question was: How do homecare professionals perceive safety in relation to older adults’ use of telecare? The analysis identified two themes that illustrate the participants’ perceptions. The first theme, A protection against injury and insecurity, was based on the two categories Preventing harm and Feeling safe. The second theme, Involves challenges that could lead to harm, was based on the two categories Technological limitation and Difficulties managing and understanding the technology. The findings show that the participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also perceived that the use of telecare involves challenges that could lead to harm, related to technological limitations and difficulties managing and understanding the technology. Paper II presents the findings from focus group interviews with in total 20 participants, including ten homecare professionals (nine registered nurses and one occupational therapist), and ten managers (eight health and care managers and two telecare project group managers). The research question was: What do managers and homecare professionals perceive as important for safe and secure use of telecare for older adults in community homecare services? The analysis identified three categories that refer to the participants’ perceptions: Sufficient knowledge, Close follow-up, and Meet the needs of the users. The findings show that the participants considered it important that both healthcare personnel and service users receive essential information and training about the telecare technologies in use. Furthermore, it was deemed vital that both the technology and its use are closely followed up and that the solutions offered complies with the service users’ individual desires, needs, and resources. The participants also referred to the significance of increased attention to early initiatives and the use of telecare in a preventative perspective. Paper III present the findings from individual interviews with nine older telecare users (seven service users and two spouses). The research question was: How do older adults experience safety when using a telecare at home? The analysis identified one theme that illustrates the participants’ experiences: Feeling free and protected from danger. The theme was based on the three categories Being protected against harm, Trusting and managing the device, and Becoming more independent. The findings show that the participants experienced an increased feeling of safety by using their mobile safety alarm with GPS or electronic medicine dispenser. This was linked to a sense of being protected from physical harm, and finding their device reliable and easy to use and understand. Moreover, the findings reveal that the increased feeling of safety was significant in that the participants could maintain their daily activities and live more independently at home. Conclusions This thesis has demonstrated how both technological, individual, and organizational conditions have importance for patient safety and feeling of safety in telecare use. The thesis has revealed how patient safety and feelings of safety are promoted by functionalities related to the telecare devices. The enhanced feeling of safety from using telecare devices has significance to that home-dwelling older adults can maintain their activities and live more independently at home. Thus, this thesis provides insight and knowledge on what feeling of safety from using telecare devices mean for older adults who use the technologies in their everyday lives. The findings of this thesis suggests that telecare can be a significant tool to prevent injury among home-dwelling older adults, and allow them to feel safer and live more independently at home. However, this thesis has revealed how patient safety and feelings of safety are challenged by technological inadequacies and limitations, and difficulties for some older users to understand and manage telecare functionalities. Thus, this thesis provides important insight and knowledge regarding technological vulnerabilities. This thesis has further revealed how patient safety and feelings of safety are promoted by organizational conditions in terms of telecare routines, drills, and targeted training. Furthermore, the thesis has emphasized the importance of ensuring that telecare solutions fit the users’ individual needs and prerequisites. Moreover, the thesis has highlighted homecare professional’s crucial role and function by facilitating patient safety and feelings of safety when telecare is used among home-dwelling older adults.

NORSK SAMMENDRAG: Bruk av velferdsteknologi (VT) anses som et viktig tiltak i møtet med framtidige utfordringer innen helsetjenesten, og er et stort satsingsområde både i Norge og internasjonalt. Ved hjelp av velferdsteknologi skal eldre personer med kronisk sykdom og nedsatt funksjonsevne bli bedre i stand til å kunne mestre sin sykdom og hverdag, og kunne bo hjemme så lenge som mulig. Hjemmeboende eldre er en viktig mål - og brukergruppe. En viktig intensjon for implementering og bruk av velferdsteknologiske løsninger er å øke pasientsikkerheten og følelsen av trygghet. Det er imidlertid mangel på forskning vedrørende pasientsikkerhet og følelse av trygghet når velferdsteknologi benyttes blant hjemmeboende eldre i en kommunal kontekst. Mål Det overordnede målet med denne avhandlingen var å bidra til mer innsikt og kunnskap vedrørende pasientsikkerhet og følelse av trygghet når velferdsteknologi benyttes blant hjemmeboende eldre, ved å utforske opplevelsene og erfaringene til helsepersonell, ledere og eldre VTbrukere. Metode Denne kvalitative studien har et eksplorativt, induktivt design. Totalt 29 deltagere fra til sammen ti norske kommuner deltok i studien. Alle deltagerne hadde praktisk og/eller administrativ erfaring med til sammen 12 ulike velferdsteknologiske løsninger. Data ble samlet inn ved bruk av fokusgrupper og individuelle intervju. Alle data ble analysert ved hjelp av kvalitativ innholdsanalyse. De innsamlede dataene dannet grunnlag for tre forskningsartikler (Artikkel I, II & III).