Background: The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. Aim: The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. Method: We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. Results: NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. Conclusion: Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare. © 2024 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

Background

The implementation of e-health is transforming healthcare. The acknowledged benefits of digitalization are quality improvement, patient empowerment, and increased efficiency. The mobility of e-health makes it especially suitable for home healthcare. eMar is a common e-health technology used in Swedish home healthcare. Decisions about technology design are governed by developers’ perceptions of intended users. These perceptions can be identified in the description and promotion of a specific product.

Purpose

The purpose of the presentation is to contribute to increased knowledge about the values entailed in a specific eMar used in Swedish home healthcare, and furthermore to discuss how these values conform with existing national missions such as people-centered care.

Method

Information consisting of sales materials about a specific eMar used in several Swedish municipalities has been analyzed through critical discourse analysis to visualize values embedded in the eMar.

Findings

Preliminary results show that the provider of the specific eMar describes care in terms borrowed from the industrial sector, such as shift changes and production of care. Good and safe care is defined as the right person receiving the right medicine at the right time. Furthermore, the app is advertised as a tool for monitoring assuming that the performance of tasks can be influenced through the remote control of the employee. The eMar is described as representing new and modern technologies that are expected to raise the status of healthcare professions and facilitate the recruitment of employees.

Increased use of digital technologies in healthcare offers healthcare professionals multiple ways to perform tasks and interact with patients and colleagues. We used the JDCS model to identify employee´s well-being in relation to the use of an eMar. The analysis indicated that the specific technology influenced the work environment for registered nurses and nursing assistants in different ways.

Background:eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals.

Objective: The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality.

Methods: This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz.

Results: Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants.

Conclusions: Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels. ©Sara Karnehed, Lena-Karin Erlandsson, Margaretha Norell Pejner.

Background: There is a strong need to improve medication adherence (MA) for individuals with hypertension in order to reduce long-term hospitalization costs. We believe this can be achieved through an artificial intelligence agent that helps the patient in understanding key individual adherence risk factors and designing an appropriate intervention plan. The incidence of hypertension in Sweden is estimated at approximately 27%. Although blood pressure control has increased in Sweden, barely half of the treated patients achieved adequate blood pressure levels. It is a major risk factor for coronary heart disease and stroke as well as heart failure. MA is a key factor for good clinical outcomes in persons with hypertension.

Objective: The overall aim of this study is to design, develop, test, and evaluate an adaptive digital intervention called iMedA, delivered via a mobile app to improve MA, self-care management, and blood pressure control for persons with hypertension.

Methods: The study design is an interrupted time series. We will collect data on a daily basis, 14 days before, during 6 months of delivering digital interventions through the mobile app, and 14 days after. The effect will be analyzed using segmented regression analysis. The participants will be recruited in Region Halland, Sweden. The design of the digital interventions follows the just-in-time adaptive intervention framework. The primary (distal) outcome is MA, and the secondary outcome is blood pressure. The design of the digital intervention is developed based on a needs assessment process including a systematic review, focus group interviews, and a pilot study, before conducting the longitudinal interrupted time series study.

Results: The focus groups of persons with hypertension have been conducted to perform the needs assessment in a Swedish context. The design and development of digital interventions are in progress, and the interventions are planned to be ready in November 2020. Then, the 2-week pilot study for usability evaluation will start, and the interrupted time series study, which we plan to start in February 2021, will follow it.

Conclusions: We hypothesize that iMedA will improve medication adherence and self-care management. This study could illustrate how self-care management tools can be an additional (digital) treatment support to a clinical one without increasing burden on health care staff. © Kobra Etminani, Carina Göransson, Alexander Galozy, Margaretha Norell Pejner, Sławomir Nowaczyk.

Background and aim: Due to reported shortcomings in elderly care in Sweden, the government has introduced national guidelines to establish core values and guarantees of dignity. With a bottom-up perspective, core values and local guarantees of dignity were developed using an participatory and appreciative action and reflection (PAAR) approach and implemented in municipal elderly care. The aim of this study was to evaluate the core values and local guarantees of dignity applied by the municipal healthcare staff caring for older persons. Method and results: A cross-sectional descriptive design study using a questionnaire was conducted one year after the implementation of core values and local guarantees of dignity in municipal elderly care. In total, 608 caregivers answered the questionnaire. The results show that the caregivers strived to apply the core values and local guarantees of dignity, but experienced obstacles from the organisation. Proposals were given to facilitate further application of the core values. © 2020 Nordic College of Caring Science

Elderly patients sometimes seek emergency services unnecessarily. Emergency clinics can be detrimental to the elderly. The purpose of this study was to find health promotion practices that enable a registered nurse in community health to reduce the need for home care clients to seek emergency care. The method of integrative literature review was used. Through health promotion work in the home, the registered nurses in community health (in conjunction with other professionals) can strengthen patients’ self-esteem and reduce their emergency care visits. Patient involvement is part of this work, and the registered nurses in community health needs to get to know patients to learn their health needs, design individual care plans, and find out whether they need education about their own health and/or health care services available to them. Registered nurses in community health experience difficulties in performing health promotion because they perceive that other tasks have higher priority. Copyright © 2019 by SAGE Publications

Background: Older adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people’s independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes, and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of the health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their care. It is also a challenge to perform adequate health assessment and appropriate communication between health care professionals.

Objective: The purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information sharing among care providers and care receivers in order to support and promote medication self-management among older people.

Methods: The authors used a participatory design (PD) approach for this mixed-method project, which was divided into four phases: Phase I, Conceptualization, consisted of the conceptualization of a system to support medication self- management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consisted of building and bringing together the conceptualized systems from phase I. Phases III (pilot study) and IV (a full-scale study) are described briefly.

Results: Our participants in phase I were people who were involved in some way in the care of older adults, and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The system will also encourage information sharing between care providers and care receivers. The first is the concept of the Intelligent Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason and act in response to individual needs, preferences and behaviors as these change over time. The second concept is the MedOP system, a system that would be supported by the IAFH, and which consists of three related components: one that assess health behaviors, another that communicates health data, and a third that promotes medication self-management.

Conclusions: The participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication and medication self-management: the Intelligent Friendly Home (IAFH), and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management in older people. © The authors. All rights reserved. 

Background: Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge.

Methods: This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data.

Results: Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person’s identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other’s conditions. The person’s self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed.

Conclusion: Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people’s self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing. © The Author(s). 2019

Aim: To describe how Registered Nurses in a municipal home care context experience adverse event reports.

Design: A qualitative design was used.

Method: Twelve semistructured individual interviews with Registered Nurses in a municipal home care context were collected on two occasions and analysed with qualitative content analysis.

Results: The results show that conflicts exist between being able to trust the managers and their feedback, being loyal to colleagues and retaining professional pride. These are described in the theme “Contradiction” and the three categories: “Awareness”; “Uncertainty”; and “Concealment.” © 2018 The Authors.