Technology-assisted Care Research Articles

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Enhancing Health Monitoring and Active Aging in the Elderly Population: A Study on Wearable Technology and Technology-Assisted Care

The constant monitoring of human physical activity, behaviour, and physiological signs has undergone a revolution thanks to wearable technology, which has provided invaluable insights into many facets of everyday life. Wearable technology has become a potent instrument for improving healthcare efficiency and lowering costs as the prevalence of an ageing population and the need for technology-assisted care increase. By analysing gait patterns and promoting a healthy lifestyle in age-friendly settings, this study aims to investigate how valid and trustworthy wearable devices, in conjunction with technology-assisted care, can facilitate the monitoring and improvement of the health of the elderly population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards for data inclusion and exclusion are used in the study, which collects data from the Scopus database. The results show that wearable technology, which offers two main device categories—those intended for healthcare professionals and those aimed at consumers—plays a critical role in gait-pattern analysis. These gadgets offer robust data-collecting capabilities, allowing for precise evaluation and tracking of walking habits. Furthermore, the incorporation of wearable technology with eHealth solutions enhances the quality of life for the aged population by enabling them to live in settings that are age-friendly and successfully manage their health. The study also emphasises how critical it is to use reliable wearable technology to address the diversity of health issues and the occurrence of chronic diseases among the senior population. According to the study’s findings, wearable technologies have great promise for promoting the health and well-being of senior citizens. To meet the unique requirements and problems of the ageing population and to guarantee the successful integration of wearable devices into healthcare practices, more research and development are needed. In the end, wearable technology has enormous potential to revolutionise aged care and enhance health outcomes in ageing-friendly settings.

Technology-Supported Independent Living for Adults With Developmental Disabilities

Abstract Date Presented 04/22/2023 This 3-year longitudinal descriptive study analyzed the effect of technology-assisted care through a smart home on cost of caregiving, and performance and satisfaction of specified tasks, for adults with developmental disabilities. Currently, independent living options for those with developmental disabilities are limited. This research on the effect of smart homes will advance the development of independent living options for adults with developmental disabilities. Primary Author and Speaker: Shannon Turnley Additional Authors and Speakers: Ashlyn Denault, Isabel Ferreira, Grace Fuller, Lauren Winslow Contributing Authors: Claire Morress

Ethical and Legal Aspects of Technology-Assisted Care in Neurodegenerative Disease.

Technological solutions are increasingly seen as a way to respond to the demands of managing complex chronic conditions, especially neurodegenerative diseases such as Parkinson’s Disease. All of these new possibilities provide a variety of chances to improve the lives of affected persons and their families, friends, and caregivers. However, there are also a number of challenges that should be considered in order to safeguard the interests of affected persons. In this article, we discuss the ethical and legal considerations associated with the use of technology-assisted care in the context of neurodegenerative conditions.

“My attitude on telehealth has completely changed.”: Facilitators and Barriers to Implementing Technology for Care Delivery in Community Mental Health Centers

The purpose of this study was to explore facilitators and barriers aiding community mental health centers in implementing technology-assisted care during the COVID-19 pandemic. Six key informants were interviewed and 28 clinicians were surveyed from three community mental health centers. Interviews focused on technology-assisted care implementation efforts and factors that facilitated adoption. Surveys focused on clinician beliefs and experience with technology-assisted care in addition to training needs. Barriers to technology-assisted care implementation included beliefs about the quality of virtual services and a lack of technology access. An increase in service utilization was reported. Technology-assisted care facilitators included reimbursement policy changes and clinic-based factors such as clinician training and supervision efforts. Clinicians reported having the skills necessary to implement technology-assisted care however endorsed a need for training. Implementation of technology-assisted care in community mental health centers was largely successful however support is needed to help clinicians adapt services to client needs.

Let There Be PEACE: Improving Continuous Symptom Monitoring in Hospice Patients.

ObjectiveTo ensure that a standardized method of continuous symptom monitoring was available to hospice patients enrolled at our institution.Patients and MethodsThe Palliative/End-of-Life/Assessment/Care Coordination/Evidence-Based Program (PEACE) seeks to enhance the provision of hospice care through symptom control and patient support. We conducted a quality improvement initiative between November 1, 2015, and March 31, 2017, following Define-Measure-Analyze-Improve-Control methodology to improve hospice care at a rural hospice. The gap in our current hospice model was a standardized method of continuous symptom monitoring. We aimed to explore ways in which technology-assisted care coordination could enhance end-of-life and hospice care. We measured continuous symptom assessments through co-developed condition management protocols (CMPs), technology-assisted care pathways (TACPs), nursing visits, length of stay, respite days, and satisfaction survey data from patients, caregivers, and hospice staff. At baseline, no continuous symptom monitoring was being performed. Baseline data for our enrolled population was compared with data from patients who were eligible, but opted out.ResultsWe monitored 50 patients using CMP and TACP. The mean ± SD number of skilled nursing visits per patient in the enrolled population compared with those who were eligible but opted out was 13.7±7.6 vs 14.2±10.5, respectively. In response to the survey question, “Because of the overall program, I felt supported and confident at home,” 74% (37 of 50) of patients and caregivers answered, “always.”ConclusionPEACE enhanced hospice care through symptom control and patient support through CMP and TACP. PEACE is a unique and feasible care platform for hospice patients, with high patient and caregiver satisfaction.

Transforming Nursing Education and Practice: a Review on the Innovation Strategy towards Sustainable Primary Healthcare Workforce

Nurses embody largest group of healthcare providers and the initial access of patient contact in many settings. They convey primary care in small and large hospital practices in clinics, schools and workplace. They function independent and collaborative practices often taking lead clinical, management, accountability roles in innovative means in rural areas, where modern technology-assisted care delivery is little. The researcher-utilized reviews using content analysis to address aim of identifying barriers and innovation strategies that nurses have helped implement in health services to transform primary healthcare. Search strategy is based on combining terms including, health innovation, practice, innovation strategy, and primary healthcare policy, yielded 84 results. Due to diverse potential findings, the review utilized degrees of criteria selection. Multi-staging strategy was developed to identify relevant review literatures. ProQuest and Ebscohost serve as databases during retrieval. Results revealed barriers to transforming PHC practice include frequent staff turnover, scope-of-practice limitation, fragmentation of care and lack of support from key stakeholders. Literatures unveiled that these be resolved by allowing nurses practice fully their training, expanding opportunities for nurses to lead collaborative efforts and implementing nurse residency program. Additionally, transition programs should typically include periods of orientation, preceptorship from key stakeholders to promote innovative culture in workplace.

A Comparison of Telemental Health Terminology Used Across Mental Health State Licensure Boards

Mental health care professional shortage areas fall across the United States (Rural Assistance Center, 2015). According to the Health Resources and Services Administration, there is an immediate need for approximately 4,000 mental health providers nationwide (Kaiser Family Foundation, 2014). According to the Bureau for Labor Statistics (2014), the mental health counselor workforce is not distributed in proportion to the need. The National Institute of Mental Health (2014) estimated 43.6 million adults aged 18 or older in the United States suffered from some form of mental illness in the past year. Many individuals' mental health needs go untreated due to gaps in resources or delivery of services (Brown, 1998; Gibson, Morley, & Romeo-Wolff, 2002; Modai et al., 2006).The U.S. government has demonstrated a strong commitment to the development, promotion and integration of technology-assisted care into the U.S. health care system through ongoing work in telemental health (Godleski, Nieves, Darkins, & Lehmann, 2008; National Center for Telehealth & Technology, 2011, 2015; Pruitt & Woodside, 2015). In addition, the government has issued numerous grants for telemental health and other health services for license reciprocity (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2015), established the Office for the Advancement of Telehealth, and published the 2015 Treatment Improvement Protocol (Substance Abuse and Mental Health Services Administration, 2015).Pruitt, Luxton, and Shore (2014) stated that home-based telemental health has several important benefits for both patients and clinical practitioners including improved access to services, convenience, flexibility, and potential cost savings (p. 340). Policymakers and advocates view telehealth technology as particularly promising given the continuing shortage of mental health clinicians and long travel distances to obtain care (Lambert, Gale, Hansen, Croll, & Hartley, 2013).With advancements in technology and the availability of the Internet, mental health care providers have sought new ways to integrate technology into practice (Maheu, Pulier, Wilhelm, McMenamin, & Brown-Connolly, 2005), including implementing technology in scheduling appointments, distributing assessments and providing treatment services. Using Internet-based videoconferencing, mental health care providers can easily connect with clients without requiring in-office meetings (Baker & Bufka, 2011). Some individuals will not or cannot seek mental health services when inperson services are needed; therefore, the in-person treatment process becomes a treatment barrier (Bensink, Hailey, & Wootton, 2006). According to Brown (1998), some individuals fail to seek mental health services due to geographical restrictions. Other individuals may struggle with physical health restrictions, preventing them from seeking traditional, in-office services. Mental health conditions such as panic disorder (Klein, Richards, & Austin, 2006), agoraphobia and eating disorders (Zabinski, Celio, Wilfley, & Taylor, 2003) may restrict individuals from receiving traditional services. Using Internet-based services, mental health practitioners can reach clients who are in rural locations, who are seriously ill or who do not seek traditional counseling.While the use of technology increases access to care, the technology itself creates new, unique challenges and potential risks for mental health providers (Baker & Bufka, 2011). Fifteen years ago, Riemer-Reiss (2000) discussed utilizing distance technology in mental health practice, listing foreseeable concerns for practitioners. More recent publications (Barnett & Kolmes, 2016a, 2016b) present similar concerns and questions for mental health providers. Counselors must attain competency in working with special populations or in specific practice areas, including the use of telemental health services (Baker & Bufka, 2011; Barnett & Kolmes, 2016a, 2016b). …

The E-Coach technology-assisted care transition system: a pragmatic randomized trial.

Care transitions from the hospital to home remain a vulnerable time for many patients, especially for those with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Despite regular use in chronic disease management, it remains unclear how technology can best support patients during their transition from the hospital. We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality. Using a pragmatic randomized trial, we enrolled patients (511 enrolled, 478 analyzed) hospitalized with CHF/COPD to "E-Coach," an intervention with condition-specific customization and in-hospital and post-discharge support by a care transition nurse (CTN), interactive voice response post-discharge calls, and CTN follow-up versus usual post-discharge care (UC). The primary outcome was 30-day rehospitalization. Secondary outcomes included (1) rehospitalization and death and (2) days in the hospital and out of the community. E-Coach and UC groups were similar at baseline except for gender imbalance (p = 0.02). After adjustment for gender, our primary outcome, 30-day rehospitalization rates did not differ between the E-Coach and UC groups (15.0 vs. 16.3%, adjusted hazard ratio [95% confidence interval]: 0.94 [0.60, 1.49]). However, in the COPD subgroup, E-Coach was associated with significantly fewer days in the hospital (0.5 vs. 1.6, p = 0.03). E-Coach, an IVR-augmented care transition intervention did not reduce rehospitalization. The positive impact on our secondary outcome (days in hospital) among COPD patients, but not in CHF, may suggest that E-Coach may be more beneficial among patients with COPD.NIH trial registry number: NCT01135381Trial Protocol: http://dx.doi.org/ 10.1016/j.cct.2012.08.007.

Supporting Active and Healthy Ageing in Northern Ireland

Bernadette Hannigan Chief Scientific Advisory, Department of Health, Northern Ireland With a population of 1.8 million people, Northern Ireland (NI) is the smallest of the four UK administrative regions, each with separate responsibility for health and social care services. The separate UK systems share many commonalities, e.g. services free at the point of care, however each is increasingly focussed on particular local needs. In NI, health and social care services are fully integrated and account for roughly half of all public expenditure. Without independent tax-raising powers and within tight public finance constraints, innovative, effective approaches are essential. Demographically, NI is skewed towards the youngest ages and older people; the number of people of pensionable age is expected to grow by 19% by 2020. Participation in the EIP on Active and Healthy Ageing (EIP AHA) has occurred alongside a major strategic shift, e.g. enhanced linkages between primary and secondary care, home-based, technology-assisted care and a focus on reducing inequalities in population health. Further, to ensure that all changes are likely to be beneficial, robust research-informed methodologies and evidence are being embedded into service evaluation, policy-making and technological evaluation. Thus there is considerable alignment with the ‘triple win’ objective of EIP AHA. The quality of what is being achieved led to the recognition of NI as a Reference Site for EIP AHA (3 star) on the basis of initiatives in:

Telehealth Is Ready, Payment System Isn't

Telehealth Is Ready, Payment System Isn't

Specialty services for children with special health care needs: supplement not supplant the medical home

Children with special health care needs (CSHCN) are a large part of the population in developed countries throughout the world.1 Definitions vary, and can encompass children with congenital, acquired and...

Using Diffusion of Innovation Concepts to Enhance Implementation of an Electronic Health Record to Support Evidence-based Practice

The article identifies the explosion of clinical data that are available and how difficult it is for clinicians to find answers to clinical questions. Electronic healthcare records (EHRs) are increasingly used to assist clinicians in this process; however, resistance to the implementation of technology-assisted care is not uncommon. The article reviews the diffusion of innovation research and provides the nurse manager with suggestions for applying these concepts to enhance the implementation of an EHR that can support evidence-based practice. Five characteristics of innovations, as perceived by individuals, are discussed as they help explain different rates of adoption. The innovation-decision process is studied as it relates to EHR implementations.

Research themes for our future

Research themes for our future

Excess risk of severe acute illness in children with chronic health conditions.

We estimated the relative risk (RR) of an unscheduled pediatric intensive care unit (ICU) admission as a marker for severe acute illness in children with chronic health conditions, compared with previously healthy children. Potentially preventable events that lead to acute illness were identified to develop preventive strategies. Children with chronic conditions were defined as those who have a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. RR was estimated from admissions and regional population data. Potentially preventable events that lead to ICU admission of chronically ill children were identified retrospectively from hospital records. Children with chronic health conditions had an RR of 3.3 for an unscheduled ICU admission related to their chronic condition, compared with previously healthy individuals (95% confidence interval [CI] = 2.5-4.2). The risk of severe acute illness in the small subgroup that received technology-assisted care was much greater (RR = 373; 95% CI = 330-422) than for the large group of chronically ill patients who did not require technology-assisted care (RR = 2.3; 95% CI = 1.7-3.0), each expressed relative to previously healthy children. Acute illness related to chronic health conditions accounted for 45% of 251 unscheduled ICU admissions during the 1-year study. Thirty-two percent of admissions that were related to chronic conditions were judged to have been potentially preventable. Preventable events were more common for those who did not require technology-assisted care, occurring in 38% of admissions, compared with those who received technology-assisted care, for whom 19% of admissions involved a preventable event. Fifty-six percent of potentially preventable events involved the physical or social environment and decisions made by the family, whereas 64% could be attributed to health care system factors. Children with chronic health conditions account for a substantial share of severe acute illness in a region. Because their underlying conditions have already been identified, problems may be anticipated. The small number of children who receive technology-assisted care each have such a high risk of severe and unavoidable acute illness that individualized emergency care plans are justified. For the remainder of children with chronic conditions, investigation of health system strategies to improve families' ability to anticipate, minimize, or prevent related acute illness is warranted.