An exploration into the implementation of monitoring technologies in care homes for people with dementia

UoM administered thesis: Phd


Background: An ageing society and rising prevalence in dementia are associated with rising demand for care home places. Monitoring technologies (e.g. bed-exit alarms; wearable location-tracking devices) are appealing because of their potential to enhance safety, increase resident freedom, and reduce staff burden. However, it is unclear how far use of such technologies can deliver potential benefits, and there are ethical challenges from their use. This study explored the implementation of monitoring technologies in care homes for people with dementia, to identify facilitators and barriers to the implementation of these technologies in practice.Methods: An embedded multiple-case study design was employed with 3 dementia-specialist care homes in North-West England. Data collection included 36 semi-structured interviews with staff, relatives and residents, informed by Normalization Process Theory to focus on individual and organisational factors within implementation; 175 hours' non-participant observation; investigation of care records and technology manufacturer literature; and questionnaires to establish participant attitudes towards technologies. Qualitative data were analysed using Framework Analysis.Findings: 5 overarching themes emerged: (1) Reasons for using technologies; (2) How technologies were implemented; (3) What happened when using technologies; (4) Understanding of technologies; (5) Business and environmental influences. Mitigation of risk seemed to override other potential benefits (e.g. resident freedom) or ethical concerns (e.g. the remote monitoring of residents with impaired cognition), as a reason for use. This emphasis seemed to position monitoring technologies as being understood as fundamentally different to other interventions, and challenged adherence to philosophies of care emphasising resident choice. Some staff, relatives and residents did not seem to be involved in discussion and decision-making regarding technologies, and seemed to lack knowledge about technologies within the homes. Staff training appeared mainly informal, based upon assumptions of simplicity of use, which might not have been sufficient to ensure that staff fully understood the technologies. Staff understanding and awareness of the technologies appeared to be influenced in part by location, both organisationally (i.e. their role) and physically (i.e. within the building). Technical and physical properties of the technologies appeared to work in relation with the physical environments of the homes, which suggested that there may not be an ideal set of physical properties for any particular technology. Some technologies offered a range of functional and information-gathering capabilities, which at times were perceived to be useful complements to practice, but at other times less useful, particularly if they were imbued with a financial cost that was not justifiable from a business perspective.Conclusions: Care homes may need to consider greater involvement of all stakeholders in discussions and decisions regarding the use of monitoring technologies, in order to deepen understandings about the potential benefits and challenges from their use. There is also a need to consider the technical compatibility of technologies with the care home premises, and the financial implications from investing in technologies.


Original languageEnglish
Awarding Institution
Award date31 Dec 2016

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Prize: Fellowship awarded competitively

Prize: Fellowship awarded competitively

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