Implementing Monitoring Technologies In Nursing Homes: The Importance of Stakeholder Involvement

This project explores facilitators or barriers to the implementation of monitoring technologies in nursing and residential care homes for people with dementia. Case study methodology was used, with participants recruited from three dementia-specialist care homes in the North-West of England. Each home was using nurse call systems and other body-worn and environmental technologies to monitor resident and staff activity. Data collection included 36 semi-structured interviews with staff, relatives and residents, informed by Normalization Process Theory focusing on individual and organisational factors influential within successful implementation; 175 hours’ non-participant observation; analysis of care records and technology manufacturer literature. Findings suggested that implementation of monitoring technologies was influenced by a powerful fear of blame culture within social care. An emphasis upon safety and mitigation against risk seemed to override consideration of other potential benefits (e.g. freedom of movement for residents) or ethical concerns (e.g. impact upon resident privacy) as a justification for using monitoring technologies. This emphasis appeared to shape understandings of monitoring technologies as being fundamentally different to other interventions. Staff, relatives and residents did not always seem to be involved in discussions and decision-making regarding implementation, and at times appeared to lack knowledge about the status of technologies with the homes. Involvement of staff, residents and relatives within the implementation process may help to develop a deeper understanding of a range of benefits and challenges from using monitoring technologies, and may be considered to be an important factor to align the implementation of monitoring technologies with person-centred philosophies of care.