Integration of an in-home monitoring system into home care nurses' workflow: A case study

Background: The healthcare system faces a major challenge in caring for an increasingly ageing population as this task requires more resources than are currently available. Adopting monitoring technologies could enable more efficient care practices and support ageing in place. Objectives: To investigate how the use of an in-home motion monitoring system can be integrated into home care nurses' workflows and to uncover the factors behind system adoption. Design: A single case study adopting a qualitative approach. Setting: A home care unit serving older adults living in independent living residences within an apartment complex. Method: Multiple data collection methods were used including individual and group interviews, a questionnaire with open-ended questions, evaluation probes, and system log data. The qualitative material was analysed using a stepwise-deductive inductive approach. Results: A central factor behind system adoption was the perceived usefulness of gaining information about older adults' night-time activities. In particular, monitoring older adults suffering from memory disorders was considered advantageous. The information that the system provided supported nurses in health assessments and assisted in adjusting care decisions. Previous negative experiences with similar technologies initially influenced the time for adoption. Further, although nurses were closely involved in the system design process, they took some time to get acquainted with the system and to integrate its use into daily practice. System reliability and accuracy issues influenced nurses' trust in the sensory data. Conclusion: The findings suggests that in a home care setting, focusing on motion pattern monitoring for older adults with memory disorders can provide significant benefits and therefore also facilitate system adoption among nurses. Involving nurses in the design of the technology and providing opportunities to trial the system in real practice also appear to be important in achieving system adoption.