Understanding the possibilities and limitations of assistive technology in health and welfare services for people with intellectual disabilities, staff perspectives.

PURPOSE: Little is known regarding what assistive technology (AT) exists and how it is used in welfare services for people with intellectual disabilities (ID). This study aimed to explore healthcare staff's perspectives and insights regarding AT in daily support and welfare services for people with ID. We also sought to explore the associations between the use of AT and workplace-related factors and background characteristics (e.g., gender, age, and experience). MATERIALS AND METHODS: Three focus group discussions were conducted with 11 informants (8 women, 3 men) working in home-based and day services. Also, 176 healthcare staff (43 men, 133 women) who worked in municipal home-based services and day services completed a questionnaire comprised of background questions and 14 items with a five-point answer scale. RESULTS: Number of years using AT was positively associated with a positive attitude and use of AT among the staff. Staff were mainly positive towards AT and believed that it could represent various possibilities in the everyday lives of people with ID and their own service delivery. However, the staff expressed uncertainties and ethical concerns regarding AT, and they experienced a lack of knowledge, focus, and awareness about technology in services for this group. The quantitative results mainly showed positive associations between believing in AT's usefulness and using it in services for people with ID. CONCLUSIONS: The findings indicate that providing equipment and resources, personal interests, and staff attitudes are essential factors in successfully implementing AT for people with ID.Implications for rehabilitationHealthcare staff have a positive attitude towards using AT for people with intellectual disabilities, but they also perceive uncertainty and ethical concerns.The staff believe that there is a broad range of AT devices and systems available that can support the independence and participation of people with intellectual disabilities.The staff need to receive more training and technical supports from their workplace and AT-related experience is associated positively with the use of assistive technology by the staff.

Beyond the Point of No Return: A Discourse Analysis of Healthcare Professionals' Perceptions of Digitally Supported Person-Centred, Integrated, and Proactive Care.

Most countries are facing a common challenge: a rise in the number of chronically ill patients and limited medical resources. The combination of digital support and the principles of person-centred, integrated, and proactive care (Digi-PIP care) services constitutes the most ambitious initiative for patients with long-term needs. While there is research on digital support, person-centred, integrated, and proactive care, the combination of these components has been less explored. The data set consisted of 29 qualitative interviews with healthcare professionals involved in four Nordic Digi-PIP care initiatives. Building on prevailing discourses on the modernisation of healthcare, we used discourse analysis to determine how the professionals discussed their perceptions and experiences of the care transformation initiatives. We identified four discourses illustrating that, despite challenges with adoption, the vision of Digi-PIP care was strongly embedded among participants across professions and contexts. In contrast to the discourses on their separate components, the emergent discourses on Digi-PIP care were surprisingly consistent. The new care model was found to be beneficial for patients, healthcare professionals, and society. Digitalisation may vitalise and even catalyse person-centred, integrated, and proactive practices. To the employees involved, Digi-PIP has moved beyond the point of no return; it is the future of modern healthcare.

Using welfare technology for individuals with intellectual disabilities. Expectations, experiences, and challenges of intellectual disability nursing students during clinical placement.

PURPOSE: Little is known about how welfare technology (WT) is used in welfare services for people with intellectual disabilities. This study aimed to explore expectations, experiences, and challenges concerning the use of WT for people with intellectual disabilities among bachelor-level intellectual disability nursing students during clinical placement. MATERIALS AND METHODS: A written reflection assignment (four open questions about using WT) was collected from 100 intellectual disability nursing students (30 males, 70 females). Four focus group discussions were also performed with 13 intellectual disability nursing students before and after their clinical placements. RESULTS: Analysis of the assignments showed that "security and safety" technology was the most frequently used WT category for people with intellectual disabilities in the clinical placement settings in municipal welfare and day services. The students reported "Compensation and wellness" technology as the top category to promote the quality of services for people with intellectual disabilities. However, people with intellectual disabilities mostly used WT for "Social contact". Students were mainly positive towards WT and believed it could improve the service quality and the everyday lives of this group. However, the students requested to learn more about WT and ethical issues regarding WT before clinical placement. Additionally, they experienced a lack of knowledge, focus, and awareness about technology in services for this group. CONCLUSION: The findings suggest that although intellectual disability nursing students have a positive attitude towards using WT for people with intellectual disabilities, they require more skill training and ethical knowledge before entering clinical practice. IMPLICATIONS FOR REHABILITATIONStudents were mainly positive towards welfare technology and believed that it could improve the service quality and the everyday lives of people with intellectual disabilities.Before their clinical placement, intellectual disability nursing students requested to learn more about welfare technology and ethical issues regarding welfare technology."Security and safety" technology was the most used category for people with intellectual disabilities in the municipal welfare and day services."Social contact" technology was the most used category by people with intellectual disabilities.

Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers' beliefs matter.

BACKGROUND: Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016-2020). It originates at one of ten work packages in this project. METHOD: The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. RESULTS: While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. CONCLUSION: Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.

Experiences of returning to work after brain tumor treatment.

BACKGROUND: Work participation has a profound influence on the individual's overall health and well-being. Cancer survivors are at risk of unemployment, and the people with the highest risk are diagnosed with cancer in the central nervous system. Many diagnosed with this cancer survive and try to return to a normal life including work participation. Experiences related to returning to work after brain tumor treatment seem to be an unexplored phenomenon. OBJECTIVE: The current study focuses on the gap in the scientific literature concerning the individual experience after undergoing treatment for brain cancer and the return to work (RTW) process. METHODS: Semi-structured in-depth interviews were conducted with four informants, and a thematic content analysis of the transcribed data was used. RESULTS: The results show RTW among our informants as a process consists of three main themes: easier said than done, from mastering to the feeling of inadequacy, and the environment's impact. The categories various components may be relevant. CONCLUSION: In a health promotion perspective, several resources such as aspects of motivation, self-awareness, and opportunities for facilitation and empowerment need to be available in the process of RTW for individuals who have undergone treatment for brain cancer.

Importance of participation in major life areas matters for return to work.

INTRODUCTION: The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. METHODS: This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. RESULTS: The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. CONCLUSION: To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs.

Gender differences in the importance of participation associated with injured workers/persons perceived barriers to returning to work in the context of vocational rehabilitation.

PURPOSE: To investigate gender differences in the importance of participation in core domains of life, and the association to perceived hindrances for return to work (RTW) before (T1) and after (T2) vocational rehabilitation. METHODS: Two hundred-seventy (T1) and 149 (T2) respondents completed the questionnaire. Gender differences in the importance of participation were calculated using t-tests. A principal component analysis was conducted on 21 questions of hindrances for RTW. A four-component structure was chosen. The family care barrier component was kept as an outcome variable in the logistic regression. RESULTS: There were mean gender differences in importance of participation in family prior to chronic pain and at T1. Importance of work changed from prior to pain to rehabilitation. At T1 children, age and importance of participation in work and family contributed to the model for women. For men importance of participation in leisure contributed to the model. The variables which contributed to the model at T2 for women were age and importance of participation in work and for men; children and importance of participation in leisure. CONCLUSION: Understanding gender differences in participation, and the association to hindrances for RTW, can enhance the rehabilitation counsellor's ability to work collaboratively with the clients. Implications for Rehabilitation Participation is a value and context driven process which influences the process of vocational rehabilitation. Understanding the driving forces for participation in important domains of life can illuminate gender differences in the process and outcome of vocational rehabilitation. Understanding gender differences in importance of participation, and the association to perceived hindrances to return to work, facilitates a shared understanding of rehabilitation goals among clients and rehabilitation professionals.

Understanding experiences of participation among men and women with chronic musculoskeletal pain in vocational rehabilitation.

OBJECTIVE: The objective of this study was to provide knowledge about participation and change in participation among men and women experiencing chronic musculoskeletal pain and undergoing multidisciplinary vocational rehabilitation. PARTICIPANTS: Six women and four men participating in a vocational rehabilitation intervention. METHOD: Data were collected through semi-structured in-depth interviews. The participants were encouraged to talk about their experiences and thoughts regarding participation in different life areas using previous, present, and future expectations. The analysis performed was constant comparative and inspired by grounded theory. RESULTS: The core category was identified as "goal-oriented participation" which represented participation as intentional and situated. Three categories, "participating as before," "participation constantly changing," and "participating in work on hold," were used, taking into account gender-influenced trajectories and understandings of participation before, during, and after sick leave and rehabilitation. CONCLUSION: The different trajectories of participation seemed to be gender specific and were connected to broader societal and environmental factors. These combined aspects seemed to affect values, motivation, and understanding of important goals while experiencing chronic pain. Examining goal-oriented participation may add to the understanding of gender differences in the rehabilitation process and thereby have implications for rehabilitation interventions.