Implementing global positioning system trackers for people with dementia who are at risk of wandering.

OBJECTIVE: The main aim of this study was to evaluate the feasibility and acceptability of using a GPS tracker to mitigate the risks associated with wandering for people with dementia and those caring for them and further evaluate the impact of trackers in delaying 24-hour care and the potential for reducing the involvement of support services, such as the police, in locating patients. METHODS: We recruited forty-five wearers-carers dyads, and a GPS tracker was issued to each participant. Dyads completed pre-and post-outcome questionnaires after six months, and a use-log of experiences was maintained through monthly monitoring calls. At six months, focus groups were conducted with 14 dyads where they shared ideas and learning. Data analyses were performed on outcome questionnaires, use-log analysis, and focus groups discussion. RESULTS: A 24% (N = 14) attrition rate was recorded, with 76% (N = 34) of the participants completing pre- and post-outcome questionnaires, of which 41% (N = 14) attended four focus group meetings. Participants reported enhanced independence for wearers as fewer restrictions were placed on their movements, peace of mind and reduced burden for the carers with less need to involve police or social services, and delays in 24-hour care. CONCLUSION: The results supported the feasibility of routine implementation of GPS trackers in dementia care with clear guidance, monitoring and support to family carers on safe use. This could delay admission into 24-hour care as wearers and carers have a greater sense of safety and are better connected should help be required. Studies with larger sample sizes, diverse participants and health economic analysis are needed to develop the evidence base further ahead of the routine implementation of GPS trackers in health and social care services.

Wayfinding in Complex Medical Facilities: The Indexicality of Directional Arrows.

OBJECTIVES, PURPOSE, OR AIM: The aim of this article is to contribute to the better design of wayfinding systems by explicating the indexical properties of directional arrows and their consequences for wayfinding behavior. BACKGROUND: The challenges associated with designing for the wayfinding needs of the different groups of users continue to be documented with the poor design of built environments being largely to blame for the wayfinders' inability to navigate complex settings. Directional arrows have been found to be especially problematic in such settings. METHODS: Ethnographic data were collected and analyzed over a period of 3 years in three overlapping phases. The unique adequacy requirement of methods, which stipulates that the methods used to produce a description of a situation should originate from the situation they describe, was adopted. RESULTS: Directional arrows derive their meaning from the position they occupy within the physical environment and from three sources: the spatial configuration of the setting, the positioning of the sign within the setting, and the directional arrow itself. The affordance closest to the sign will be taken as the one which the sign refers to. Wayfinders treat that affordance as being indicated by the arrow until such time as it becomes apparent that it is not. CONCLUSIONS: In response to the need to find lasting solutions to the enduring problems of wayfinding, this article demonstrates how better design of wayfinding systems can be achieved by explicating the indexical properties of directional arrows and their consequences for wayfinding behavior.

An introduction to unique adequacy.

AIM: To introduce nurse and healthcare researchers to the ethnomethodological (EM) criteria of the unique adequacy (UA) requirement of methods and to provide guidance on conducting UA research. BACKGROUND: Despite the recent shift in emphasis from quantitative to qualitative methods in nursing research, the practice of EM has been largely overlooked. DATA SOURCES: Published work in EM. REVIEW METHODS: The paper draws on discussions of UA and related concepts in foundational texts of the discipline, as well as the few examples that exist in nursing research. DISCUSSION: EM is a challenging practice to master but when understood and practised properly, it can yield findings that are unavailable to other approaches. UA insists simultaneously on a day-to-day familiarity with the research setting and a principled refusal of explanatory theories that are not native to that setting. Thus, in the UA requirement, EM provides criteria for effectively identifying problems and analysis without recourse to theoretical commitments that might distort or obscure the reality of the research/setting. CONCLUSION: With regards to the increasing call for more appropriate ways of combating the challenges associated with conducting real-world research, EM provides an effective and alternative method. In EM, nurse researchers can find the potential to develop practical solutions that are sensitive to the setting in which problems occurs. This can underpin the development of an approach to nurse research that is tailored to the principles and practices of the profession. IMPLICATIONS FOR RESEARCH/PRACTICE: Conformance to the UA requirement enables an exclusive focus on workplace issues. UA research provides an account of those issues as they are known and understood to members of the workplace setting. UA directs attention to the detailed analysis of work practices, providing a basis for practical solutions and innovations.

Involving service users in delivering alcohol addiction therapy.

Involving and empowering people who use health services, and taking their experiences into account, has evolved from being considered good practice to being duties of the NHS. However, evidence suggests that the rate of progress and change has been slow, despite the constant emphasis on the merits of involving and engaging the public and patients. This article, written in collaboration with two service users, reports on efforts by nursing staff working in alcohol addiction to involve service users in setting up and managing the self-management and recovery training initiative at the Brian Hore Unit, part of the Manchester Mental Health and Social Care Trust. The article aims to encourage healthcare professionals to appreciate the benefits of proactive patient and public involvement for their organisations and for those who get involved.