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Background: Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges.

Objective: The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession.

Methods: Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations.

Results: The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as “too slow” (4/4, 100%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the “right pace” (4/7, 57%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2%) (P<.001).

Conclusions: Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel’s resistance to welfare technology and patients’ participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care.

Background: Due to the increasing ageing population worldwide, humanity is facing global demographic challenges. For many people, their later years are often lived with changed functioning and the need for support in daily living activities. Assistive technology and welfare technology (AT/WT) constitute a partial solution to the demographic challenges. Objectives: The purpose of this literature review is to identify the policy features, such as decision models and guidance for the provision of AT/WT as reported in the current scientific literature. Methods: A literature review with a deductive approach using the structure of the Global Cooperation on Assistive Technology (GATE) model was conducted. The data were searched from the databases: PubMed, Cinahl Plus, and the Web of Science, resulting in nine included articles. Results: The findings are presented according to the structure of the eight domains from the GATE model— policy, assessment, procurement, technology, environment, usability, sustainability and rights— which are further grouped into categories exploring the variations in every domain. Conclusion: The review reveals a nascent and growing interest in the area; however, evidence-based decision models and other guidance on AT/WT are lacking. Recent scholarships and policy reforms can form the basis of stronger guidance to organise complex AT/WT systems, but further and future research is needed.

Assistive and welfare technology (AT/WT) has been introduced as a way of facing an ageing population and providing support for older adults in their daily lives. There is much research concerning the assessment and recommendation of AT/WT to individual end-users. However, few studies have explored AT/WT decision-making from a managerial perspective. This study explores what aspects influence decision-making in assistive technology organizations concerning new technology procurements. The study is based on interviews with 24 managers engaged in assistive technology organizations, representing 13 of 21 regions in Sweden. The interview data consisted of the participants’ experiences deciding on AT/WT procurement. A reflexive inductive thematic analysis was used to identify aspects that influenced decision-making. The main findings show that decision-making is in the making, meaning that decision-making is a constant on-going managerial process. Furthermore, the findings show that managers experience uncertainty in the decision-making, sometimes make ad hoc decisions and request an evidence-based, person-centred approach to improve decision-making. The study concludes that supportive, technology, patient, and knowledge aspects influence managers’ decisions.

Purpose: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers.

Materials and methods: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles.

Results: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself.

Conclusions: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations.

This article reports on the results of a pilot study exploring whether and how the meal situations of persons with intellectual disabilities (PWIDs) in need of help and support during meal situations were affected by an eating aid. This article also analyzes how PWIDs and their assistants perceived their experiences of using an eating aid during meal situations. Data for the study were collected in interviews with PWIDs and their assistants. The results are presented in five themes: independence in the meal situation, motivation to use the eating aid, functions of the eating aid, social aspects of using the eating aid, and design corresponding to intellectual disability. The eating aid’s function, user-friendliness, and the assistants’ attitudes appear to be crucial for using the eating aid. Another important aspect is the introductory and training phase, which must be fundamentally adapted to suit the PWIDs ability to learn and understand. When these aspects are controlled, the eating aid can be a tool for increased independence during meal situations for PWIDs who are unable to move their arms or hands.

Mälardalen University has a long history of a successful cooperation and coproduction with the industry and public sector in Sweden. This has eventually led it to become one of the leading higher education institutes in Sweden for excellent coproduction with different societal actors, both internationally and nationally. The university has through its coproduction activities become convinced of its value and of the wide range of opportunities it can bring to all parties involved. In this paper, we share our experience through some good examples both from research and education and discuss what is needed for successful and sustainable coproduction with industry and public sector.

The people with dementia experience a progressive loss of cognition, while more than 90% of them develop behavioral and psychological symptoms of dementia (BPSD). BPSD may result in physical injuries and psychological distress among people with dementia and their family/caregivers. First-line care strategies in dementia care should not unthinkingly involve pharmacological interventions to avert or reduce the behavior, and should rather consider the person and their unique requirements. Therefore, a combination of pharmacological and non-pharmacological interventions is strongly recommended. Since the care staff in dementia care is required to be informed regarding the non-pharmacological approaches to address BPSD, the present study was aimed to evaluate the use of a rocking chair in the context of BPSD, quality of life, and medication usage among people with dementia at individual level. The secondary aim of the present study was to describe care staff’s experiences related to the feasibility and usability of rocking chair in providing care for PwD in a nursing home setting. The present research is a single-case study, performed using a mixed-methods approach, with six people having dementia and 11 care staff members in a nursing home setting. The people with dementia used the ErgoNova Rocking chair® for a mean number of five times/week, for eight weeks in total. Quantitative and qualitative data were collected prior to, during, and post-intervention (A-B-A design). The quantitative and qualitative data were consistent with each other. The mean, median, and relative change measures indicated a decrease in the BPSD symptoms, such as aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, and increased quality of life upon using the ErgoNova Rocking chair®. It was also considered to be feasible, usable, and non-labor-intensive intervention by the care staff. The obtained data suggested that the use of ErgoNova Rocking chair® provided short-term relief from aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, along with an increase in the quality of life of the person with dementia. The use of ErgoNova Rocking chair® may serve as a complementary tool to the non-pharmacological management techniques for people with dementia in nursing homes.

More than 90% of people with dementia develop behavioral and psychological symptoms of dementia. First-line care strategies in dementia care should consider a combination of pharmacological and non-pharmacological interventions. The present single-case research study aimed to evaluate the use of virtual reality in the context of behavioral and psychological symptoms of dementia, quality of life, and medication use among people with dementia. Ten persons with dementia used virtual reality for a mean of twice per week for eight weeks. In each virtual reality session, lasting for a maximum of 30 minutes, the persons with dementia chose one to three short films from 11 different films: a hen run, a farm with animals, two cafés, an old-fashioned grocery shop, a local river, a square in the local city, a museum, a castle, a fishing boat and an Austrian mountain scenery. Quantitative and qualitative data were collected pre-, during, and post-intervention. No major differences in the quantitative data in terms of behavioral and psychological symptoms of dementia, quality of life, or medication use were observed. However, the qualitative data showed that the use of virtual reality provided the persons with dementia with short-term enjoyment, heightened energy and alertness, and an experience of reminiscence. The use of virtual reality may therefore serve as a complementary tool to the existing non-pharmacological management techniques of people with dementia in nursing homes.

Registered nurses’ [RNs] experiences of caring in nursing, working  conditions for caring and reflection in municipal night care was explored to create expanded knowledge and understanding of care for older people. As a consequence of the Ädelreform and development in hospital health care a displacement from clinical health care to municipal care of older people has taken place. Night RNs’ work in the complex municipal care of older people implies single handed work in a consultative function. The RNs are distanced from the care receivers; it is care staff who mainly perform bed side caring. Municipal RNs’ care for older people during nights means trusting their own knowledge and reflective ability, in having nursing responsibility for large groups of old care recipients.   

This thesis takes point of departure in a qualitative research approach, with four empirical studies. These have been accomplished in a medium sized municipality in the middle parts of Sweden. The aims of the part studies were: to elucidate municipal night nurses’ experiences of the meaning of caring in nursing (I), to explore Swedish municipal night nurses’ experiences of their working conditions for caring in nursing (II), to examine the caring for care staff offered by municipal night nurses, in the setting of old care recipients people enrolled in the municipal social care system (III) and to describe nurses’ conception of reflection in their working situation (IV). Data were collected with interviews (I, II, IV), diary notes (II) and participative observations (III). The data were analyzed with phenomenological hermeneutics (I), thematic content analysis (II, III) and phenomenography (IV).

The results reveal that night RNs caring in nursing means the paradoxes: being close at a distance, being responsible without control and being independently dependent. Caring in nursing means a caring stance in prioritizing and taking responsibility for care recipients and care of care staff (I). Night RNs’ caring is dependent on the organization and care staff, and is complex by the fact that the RNs are not care staff leaders. The RNs’ autonomy prerequisite the ability to handle their work, which mainly means mediated caring communicated by telephone (II). The night RNs’ care of care staff means an informal nursing leadership. With their medical competence and authority the RNs occupy a superior caring leader function in nursing (III). Reflection is conceptualized as an instrument to handle the working situation and requires capacity of presence, flexibility and courage. To reflect is experienced to use knowledge, ethics and also personal values, in considering, estimating and assessing caring situations and actions (IV).

The conclusion of the studies (I-V) is that the night RNs’ caring is dependent on the prerequisites described in the dimensions of the organization, self-understanding and vocational and professional relations. The RNs must be able to reflect and handle the situation of caring at a distance, without loosing the vocational fundamental condition of caring, though the consultant function implies that they seldom encounter the care recipients. Increased quality, development and creating possibilities for dignity in care for older people means the RNs must participate more in bed side caring. The RNs should also be caring leaders and be given the opportunity for adequate specialist training in gerontology nursing.

Bakgrund: I dag finns ingen behandling som botar demens och SBU betonar att forskningen om demenssjukdomar bör fokusera på vård och omvårdnad för att förbättra välbefinnande för personer som på olika sätt påverkas av sjukdomen såsom den sjuke, anhöriga och vårdpersonal. Samvaro med sällskapsdjur kan ses som ett sådant alternativ. Sällskapsdjur kräver skötsel och omhändertagande och det finns även risker för skador och smittspridning. Ett alternativ kan vara interaktiva robotar. Flera studier, främst japanska, har visat positiva resultat när robotsälen Paro har använts i vården av äldre med demens. Studierna visar att samvaron med robotsälen ger ett förbättrat humör och de äldre blir mer aktiva. Kommunikationen förbättras, stressnivåerna sänks och ökad  EEG har påvisats hos äldre personer med demens i samvaro med Paro. De flesta studierna är gjorda i Japan och det är troligt att det finns skillnader mellan olika kulturer.  Syfte:Med utgångspunkt att robotsälen Paro indikerar goda resultat har ett alternativt robotdjur -- Robotkatten -- utvecklats. Den är billigare och har mindre avancerad robotik än den tidigare nämnda robotsälen. Sälen kostar idag drygt 60 000 kr och är dessutom så tekniskt avancerad att skinnbyte (byte av syntetpäls) inte är möjligt, vilket gör att gällande smittskyddsregler inte kan efterföljas. I ett svenskt perspektiv antas att en robotsäl inte anspelar på samma sätt till personers minne som en robotkatt förmodas kunna göra (reminiscens). Robotkatten är dessutom konstruerad för att vårdhygieniska principer ska kunna efterföljas för att undvika smittspridning. Utifrån tidigare forskning och samarbete med vårdpersonal vid ett boende för personer med demens har följande funktioner utvecklats hos robotkatten: rörelser som påminner om andning, katten jamar, den avger värme, har ett spinnliknande ljud som uppstår efter cirka tio strykningar/klappningar. Katten har också ett utseende och vikt likande en riktig sovande katt och kostnaden är 12 000 kr. Metod: och resultat:En pilotstudie med prototyper av robotkatten indikerar nytta och värde för personen med demens, anhöriga och vårdpersonal. Pilotstudien visar tendenser att personer med demens som har robotkatten i sin vardag blir lugnare, med minskade agitativa beteenden. Mätningar av livskvalitet visar tendenser till förbättrad livskvalitet. Analys av intervjuer genomförda med vårdarna och anhöriga visar att användning av robotkatten ger ökad livskvalitet, skapar lugn och utgör ett verktyg till anhöriga och vårdaren i interaktionen med personen med svår demens.

Abstract

We are facing a rapidly expanding market offering welfare technology to health and social care. It is important that users (patients, relatives, professional caregivers) and researchers are active and involved in both development and implementation. This text addresses important aspects of this work: Welfare technology corresponding to real needs, Ethical considerations and Scientific evaluations, which are exemplified in a project where researchers developed an interactive robotic cat; JustoCat www.justocat.se.

The aim of this study was to elucidate municipal night registered nurses’ (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs’ experience of caring is interpreted as meanings in paradoxes: ‘being close at distance’, the condition of ‘being responsible with insignificant control’, and ‘being interdependently independent’. The RNs’ experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding tovocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.

Aim. The aim of the study was to describe nurses' conception of reflection in their working situation. Background. To be a municipal night duty registered nurse in Sweden means to shoulder nursing care responsibility for numerous units with older people in need of care. Two night nurses share nursing care responsibility for up to 1300 people. In nursing research, reflection is an often-mentioned phenomenon discussed with advantages and benefits within the 'traditional fields' of nursing (hospital context). A question to ask is, how do night nurses having an untraditional amount of nursing care responsibility conceptualise and experience reflection in their working situation? Design. A phenomenographic methodology was used. Methods. Data were collected by interviewing all nurses (n = 7) in a medium-sized municipality bordering a metropolitan area of Sweden. Results. The nurses' conceptions of reflection are categorised as 'Field of applications' (an instrument for interpreting, a strategy for handling the working situation and an approach to learning) and 'Field of prerequisites' (presence facilitates reflection; flexibility implies reflection; courage in thought and activity increases reflection). Conclusion. The findings reveal that reflection in the nurses' working situation is more than an instrument for learning, understanding and encouragement for change and improvement. Reflection is conceptualised as an instrument for interpreting nursing care situations, which requires courage and is facilitated by presence and flexibility. Reflection is also conceptualised as an approach to handling, managing and coping with a sometimes impossible working situation that includes nursing responsibility for hundreds of older people and can sometimes entail difficulties and stress. Relevance to clinical practice. The findings showed that reflection has a broader use than had earlier been described. Deliberate use of reflection could mean improved nursing practice. This guides nursing managers to pay attention to the phenomenon as an instrument for nursing care improvement.

Qualitative nursing researchers have long recognized that reflective practice (RP) seems to be a valuable tool in nursing care. The aim of the present meta-study was to analyse current qualitative research on RP in nursing care, in order to create and synthesize the knowledge and the understanding of registered nurses' RP. Using a meta-study synthesis approach, embedded assumptions were identified in qualitative studies that have influenced the way researchers have interpreted and made sense of RP in nursing care. Despite empirical focus in research on RP in nursing care, it was found that assumptions about RP were predominantly based on theory. The reflective movement within the practice of nursing care has mainly a constructivist epistemology, based on learning from experience. The individual nurse's RP capability is essential in providing and improving ethical and holistic nursing care

BACKGROUND: Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses' reflections, what do they reflect about, and how do they deal with their reflections? AIMS AND OBJECTIVES: The aim of this study was to describe the RNs' experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs' reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development? DESIGN AND METHOD: The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study. RESULTS: The qualitative differences regarding the RNs' experiences of reflection were categorized as follows: to reflect (to think back--consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development. CONCLUSION: By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development. RELEVANCE TO CLINICAL PRACTICE: The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge.

Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

Aim  The aim of the present study was to examine the support night nurses’ give to staff in community night nursing.

Background  Studies have shown that support given to staff is one of night registered nurses’ (RNs’) experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described.

Methods  All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations.

Results  The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership.

Conclusions  Out of ‘concern for the staff’ the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs’ awareness that by giving support to staff this affects the staffs’ caring for older people.

Implications for nursing management  The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

The aim of the present study was to examine the support night nurses give to staff in community night nursing. Studies have shown that support given to staff is one of night registered nurses (RNs) experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described.

All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership.Conclusions Out of concern for the staff  the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs awareness that by giving support to staff this affects the staffs caring for older people. Implications for nursing management The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

Background: The fact that patients and relatives experience poor healthcare encounters is evident in the number of complaints to patients’ advisory committees, and from studies and statistics. Looking at ‘the other side of the coin’, research into good caring encounters experienced as meaningful encounters in healthcare is scarce.

Aim: To illuminate the signification of meaningful encounters in healthcare. 124 narratives from patients, relatives and healthcare staff regarding experiences of meaningful encounters in Swedish healthcare were analysed using a phenomenological hermeneutic research method.

Conclusions: The results indicate that a meaningful encounter means gratefulness, is founded on trust, cooperation and courage, and results in self-trust through wellbeing, increased understanding and life-changing insights. The encounters have given insight into, and increased understanding of, the patient’s own life, the families’ lives, and/or healthcare professionals’ lives. With this, and awareness of the importance and power of meaningful encounters, healthcare staff might use a meaningful encounter as a powerful instrument in caring.

Implications for practice:

• For patients and relatives, trust derived from meaningful encounters in healthcare leads to self-trust
• Caring within healthcare consisting of meaningful encounters, ‘the other side of the coin’ gives important knowledge that could facilitate improvements in healthcare staff’s encounters with patients and relatives, and also enrichment in their own professional development
• Increased understanding and awareness of the power of meaningful encounters can be discussed in terms of patient safety

The proportion of elderly people in the world’s population is growing. Thailand and Sweden have disparate cultural traditions of caring for older people, though both countries are facing a larger population of older people. Sweden and Thailand are involved in several cooperative projects and exchange programs for nursing students in this area, raising the questions of if and how the different cultures of gerontological care influence students’ attitudes in the issue. The aim of the study was to compare Swedish and Thai nursing students’ attitudes towards older people. A convenience sample of 241 Thai nursing students and 299 Swedish nursing students participated in the study. The Kogan’s Old People Scale, a 34-item questionnaire, was used in this research. The questionnaire consists of 17 positive (OP+) statements and 17 negative (OP-) statements and uses a Likert scale. Concerning attitudes towards older people, there was no significant difference in Swedish and Thai students’ positive scores in the distribution across the groups. In contrast, these students did differ on negative scores across countries (p.001). This was understood to  be related to age; the Swedish students’ higher age was positively associated with their positive attitudes; as the age increased, the students’ scores were also higher. Attitudes towards older people are not only influenced by cultural values, norms, and social structures, they also have a foundation in gerontological knowledge and experiences. Education addressing cultural awareness of negative ageism should be incorporated into all aspects of education, not just gerontological courses.

The aim of the pilot study was to explore the re­actions of individuals with dementia to an interactive robotic cat and their relatives’ and professional caregivers’ experiences regarding its usability, function, and effects. Method The pilot study had an inter­vention, mixed-methods design¹ and was conduct­ed in two stages. A quantitative single-case study² including individuals with demen­tia, and a qualitative interview study³, including rela­tives and professional caregivers, were conducted. JustoCat® is an inter­active robotic pet developed using reminiscence therapy as a frame­work⁴. The development of JustoCat is based on promising work with the robotic seal, PARO^5,6. However, the inventors of JustoCat assumed that a seal would not appeal in reminiscence therapy, a robotic cat was supposed appeal to individuals’ memories of cats. There was also the idea of downscaled, advanced tech­nology based on the hypothesis of a robotic cat’s functional reliability and lower cost. The construction of JustoCat (e.g., easy-to-change fur facilitating personalized use, wash­able fur) was developed following Swedish hygiene routines required in nursing homes and hospital set­tings. Results & Discussion In the Western world, the majority of individuals with dementia spend the last part of their lives in nursing homes or dementia care homes. Some individuals with dementia could increase their well-being with different thera­pies, for example massage, singing, music or by the company of pets. The current pilot study of four individuals with dementia and their relatives and professional caregivers showed interesting results. First, living with severe dementia is a situa­tion with ups and downs concerning quality of life and agitated behavior, as presented in the single-case study design. Second, the analysis of the interviews shows the positive effects of the robotic cat providing stimu­lation, comfort, and peace to indi­viduals living with dementia. Third, professional caregivers and relatives found the robotic cat to be a useful, reliable, and multifunctional tool in their relationships with the partici­pants⁶.

The current study aimed to explore (a) reactions of individuals with dementia to an interactive robotic cat and their relatives’ and professional caregivers’ experiences, and (b) to measure usability in developing the care/treatment of individuals with dementia using interactive robotic pets. An intervention design in a pilot study using mixed methods was conducted in two stages: a quantitative single-case study (n = 4) and a qualitative interview study (n = 14). Results indicated less agitated behavior and better quality of life for individuals with dementia. Interviews showed positive effects by providing increased interaction, communication, stimulation, relaxation, peace, and comfort to individuals with dementia. The tested interactive robotic cat was also considered easy to use. There is an increased need for alternative/complementary forms of care to meet an increasing number of individuals with dementia. For some individuals with dementia, an interactive robot, such as a robotic cat, can increase well-being and quality of life.

We are facing an aging population¹ and the need for health and welfare technology to meet the users’ ‘need is a fact. To meet this challenge, the Arena for Health and Welfare Technology (the Arena) was initiated at Mälardalen University in 2014, as a multi-professional and interdisciplinary research initiative². The aim of the Arena is to increase the collaboration of the researchers from the University and the external actors to create benefit and value for the future health and welfare. The Arena organizes events promoting interaction and interdisciplinary research projects. At a thematic day in May 2016, a working process to effectively initiate interdisciplinary research based on the users ‘needs, was introduced. Method To increase the participation for the thematic day and for future research projects within health and welfare technology, a call offering a grand from the Arena fond was created for participants that attended the thematic day. This call was aimed at stimulate the creation of interdisciplinary research projects within health and welfare technology, with the purpose to write proposals for external research funding. Speakers from the region were invited, representing health and social care, companies within the health and welfare technology field and regional R&D units. The speakers were presenting real needs based from the view of the clients, patients, relatives, staffs and organizations, which possibly could be solved by using health and welfare technology. After the user need presentations, a working process was followed, led by the company Konkret Utveckling AB. The goal of the working process was to identify prioritized needs for the day, and in the continuation create project groups to be the basis for future interdisciplinary research projects. After identifying the prioritized user needs, project groups started work to specify the framework for the planned research project, and then make a short oral presentation to share and discuss their research ideas. Results & Discussion The theme day attracted more than 50 interested participants. At the end of the thematic day, four interdisciplinary groups, including new constellations of researchers exists. The aims of the four groups were based on prioritized user needs, presented by regional health and welfare representatives. Involved group participants, researchers and company representatives, represented different disciplines, for example engineering, sensor technology, robotics, pedagogics, physiotherapy, nursing, social work and economy. The working method used during the thematic day was successful, and can be used in developing initiatives for interdisciplinary health and welfare technology research projects based on the needs of the end users.

This study focuses on the meaningful encounters of patients and next of kin, seen from their perspective. Identifying the attributes within meaningful encounters is important for increased understanding of caring and to expand and develop earlier formulated knowledge about caring relationships. Caring theory about the caring relationship and provided a point of departure for the study. The aim of this study was to illuminate the meaningful encounter in health care contexts narrated by patients and next of kin. A qualitative explorative design with a hermeneutic narrative approach was used to analyze and interpret the written narratives. Phases were: Naïve interpretation, structure analysis on two different levels a) analysis of narrative structure b) analysis of deep structure through metaphors and finally a dialectic interpretation. In the narratives the meaning of the meaningful encounter was sharing, a nourishing fellowship, common responsibility and coming together experienced as safety and warmth and gives, by extension, life changing moments, a healing force and dissipated insight. The meaningful encounter can be seen as a complex phenomenon that has different attributes. Understanding the meaningful encounter will enable nurses to plan and provide professional care, based on caring science focusing on patient and next of kin experience.

Demographic changes and a predicted shortage of nursing staff are progressively putting pressure on the healthcare system. Care robots may represent one part of a possible solution to this problem as they can assist care work. However, large parts of the population are reportedly skeptical about robotics in care, and field studies are difficult to conduct due to the low prevalence of real robotics in the field. Therefore, we follow an experimental approach pertaining to the question of individual decision-making. In this regard, we analyze the aspects that influence the individual's choice between a care robot and a human caregiver for assistance in their daily life. Our economic experiment is conducted in a virtual laboratory to examine specifically how quality uncertainty of care affects individual's decisions for and against robotic care. In the experiment, 162 participants fully completed the experiment in which they were asked to repeatedly choose between a human caregiver and a care robot. Our results reveal that, overall, the care robot is chosen more often than a human caregiver. At the same time, the quality uncertainty of care linked to a human caregiver barely affected the choice of participants. On the other hand, a participant's health status and their attitude toward direct interactions with care robots did partially affect their choice. Additionally, we explored causes for indecisiveness and its effect on the choice. Here, we found indecisive participants tending to choose a human caregiver more often. 

This chapter analyzes older people’s expectations and perceptions about welfare technology and in particular about robots in elderly care. Assistive robots may serve as a means to prolonged autonomy in old age as well as support for nursing staff. Justified by a rapid change in the health care sector, the need to focus on user driven and not technology driven development of assistive robots must be emphasized to ensure an adequate and sustainable orientation process toward assistive robots. This study presents an inventory of the expectations and perceptions of older people regarding assistive robots, by conducting a qualitative approach with focus group discussions. Our findings reveal that seven themes in particular need to be addressed in order to improve older people’s perceptions of robot technology: (1) independence and safety, (2) physical and mental assistance, (3) communication and socialization, (4) relief to nursing staff, (5) individual’s right to decide, (6) data protection, and (7) liability. Additionally, the focus group interviews stress that dissemination of information on how robots can provide assistance may change older people’s attitudes towards technology

The rapid demographic shift toward a greater percentage of the elderly population increases the need for welfare services. Welfare technology and especially care robots can be regarded as an important measure to counteract such demographic challenges. However, when implementing new technologies, structured information is of immense importance to develop societal trust. Frequently, research addresses trust solely at the level of the end-user. However, trust at the level of opinion leaders and political decision-makers is also relevant as they are catalysts for trust. This study aims to detect the perceived trust level of users from the viewpoint of opinion leaders (politicians, insurance organizations, and media) in the Swedish, Finnish, and German society. Furthermore, this study uses qualitative expert interviews and identifies four trust categories: trust in the health care system, trust in regulations, trust in technology, and interpersonal trust. The findings stress that targeting only the end-users is not sufficient for developing technology trust in society.

This paper explores Finnish, German and Swedish older adults’ perceptions of a future welfare service with increased use of welfare technologies, specifically care robots. The issues are the rapid digitalization and development of health and welfare technology, which presently is mainly technology driven (not need or user driven), and the demographic challenge. The aim of the study was to explore older adults’ perception of the future use of welfare technology or care robots. A qualitative approach with focus group discussions was employed, followed by thematic analysis. The results are presented in four overall themes: the impact on daily life for older adults and professional caregivers, codes of practice and terms of use, dissemination of information and knowledge, and conditions for successful implementation. There were significant differences in the informants’ attitudes toward and knowledge about care robots. However, the informants’ attitudes appeared to change during the focus groups and in general, became more positive. Authentic needs, which care robots could support, refer to independence, safety and security, and the ability to manage or ease daily life or working life. The results suggest that older adults, after receiving relevant information, were open to the idea of being supported by care robots in their daily lives. 

Exploring the specific field of care robot orientation generates many questions regarding the meaning, content and how it should be conducted. The issue is important due to the general digitalisation and implementation of welfare technology and care robots. The aim of the study was to explore perceptions of care robot orientation from the potential users' perspective. Data were collected by focus group interviews in Finland, Germany and Sweden. In all three countries, potential user groups were represented: older adults, relatives, professional caregivers and care service managers. A qualitative descriptive method was used for analysing data. The data revealed three aspects of care robot orientation: (1) What care robot orientation is, (2) Who needs it and by Whom it should be given and (3) How it should be performed. The need for care robot orientation is general in society. In the absence of knowledge about care robots, it is nearly impossible to know what to ask for or actually seek information about. Therefore, care robot orientation must be founded on agile implementation planning for care robots, with a firm basis in trustworthy knowledge and information and respecting individuals' wishes. This also gives rise to an ethical challenge when care robots are offered to people having reduced decision-making ability (dementia, cognitive impairment), along with the issue of who then should make the decision. The mapping of the What, Who/Whom and How aspects of care robot orientation offers a foundation for the creation of orientation models, which might facilitate structured and goal-oriented care robot orientation strategies.

De som har en ställföreträdare, vilka kallas för huvudmän, är en sårbar grupp eftersom de i många fall är beroende av andra för att kunna klara sig i sin vardag. Människor som av fysiska eller psykiska orsaker inte kan föra sin egen talan i rättsliga frågor kan få hjälp i form av en ställföreträdare enligt föräldrabalken. En ställföreträdare träder in i huvudmannens ställe i en rad situationer där huvudmannen behöver hjälp. Huvudmännens relationer till ställföreträdare har stor betydelse för huvudmännens levnadsvillkor i vardagen.

Syftet med denna förstudie har varit att undersöka huvudmännens förväntningar på och erfarenheter av att leva med hjälp från god man eller förvaltare för att kunna klara sig i sin vardag. Förstudiens frågeställningar är följande: Vilka förväntningar har huvudmännen på sin ställföreträdare? Vilka erfarenheter har huvudmännen av hjälp från ställföreträdare i sin vardag? Hur upplever huvudmännen tilltron till sin egen förmåga att kunna klara sig på egen hand i sin vardag? Hur upplever huvudmännen tilltron till sin egen förmåga att kunna påverka vilken hjälp de kan få av sin ställföreträdare? Vilka utvecklingsområden finns avseende hjälp genom ställföreträdarskap och huvudmännens tilltro till sin egen förmåga?

Ett praktiskt och erfarenhetsbaserat lärande och utveckling har stått i centrum i förstudiens design redan från början genom ett praktiknära och deltagarbaserat forskningsperspektiv. Både tematiskt öppna frågor och slutna frågor användes vid datainsamling. Beroende på deltagarnas behov och kognitiva funktionsnedsättning gavs kompletterande förklaringar av frågorna.

Huvudmännens förväntningar på och erfarenheter av att leva med hjälp från god man eller förvaltare för att kunna klara sig i sin vardag visar intressanta resultat. Likheter och skillnader om hjälp från ställföreträdare ger en bra grund för vidare utvecklingsarbeten. En generell slutsats är att det görs en del goda arbeten för huvudmännen, men det behövs en del förbättringar också. Följande rekommendationer vill vi särskilt uppmärksamma:

- Goda exempel och framgångsfaktorer i ställföreträdarskap bör tas tillvara och synliggöras

- Vad som ingår i ställföreträdarskap enligt bestämmelser bör tydliggöras mer både för huvudmännen och ställföreträdare

- Utbildningsinsatser för ställföreträdare bör ses över och kunskaper om olika typer av funktionsnedsättning som huvudmännen har ges tillräckligt

- En heterogen grupp framträder där tilltron till förmågan och förväntningar och erfarenheter varierar till en viss del, vilket är ett tecken på att dialog, samråd och lyhördhet bör prioriteras i fortsatt utvecklingsarbeten

Background: The value of support, service, and care in intellectual disability (ID) practice is linked to the competence of the professionalcaregivers. The quality of work is affected by the level of education of healthcare employees involved.Specific Aims: This study aimed to collect data on how employees perceive their education and training in ID practice and howeducational programs prepare them for their working environment.Methods: We used a quantitative approach to investigate how employees reflect on their knowledge about ID and other disabilitiesand the sources of such knowledge. A total of 262 employees engaged in ID practice completed an online survey.Findings: The results indicated that education significantly influenced the participants’ knowledge level, and highly specific education(i.e., workplace training) can substitute for work experience in ID practice. The authors conclude that all workplaces shouldexamine their employees’ skills regularly from the viewpoint of fulfilling the needs of people with ID.Discussion: Based on the results, it can be concluded that employees in ID practice need specific knowledge through workplacetraining (i.e., through hands-on practice at the workplace). Competence development in the form of workplace training is neededto upskill the staff and possibly increases employees’ participation at work.

Studies on hard of hearing (HH) individuals have focused mostly on children´s experinces in school. Howerver, their lives as young adults have not received much attention. The present study therefore examined HH young adults´experiences of social identity and group membership. Semi-structured interviews were counducted with 16 individuals (10 males, 6 females) with servere-to-profound hearing loss. They were from diverse cultural backgrounds. A qualitative content analysis was performed with a manifest analysis. Two categories emerged: belonging to a social enviroment and engaging in important communication. The results indicate that the HH individuals, either deliberately or unconsciously, chose to be with other HH individuals because of their longing for group membership and desire to avoid being misunderstood. The participants longed for inclusion, acceptance, and opportunities to create an inclusive social environment and to communicate with others.

Robots are not yet typical in daily use in elder care services, but recent studies suggest that they will soon be mainstream. In this study, we focus on the future of elder care, affected by the emergence of care robotics. We tackle the socio-technical transition—a multi-level change with a re-configuration of social and technological elements of the system—of elder care. The transition in the elder care system and the conditions of the embedding the robots in welfare services and society in three European countries, Germany, Sweden and Finland, are examined. Our qualitative study focuses on current situation in the use of robots in elder care as well as advancing and hindering elements in embedding robots into society and elder care practices. According to the results, there is a shift towards using robots in care, but remarkable inertia exists in both technological development and socio-institutional adaptation. Advancing and hindering elements in transition are both technical and social – and increasingly interrelated, which needs to be considered in management and policy measures to promote successful future transition pathways. The change of attitudes and embedding robots into society is promoted, for instance, by raising relevant knowledge on robots at different levels. 

In today's healthcare system, there is an imbalance between what patients expect of caregivers' care and their perception of the care they get. How is it possible to reduce this imbalance? The aim of this paper was to describe attributes associated with meaningful encounters in the Swedish healthcare system based on patients' and caregivers' written narratives and to note the differences and similarities between the attributes identified by the two groups. This paper is a qualitative descriptive study. The analysis was guided by qualitative content analyses. Based on patients' narratives, attributes associated with a meaningful encounter fell into four categories: the kind-hearted caregiver, the thoughtful caregiver, the mutually oriented caregiver, and the helpful caregiver. Based on caregivers' narratives, the attributes were categorized as being humane, caring through physical contact, caring by nurturing communication, joy and laughter in care, and a sense of mutuality. The results show that there are both similarities and differences in patients' and caregivers' opinions about the attributes of a meaningful encounter. Knowing more about the attributes associated with meaningful encounters makes it possible for caregivers to individualize care for patients and makes it easier to help and support patients in what they most need support with.

In today’s healthcare system, there is an imbalance between what patients expect of caregivers’ care and their perception of the care they get. How is it possible to reduce this imbalance? The aim of this paper was to describe attributes associated with meaningful encounters in the Swedish healthcare system based on patients’ and caregivers’ written narratives and to note the differences and similarities between the attributes identified by the two groups. This paper is a qualitative descriptive study. The analysis was guided by qualitative content analyses. Based on patients’ narratives, attributes associated with a meaningful encounter fell into four categories: the kind-hearted caregiver, the thoughtful caregiver, the mutually oriented caregiver, and the helpful caregiver. Based on caregivers’ narratives, the attributes were categorized as being humane, caring through physical contact, caring by nurturing communication, joy and laughter in care, and a sense of mutuality. The results show that there are both similarities and differences in patients’ and caregivers’ opinions about the attributes of ameaningful encounter. Knowing more about the attributes associated with meaningful encounters makes it possible for caregivers to individualize care for patients and makes it easier to help and support patients in what they most need support with.

The purpose of the project was to evaluate the staff’s experience of using Tovertafel UP at a daily activities centre and determine whether, according to the staff, the use of Tovertafel UP results in any development for people with intellectual disabilities with focus on physical activities and social interaction.

Syftet med projektet var att utvärdera personals erfarenheter av att använda Tovertafel UP på en daglig verksamhet för personer med intellektuell funktionsnedsättning och om användandet av Tovertafel UP enligt personalen innebar någon utveckling för användarna med fokus på fysiska aktiviteter och social interaktion.