Background: Lack of participation from staff when developing information and communication technologies (ICT) has been shown to lead to negative consequences and might be one explanation for failure. Management during development processes has rarely been empirically studied, especially when introducing ICT systems in a municipality context. Objective: To describe and interpret experiences of the management during change processes where ICT was introduced among staff and managers in elderly care. Design: A qualitative interpretive method was chosen for this study and content analysis for analyzing the interviews. Results: “Clear focus–unclear process” demonstrated that focus on ICT solutions was clear but the process of introducing the ICT was not. “First-line managers receiving a system of support” gave a picture of the first-line manager as not playing an active part in the projects. First-line managers and staff described “Low power to influence” when realizing that for some reasons, they had not contributed in the change projects. “Low confirmation” represented the previous and present feelings of staff not being listened to. Lastly, “Reciprocal understanding” pictures how first-line managers and staff, although having some expectations on each other, understood each other’s positions. Conclusions: Empowerment could be useful in creating an organization where critical awareness and reflection over daily practice becomes a routine.

BACKGROUNDThe tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care.OBJECTIVESThis study interprets values related to care and technologies connected to the practice of good care.RESEARCH DESIGNThis research study was part of a development project aimed at developing innovative work practices through information and communication technology. Participants and research context: All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis. Ethical considerations: The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation.FINDINGSFour values were identified: 'presence', 'appreciation', 'competence' and 'trust'. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment.DISCUSSIONCaregivers' desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers' arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care.CONCLUSIONIntroducing new technology in caring should support the caring relationship. Although society's overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.

Policymakers emphasize that the increased use of information andcommunication technologies (ICT) will improve efficiency and reinforceaccountability in health and social care. Care has an intrinsic value that isunquestionable; everyone needs care more or less throughout their life. The twodifferent rationalities, the technical rationality and the caring rationality,raise the question of how technologies can be used in the care sector as ameans to support care. The overall aim of thisdoctoral thesis was to describe and interprethealth and social care staff´s expectations, perceptions, experiencesand values when changing work routines by introducing ICT.Data was collected through group- and individual interviews with primary healthcare and social care staff during a research and development (R&D) project.The R&D project aimed at developing work procedures for staff in health andsocial care by introducing new ICT applications. Data was analyzed with qualitative interpretiveapproaches. The results showed that expectations from participating staff were overshadowed by earlier development work and they distancedthemselves from the R&D project. Staff perceived the ICT solution inrelation to utility in their daily practice but also on its impact on thealready strained economy and the working environment. Participants experiencedunclear decisions and hardly any power of influence in the project. Similarexperiences from the past seemed to trigger participants as they were emotionaland upset. Once again they experienced low power to influence. Interpretedvalues showed that staff did not reject technologies per se but they argued foror against the technologies in relation to what they believed would supporttheir view of what good care was. This leads to the conclusionthat disturbance-free interactions with the care receiver were prerequisitesfor accepting any technologies. Furthermore, participants had a wish of takingresponsibility in care work and of being confirmed, in an organization withclear visions and management. The caregiving process and its challenges fromthe perspective of the caregivers need consideration and the concept of caringrationality needs to be put on the agenda. More concern of what good care is and who is defining it should be more investigated and discussed.Change processes in health and social care often focuses on finance andeffectiveness. R&D projects and nursing researchers should consider thatfrom a staff perspective it would be beneficial to use approaches where powerrelations are questioned, and organizations that management should encouragechange initiatives from staff. Key words: Care, ICT, staff perspectives, values, nursing, individual interviews, group interviews, qualitative interpretive analysis, feminist ethics of care

Användarmedverkan i teknikutveckling kan både ses utifrån demokratiska potentialer och som en kommersiell investering – ett sätt att förkorta ledtid från idé till produkt. Användarmedverkan kan också uppfattas som ett sätt att kvalitetssäkra en utvecklingsprocess. Inom vård och omsorg involveras idag vårdtagare, anhöriga och vårdgivare i en ”boom” kring eHälsa och digitala applikationer och tjänster för vård och omsorg. Det vi kallar en ”boom” kan förväntas sträcka sig över ett antal år innan branschen stabiliserats. Inom denna ”boom” har – med offentliga aktörer som påskyndare – ”användarmedverkan” i teknikutveckling från vård- och omsorgspersonalens sida närmast institutionaliserats. Frågan är, i tidens vurm för deltagande och bottom-upprocesser, hur ”användarens” intressen tillvaratas när deltagande blir en arbetsuppgift? Och vilka är ”användarens” intressen? Deltagande, även kallad interaktiv forskning (med flera begrepp) innehåller instruktioner för demokratiska förhållningssätt, som ger utrymme för den senare frågan att besvaras i varje konkret sammanhang. Men kriterierna för att tillämpa de här instruktionerna är inte med nödvändighet uppfyllda i den stora gruppen forsknings- och innovationsprojekt där personal ”på golvet” involveras. Med (semi)institutionaliseringen av deltagande metoder flyttar den springande punkten från att röra forsknings- och utvecklingsmetod till arbetsorganisation, och här specifikt hur vård- och omsorgspersonalens deltagande organiseras. Vi är här intresserade av hur ”medverkan” i teknikutveckling inom vård och omsorg hanteras idag – och hur den bör hanteras om man ser till vård/omsorgspersonalens intressen. Till att börja med är det värdefullt att skapa en plattform för problematisering, och syftet med vårt inlägg här är att föreslå en sådan modell.

Purpose - To describe staffs’ perceptions of digital support for medication administration (DSM) and out of the perceptions interpret underlying values. Design/methodology/approach - Twenty-two persons working in elder-care participated in the study. The study had a qualitative approach and focus-group interviews were used to collect data. To analyze the manifest content a phenomenographic method was used. An interpretation of perceptions was then undertaken aimed at identifying underlying values. Findings - Three descriptive categories, "Utility", "Impact on working environment" and "Economic impact" were the result of the manifest analysis. The values of having a "Good working environment", "Benefits" and "Good economy" were interpreted as guidance for staffs’ acceptance or rejection of the DSM.Originality/value - This study had a twofold approach with the intention of going beyond descriptions. To gain a deeper understanding a normative interpretation was completed. Ethical conflicts are frequently characterized as conflicts between at least two values. In this study staffs expressed fear of losing prerequisites needed to perform their work well. Prerequisites that were identified as values and these values were threatened by the DSM

Background: There are assumptions that innovative ICT solutions in healthcare can improve the efficiency and contribute to increased quality. Innovation through ICT is also expected to increase status of and attract men to care work.A project aimed at finding innovative ICT solutions was realized between 2009 and 2012. The project involved a healthcare center and two nursing homes. Technicians (all men) were those in the project given the assignment of finding innovative solutions together with staff. Involved in the project were also ICT companies and academic researchers. This research study was undertaken in a nursing home context. A tool for medication administration was under development and to be tested.Purpose; to describe staff’s perceptions of digital support for medication administration and understand staff’s underlying values when arguing for or against the tool.Data collection; focus-group interviews were carried out to collect data. To analyze and interpret the content of the data, a phenomenographic method was used.Findings; Participants questioned the utility and also the need of the ICT solution. Participants also expressed a risk for impaired working environment as an effect of the tool. They also thought the tool would be complicated to use and sometimes would lack in performance. Increased status as an effect of introducing ICT was a belief that was not held by the staff.Conclusions; Setting aside the fact that from the perspective of an outsider, the intention of the project was indeed to do good , staff did not perceive the ICT solution in a positive manner. Politicians and policymakers may be over emphasizing the possibilities of ICT for solving future challenges in healthcare. Focus on technological innovations and a discourse in which care workers are excluded can actually be contra-productive to the possibilities of enhancing the status of care work, which is still predominantly performed by women

This study was undertaken to describe staff expectations prior to implementation of new electronic applications in a changing organization. Changes are a part of human existence; changes based on implementation of technology and information and communication technology are taking place in the health care sector globally. The Swedish public health care and social care sector is taking a similar path. A qualitative approach with group interviews of 23 staff divided in 5 groups was performed. Latent content analysis was used to analyze the transcribed interviews. The theme, taking standpoint today in relation to the past, emerged from 3 areas of discussion: "distance holding," "ruled by the organization," and "health care development in the future." New restraints on staff affect the caregiving process. Managers should consider whether a particular change is revolutionary or evolutionary and act in the change process according to the possible psychological impact of the change.