Improving communication

Overall, nursing home managers considered that DHT would become integral to nursing home care in the future. They understood that investment in secure digital systems and improved connectivity would be required to bring about benefits such as improved communication, digital algorithms for risk identification and risk management applications (for example digital alerts that are generated when a risk of falls is identified and suggest management actions).

One manager who was already fully engaged with DHT suggested that embracing innovation was part of their professional duty to improve care, saying ‘It is the ethos of the home, we embrace progress and always like to move forward’. However, managers who had less experience of DHT expected there to be practical and administrative challenges with DHT implementation, for example training agency staff. Nevertheless, they recognised the benefits of a common digital communication system shared between health and social care services.

Engaging with DHT and retaining humanised care

Some nursing home managers discussed how residents might be anxious about the use of DHT in case it resulted in decreased human interaction; for example, one manager mentioned the possibility of ‘staff looking at screens instead of looking at residents’. This was balanced by the views of other managers, who recognised the potential efficiency gains that DHT could bring; for example, staff spending less time ‘doing paperwork’ and using that time to ‘spend quality time’ with residents instead. Some managers suggested that easier access to residents’ records could assist staff in identifying health risks and improve continuity of care across shifts.

Managers also suggested that using digital algorithms to monitor the risk of deterioration and identify clinical ‘red flags’ – such as skin breakdown on pressure areas – could ‘back up staff’s perceptions, intuitions and gut feelings’ and ultimately improve care. Another suggestion was that DHT could increase opportunities for staff to communicate with relatives, who might be able to provide information about the resident’s health, for example letting staff know what the resident had eaten or how mobile they had been during an outing. One manager commented: ‘It would be fantastic if relatives could also input information on an iPad at the front desk.’ Overall, managers suggested that the use of effective DHT that enhances personalised care would encourage staff to support digital innovation.

Introducing DHT and protecting data security

Nursing home managers felt that staff using handheld devices such as tablets and smartphones in the presence of residents would require careful introduction so that all stakeholders would be comfortable. Some concerns were expressed about potential technological challenges, such as giving agency staff access to temporary login details and managing the transition from paper-based to digital records. Some managers favoured gradual change, with paper-based and digital records running simultaneously for a short time and senior staff trained to cascade information to the rest of the team. Managers identified that discussion and detailed planning were the optimal strategies to move from paper-based to digital records, recognising that implementing change could be challenging but that sharing the potential benefits of DHT with staff could encourage engagement.

Improving communication

Residents and relatives identified that the ‘age of technology’ represented the future of healthcare and considered keeping up with technological advances to be important for nursing homes. They recognised that improved access to information would be positive for staff in terms of the efficiency and accuracy of internal and external communications.

Some residents and relatives suggested that devices such as tablets could be used to enable communication through online platforms such as Skype or FaceTime, as well as sharing updates between residents, relatives and staff. A further suggestion was that DHT would speed up information sharing in nursing homes and reduce reliance on paper-based records.

Engaging with DHT and retaining humanised care

The quality of care was often mentioned by residents and relatives, who were interested in the implications of DHT for human interactions and concerned about the possible depersonalisation of care. One expressed concern about ‘forgetting the person in the room’, while another stated ‘they can’t wash you while they’re using a keyboard’. However, residents and relatives acknowledged that implementing DHT could improve communication and therefore release staff time to spend on care. When digital algorithms were explained to them, they recognised the potential benefit of having an ‘extra set of eyes’ that could assist in identifying risks and reducing errors.

Introducing DHT and protecting data security

Residents and relatives identified that DHT could pose a risk to data security and confidentiality, although they thought that most of these challenges could be resolved. Most of the residents and relatives thought that, if DHT was carefully introduced, the majority of residents would be happy to see it used in their nursing home. Overall, residents and relatives wanted to encourage DHT innovation.

Improving communication

Nurses’ responses indicated that they understood how DHT could be used to monitor health trends, such as blood glucose levels, more effectively than paper-based records or charts. Nurses identified positive effects of DHT on communication between staff; for example, DHT would enable information, such as a new resident’s dietary requirements, to be communicated in real time. One nurse cited the example of a resident who was at the end of life and whose relatives had arrived at the nursing home to say goodbye; digital communication in the form of a mobile phone text message was used to alert cleaning staff so that they would not disturb the family.

Nurses were particularly interested in the use of digital records and their potential to reduce the burden of paperwork and save time. One nurse used the example of accessing a resident’s latest podiatry appointment, explaining how this involved searching through paper-based records stored in the nursing home office, whereas DHT would enable staff to retrieve the information digitally through ‘a single click’. With paper-based records, nurses and care staff had to spend significant amounts of time amending care plans; with digital records, it would be possible to amend care plans with comparative ease.

Engaging with DHT and retaining humanised care

The interviews with nurses showed that some had limited knowledge of the algorithms available through DHT. Nurses emphasised the value of knowing residents and using their own clinical judgement to identify any risk of deterioration, stressing that personal contact enabled high-quality nursing care. This was balanced by the understanding that the ‘extra set of eyes’ provided by DHT could be of assistance, particularly since nurses experienced high workloads and often relied on care staff observations to formulate clinical judgements.

Nurses felt that digital records would enable them ‘to spend more time with the resident, rather than on the paperwork’, supporting the human interaction elements of care. They suggested that DHT innovations such as digital records and digital algorithms might release staff time, thereby reducing staff’s workload, enabling them to take regular breaks and allowing them to leave work on time. Another suggestion was that time savings obtained through DHT would enable nurses to spend more time with residents, thereby improving their job satisfaction. Overall, the interviews with nurses emphasised that improvements in the work environment supported by DHT could benefit nurse retention and recruitment.

Introducing DHT and protecting data security

The security risks associated with digital records generated a significant amount of discussion, particularly in relation to nurses’ professional responsibility to maintain confidentiality (Nursing and Midwifery Council 2018). While nurses identified that there were risks involved in using paper-based records, for example the risk of destruction by fire, they were aware that digital data security was a challenge, particularly when sharing data between settings. Nurses suggested that digital access to data would require careful management, including individualised and secure login details, and that access to patients’ records should be traceable to individual members of staff. Agency staff would also require individualised and secure login details.

Training nursing home staff to use DHT was regarded as essential in the transition from paper-based to digital systems, with training tailored to individual staff’s needs. A gradual transition to digital systems, with nurses leading the change from planning to completion, was considered the optimal strategy. Nurses suggested that ‘DHT champions’ could be involved in rolling out DHT innovations. Furthermore, nurses identified that DHT suppliers would need to provide 24/7 support to nursing homes in various formats, such as troubleshooting guides, telephone helplines and fast-response emergency visits. Nursing homes would need to purchase DHT devices and software and possibly upgrade their internet access. Nurses stated that the costs and benefits of DHT innovations would need to be carefully balanced if implementation was to be successful.

Overall, nurses felt that DHT could contribute to efficiency gains in nursing homes and improve the quality of residents’ care and the quality of the work environment. However, these improvements would rely on factors such as effective staff training, supplier support and data security measures, all of which were central to the planning and delivery of any DHT innovation.