Successful healthcare technology requires person-centred relationships and contexts: case narratives on medication-dispensing systems

Background: Providing person-centred care with a limited workforce is a major challenge in our ageing society. While care technologies such as electronic medication-dispensing systems are a means to help older persons with chronic conditions continue living independently, few studies have explored their implementation and use from a multiple stakeholder perspective. This prompted six Dutch care organisations and a university of applied sciences to collaborate in the Living Longer @ Home practice development project. Aim: To explore the influence of medication-dispensing systems on service user self-reliance and self-determination, as well as on professional and informal carer workload, in the community setting. Methods: A total of 14 case studies were used to understand the complexity and particularity of medication-dispensing systems in community care. Case narratives were constructed by (supervised) nursing students, then collated, and critically and creatively analysed by university- and practice-based researchers. Results: The case narratives reveal that while technology can increase self-reliance and self-determination for service users, it can also raise (new) concerns about medication safety and social isolation. Even after careful medication-dispensing systems indication, introduction and implementation, carer workloads may simply be changed rather than reduced. The dyadic and triadic relationships are affected as roles and responsibilities change, and trust may need to be rebuilt. Conclusions: Working with medication-dispensing systems entails more than implementing a piece of technology. While these systems can increase the duration of safe independent living, their effect on the lifeworld of those involved also needs to be considered and prepared for. A person-centred and relationship-oriented as opposed to task-orientated approach is advisable. Implications for practice: Before the introduction of care technology, nurses should discuss its impact on service users, informal carers, themselves and the dyadic/triadic relationship Practitioners, managers and technicians should collaboratively integrate care technology into community care services (Supervised) construction of case narratives enables workplace learning and practice development