The role of the technology generation effect in the use of telecare technology interfaces among Dutch care nurses
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The Dutch population is aging, and as a consequence, the increasing demand for healthcare is becoming problematic for the Dutch healthcare sector. Older people often need more healthcare, including nursing care and other social services. On the care providers’ side, care nurses are also aging, and the inflow of experienced younger care nurses is expected to be too low to comply to the upcoming shortages in experienced care nurses in the upcoming years. At the same time, development of new technologies for the purpose of making healthcare processes more efficient and cost effective, without the loss of the quality of care, is advancing at an increased pace. One group of technologies that aims at increasing the efficiency and cost-effectiveness of the care provision is called ‘telecare’. In this research, telecare is defined as ‘the use of telecommunication and information technologies for the facilitation of the healthcare process and to provide health and social care directly to the user’ (Barlow et al, 2007, p. 172). Although the expectations of telecare technologies are high, not many telecare technologies are being used yet in Dutch healthcare. An increasingly important factor that influences the success of a telecare technology appears to be the age of its users (Lim, 2010). Docampo Rama (2001) argues that the understanding and use of present-day telecare technology interfaces is influenced by specific previous experiences by end users (i.e. people who use telecare technologies and their interfaces, either to provide or to receive care services) of technology interfaces. A technology generation in that context is described as age categories of persons who experienced the availability of the same types of consumer products during their formative period, which is operationalized in this research as the time before the 25th year of age. The way users can interact with technology is mainly determined by the interface of that technology (Docampo Rama, 2001). Until now, studies on the use of telecare have mainly focused on difficulties with telecare technologies by clients of different ages as users of telecare technologies. However, the ability to understand and use telecare technology interfaces by care nurses of different ages can be just as important for the successful implementation of telecare into the daily care processes of a care organization. This research aims to provide more insight in the experiences by care nurses in working with telecare technology interfaces, and focuses on the following main research question: ‘What role does the technology generation effect have among Dutch care nurses in using telecare technology interfaces?’ Interfaces can be characterized by their associated interaction styles, which are defined as follows: ‘In an interaction style, specifications are given of re-useable application controls, specific selections and designs of such controls, and general design principles’ (Docampo Rama et al, 2011, p. 26). Interaction styles change over time. Care nurses that are currently working can have experienced two types of interaction styles: an electro-mechanical (EM) style (until the early eighties) and a Digital Software (DS) style from the eighties until now. This categorization is based on significant changes in interaction styles. To study what difficulties the two different technology generations of care nurses experienced with the telecare interface, an exploratory case study was carried out. In this case study, in depth-semi structured qualitative interviews were held with care nurses of different ages that were all working with telecare technologies in the same care organization. This care organization is located in the south of the Netherlands and has integrated telecare services into the daily care processes since 2005. In addition to the interviews with care nurses, three other stakeholders of the use of telecare at the care organization were interviewed: the team leader of the telecare department, a technological consultant for the implementation of the telecare technologies at the care organization, and the CEO of an organization that was involved in supervising and coordinating the implementation of telecare at the care organization. The Social Construction of Technology (SCOT) approach was used to reflect on the influence and role of the technology generation effect in the use of telecare technology interfaces by care nurses against other characteristics that influence the willingness to work with telecare technology interfaces. All interviewees were asked open questions about their experiences with the telecare technology that is used at the care organization, their opinion about the interface of this technology (appearance, functionality, difficulties in usage), and solutions they applied in order to deal with issues with the technology. The responses were recorded and transcribed literally, translated to English and interpreted by use of a narrative approach. The results of the analysis show that the technology generation effect does influence the ability to understand and use telecare technology interfaces. Previous experiences with technology interfaces by older care nurses of the EM generation differed from the younger DS generation of care nurses in that the older care nurses took effort in learning new technology interfaces only when it was crucial for the ability to do their work. The younger care nurses of the DS technology generation showed more interest in new technological developments, and used trial-and-error based strategies in learning how to use the telecare technology interface, while older care nurses of the EM generation applied an incremental learning strategy and only used interface features that were crucial to be able to provide telecare. Also, care nurses of the DS generation were more concerned about the social-emotional characteristics of the use of telecare technologies, whereas older care nurses of the EM generation were more concerned about the technological features of the telecare technology interface. More importantly, the technological consultant, the CEO of the spin-off organization, the team leader and the majority of the care nurses acknowledged that there is a difference in the way different generations learn and understand new technology interfaces. However, the technology generation effect did not influence the willingness of care nurses to use telecare technologies. The findings in this research suggest that care nurses at the telecare department did not consider the technology a threat to their work, nor did they see it as a replacement for their responsibilities. They did not show more discomfort in using the system. On the contrary: the social group of care nurses considered the technology a solution to individual physical problems and discomfort they experienced, and the use of telecare technologies was an opportunity to be able to continue their work as a care nurse. Thus, not only are older care nurses capable to learn how to use telecare technology interfaces, but it also enables them to carry out their work as a care nurse for a longer period, and to continue to provide a valuable role in the provision of care. The technology generation effect can only be problematic if managers concerned with the implementation of telecare in their care organization do not actively involve and motivate the care nurses that need to work with it. The role of the technology generation effect is that it can influence the ability of care nurses to understand and use telecare technology interfaces, but it does not influence the willingness to work with these technologies if it means that care nurses can still use their expertise as a care nurse to help clients in their daily need for care. Policy makers on the use of telecare technology related innovations for the purposes of facilitating care processes and increasing their efficiency should therefore not consider older care nurses as technologically incompetent, but instead as extremely competent potential ‘telecare nurses’, as long as they are actively stimulated and guided in their work with these technologies.