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Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care
Hall A, Brown Wilson C, Stanmore E, Todd C.. BMC geriatrics, 2019-05-24
Topic: Risk, prevention and care in population studies
Background Use of monitoring technologies (e.g. wearable or environmental sensors) in long-term care generates extensive ethical debate, primarily about their potential to enhance resident safety weighed against concerns about their impacts upon resident autonomy. There are a number of other ethical aspects which are far less debated, including questions about the monitoring of the workforce, and equality of access to technologies. In this paper, we explore the extent to which remote monitoring of the workforce, and equality of access to technologies, were seen to influence the implementation of monitoring technologies within long-term care facilities. Methods An embedded multiple-case study design was used with three dementia-specialist care facilities in England that had experience using a range of monitoring technologies. Data were collected through 175 h' observation of daily practice, semi-structured interviews with 36 staff, residents and relatives, and examination of organisational documentation and technology manufacturer literature. Data were analysed using Framework Analysis. Results Use of technologies for workforce monitoring was understood in relation to the ethical obligations to fulfil a duty of care to residents. There was little recognition of any negative implications for the workforce, but staff were susceptible to rumours that technologies were being used for performance management even when this was not the case. There were questions about how far data collected by monitoring technologies could constitute 'evidence' of appropriate care delivery. Equality and access to technologies involved a need to compromise between generic designs that were not universally suitable, but were more affordable than bespoke designs. Contracts with suppliers imposed limitations on product choice. Conclusions There is an urgent need for greater consideration of the ethical and legal implications that remote technological monitoring might have upon workforce morale, recruitment and retention. Ensuring variety of technological design to facilitate equitable access for residents is financially extremely challenging. It is possible that considerations of equitable access are not deemed a priority due to the current generation of residents' low levels of technological familiarity and expectation. It might be overstated and unrealistic to view expensive technologies as the pinnacle of innovative practice in care homes.
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APA 7th
Hall, A., Brown Wilson, C., Stanmore, E., & Todd, C. (2019). Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care. BMC geriatrics. https://doi.org/10.1186/s12877-019-1155-6
Vancouver
Hall A, Brown Wilson C, Stanmore E, Todd C. Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care. BMC geriatrics. 2019. doi:10.1186/s12877-019-1155-6. PMID: 31126240.
BibTeX
@article{hall2019-31126240,
author = {Hall, A. and Brown Wilson, C. and Stanmore, E. and Todd, C.},
title = {{Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care}},
journal = {BMC geriatrics},
year = {2019},
doi = {10.1186/s12877-019-1155-6},
pmid = {31126240},
url = {https://doi.org/10.1186/s12877-019-1155-6}
}
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Key findings
- Results Use of technologies for workforce monitoring was understood in relation to the ethical obligations to fulfil a duty of care to residents.
Why it matters
This qualitative study of three dementia-specialist care facilities found that using monitoring technologies for workforce monitoring was understood in relation to the duty of care to residents, with little recognition of negative implications for staff. It addresses ethical and practical issues in long-term care and does not test any treatment, cure or prevention for Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 44/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMC geriatrics) |
| Journal's citation record | 2 / 4 | BMC Geriatrics: journal h-index 153 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 60 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 6.7 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 3 / 6 | Cited 5.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 2 / 4 | Cited 36 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Chris Todd: h-index 87 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Manchester: institution h-index 1,304 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31126240) |
| Free to read | 2 / 2 | Free to read |
| Total | 44 / 100 | — |
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