Distant Presence: Care Workers' Experiences of Digital Monitoring Systems in Dementia Care.

AIMS AND

objectivesTo add nuance to when and how remote technologies should be used to support dementia care, we examine care workers' experiences of two phone-based digital systems used for monitoring and planning in daily care. METHODOLOGICAL DESIGN AND JUSTIFICATION: Short-term ethnography at three care homes, 49 qualitative interviews, and five video-recorded situations provided data for a detailed account of care workers' experiences of the digital systems. Latour's concept of "presence in absence" was used to theorise the emergent theme of distant presence. ETHICAL ISSUES AND APPROVAL: Participants were given information about the project, asked to provide written consent, and could stop their participation at any time. The study was approved by the Swedish Ethical Review Authority. RESEARCH

methodsEthnographic notes and interview transcripts were analysed using reflexive thematic analysis to identify recurrent and meaningful themes. Video recordings were transcribed and analysed using multimodal conversation analysis to illustrate how the technology affected the progression of interaction.

resultsThe notion of distant presence highlights how digital technology can support care work by enabling presence at a distance: Reducing disturbances and increasing efficiency. At the same time, it captures how digital tools may undermine ethical care when alarms introduce the distant into the present-competing with patients for attention-or when plans fail to adjust to the specific conditions of dementia care. STUDY LIMITATIONS: All participants had worked in dementia care for several years, so the experiences of new care workers were not studied.

conclusionsThe findings provide insights into the complexities of how digital tools can both support and obstruct care: By introducing distant presence, digital tools can simultaneously protect patients' integrity and create a false sense of safety.