Caring Futures: Developing Care Ethics for Technology-Mediated Care Practices

Implications of using digital technologies in child welfare work

While the pace of the digital development has been slower in child welfare services relative to other welfare services in Norway, there is currently a promise of a technological “revolution”. DigiBarnevern is an ongoing nationwide project managed by the state and municipalities, promising better and more efficient child welfare services through various digital technologies. There is however limited research on the implications of using digital technologies in Norwegian child welfare work.

This project will contribute to fill this gap by drawing on various data materials collected at different moments in the implementation process of DigiBarnevern:

1. Pre-DigiBarnevern implementation phase (data collection: medio 2022-medio 2023): Focus group interviews with social workers in 5 municipal child welfare services in Norway. In the focus groups we explore social workers’ experiences of using digital technologies and expectations towards how DigiBarnevern will influence child welfare work.
2. DigiBarnevern implementation phase (data collection: ultimo 2023): Individual interviews with 10 “super users” of DigiBarnevern. These participants have a special responsibility for training social workers in how to use the various digital technologies in DigiBarnevern. In the individual interviews we explore super users’ experiences of the implementation process.
3. Pre-post DigiBarnevern: One of the technologies that are currently operational in DigiBarnevern is “the national portal for reports of concern”. The portal was launched in April 2020 and is now used by more than 200 municipalities. Reports of concern were previously received by the municipal child welfare services via various channels - tel., letter, electronic. To gain a better understanding of how the portal has impacted the practice of writing reports of concern, we will analyse reports of concern written in the portal (n=150) and compare these with reports of concern written before the portal came into force (n=150).

Methods:

The project relies on 3 methods:

1. Focus group interviews with social workers in municipal child welfare services in Norway.
2. Individual interviews with super users of DigiBarnevern.
3. Comparative document study of reports of concerns pre- and post DigiBarnevern launch.

Work package leader: Ida Bruheim Jensen, Associate professor at the Department of Social Studies, University of Stavanger

Researchers:

• Hulda Mjöll Gunnarsdottir, Associate professor, Department of Social Studies, University of Stavanger
• Ingunn Tollisen Ellingsen, Professor, Department of Social Studies, University of Stavanger

Becoming a healthcare professional in technology-mediated care practices

The introduction of new technology in healthcare can raise ethical dilemmas and affect professionals’ motivation to change their caring practices. Ideals and realities in care practice are informed by professionals’ self- understanding, in turn shaped by their life and work experiences, as well as their societal context. Caring professionals need to be reflexively in touch with their own responses, emotions and vulnerabilities in order to engage in effective therapeutic relationships with users. Ethical conduct demands sensitivity to unequal power distributions in caring relationships and to relational dilemmas. Caring professionals may worry that future technologies will challenge conditions for sustaining therapeutic relationships or even shift the rationale for professional relational care.

Despite such concerns, there is currently a policy-driven societal impetus toward rapid implementation of new technology to alleviate care work for vulnerable population groups, such as the elderly, as seen in the Dementia Plan from 2020. However, if professionals feel reluctant to use new technologies and their concerns are not addressed by policy makers and healthcare management, such implementations can result in irresponsible practice and compromised patient safety.

Objectives

1. to expand knowledge of how healthcare professionals’ self-understanding and ideals in high- and low technology-mediated care influence their motivation for taking new technology into use and their care ethics, and
2. to support reflective practice in midwifery care.

Work package 2 consists of four sub-studies:

• Study 1a) is a research project based on life-history interviews with healthcare professionals, run by postdoctoral candidate Sissel Merete Finholt-Pedersen.
• Study 1b) is a researcher project based on six focus groups (n=35) to cover variations in professionals’ ideals in high-tech and low-tech care healthcare sectors, and their attitudes to technology-mediated care. The study is conducted by Professors Ellen Ramvi.
• Study 1c) is a research project on relational ethics in technology-mediated GP practice, relying on semi-structured interviews for data collection. The study is run by Postdoctoral candidate/MD Damoun Nassehi.
• Study 2) is an educational project will identify whether a new educational model contributes to midwives’ reflective practice and care ethics in light of increasingly technology-mediated professional practice. The study is led by Marta Høyland Lavik.

Work package leader: Ellen Ramvi, Professor at the Faculty of Health Sciences, University of Stavanger

Researchers:

• Marta Høyland Lavik, Professor II, University of Stavanger
• Sissel Merete Finholt-Pedersen, Postdoctoral candidate, University of Stavanger
• Damoun Nassehi, Postdoctoral candidate, University of Stavanger
• Wendy Hollway, Emeritus Professor, The Open University
• Henning Salling Olesen, Emeritus Professor, Roskilde University
• Signe Egenberg, Ph.D,  Midwife, Stavanger University Hospital

The impact of robots and other caregiving techno-bodies on agency and quality of care

We are particularly interested in technology that imitates animals or humans, or technology that is attached to or integrated into the human body. What does it mean to live with technology that enables quality of life? What kind of care ethial dilemmas arise from our increasing interactions with technologies and robots?

The project consists of three parts.

Part 1 is a PhD project reading science fiction stories of care robots against Immanuel Levinas' ethics. The project is led by Ilghar Azarmanesh.

Part 2 is a researcher project exploring how cultural imaginaries impact on our understanding of health and welfare technologies, particularly the care robot. This study has an innovative design, using Visual Matrix Methodology, a  qualitative method facilitating group associations and imaginaries on topics that are difficult to put into words (Gripsrud et al. 2018; Ramvi et al. 2019).

Part 3 is a study with conducted by Ingrid Leiknes. Parkinson’s patients living at home with an implanted Duodopa medicine pump are interviewed about their life-world narratives on living with on-the-body medical technology.

Work package leader: Ingvil Hellstrand, Associate professor at the Faculty of Health Sciences, University of Stavanger

Researchers:

• Ingrid Margrethe Leiknes, Senior lecturer, Faculty of Health Sciences, University of Stavanger
• Ilghar Azarmanesh, PhD candidate, Faculty of Social Sciences, University of Stavanger
• Roger Andre Søraa, Associate professor, NTNU
• Hege Tapio, PhD candidate, OsloMET
• Aino-Kaisa Koistinen, Postdoctoral researcher, University of Jyväskylä
• Nora Simonhjell, Professor, University of Agder

Implementation of welfare technologies in municipal healthcare services

The state authorities and suppliers promote welfare technologies as a solution to a situation characterised by scarce resources - a situation municipal personnel are aware of. However, it is possible that they consider welfare technologies as a threat to service quality. The work package explores tensions between care ethics and the use of technologies that claim to improve quality and efficiency in healthcare delivery. How, and in which contexts do such tensions appear, and how do municipalities and suppliers deal with them? Theories claiming that user needs are embedded in the technology are part of the theoretical framework, and this work package also explores how suppliers understand users’ needs.

Method

The data consists of interviews with suppliers and municipal managers in middle and lower level management. The lower level managers have been selected since we expect them to have to balance municipal demands of efficiency on the one hand and users’ need for service quality on the other. Relevant policy and plan documents have been collated. The analysis will be inductive-deductive.

Work package leader: Brita Gjerstad, Associate Professor at the Department of Social Studies, University of Stavanger

Researchers:

• Inger Lise Teig,  Associate Professor at the Department of Global Public Health and Primary Care
• Ragnhild Sørensen-Gjerstad, Researcher at NORCE