JMIR Publications

ABSTRACT

Background:

Many clinically relevant aspects of health are expressed through behavior, affect, and interaction and therefore rely on observation rather than instrumental measurement. However, such observation-based information is often documented infrequently in routine care. Structured high-frequency observational data may offer more nuanced insight into behavioral variation over time. Dementia, and particularly Behavioral and Psychological Symptoms of Dementia (BPSD), provides a relevant case for examining this challenge because symptoms fluctuate across time and context. However, little is known about how daily symptom assessment can be embedded in everyday dementia care.

Objective:

To examine the feasibility of integrating structured daily observational routines, supported by digital documentation, into residential dementia care.

Methods:

A convergent mixed-methods design was applied across four nursing home units in southern Sweden. Quantitative data consisted of structured daily registrations collected by care staff over 90 days for eight residents with BPSD. Quantitative data were analyzed descriptively and interpreted using selected NASSS (Nonadoption, Abandonment, Scale-up, Spread, and Sustainability) domains (condition, technology, value proposition, adopters, and organization) to contextualize variation in symptom patterns, adherence, and registration practices. Semi-structured dyadic interviews were analyzed using deductive content analysis guided by the same NASSS domains. Integration occurred during both the analytical and interpretive stages.

Results:

A total of 21,993 registrations were completed, though engagement varied considerably among staff. The routine was experienced as technically straightforward and easy to incorporate into daily work. At the same time, challenges emerged, including time constraints, inconsistent participation, varying levels of interpretive confidence, and difficulties distinguishing among overlapping symptoms. Organizational routines, leadership support, and team stability were central to sustaining staff engagement.

Conclusions:

The high number of completed registrations indicates that daily observations can be integrated into daily dementia care. The participants perceived it as meaningful and useful. Feasibility was primarily influenced by organizational and interpretive factors rather than technical constraints. Further research should explore strategies to support shared routines and sustain engagement over time.