Table_3_Analyzing the use of videoconference by and for older adults in nursing homes: an interdisciplinary approach to learn from the pandemic.DOC

IntroductionDuring the Covid-19 pandemic and the resulting visitation restrictions, digital tools were used in many nursing homes in France to allow the older adults and their relatives to maintain social contact via videoconferencing. This article adopts an interdisciplinary approach to analyze the processes that affect the use of digital technologies.
MethodsDrawing on the concept of “mediation,” it seeks to shed light on how individuals embrace these tools in a relational situation. The interviews and observations undertaken among residents, their relatives, professionals, and the management head of seven nursing homes in 2021, make it possible to outline the different forms of practices and uses and to identify the factors leading to the variations observed.
ResultsWhile the key objective of these technical and technological tools is to compensate – on a functional level – for the communication problems and the isolation of individuals in order to promote residents’ “quality of life” by maintaining “social contact,” our study reveals that these tools’ uses and practices largely differ. It also shows considerable inequalities in terms of residents’ acquisition of subjective feelings of ownership of the tools. These are never attributed to isolated physical, cognitive, psychic, and social difficulties, but are influenced by specific organizational, interactional, and psychic configurations. Some of the structures analyzed revealed situations in which mediation failed, occasionally exposing the risk associated with seeking “ties at all costs,” or revealing a disturbing strangeness when residents were placed in front of screens. Some configurations, however, showed that it was possible to set up an intermediate space for the experience to unfold, which in turn opened up a space where individuals, groups, and institutions could experiment, allowing them to develop subjective feelings of ownership of this experience.
DiscussionThis article discusses how the configurations that failed to promote the mediation process reveal the need to assess the representations of care and assistance in the relationships between older adults, their loved ones, and nursing home professionals. Indeed, in certain situations, the use of videoconferencing, while seeking to produce a positive effect, risks displacing and increasing the effects of the “negative” associated with dependency, which may worsen individuals’ difficulties within nursing homes. The risks associated with the failure to take into account residents’ requests and consent explain why it is important to discuss how certain uses of digital tools may renew the dilemma between concerns for protection, on the one hand, and respect for autonomy on the other.

引言
新冠疫情（COVID-19）及其带来的探视限制政策期间，法国多家养老院引入了数字工具，以便老年人与其亲属能够通过视频会议维持社交联系。本文采用跨学科研究方法，剖析影响数字技术使用的各类进程。

方法
本文依托“中介（mediation）”概念，旨在阐明个体在社交场景中如何接纳此类工具。2021年，研究团队对7家养老院的入住老人、亲属、护理人员及管理层负责人开展访谈与观察，借此梳理出各类实践与使用形式，并明确导致观测到的差异的影响因素。

结果
尽管此类数字工具的核心目标是从功能层面弥补个体的沟通障碍与社交孤立问题，通过维持“社交联系”提升入住老人的“生活质量”，但本研究发现，这些工具的实际使用与实践模式存在显著差异。研究同时揭示，入住老人对工具的主观掌控感存在显著不均。此类差异绝非源于单一的生理、认知、心理与社交障碍，而是受到特定组织、互动及心理情境的影响。部分受访养老院的情境中，中介过程出现失效，时而暴露出“不惜一切代价维系联系”所伴随的风险，或是当入住老人面对屏幕时，呈现出令人不安的疏离感。但部分情境表明，可为该使用过程搭建过渡性空间，进而为个体、群体与机构提供试验场域，使其逐步形成对该体验的主观掌控感。

讨论
本文探讨了阻碍中介过程的各类情境如何凸显出：有必要评估老年人、其亲友与养老院护理人员之间的照护与帮扶关系认知。诚然，在部分场景中，视频会议工具虽旨在产生积极效果，却可能转嫁并加剧与依赖相关的“负面”影响，进而加剧入住老人在养老院中的困境。未顾及入住老人的诉求与同意所带来的风险，也阐释了为何有必要探讨数字工具的特定使用方式，会如何重新引发“守护关怀”与“尊重自主”之间的经典伦理困境。