The influence of a wound care teleassistance service on nursing practice: a case study in Quebec

Barriers to the implementation of virtual care programmes for patients with chronic wounds: Qualitative empirical research

AIM

To assess the barriers to the implementation of virtual care for patients with chronic wounds from wound therapists' perspective.

DESIGN

A qualitative study.

METHODS

The study was conducted in two consecutive phases: (1) literature review, (2) descriptive qualitative study. In the first phase, texts published in English until 2023 were identified using international databases. The entire text of the selected studies was evaluated independently by two reviewers. Data analysis was carried out using textual content analysis. In the second phase of the study, twelve participants from Iranian wound care clinics participated. Data were collected through focus group discussion and analysed using conventional content analysis. Integration of both phases was conducted in the data analysis stage.

RESULTS

The most important barriers in providing virtual care to patients with chronic wounds were identified into five categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, IT users' insufficient knowledge and limitation of virtual care scope of practice.

CONCLUSION

The findings of the present study identified different barriers in the implementation of virtual care for patients with chronic wounds. In order to successfully develop a virtual care programme, it is necessary to adopt suitable policies regarding information and communication technology, provide the necessary legal frameworks, assign an adequate budget and consider the ethical, cultural, social and social issues.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Identifying barriers to developing a virtual care programme will help manage patients with chronic wounds at home.

IMPACT

This study accurately identifies barriers to providing virtual care for patients with chronic wounds and helps plan to address these barriers and facilitate the development of a virtual care programme for these patients at home.

REPORTING METHOD

This research has adhered to the SRQR reporting guideline.

NO PATIENT OR PUBLIC CONTRIBUTION

The involvement of patients or the public in the design, or conduct, or reporting, or dissemination plans of this research was not suitable.

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

BACKGROUND

Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth.

OBJECTIVE

This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients.

METHODS

Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys.

RESULTS

This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2).

CONCLUSIONS

This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

Impacts of Technology Use on the Workload of Registered Nurses: A Scoping Review

INTRODUCTION

Technology is an integral part of healthcare. With the rapid development of technological innovations that inform and support nurses, it is important to assess how these technologies may affect their workload particularly in rural contexts, where the workforce and supports may be limited.

METHODS

This literature review guided by Arksey and O'Malley's scoping review framework describes the breadth of technologies which impact on nurses' workload. Five databases (PubMed, CINAHL, PsycInfo, Web of Science, Business Source Complete) were searched. Thirty-five articles met the inclusion criteria. A data matrix was used to organize the findings.

FINDINGS

The technology interventions described in the articles covered diverse topics including: Cognitive care technologies; Healthcare providers' technologies; Communication technologies; E-learning technologies; and Assistive technologies and were categorized as: Digital Information Solutions; Digital Education; Mobile Applications; Virtual Communication; Assistive Devices; and Disease diagnoses groups based on the common features.

CONCLUSION

Technology can play an important role to support nurses working in rural areas, however, not all technologies have the same impact. While some technologies showed evidence to positively impact nursing workload, this was not universal. Technology solutions should be considered on a contextual basis and thought should be given when selecting technologies to support nursing workload.

Developing Competencies of Nurses in Wound Care: The Impact of a New Service Delivery Model Including Teleassistance

BACKGROUND

The implementation of a new wound care model of service delivery, including training and teleassistance, provided us with the opportunity to study nursing competencies in a primary health care context.

METHOD

A mixed-methods study was chosen to address the complexity related to the development of competencies from two complementary perspectives.

RESULTS

Nurses' self-perceived knowledge and skills improved immediately after training. Factors identified as influencing the development process were grouped into three themes: Acquired Skills and Knowledge, Personal Factors, and Work Organization Factors.

CONCLUSION

Our study demonstrates that the skills and knowledge can be enhanced through integrated continuing education efforts, and brings a deeper understanding of factors that influence the competency development. Finally, the research team highlighted the potential of telehealth technologies. [J Contin Educ Nurs. 2020;51(12):547-555.].

A Conceptual Framework and Pilot Study for Examining Telemedicine Satisfaction Research

Stakeholder satisfaction is often considered a key to the success of telemedicine systems. However, it can be difficult to understand and compare satisfaction evaluations because of variations in reporting and study designs. This research will contribute to the knowledge by developing a conceptual framework around key concepts that relate to understanding studies on telemedicine satisfaction. The framework is built based on a developmental review of the telemedicine and telehealth literature obtained from searches of PubMed and Google Scholar. Using a conceptual matrix, researchers have synthesized the results into a framework that includes: satisfaction dimensions, stakeholders, type of care, type of system, context and methodologies. This research expands these concepts by discussing attributes of each and tests the framework by conducting a pilot study that identifies the concepts in primary study sources. The results of the framework and the pilot study are reported.

Feasibility and safety of surgical wound remote follow-up by smart phone in appendectomy: A pilot study

INTRODUCTION

The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up.

MATERIAL AND METHODS

24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study.

RESULTS

The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92-0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods.

CONCLUSIONS

The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.

Telemedicine Supported Chronic Wound Tissue Prediction Using Classification Approaches

Telemedicine helps to deliver health services electronically to patients with the advancement of communication systems and health informatics. Chronic wound (CW) detection and its healing rate assessment at remote distance is very much difficult due to unavailability of expert doctors. This problem generally affects older ageing people. So there is a need of better assessment facility to the remote people in telemedicine framework. Here we have proposed a CW tissue prediction and diagnosis under telemedicine framework to classify the tissue types using linear discriminant analysis (LDA). The proposed telemedicine based wound tissue prediction (TWTP) model is able to identify wound tissue and correctly predict the wound status with a good degree of accuracy. The overall performance of the proposed wound tissue prediction methodology has been measured based on ground truth images. The proposed methodology will assist the clinicians to take better decision towards diagnosis of CW in terms of quantitative information of three types of tissue composition at low-resource set-up.