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Tan AJ, Rusli KD, McKenna L, Tan LL, Liaw SY. Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review. J Telemed Telecare 2024; 30:230-249. [PMID: 34666535 DOI: 10.1177/1357633x211049206] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. METHODS A scoping review was conducted. A systematic search for articles published in 2000-2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included 'telemedicine', 'telehealth' and 'nursing homes'. RESULTS Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. CONCLUSION AND IMPLICATIONS Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers' perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.
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Affiliation(s)
- Apphia Jq Tan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Khairul Db Rusli
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lc Tan
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Windle A, Marshall A, de la Perrelle L, Champion S, Ross PD, Harvey G, Davy C. Factors that influence the implementation of innovation in aged care: a scoping review. JBI Evid Implement 2023; 22:02205615-990000000-00072. [PMID: 38153118 PMCID: PMC11163893 DOI: 10.1097/xeb.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. INTRODUCTION Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. INCLUSION CRITERIA This review included studies of any design, that examined the implementation of innovations in aged care settings. METHODS Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. RESULTS Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. CONCLUSIONS Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.
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Affiliation(s)
- Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lenore de la Perrelle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Stephanie Champion
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Paul D.S. Ross
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Estupiñán Artiles C, Regan J, Donnellan C. Dysphagia screening in residential care settings: A scoping review. Int J Nurs Stud 2020; 114:103813. [PMID: 33220569 DOI: 10.1016/j.ijnurstu.2020.103813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adults with dysphagia are at a higher risk of experiencing serious complications where dysphagia is not identified and adequately managed. Nursing personnel are critical for timely identification and management of dysphagia and prevention of these subsequent serious complications in residential care settings. OBJECTIVES To identify dysphagia screening tools used in residential care and to establish whether validated and used as per guidelines, their diagnostic accuracy and reliability and to identify the prevalence rate of dysphagia in this setting. DESIGN A scoping review based on Arksey & O'Malley (2005) methodological framework. DATA SOURCES An electronic search of databases CINAHL, Pubmed and Scopus was conducted. Reference lists were checked in all identified articles for additional studies. Peer-reviewed publications describing the process of identifying dysphagia and using a screening protocol in residential care settings were considered for inclusion. REVIEW METHODS All identified studies were screened by reading of titles, keywords and abstracts. Those articles that were deemed eligible for inclusion were read in full. RESULTS Nineteen quantitative studies and one mixed-methods study out of 1,674 articles were included in the review. Thirteen different instruments for dysphagia screening were identified, with the Modified Water Swallow Test being the most commonly used. Other diagnostic procedures, such as fiberoptic endoscopic evaluation of swallowing, pulse oximetry or cervical auscultation, were implemented along with the administration of a dysphagia screening tool in six studies. The 3-Ounce Water Swallow Test, the Yale Swallow Protocol and the Gugging Swallowing Screen were identified as the instruments with the best clinical accuracy values. The reported prevalence of dysphagia in this setting ranged from 15% to 70%. CONCLUSIONS Formal dysphagia screening in residential care settings is not common practice. The dysphagia screening tools identified in this review are not validated for use in this setting. The implementation of dysphagia screening protocols specific to this population may facilitate identification of dysphagia and avoid complications.
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Affiliation(s)
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Faculty of Arts, Humanities and Social Sciences, Trinity College Dublin, Ireland
| | - Claire Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Ireland
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Bidmead E, Marshall A. Covid-19 and the 'new normal': are remote video consultations here to stay? Br Med Bull 2020; 135:16-22. [PMID: 32827250 PMCID: PMC7499498 DOI: 10.1093/bmb/ldaa025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION During the UK Covid-19 lockdown, video consultations (telemedicine) were encouraged. The extent of usage, and to which concerns to earlier implementation were set aside, is unknown; this is worthy of exploration as data becomes available. SOURCES OF DATA Sources of data are as follows: published case studies, editorials, news articles and government guidance. AREAS OF AGREEMENT Video can be clinically effective, especially where patients cannot attend due to illness or infection risk. Patients are positive, and they can benefit from savings in time and money. Adoption of telemedicine is hindered by a range of known barriers including clinician resistance due to technological problems, disrupted routines, increased workload, decreased work satisfaction and organizational readiness. AREAS OF CONTROVERSY Despite policy impetus and successful pilots, telemedicine has not been adopted at scale. GROWING POINTS Increased use of telemedicine during the Covid-19 crisis presents opportunities to obtain robust evidence of issues and create service transformation effectively. AREAS TIMELY FOR DEVELOPING RESEARCH Examination of telemedicine use during the Covid-19 crisis to ensure that the benefits and usage continue into the post-lockdown, 'new normal' world.
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Affiliation(s)
- Elaine Bidmead
- Centre for Research in Health and Society, Institute of Health, University of Cumbria, Carlisle, Cumbria, UK
| | - Alison Marshall
- Centre for Research in Health and Society, Institute of Health, University of Cumbria, Carlisle, Cumbria, UK
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Bidmead E, Lie M, Marshall A, Robson S, Smith VJ. Service user and staff acceptance of fetal ultrasound telemedicine. Digit Health 2020; 6:2055207620925929. [PMID: 32477585 PMCID: PMC7232054 DOI: 10.1177/2055207620925929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective We present qualitative findings from interviews with frontline clinicians and
service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were
conducted, undertaken as part of a service evaluation. Data collection was
undertaken by different teams, using interview schedules aligned to
independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation;
the requirement to resist scanning intuitively; communications during the
scan; and restricted room space. Notwithstanding, all clinicians reported
that participating women were accepting of the technology. Service users
reported few concerns. The main benefits of fetal telemedicine were
identified as upskilled staff, increased access to specialist support and
improved management of complex pregnancies. Convenience was identified as
the main benefit by service users, including savings in time and money from
not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service.
Service users reported satisfaction with communications during the
consultation and awareness that telemedicine had facilitated local access to
clinical expertise. Whilst clinical stakeholders reported challenges, the
iterative nature of the evaluation meant that concerns were discussed,
responded to, and overcome as the pilot developed. Clinical stakeholders’
perception of benefits for service users encouraged their acceptance.
Moreover, the evaluation established that fetal ultrasound telemedicine is a
viable method to access expertise safely and remotely. It provided
demonstrable evidence of a potential solution to some of the healthcare
challenges facing rural hospitals.
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Affiliation(s)
| | - Mabel Lie
- Population and Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, UK
| | - Vikki J Smith
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, University of Northumbria, UK
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Ditchburn JL, Marshall A. Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members’ experience. J Ren Care 2017; 43:175-182. [DOI: 10.1111/jorc.12207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jae-Llane Ditchburn
- Department of Science, Natural Resources and Outdoor Studies; University of Cumbria; Carlisle Cumbria UK
| | - Alison Marshall
- Department of Nursing, Health and Professional Practice; University of Cumbria; Lancaster UK
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