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Golden BN, Elrefaay S, McLemore MR, Alspaugh A, Baltzell K, Franck LS. Midwives' experience of telehealth and remote care: a systematic mixed methods review. BMJ Open 2024; 14:e082060. [PMID: 38553065 PMCID: PMC10982796 DOI: 10.1136/bmjopen-2023-082060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. METHODS Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. RESULTS After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. CONCLUSIONS Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.
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Affiliation(s)
- Bethany N Golden
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Shaimaa Elrefaay
- Department of Community Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Monica R McLemore
- Child, Family, and Population Health Nursing Department, University of Washington, Seattle, Washington, USA
| | - Amy Alspaugh
- The University of Tennessee Knoxville College of Nursing, Knoxville, Tennessee, USA
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Dai Y, Min H, Sun L, Wang X, Zhu C, Gu C. Assessing women's and health professionals' views on developing a midwifery-led mobile health app intervention in pregnancy: A descriptive qualitative study. J Adv Nurs 2024. [PMID: 38332497 DOI: 10.1111/jan.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
AIMS To explore women's and health professionals' views on the development of a midwifery-led mHealth app intervention in antenatal care and their demands for app functionality. DESIGN Descriptive qualitative research was utilized. METHODS In total, 15 pregnant or postpartum women were interviewed via in-depth interviews and 10 health professionals including obstetricians, midwives and obstetric nurses were invited to participate in a focus group discussion (FGD). All interviews and the FGD were analysed using qualitative content analysis. RESULTS Four key themes emerged from the data, including (1) limitations of current maternity care services; (2) potential benefits for mHealth app-based midwifery care; (3) possible challenges for providing midwifery care through mHealth apps and (4) suggestions and needs for developing a midwifery-led mHealth app. Participants agreed on the potential need of developing a midwifery-led mHealth app in antenatal care to increase access to midwifery care services and to meet women's diverse needs. Participants preferred to develop professional, reliable, full-featured and interactive mobile applications. The main functions of midwifery-led mHealth apps included personalized assessment and health education, self-monitoring and feedback, data sharing and interactive functions. Women mentioned that online communication and consultation with midwives could help them receive continuous support outside facilities. Health professionals expressed it would be of great convenience and timeliness to send personalized messages to women and to inform them of healthy lifestyles during pregnancy. The challenges included a shortage of human resources, medico-legal risks associated with mHealth and data security risks. CONCLUSIONS This study explores the individual views and functional needs of target users and healthcare providers for developing a midwifery-led mHealth app in antenatal care, which will serve as a reference for future application development. IMPACT Our study has important and practical implications for guiding the development of future midwifery-led mHealth app interventions. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yaming Dai
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Hui Min
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Liping Sun
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Borrelli S, Fumagalli S, Colciago E, Downey J, Spiby H, Nespoli A. How should a video-call service for early labour be provided? A qualitative study of midwives' perspectives in the United Kingdom and Italy. Women Birth 2023; 36:504-510. [PMID: 37365096 DOI: 10.1016/j.wombi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/23/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay admission to the maternity unit, but they may find this challenging without appropriate professional support. BACKGROUND Prior to the pandemic, research conducted with midwives and women showed positivity towards using video-technology for early labour, with concerns raised about privacy. AIM To explore midwives' perspectives on potential use of video-calls during early labour METHODS: A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained prior to commencing the study and ethical processes were followed. Seven virtual focus groups were conducted with 36 participants, 17 midwives working in the UK and 19 midwives working in Italy. Line-by-line thematic analysis was performed and themes agreed by the research team. FINDINGS The findings include three main themes: 1) who, where, when and how: key aspects to consider for an effective video-call service in early labour; 2) video-call content and expected contribution; 3) potential barriers to address. DISCUSSION Midwives responded positively to the concept of video-calling in early labour and provided detailed suggestions on how an ideal video-call service for early labour should be provided to maximise effectiveness, safety and quality of care. CONCLUSION Guidance, support and training should be provided to midwives and healthcare professionals, with dedicated resources for an early labour video-call service that is accessible, acceptable, safe, individualised and respectful for mothers and families. Further research should systematically explore clinical, psychosocial and service feasibility and acceptability.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom
| | - Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
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Borrelli S, Downey J, Colciago E, Fumagalli S, Nespoli A, Spiby PH. Mothers' perspectives on the potential use of video-calling during early labour in the United Kingdom and Italy: A qualitative study. Women Birth 2023:S1871-5192(23)00017-3. [PMID: 36682951 DOI: 10.1016/j.wombi.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay maternity unit admission, but they may find this challenging without appropriate professional support. BACKGROUND Despite pre-pandemic research which identified potential advantages of video-calling in early labour, implementation of such service has not been reported. AIM To explore mothers' perspectives on potential use of video-calls during early labour. METHODS A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained and ethical processes were followed. Six virtual focus groups were conducted with 37 participants, 24 mothers who gave birth in the UK and 13 who gave birth in Italy. Line-by-line thematic analysis was performed and themes agreed. FINDINGS Two themes emerged: 1) women's expectations of video-calls' content and features; 2) technological challenges and solutions. Mothers responded positively to the concept of video-calling in early labour. Receiving guidance, information on coping with pain and advice on timely access in early labour was perceived as key. Women highlighted the importance of accessible, reliable and user-friendly technology. Equitable access, technological literacy, acceptability and privacy were considered as challenges to implementation, with solutions proposed to overcome disparities. DISCUSSION AND CONCLUSION Guidance and training should be provided to midwives, with designated resources to build a service that is accessible, acceptable, safe, individualised and respectful for mothers and birth companions. Further research should explore feasibility, acceptability, clinical and cost-effectiveness.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom.
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Prof Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
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Li T, Zeng Y, Fan X, Yang J, Yang C, Xiong Q, Liu P. A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science. J Multidiscip Healthc 2023; 16:677-692. [PMID: 36938484 PMCID: PMC10015947 DOI: 10.2147/jmdh.s398218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/17/2023] [Indexed: 03/13/2023] Open
Abstract
Objective This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science. Methods Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords. Results Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05). Conclusion This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.
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Affiliation(s)
- Tingting Li
- Department of Science and Education, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Yilan Zeng
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xianrong Fan
- Department of Hospital Office, The Maternal and Child Health Hospital of Yongchuan, Chongqing, People’s Republic of China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Chengying Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Qingyun Xiong
- Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, Changsha, Hunan Province, People’s Republic of China
- Qingyun Xiong, Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, No. 22, Xingsha Avenue, Changsha County, Changsha City, Hunan Province, 410100, People’s Republic of China, Tel +86 731-85259000, Email
| | - Ping Liu
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
- Correspondence: Ping Liu, Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, 311 Yingpan Road, Kaifu District, Changsha, Hunan Province, 410005, People’s Republic of China, Tel +86 15973136512, Email
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Hedqvist A, Svensson A, Larsson LG. Nurses' experiences of person-centred care planning using video-conferencing. Nurs Open 2022; 10:1879-1888. [PMID: 36326034 PMCID: PMC9912454 DOI: 10.1002/nop2.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
AIM The aim was to illuminate how nurses experience person-centred care planning using video conferencing upon hospital discharge of frail older persons. DESIGN Care planning via video conferencing requires collaboration, communication and information transfer between involved parties, both with regard to preparing and conducting meetings. Participation of involved parties is required to achieve a collaborative effort, but the responsibilities and roles of the involved professions are unclear, despite the existence of regulations. METHOD A qualitative content analysis was conducted based on 11 individual semi-structured interviews with nurses from hospitals, municipalities and primary care in Sweden. RESULTS This study provides valuable insights into challenges associated with care planning via video conferencing. The meeting format, that is video conferencing, is perceived as a barrier that makes the interaction challenging. Shortcomings in video technology make a person-centred approach difficult. The person-centred approach is also difficult for nurses to maintain when the older person or relatives are not involved in the planning.
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Affiliation(s)
| | - Ann Svensson
- School of Business, Economics and ITUniversity WestTrollhättanSweden
| | - Lena G. Larsson
- Department of Health SciencesUniversity WestTrollhättanSweden,Research, Education, Development and Innovation, Primary Health CareRegion Västra GötalandGothenburgSweden
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Evans C, Evans K, Booth A, Timmons S, Jones N, Nazmeen B, Sunney C, Clowes M, Clancy G, Spiby H. Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol. BMJ Open 2022; 12:e062106. [PMID: 36127105 PMCID: PMC9490633 DOI: 10.1136/bmjopen-2022-062106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts? METHODS AND ANALYSIS The review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20-35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426-1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences. PROSPERO REGISTRATION NUMBER CRD42021288702.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Booth
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Nia Jones
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Benash Nazmeen
- School of Allied Health Professionals and Midwifery, University of Bradford, Bradford, UK
| | | | - Mark Clowes
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Georgia Clancy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Koppel PD, De Gagne JC, Docherty S, Smith S, Prose NS, Jabaley T. Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: A Qualitative Study (Preprint). J Med Internet Res 2022; 24:e39920. [PMID: 36074558 PMCID: PMC9501656 DOI: 10.2196/39920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. Objective This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). Methods In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. Results Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. Conclusions Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. International Registered Report Identifier (IRRID) RR2-10.2196/27940
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Affiliation(s)
- Paula D Koppel
- School of Nursing, Duke University, Durham, NC, United States
| | | | | | - Sophia Smith
- School of Nursing, Duke University, Durham, NC, United States
- Duke Cancer Institute, Duke Health, Durham, NC, United States
| | - Neil S Prose
- Department of Dermatology, Duke University, Durham, NC, United States
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Terri Jabaley
- Phyllis F Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
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Gavine A, Marshall J, Buchanan P, Cameron J, Leger A, Ross S, Murad A, McFadden A. Remote provision of breastfeeding support and education: Systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2022; 18:e13296. [PMID: 34964542 PMCID: PMC8932718 DOI: 10.1111/mcn.13296] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022]
Abstract
The Covid‐19 pandemic has led to a substantial increase in remotely provided maternity care services, including breastfeeding support. It is, therefore, important to understand whether breastfeeding support provided remotely is an effective method of support. To determine if breastfeeding support provided remotely is an effective method of support. A systematic review and meta‐analysis were conducted. Twenty‐nine studies were included in the review and 26 contributed data to the meta‐analysis. Remotely provided breastfeeding support significantly reduced the risk of women stopping exclusive breastfeeding at 3 months by 25% (risk ratio [RR]: 0.75, 95% confidence interval [CI]: 0.63, 0.90). There was no significant difference in the number of women stopping any breastfeeding at 4–8 weeks (RR: 1.10, 95% CI: 0.74, 1.64), 3 months (RR: 0.89, 95% CI: 0.71, 1.11), or 6 months (RR: 0.91, 95% CI: 0.81, 1.03) or the number of women stopping exclusive breastfeeding at 4–8 weeks (RR: 0.86, 95% CI: 0.70, 1.07) or 6 months (RR: 0.93, 95% CI: 0.85, 1.0). There was substantial heterogeneity of interventions in terms of mode of delivery, intensity, and providers. This demonstrates that remote interventions can be effective for improving exclusive breastfeeding at 3 months but the certainty of the evidence is low. Improvements in exclusive breastfeeding at 4–8 weeks and 6 months were only found when studies at high risk of bias were excluded. They are also less likely to be effective for improving any breastfeeding. Remote provision of breastfeeding support and education could be provided when it is not possible to provide face‐to‐face care. This systematic review investigated the effectiveness of breastfeeding support interventions provided remotely. There was significant heterogeneity in how support interventions and standard care were provided. There is low‐quality evidence that remotely provided breastfeeding support significantly reduced the risk of women stopping exclusive breastfeeding at 3 months but not at 4‐8 weeks or 6 months. There was no significant difference in the number of women stopping any breastfeeding. Interventions tended to demonstrate more positive effects when standard care was limited suggesting remote support is preferable to no support. There was a lack of evidence exploring women's satisfaction and the impact on maternal mental health. More research is needed to explore this.
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Affiliation(s)
- Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Joyce Marshall
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | | | - Joan Cameron
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | | | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Amal Murad
- Maternity and Childhood Nursing Department, College of Nursing, Taibah University, Medina, Saudi Arabia
| | - Alison McFadden
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
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11
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Beauséjour W, Hagens S. Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses. JMIR Nurs 2022; 5:e33586. [PMID: 35357326 PMCID: PMC9015777 DOI: 10.2196/33586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/15/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. OBJECTIVE This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. METHODS We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. RESULTS In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record-keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses' perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. CONCLUSIONS This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record-keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery.
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12
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Zhang W, Jia X, Yao X, Zhang X, Liang Y, Zhang Y, Zhang X, Su P, Zhang X, Du S, Yin Z. Exploring the perceptions and barriers of nurses working in remote areas on tele-educational delivery of pharmacy knowledge in Henan, China: a qualitative study. BMJ Open 2022; 12:e051365. [PMID: 35135766 PMCID: PMC8830228 DOI: 10.1136/bmjopen-2021-051365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There are insufficient educational resources and opportunities available to nurses at county-level medical institutions in China to receive pharmacy knowledge education. Video conference pharmacy education (VCPE) has become a solution. However, a few studies have explored the perceptions of nurses participating in VCPE. The study was aimed to explore the perceptions of nurses participating in VCPE at county-level medical institutions in remote areas in China. The barriers and suggestions to improve the VCPE were also assessed. SETTING The study was conducted in two county-level hospitals in Henan, China. DESIGN AND PARTICIPANTS This qualitative study comprises two focus group discussions. Twenty-three nurses from two county-level hospitals in Henan province participated in the interview in May 2019. RESULTS The average age of our participants was 34.83±6.24 years old (from 26 to 55 years old). By deeply analysing the data, the following four domains were extracted: Four themes were extracted on VCPE from this qualitative study: (1) the pharmacy knowledge gains from VCPE, (2) the shortcomings VCPE, (3) the advantages of the VCPE and (4) the expectations and suggestions for the VCPE. CONCLUSION The results of this study indicate VCPE is a valuable tool to provide education to nurses working at remote area county-level institutions. The results contribute to improvements in future VCPE deliveries.
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Affiliation(s)
- Wan Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xuedong Jia
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiali Yao
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiang Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yan Liang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yingjie Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiao Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Pei Su
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiaojian Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Shuzhang Du
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Zhao Yin
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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13
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Disparity in cancer survivorship care: A cross-sectional study of telehealth use among cancer nurses in Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Koppel PD, De Gagne JC. Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study. JMIR Res Protoc 2021; 10:e27940. [PMID: 34125073 PMCID: PMC8240804 DOI: 10.2196/27940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/23/2023] Open
Abstract
Background Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. Objective This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. Methods Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. Results Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. Conclusions This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. International Registered Report Identifier (IRRID) PRR1-10.2196/27940
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Affiliation(s)
- Paula D Koppel
- Duke University School of Nursing, Durham, NC, United States
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15
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Jacob C, Sanchez-Vazquez A, Ivory C. Factors Impacting Clinicians' Adoption of a Clinical Photo Documentation App and its Implications for Clinical Workflows and Quality of Care: Qualitative Case Study. JMIR Mhealth Uhealth 2020; 8:e20203. [PMID: 32965232 PMCID: PMC7542402 DOI: 10.2196/20203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) tools have shown promise in clinical photo and wound documentation for their potential to improve workflows, expand access to care, and improve the quality of patient care. However, some barriers to adoption persist. OBJECTIVE This study aims to understand the social, organizational, and technical factors affecting clinicians' adoption of a clinical photo documentation mHealth app and its implications for clinical workflows and quality of care. METHODS A qualitative case study of a clinical photo and wound documentation app called imitoCam was conducted. The data were collected through 20 in-depth interviews with mHealth providers, clinicians, and medical informatics experts from 8 clinics and hospitals in Switzerland and Germany. RESULTS According to the study participants, the use of mHealth in clinical photo and wound documentation provides numerous benefits such as time-saving and efficacy, better patient safety and quality of care, enhanced data security and validation, and better accessibility. The clinical workflow may also improve when the app is a good fit, resulting in better collaboration and transparency, streamlined daily work, clinician empowerment, and improved quality of care. The findings included important factors that may contribute to or hinder adoption. Factors may be related to the material nature of the tool, such as the perceived usefulness, ease of use, interoperability, cost, or security of the app, or social aspects such as personal experience, attitudes, awareness, or culture. Organizational and policy barriers include the available clinical practice infrastructure, workload and resources, the complexity of decision making, training, and ambiguity or lack of regulations. User engagement in the development and implementation process is a vital contributor to the successful adoption of mHealth apps. CONCLUSIONS The promising potential of mHealth in clinical photo and wound documentation is clear and may enhance clinical workflow and quality of care; however, the factors affecting adoption go beyond the technical features of the tool itself to embrace significant social and organizational elements. Technology providers, clinicians, and decision makers should work together to carefully address any barriers to improve adoption and harness the potential of these tools.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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16
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020; 8:e15935. [PMID: 32130167 PMCID: PMC7059085 DOI: 10.2196/15935] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom.,University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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17
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020. [PMID: 32130167 DOI: 10.2196/preprints.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. OBJECTIVE The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians' adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. METHODS A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. RESULTS The technological factors impacting clinicians' adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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18
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Niela-Vilen H, Rahmani A, Liljeberg P, Axelin A. Being 'A Google Mom' or securely monitored at home: Perceptions of remote monitoring in maternity care. J Adv Nurs 2019; 76:243-252. [PMID: 31576577 DOI: 10.1111/jan.14223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
AIMS To understand the perspectives of both healthcare professionals in maternity care and pregnant women with higher risk pregnancies about remote monitoring in maternity care. DESIGN Qualitative descriptive design. METHODS Individual and focus group interviews were conducted in public maternity care and in a level III hospital in Finland during April-May 2018. The sample consisted of healthcare professionals working in the primary care and at the hospital and hospitalized pregnant women. Altogether, 17 healthcare professionals and 4 pregnant women participated in the study. The data were analysed using inductive thematic network analysis. RESULTS Many possibilities - and an equal number of concerns - were identified regarding remote monitoring in pregnancy, depending on the respondent's viewpoint from holistic to symptom-centred care. Healthcare staff had reservations about technology due to previous negative experiences and difficulties trusting technology. The pregnant women thought that monitoring would ease the staff's workload if the latter had enough technological skills. Remote monitoring could increase security in pregnancy care but create a feeling of false security if the women ignored their subjective symptoms. Face-to-face visits and the uniqueness of human contact were strongly favoured. Pregnant women wished to use monitoring as a confirmation of their subjective feelings. CONCLUSION Remote monitoring could be used as a supplementary system in pregnancy care, although it could replace only some healthcare visits. Pregnant women identified more possibilities for remote monitoring compared with the staff members both in primary care and the hospital. IMPACT A comprehensive understanding of pregnant women's and healthcare professionals' perceptions of remote monitoring in pregnancy was built to be able to develop new technologies in maternity care. In certain cases, remote monitoring would supplement traditional pregnancy follow-ups. Staff in primary and specialized care, and healthcare managers, should support teamwork to be able to understand different approaches to pregnancy care.
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Affiliation(s)
| | - Amir Rahmani
- Department of Computer Science and School of Nursing, University of California, Irvine, CA, USA
| | - Pasi Liljeberg
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
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19
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Bagot K, Moloczij N, Arthurson L, Hair C, Hancock S, Bladin CF, Cadilhac DA. Nurses' Role in Implementing and Sustaining Acute Telemedicine: A Mixed-Methods, Pre-Post Design Using an Extended Technology Acceptance Model. J Nurs Scholarsh 2019; 52:34-46. [PMID: 31508882 DOI: 10.1111/jnu.12509] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Technology-based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non-nurses. DESIGN A mixed-methods, pre-post design with implementation of a new acute stroke telemedicine service. METHODS A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014-2017). Open-ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010-2011) was completed to provide greater explanatory detail. FINDINGS Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non-nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non-nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). CONCLUSIONS Important factors for acute stroke telemedicine varied between nurses and non-nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non-nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. CLINICAL RELEVANCE Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence-based implementation strategies must be tailored over time, and between nurses and non-nurses, to ensure initial uptake and ongoing use.
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Affiliation(s)
- Kathleen Bagot
- Research Fellow, Public Health: Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne University, Melbourne, Australia
| | - Natasha Moloczij
- Program Manager-Nurse-led Research, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Lauren Arthurson
- Stroke Coordinator & Allied Health Manager, Inpatient Rehabilitation, Echuca Regional Hospital, Echuca, Australia
| | - Casey Hair
- VST Site Coordinator, Ballarat Health Service, Ballarat, Australia
| | - Shaun Hancock
- Research Officer, Public Health: Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne University, Melbourne, Australia
| | - Christopher F Bladin
- Director, Victorian Stroke Telemedicine Program, Ambulance Victoria, Blackburn, Australia
| | - Dominique A Cadilhac
- Head, Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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20
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Bradford N, Chambers S, Hudson A, Jauncey-Cooke J, Penny R, Windsor C, Yates P. Evaluation frameworks in health services: An integrative review of use, attributes and elements. J Clin Nurs 2019; 28:2486-2498. [PMID: 30811715 DOI: 10.1111/jocn.14842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/05/2019] [Accepted: 02/20/2019] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVE To synthesise the evidence on the use of evaluation frameworks by nurses and midwives in research designed to improve healthcare services and practice. A secondary aim was to identify the attributes and elements of evaluation frameworks. BACKGROUND Evaluation is an integral component of any initiative to improve outcomes or change clinical practice. Yet often an evaluation may not yield the information required to sustain or integrate an initiative into practice. Evaluation frameworks can support effective evaluations, but there is a lack of consensus regarding elements and attributes of frameworks that support use. METHODS We undertook an integrative review to synthesise the use of evaluation frameworks in practice guided by the Preferred Reporting Items for Systematic review and Meta-Analysis flow diagram and checklist 2009 (Supporting Information File 4). The protocol was registered with PROSPERO (CRD42018087033). A broad range of electronic databases were systematically searched using keywords. FINDINGS Twenty-five papers were included from a diverse range of clinical areas and across high-, middle- and low-income nations. Twenty of the research projects had used nine existing frameworks, and five had developed an evaluation specific to an initiative. Frameworks supported the processes of evaluation and made them more meaningful by simplifying a complex process (providing structure and guidance for the evaluation processes); identifying and including stakeholders; explaining reasons for outcomes; generating transferable lessons; and identifying the mechanisms driving or inhibiting change. CONCLUSION Nurses and midwives reported that frameworks were useful in undertaking evaluations. Each framework had positive attributes and missing or confusing elements. When undertaking an evaluation, it is pertinent to review the elements and attributes of a framework to ensure it includes evaluation measures that are relevant to specific projects. RELEVANCE TO CLINICAL PRACTICE Nurses are actively involved in evaluation of clinical practice. This review identifies important elements to consider when choosing a framework for evaluation.
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Affiliation(s)
- Natalie Bradford
- Centre for Children's Health Research at Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shirley Chambers
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adrienne Hudson
- Centre for Children's Health Research and Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Jacqui Jauncey-Cooke
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Penny
- Centre for Children's Health Research and Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - Carol Windsor
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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