The role of nurse-led telehealth interventions in bridging healthcare gaps and expanding access

Environmental Impact of Physical Visits and Telemedicine in Nursing Care at Home: Comparative Life Cycle Assessment

BACKGROUND

The health care sector contributes notably to environmental harms, impacting human and ecosystem health. Hence, countries increasingly set ambitions to transition to environmentally sustainable health care, focusing on resource use, energy consumption, and patient travel. Telemedicine is often considered a promising solution to reduce travel-related carbon emissions. However, underlying environmental impact assessments lack important components such as staff travel and fail to adhere to standardized conduct and reporting. Moreover, assessments of telemedicine use in primary care are scarce.

OBJECTIVE

This study aims to quantify and compare the environmental impact of physical visits and telemedicine visits in the context of domiciliary care and home nursing.

METHODS

We conducted a life cycle assessment following international ISO-14040/44 standards of all resources required per individual patient visit, either in person at the patient's home or via video calling with a dedicated user-friendly tablet. We collected anonymous user data in collaboration with a telemedicine service company, complemented by consulting staff members of four nursing organizations. Telemedicine visits were elementary in nature, such as supporting patients in taking their medication or structuring their daily agenda. We quantified average environmental impacts from cradle to grave, using the Environmental Footprint method, and verified the robustness of the comparison via uncertainty analysis. The variability of environmental impacts in different settings was explored using scenario analyses for the available minimum to maximum ranges.

RESULTS

Compared to a single physical visit in the studied setting, a telemedicine visit contributed less to global warming (0.1 vs 0.3 kg of carbon dioxide equivalents [kgCO2eq]; -60%), particulate matter formation (6.2 * 10-9 vs 1.8 * 10-8 disease incidence; -60%), and fossil resource use (1.8 vs 4.4 megajoules; -60%). Mineral/metal resource use was higher for telemedicine than for physical visits (1.1 * 10-5 vs 4.0 * 10-6 kg antimony equivalent; +180%). Only water use was not consistently different in the uncertainty analysis. Scenario analyses indicated that telemedicine's environmental impact could become similar to physical visits only in urban settings (1-3 km of travel distance) with 50%-100% car commuting (0.1-0.4 vs 0.2-0.7 kgCO2eq). In rural settings (5-15 km of travel distance, 80%-100% car commute), physical visits' environmental impact was higher (1.0-3.5 kgCO2eq), mostly even for mineral/metal resource use.

CONCLUSIONS

Using telemedicine for domiciliary care and home nursing mostly reduces its environmental impact compared to physical visits. Benefits are larger in rural settings, where travel distances between patients are larger, and apply to multiple environmental impacts but not always to mineral/metal resource use. In urban settings, factors that influence the degree to which telemedicine is environmentally beneficial are whether staff are working from home versus at the office, commuting to the office by bicycle versus by car, and reusing video-calling devices. Accordingly, considerate application of telemedicine is important to support care for both human and planetary health.

Compassion through technology: Digital empathy concept analysis and implications in nursing

Objective

Digital empathy is an emerging concept in telehealth nursing, emphasizing emotional engagement and compassionate communication in virtual care settings. Despite its importance, digital empathy remains underexplored. This concept analysis aims to define digital empathy in nursing, explore its key attributes, antecedents, consequences, challenges, and actionable recommendations for practice.

Methods

Using Walker and Avant's eight-step framework, a comprehensive literature review was conducted on digital empathy in telehealth nursing. A total of 52 sources were reviewed, comprising 46 research articles, four books, and two web pages, published between 2000 and 2024.

Results

This concept analysis identifies key attributes of digital empathy in nursing, including authenticity, trust-building, communication effectiveness, emotional engagement, adaptability, technological proficiency, and cultural sensitivity critical for meaningful connections in telehealth. Antecedents encompass digital literacy, emotional intelligence, supportive infrastructures, and cultural competence, emphasizing individual, contextual, and organizational factors. Consequences include enhanced patient satisfaction, trust, adherence to treatment, improved nurse well-being, and organizational benefits such as team cohesion and reduced staff turnover. Challenges such as cultural variability, technological limitations, and the lack of validated measurement tools highlight barriers to effective implementation.

Conclusion

This concept analysis underscores the vital role of digital empathy in telehealth nursing. By incorporating its attributes and antecedents, healthcare organizations can enhance patient outcomes and foster supportive, patient-centered environments. Addressing measurement and technological gaps will be pivotal in fully realizing the benefits of digital empathy in telehealth. Actionable recommendations include implementing targeted training, developing standardized tools, and leveraging artificial intelligence advancements to enhance empathetic communication in telehealth.

Bibliometric Analysis (2000-2024) of Research on Artificial Intelligence in Nursing

We conducted a bibliometrics analysis utilizing the Web of Science database, selecting 1925 articles concerning artificial intelligence (AI) in nursing. The analysis utilized the network visualization tool VOSviewer to explore global collaborations, highlighting prominent roles played by the United States, China, and Japan, as well as institutional partnerships involving Columbia University and Harvard Medical School. Keyword analysis identified prevalent themes and co-citation analysis highlighted influential journals. A notable increase in AI-related publications in nursing was observed over time, reflecting the growing interest in AI in nursing. However, high-quality clinical research and increased scientific collaboration are needed.

The mediating and moderating role of nursing information competence between nurses' creative self-efficacy and innovation behavior in a specialized oncology hospital

OBJECTIVE

This study aims to examine the impact of nurses' nursing information competence on their creative self-efficacy and innovation behavior, and to investigate its role as a mediating factor between these two elements.

METHODS

A survey was conducted from July to September 2023 involving 1,200 nurses from two tertiary-level oncology specialty hospitals in Beijing, selected through convenience sampling. Instruments used included the Creative Self-Efficacy Scale, Nursing Information Competence Assessment Scale, and Nurses' Innovative Behavior Scale. Data analysis was conducted using SPSS 25.0 and R 4.1.2; AMOS26 was used to construct structural equation models and Bootstrap method was used to test the mediating hypotheses.

RESULTS

Out of the distributed questionnaires, 1,166 were valid, yielding an effective response rate of 97.16%. Pearson correlation analysis revealed significant correlations between innovation self-efficacy, nursing information competence, and nurses' innovative behaviors (P < 0.001). The Bootstrap method indicated that nursing information competence serves as a mediating factor in the relationship between creative self-efficacy and innovative behaviors, contributing to 24.5% of the observed effect. Additionally, regression analysis suggested that nursing information competence moderates the relationship between creative self-efficacy and innovation behavior.

CONCLUSION

The findings suggest that nursing information competence not only mediates but also moderates the relationship between creative self-efficacy and innovative behavior. Enhancing nurses' information competence could therefore foster creative self-efficacy, leading to an increase in innovative behavior and, subsequently, improvements in the quality of oncology nursing care.