Assessing a nurse-assisted eHealth intervention posthospital discharge in adult patients with non-communicable diseases: a protocol for a feasibility study

Use of the chronic illness research recruitment taxonomy to evaluate recruitment strategies in an eHealth feasibility study

Background

Chronic illness research has many challenges making research recruitment difficult. Despite reports of facilitators and barriers to research recruitment challenges remain. The reporting of research strategies and their impact on recruitment and subsequent randomised control trials is not sufficient. A newly developed chronic illness research recruitment taxonomy (CIRRT) details factors and elements observed to impact recruitment around the components of Project, People, and Place. This paper aims to use the chronic illness research recruitment taxonomy to report and evaluate the recruitment strategies, impact they had on recruitment, and alterations to an eHealth feasibility study.

Methods

Retrospective mixed method approach was used to inductively code the research team meeting minutes during the recruitment period. The coding was then abductively matched to the chronic illness research recruitment taxonomy and gaps in the CIRRT noted. Dated coding data were integrated with recruitment progress to explore the impact of research recruitment strategies.

Results

Meeting minutes (n = 66) were analysed, recruitment strategies identified and matched to CIRRT. The reporting and identification of the recruitment strategies was aided by CIRRT use. By integrating the codes that aligned with CIRRT with recruitment progress was observed to be impacted by staffing and researcher visits.

Conclusions

CIRRT may be a useful tool in the evaluation and reporting of research recruitment strategies. Altering the roles of nurses involved and researcher visits to recruiting sites may positively impact on chronic illness research recruitment.

Nurse-Assisted Remote Patient Monitoring for Self-Management Support to Patients With Long-Term Illness-A Qualitative Multimethod Study

AIM

To explore patients and nurses' experiences of digital self-management support following participation in a remote patient monitoring intervention.

DESIGN

An exploratory qualitative multimethod study.

METHODS

The study was conducted at two Norwegian university hospitals between January 2022 and February 2023. Data were obtained through semistructured interviews of 17 patients with heart failure, 10 patients surgically treated for colorectal cancer and eight nurses. The data collection also included excerpts from chat messages between patients and nurses obtained from the digital platform during January and February 2024. Data were analysed using abductive thematic analysis.

RESULTS

The analysis revealed three themes: (1) raising illness awareness through RPM technology, (2) establishing a mutual collaboration in self-management challenges and (3) fostering a continued engagement in health behaviour change. The themes captured patients and nurses' experiences of receiving and providing digital self-management support. The analysis also identified a unifying key theme: 'bridging technology and self-management support through remote caring encounters', which firmly connected the three themes.

CONCLUSION

Remote patient monitoring appeared to benefit both patients and nurses by altering patients' self-management routines and the nurses' workflows. Furthermore, applying the theory of technological competency as caring in nursing to remote patient monitoring interventions may help ensure that the patient-nurse relationship is not weakened as technology advances.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Remote patient monitoring interventions have the potential to become a valuable tool in modern healthcare, enabling effective communication and collaboration between patients and nurses while also ensuring patient-centred care. However, future development of remote patient monitoring interventions should include nursing support.

IMPACT

This study addresses remote patient monitoring and digital self-management support from the perspectives of both patients and nurses. The findings may have an impact on remote nursing, patient satisfaction and strategies to improve digital follow-up care for patients with long-term illnesses.

REPORTING METHOD

The authors adhered to the EQUATOR guidelines through the SRQR reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illness: A qualitative study

Background

Patients living with long-term chronic illnesses often need ongoing medical attention, lifestyle adjustments, and psychosocial support beyond the initial diagnosis and treatment phases. Many experience illness deterioration and subsequently require hospitalisation, especially in the transition period after hospital discharge. A promising strategy for managing long-term conditions is promoting self-management. eHealth interventions involving remote patient monitoring have the potential to promote self-management and offer a more seamless bridge between the hospital and the patient´s home environment. However, such interventions can only significantly impact health and health care if they are effective, accepted and adopted by users, normalised into routine practice and everyday life, and able to be widely implemented. Feasibility studies are used to determine whether an intervention is suitable for the target population and effective in achieving its intended goal. They may also provide critical information about an intervention´s acceptability and usability.

Objectives

We aimed to evaluate the acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illnesses by use of the core constructs of normalisation process theory.

Design

A descriptive and explanatory qualitative approach was used, with patients observed during training and semi-structured interviews conducted with patients and nurses after study completion.

Settings

Participants were recruited from two university hospitals in Norway between December 2021 and February 2023.

Participants

Ten patients were observed during training, and 27 patients and eight nurses were interviewed after study completion.

Methods

Structured and overt observations were made while the patients received training to operate the remote patient monitoring service, guided by an observation guide. Semi-structured interviews were conducted with patients and nurse navigators about their experiences of remote follow-up care, guided by open ended questions. Data analysis followed a stepwise deductive inductive method.

Results

`Achieving acceptance and usability through digital social interaction´ emerged as a unifying theme that bridged the experiences of patients with long-term illnesses and the nurse navigators. This overarching theme was illustrated by four sub-themes, which all reflected the usability and acceptability of the nurse-assisted remote patient monitoring service in various ways.

Conclusion

Acceptability and usability are critical factors to consider when evaluating remote patient monitoring interventions. In this study, the most important feature for promoting acceptability and usability was the interaction between patients and nurse navigators. Therefore, the intervention´s feasibility and implementation potential rested upon the relationship between its deliverer and receiver.

Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial

BACKGROUND

Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care.

METHODS

A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis.

DISCUSSION

This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice.

TRIAL REGISTRATION

Clinical trials.gov (ID 301472).