Dutch nurses' willingness to use home telehealth: implications for practice and education

Telemedicine in the primary care of older adults: a systematic mixed studies review

BACKGROUND

Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults.

METHODS

In this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM's effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang's framework. All data were integrated using a joint display matrix.

RESULTS

From 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, 'user habit or preferences' was the most cited barrier and 'location and travel time' was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported 'comfort with patient communication' and 'user interface, intended use or usability' as barriers, and 'technology skills and knowledge' and 'location and travel time' as facilitators. Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes.

CONCLUSIONS

TM in older adults' primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.

Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey

BACKGROUND

In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking.

OBJECTIVE

The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients.

METHODS

A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice.

RESULTS

We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation.

CONCLUSIONS

Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care.

Digital adaptability competency for healthcare professionals: a modified explorative e-Delphi study

AIM

To establish items of the digital adaptability competency for healthcare professionals.

BACKGROUND

While the application and deployment of eHealth has continued at a rapid pace, healthcare professionals are expected to keep up and join the digital evolution. The implementation of eHealth requires a change in the healthcare professionals' competencies of which the ability to adapt to technological change is fundamental. There's more needed than just ICT skills, overall competencies to be digitally adaptable between patientcare and the use of eHealth are needed. Today, a distinct and relevant list of items for healthcare professionals related to the competency of digital adaptability is missing.

DESIGN

An exploratory modified e-Delphi study.

METHODS

This study was conducted in Flanders, Belgium. An expert group (n = 12) consisting of 2 policymakers of the Belgian federal government, 3 eHealth managers of large organizations in the Belgian healthcare sector, 1 nurse, 1 midwife, 2 health service users and 3 researchers specialized in eHealth research. Through a literature review an initial list of items was developed, consisting of 67 statements. A two-round Delphi survey was performed where experts could rate the relevance of each item. The third round comprised an online meeting, where the expert group discussed the remaining items until agreement was reached to retain, modify, or eliminate the item.

RESULTS

In round 1, eleven items were included to the final document. In round 2, ten items were included. In round 3, the panel unanimously agreed to add six items, one item was modified into two separate items. In total, 29 items were included in the final document.

CONCLUSIONS

The rather abstract concept of digital adaptability is now transformed into a more pragmatic concept of 29 items, reflecting the practical competencies of healthcare professionals necessary to be digital adaptable.

Factors affecting telepractice use in COVID-19

Background

The use of telepractice as an alternate method of delivering healthcare to people increased significantly after COVID-19 became a global pandemic.

Objectives

This study aimed to identify factors contributing to the accelerated adoption of telepractice during COVID-19 in Singapore. It also sought to examine whether there are differences in the perspectives of staff in nursing facilities and caregivers in personal homes towards telepractice.

Methods

A cross-sectional mixed method design was used. A survey with 20 items was adapted from the Telehealth Usability Questionnaire and translated into Mandarin. Anonymous responses were obtained from 70 patients and caregivers who had received speech therapy services via telepractice from a restructured hospital before and/or during Singapore’s Circuit Breaker period. Analyses were conducted using descriptive statistics and content analysis.

Results

Sociodemographic variables of age, gender, education level and language preference did not impact user satisfaction and the likelihood of using telepractice again. Service-related factors were more influential. Participants chose to use telepractice as it saved travelling time (24.0%), was easy to use (19.3%), improved healthcare access (17.5%) and reduced waiting time (17.5%). Although all respondents expressed satisfaction in telepractice, 35.5% from personal homes and 37.5% from nursing facilities were not keen to use it again. Amongst caregivers, 26.7% from personal homes and 37.5% from nursing facilities preferred not to continue telepractice use. Technical and logistical disruptions and the lack of ‘personal touch’ were contributing factors.

Conclusion

Improving technological infrastructure, providing training for users and developing guidelines would help sustain telepractice as a form of service delivery beyond COVID-19.

Healthcare providers' acceptance of telemedicine and preference of modalities during COVID-19 pandemics in a low-resource setting: An extended UTAUT model

Background

In almost all lower and lower middle-income countries, the healthcare system is structured in the customary model of in-person or face to face model of care. With the current global COVID-19 pandemics, the usual health care service has been significantly altered in many aspects. Given the fragile health system and high number of immunocompromised populations in lower and lower-middle income countries, the economic impacts of COVID-19 are anticipated to be worse. In such scenarios, technological solutions like, Telemedicine which is defined as the delivery of healthcare service remotely using telecommunication technologies for exchange of medical information, diagnosis, consultation and treatment is critical. The aim of this study was to assess healthcare providers’ acceptance and preferred modality of telemedicine and factors thereof among health professionals working in Ethiopia.

Methods

A multi-centric online survey was conducted via social media platforms such as telegram channels, Facebook groups/pages and email during Jul 1- Sep 21, 2020. The questionnaire was adopted from previously validated model in low income setting. Internal consistency of items was assessed using Cronbach alpha (α), composite reliability (CR) and average variance extracted (AVE) to evaluate both discriminant and convergent validity of constructs. The extent of relationship among variables were evaluated by Structural equation modeling (SEM) using SPSS Amos version 23.

Results

From the expected 423 responses, 319 (75.4%) participants responded to the survey questionnaire during the data collection period. The majority of participants were male (78.1%), age <30 (76.8%) and had less than five years of work experience (78.1%). The structural model result confirmed the hypothesis “self-efficacy has a significant positive effect on effort expectancy” with a standardized coefficient estimate (β) of 0.76 and p-value <0.001. The result also indicated that self-efficacy, effort expectancy, performance expectancy, facilitating conditions and social influence have a significant direct effect on user’s attitude toward using telemedicine. User’s behavioral intention to use telemedicine was also influenced by effort expectancy and attitude. The model also ruled out that performance expectancy, facilitating conditions and social influence does not directly influence user’s intention to use telemedicine. The squared multiple correlations (r²) value indicated that 57.1% of the variance in attitude toward using telemedicine and 63.6% of the variance in behavioral intention to use telemedicine is explained by the current structural model.

Conclusion

This study found that effort expectancy and attitude were significantly predictors of healthcare professionals’ acceptance of telemedicine. Attitude toward using telemedicine systems was also highly influenced by performance expectancy, self-efficacy and facilitating conditions. effort expectancy and attitude were also significant mediators in predicting users’ acceptance of telemedicine. In addition, mHealth approach was the most preferred modality of telemedicine and this opens an opportunity to integrate telemedicine systems in the health system during and post pandemic health services in low-income countries.

Needs, barriers and facilitators of older adults towards eHealth in general practice: a qualitative study

Background:

The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice.

Aim:

The aim of this study was to identify the needs, barriers and facilitators amongst community-dwelling older adults (60+) suffering from one or more chronic health conditions, in using online eHealth applications to support general practice services.

Methods:

A qualitative study, using semi-structured followed by think-aloud interviews, was conducted in the Netherlands. The semi-structured interviews, supported by an interview guide were conducted and analysed thematically. The think-aloud method was used to collect data about the cognitive process while the participant was completing a task within online eHealth applications. Verbal analysis according to the Chi approach was conducted to analyse the think-aloud interviews.

Findings:

A total of n = 19 older adults with a mean age of 73 years participated. The ability to have immediate contact with the GP on important health issues was identified as an important need. Identified barriers were non-familiarity with the online eHealth applications and a mismatch of user health needs. The low computer experience resulted in non-familiarity with the online eHealth applications. Faltering applications resulted in participants refusing to participate in the use of online eHealth applications. Convenience, efficiency and the instant availability of eHealth via applications were identified as important facilitators.

Conclusion:

To improve the use and acceptability of eHealth applications amongst older adults in the general practice, the applications should be tailored to meet individual needs. More attention should be given to improving the user-friendliness of these applications and to the promotion of the benefits such as facilitating older adults independent living for longer.

Educational intervention to increase nurses' knowledge, self-efficacy and usage of telehealth: A multi-setting pretest-posttest study

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6-10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.

Understanding Clinicians' Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks

BACKGROUND

Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors.

OBJECTIVE

This review aimed to explore which frameworks are used the most, to understand clinicians' adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors.

METHODS

This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians' adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly.

RESULTS

The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34%), the diffusion of innovation theory (DOI; 8/50, 16%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6%), whereas others used the consolidated framework for implementation research (3/50, 6%) and sociotechnical systems (STS) theory (2/50, 4%). The factors cited by more than 20% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion.

CONCLUSIONS

Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians' adoption of mHealth, taking into account all three aspects.

Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review

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.

Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review

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.

Hospital Nurses' Self-Reported Confidence in Their Telehealth Competencies

BACKGROUND

The diffusion of telehealth into hospital care is still low, partially because of a lack of telehealth competence among nurses. In an earlier study, we reported on the knowledge, skills, and attitudes (KSAs) nurses require for the use of telehealth. The current study describes hospital nurses' confidence in possessing these telehealth KSAs.

METHOD

In a cross-sectional study, we invited 3,543 nurses from three hospitals in the Netherlands to rate their self-confidence in 31 telehealth KSAs on a 5-point Likert scale, using an online questionnaire.

RESULTS

A total of 1,017 nurses responded to the survey. Nine KSAs were scored with a median value of 4.0, 19 KSAs with a median value of 3.0, and three KSAs with a median value of 2.0.

CONCLUSION

Given that hospital nurses have self-confidence in only nine of the 31 essential telehealth KSAs, continuing education in additional KSAs is recommended to support nurses in gaining confidence in using telehealth. [J Contin Educ Nurs. 2019;50(1):26-34.].

A Qualitative Content Analysis of Nurses' Comfort and Employment of Workarounds With Electronic Documentation Systems in Home Care Practice

Background

Electronic documentation systems have the potential to assist registered nurses with timely access to patient health- and care-related information. Registered nurses are the largest users of electronic documentation systems; however, limited evidence exists about their comfort with electronic documentation system usage and the types of workarounds developed within the context of home care.

Aim

To explore home care registered nurses’ comfort with electronic documentation system usage and identify the types and reasons for the development and implementation of workarounds.

Methods

A cross-sectional survey design was employed to collect quantitative and qualitative data. A total of 217 home care registered nurses participated in the survey. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using inductive content analysis. Findings: Individual (e.g., registered nurses’ technology-related experience), technological (e.g., electronic documentation system design) and organizational (e.g. training) characteristics influenced registered nurses’ comfort with electronic documentation system usage. Furthermore, workarounds stemmed from the technological characteristics of the electronic documentation system.

Conclusion

Findings highlight the need for assessing registered nurses’ level of comfort with electronic documentation system usage to inform training initiatives. Including registered nurses in the system design is advocated to ensure electronic documentation systems fit with the complexity of nursing practice, potentially enhancing registered nurses’ level of comfort and mitigating the development and employment of workarounds during system usage.

Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review

Background

Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users.

Objective

The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine.

Methods

An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies.

Results

Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models.

Conclusions

The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group’s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.

Nurses developing confidence and competence in telehealth: results of a descriptive qualitative study

BACKGROUND

The widespread use of telehealth brings benefits to improve access to healthcare for rural and remote populations.

OBJECTIVE

This study explores what nurses considered important to confidently and competently participate in telehealth.

DESIGN

A descriptive qualitative approach was selected.

METHODS

Nine New Zealand Registered Nurses who worked in different clinical settings who use telehealth were identified through snowball sampling, and participated in single semi-structured interviews, which were thematically analysed using a general inductive approach.

FINDINGS

The nurses' experience of using telehealth, from novice to becoming more proficient, was the main theme identified, with sub-themes of: Initial use of telehealth, hands-on training, specialty experience, mentorship and technological know-how. The confidence of nurses using telehealth in this study may reflect their clinical nursing experience.

CONCLUSION

Recommendations include the need for more telehealth education and preparation, including incorporating telehealth in under and postgraduate nursing programmes. Additionally, specific telehealth nursing competencies are warranted.

Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study

Background

The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology.

Objective

The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators.

Methods

A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2).

Results

In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations.

Conclusions

Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology.

Planning Telehealth for Older Adults With Atrial Fibrillation in Rural Communities: Understanding Stakeholder Perspectives

Older adults with atrial fibrillation (AF) in rural communities have less access to cardiac specialty care. Telehealth offers a viable approach to provide cardiac care, yet little is known about patients’ and providers’ views on telehealth’s potential to support rural patients with AF. This qualitative descriptive study examines patient and health providers’ perspectives, an important first step in planning a telehealth initiative. Eight patients with AF, along with one partner from rural communities, were recruited through an urban-based AF clinic. Five providers were recruited through professional practice leads in the health region. Semistructured telephone interviews were conducted with both stakeholder groups. The overriding theme was variability in patient and provider receptiveness to telehealth. Receptiveness reflected differences in past experience with telehealth, in perceived adequacy of rural health services, and in perceived gaps in AF care. These are important considerations in planning effective and sustainable telehealth in rural communities.

Internet-Generation Nursing Students' View of Technology-Based Health Care

BACKGROUND

Today's nursing school applicants are considered "digital natives." This study investigated students' views of new health care technologies.

METHOD

In a cross-sectional survey among first-year nursing students, 23 common nursing activities and five telehealth nursing activities were presented along with three statements: "I consider this a core task of nursing," "I look forward to becoming trained in this task," and "I think I will do very well in performing this task."

RESULTS

Internet-generation nursing students (n = 1,113) reported a significantly (p ⩽ .001) less positive view of telehealth activities than of common nursing activities. Median differences were 0.7 (effect size [ES], -0.54), 0.4 (ES, -0.48), and 0.3 (ES, -0.39), measured on a 7-point scale.

CONCLUSION

Internet-generation nursing students do not naturally have a positive view of technology-based health care provision. The results emphasize that adequate technology and telehealth education is still needed for nursing students. [J Nurs Educ. 2017;56(12):717-724.].

Competencies required for nursing telehealth activities: A Delphi-study

BACKGROUND

Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education.

METHOD

In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%.

RESULTS

Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth.

DISCUSSION/CONCLUSION

Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

A Mobile Phone App to Stimulate Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: Development, Feasibility, and Pilot Studies

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks.

OBJECTIVE

To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation.

METHODS

The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD.

RESULTS

The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable.

CONCLUSIONS

By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients.