Telehealth in Nursing: Evidence From Six Key Studies

Introduction

Telehealth in nursing and its ability to support quality care has received considerable attention in recent years. Several studies examine the role of telehealth in supporting patients and helping nurses provide quality care across a variety of clinical settings and populations.

Telehealth and Elderly Assisted Living

The study by Greenhalgh, Wherton, Sugarhood, Hinder, Procter et al. (2013) conducts a qualitative phenomenological study on how telehealth and telecare help elderly persons with their assisted living needs. The study finds that these tools are helpful to varying degrees depending on the patients' needs and the nurses' role in providing care. The researchers visited forty participants aged 60–98 at home on multiple occasions, building detailed pictures of their lives, illness experiences, and technology use. Data were analyzed phenomenologically and contextualized using a structuration approach. They found that each participant's needs were diverse and unique, and that most installed assistive technologies met few participants' needs — some devices had been abandoned and a few deliberately disabled. The study concludes that a radical revision of assistive technology design policy may be needed.

Patient Beliefs and Quality of Care

Gorst, Coates, and Armitage (2016) conduct a qualitative study on how patients' beliefs and personal feelings regarding telehealth affect their quality of care. The study employed semi-structured interviews with eight patients with chronic obstructive pulmonary disease who were currently using home telehealth. Most participants described their experience in positive terms, but most also valued face-to-face time with their caregivers. The study identifies four key themes: perceiving benefits of being "watched over," learning about their health condition and self-management, active engagement in health service provision, and valuing in-person care. The authors suggest that communicating the positive aspects of home telehealth — such as better access to care and peace of mind — could improve uptake, while occasional in-person visits should be maintained to sustain long-term use.

Frontline Staff Acceptance and Barriers

Brewster et al. (2014) use both qualitative and quantitative data in a mixed-methods systematic review to examine the impact of telehealth on frontline operations in nursing. The review synthesizes evidence on frontline staff acceptance of telehealth technologies for the management of chronic obstructive pulmonary disease and chronic heart failure. Fourteen studies met the inclusion criteria, including quantitative surveys, mixed-method studies, and qualitative approaches such as focus groups, interviews, document analysis, and observations. The study finds that most nurses accept telehealth positively, but that barriers related to service change, staff–patient interaction, credibility, autonomy, and technical issues remain. The authors conclude that the lack of acceptance of this new way of working may be a key barrier to implementation, and that solutions beyond mere barrier identification are needed if future rollout is to succeed.

Pediatric Telehealth and Clinical Responsibility

The study by Wilson (2016) is a mixed-methods evaluation — both qualitative and quantitative — of a pilot telehealth service for pediatric unscheduled care in rural northern Scotland. The Paediatric Unscheduled Care (PUC) pilot aimed to provide non-specialist physicians and families with fast access to specialist assessment via videoconferencing. Although the model was popular with families and junior physicians, the evaluation found that it proved expensive, and concerns emerged about where clinical responsibility lay. The study indicates that pediatric telehealth raises distinct accountability challenges and that telehealth may be better suited to senior care than to child care in certain service configurations.

Patient Satisfaction: Quantitative and Qualitative Evidence

Spindler et al. (2014) conducted a quantitative randomized controlled trial to measure patient satisfaction when telehealth services were employed for Parkinson's disease subspecialty care at a VA facility. The study enrolled 86 male patients, randomizing them to home telehealth, outreach telehealth, or usual in-office care. Patient satisfaction — assessed at six and twelve months through quantitative questionnaires and qualitative interviews — was the primary outcome. Secondary outcomes included quality of life, depression, travel cost, and clinical events. The study demonstrated the feasibility of telehealth for Parkinson's disease within a Patient-Centered Medical Home model and showed that telehealth increased patient satisfaction. The study is valuable in demonstrating that telehealth services help healthcare providers overcome practical obstacles while enabling patients to receive better quality care.