Abstract
BackgroundIntroduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced.MethodsIn a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation.ResultsUsers experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise.ConclusionSince the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients.
Highlights
Introduction ofcommunity support workers (CSWs) resulted in another change in the daily routine of the nurses
With initial study results showing reduced hospital admission and increase in capacity of case managers, in 2009, The Nottingham City Primary Care Trust (PCT) decided to implement telehealth on a larger scale alongside case management provided by community matrons (CM), chronic heart failure (CHF) nurses and chronic obstructive pulmonary disease (COPD) nurses
You are doing on telehealth and having to transfer it to SystemOne” (FGD 2009)
Summary
Introduction ofCSWs resulted in another change in the daily routine of the nurses. the nurses were involved in the training of the CSWs, they were unclear of the role of the CSWs, and what could be expected of the CSWs. The CSWs reported that their role in the telehealth service had become more clearly defined and that they had gained more confidence and established a good reputation. Nurses agreed with this and argued that what had originally been felt as a cause of disruption to routine had become a valuable resource: “We couldn’t do telehealth without her (CSW), to be honest......She’s taken it on. The telehealth service enables collection of remote patient data such as blood glucose level, weight, blood pressure, oxygen level and heart rate. Received data is studied by an elected clinical team member responsible for ensuring that any immediate alerts are addressed
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