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Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Nurses’ and community support workers’ experience of telehealth: a longitudinal case study

Authors: Urvashi Sharma, Malcolm Clarke

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

Introduction 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.

Methods

In 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.

Results

Users 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.

Conclusion

Since 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.
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Literature
1.
go back to reference Chau P, Hu P: Examining a model of information technology acceptance byindividual professionals: An exploratory study. J Mamage Inform Syst. 2001, 18: 191-229. Chau P, Hu P: Examining a model of information technology acceptance byindividual professionals: An exploratory study. J Mamage Inform Syst. 2001, 18: 191-229.
2.
go back to reference Chau P, Hu P: Investigating healthcare professionals’ decisions to accept telemedicine technology: An empirical test of competing theories. Inform Manage. 2002, 39: 297-311. 10.1016/S0378-7206(01)00098-2.CrossRef Chau P, Hu P: Investigating healthcare professionals’ decisions to accept telemedicine technology: An empirical test of competing theories. Inform Manage. 2002, 39: 297-311. 10.1016/S0378-7206(01)00098-2.CrossRef
3.
go back to reference Gagnon M, Duplantie J, Fortin J, Landry R: Implementing telehealth to support medical practice in rural/remote regions: What are the conditions for success?. Implement Sci. 2006, 1 (18): doi:10.1186/1748-5908-1-18 Gagnon M, Duplantie J, Fortin J, Landry R: Implementing telehealth to support medical practice in rural/remote regions: What are the conditions for success?. Implement Sci. 2006, 1 (18): doi:10.1186/1748-5908-1-18
4.
go back to reference May C, Gask L, Atkinson T, Ellis N, Mair F, Esmail A: Resisting and promoting new technologies in clinical practice: the case of telepsychiatry. Soc Sci Med. 2001, 52: 1889-1901. 10.1016/S0277-9536(00)00305-1.CrossRefPubMed May C, Gask L, Atkinson T, Ellis N, Mair F, Esmail A: Resisting and promoting new technologies in clinical practice: the case of telepsychiatry. Soc Sci Med. 2001, 52: 1889-1901. 10.1016/S0277-9536(00)00305-1.CrossRefPubMed
5.
go back to reference May C, Harrison R, Macfarlane A, Williams T, Mair F, Wallace P: Why do telemedicine systems fail to normalize as stable models of service delivery?. J Telemed Telecare. 2003a, 9: S1:25-S1:26. 10.1258/135763303767149906.CrossRef May C, Harrison R, Macfarlane A, Williams T, Mair F, Wallace P: Why do telemedicine systems fail to normalize as stable models of service delivery?. J Telemed Telecare. 2003a, 9: S1:25-S1:26. 10.1258/135763303767149906.CrossRef
6.
go back to reference May C, Harrison R, Finch T, Macfarlane A, Mair F, Wallace P, Telemedicine adoption study group: Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Inform Assoc. 2003, 10: 596-604. 10.1197/jamia.M1145.CrossRefPubMedPubMedCentral May C, Harrison R, Finch T, Macfarlane A, Mair F, Wallace P, Telemedicine adoption study group: Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Inform Assoc. 2003, 10: 596-604. 10.1197/jamia.M1145.CrossRefPubMedPubMedCentral
7.
go back to reference May C, Finch T, Mair F, Mort M: Towards a wireless patient: Chronic illness, scarce care and technological innovation in the United Kingdom. Soc Sci Med. 2005, 61: 1485-1494. 10.1016/j.socscimed.2005.03.008.CrossRefPubMed May C, Finch T, Mair F, Mort M: Towards a wireless patient: Chronic illness, scarce care and technological innovation in the United Kingdom. Soc Sci Med. 2005, 61: 1485-1494. 10.1016/j.socscimed.2005.03.008.CrossRefPubMed
8.
go back to reference Mair FS, May C, Finch T, Murray E, Anderson G, Sullivan F, O’Donnell C, Wallace P, Epstein O: Understanding the implementation and integration of e-health services. J Telemed Telecare. 2007, 13 (SUPPL. 1): 36-37.CrossRef Mair FS, May C, Finch T, Murray E, Anderson G, Sullivan F, O’Donnell C, Wallace P, Epstein O: Understanding the implementation and integration of e-health services. J Telemed Telecare. 2007, 13 (SUPPL. 1): 36-37.CrossRef
9.
go back to reference May C, Ellis NT: When protocols fail: technical evaluation, biomedical knowledge, and the social production of ‘facts’ about a telemedicine clinic. Soc Sci Med. 2001, 53: 989-1002. 10.1016/S0277-9536(00)00394-4.CrossRefPubMed May C, Ellis NT: When protocols fail: technical evaluation, biomedical knowledge, and the social production of ‘facts’ about a telemedicine clinic. Soc Sci Med. 2001, 53: 989-1002. 10.1016/S0277-9536(00)00394-4.CrossRefPubMed
10.
go back to reference Zanaboni P, Wootton R: Adoption of telemedicine: from pilot stage to routine delivery. BMC Med Inform Decis Mak. 2012, 12 (1): doi:10.1186/1472-6947-12-1 Zanaboni P, Wootton R: Adoption of telemedicine: from pilot stage to routine delivery. BMC Med Inform Decis Mak. 2012, 12 (1): doi:10.1186/1472-6947-12-1
11.
go back to reference Heeks R, Davies A: Different approaches to information age reform. Reinventing government in the information age. 2001, London: Routledge Heeks R, Davies A: Different approaches to information age reform. Reinventing government in the information age. 2001, London: Routledge
12.
go back to reference Peddle K: Telehealth in context: Socio-technical barriers to telehealth use in labrador, canada. Comput Supported Coop Work. 2007, 16: 595-614. 10.1007/s10606-006-9030-3.CrossRef Peddle K: Telehealth in context: Socio-technical barriers to telehealth use in labrador, canada. Comput Supported Coop Work. 2007, 16: 595-614. 10.1007/s10606-006-9030-3.CrossRef
13.
go back to reference Nicolini D: The work to make telemedicine work: a social and articulative view. Soc Sci Med. 2006, 62: 2754-2767. 10.1016/j.socscimed.2005.11.001.CrossRefPubMed Nicolini D: The work to make telemedicine work: a social and articulative view. Soc Sci Med. 2006, 62: 2754-2767. 10.1016/j.socscimed.2005.11.001.CrossRefPubMed
14.
go back to reference Nicolini D: Stretching out and expanding work practices in time and space: The case of telemedicine. Hum Relat. 2007, 60: 889-920. 10.1177/0018726707080080.CrossRef Nicolini D: Stretching out and expanding work practices in time and space: The case of telemedicine. Hum Relat. 2007, 60: 889-920. 10.1177/0018726707080080.CrossRef
15.
go back to reference Nicolini D: Medical innovation as a process of translation: A case from the field of telemedicine. Brit J Manage. 2010, 21: 1011-1026. 10.1111/j.1467-8551.2008.00627.x.CrossRef Nicolini D: Medical innovation as a process of translation: A case from the field of telemedicine. Brit J Manage. 2010, 21: 1011-1026. 10.1111/j.1467-8551.2008.00627.x.CrossRef
16.
go back to reference Tjora AH, Scambler G: Square pegs in round holes: Information systems, hospitals and the significance of contextual awareness. Soc Sci Med. 2009, 68: 519-525. 10.1016/j.socscimed.2008.11.005.CrossRefPubMed Tjora AH, Scambler G: Square pegs in round holes: Information systems, hospitals and the significance of contextual awareness. Soc Sci Med. 2009, 68: 519-525. 10.1016/j.socscimed.2008.11.005.CrossRefPubMed
17.
go back to reference Bhattacherjee A, Hikmet N: Physicians’ resistance toward healthcare information technology: A theoretical model and empirical test. Eur J Inform Syst. 2007, 16: 725-737. 10.1057/palgrave.ejis.3000717.CrossRef Bhattacherjee A, Hikmet N: Physicians’ resistance toward healthcare information technology: A theoretical model and empirical test. Eur J Inform Syst. 2007, 16: 725-737. 10.1057/palgrave.ejis.3000717.CrossRef
18.
go back to reference Schermerhorn J, Hunt J, Osborn R: Organizational behaviour. 2008, New Jersey: John Wiley & Sons, 10 Schermerhorn J, Hunt J, Osborn R: Organizational behaviour. 2008, New Jersey: John Wiley & Sons, 10
19.
go back to reference Walter Z, Lopez MS: Physician acceptance of information technologies: Role of perceived threat to professional autonomy. Decis Support Syst. 2008, 46: 206-215. 10.1016/j.dss.2008.06.004.CrossRef Walter Z, Lopez MS: Physician acceptance of information technologies: Role of perceived threat to professional autonomy. Decis Support Syst. 2008, 46: 206-215. 10.1016/j.dss.2008.06.004.CrossRef
20.
go back to reference Hu P, Chau P, Sheng O: Adoption of telemedicine technology by health care organizations: An exploratory study. J Org Comp Elect Com. 2002, 12: 197-221. Hu P, Chau P, Sheng O: Adoption of telemedicine technology by health care organizations: An exploratory study. J Org Comp Elect Com. 2002, 12: 197-221.
22.
go back to reference Biggerstaff D, Thompson RA: Interpretative Phenomenological Analysis (IPA): A Qualitative Methodology of Choice in Healthcare Research. Qual Res Psychol. 2008, 5: 214-224. 10.1080/14780880802314304. doi:10.1080/14780880802314304CrossRef Biggerstaff D, Thompson RA: Interpretative Phenomenological Analysis (IPA): A Qualitative Methodology of Choice in Healthcare Research. Qual Res Psychol. 2008, 5: 214-224. 10.1080/14780880802314304. doi:10.1080/14780880802314304CrossRef
23.
go back to reference Smith JA, Osborn M: Interpretative phenomenological analysis. Qualitative psychology: A practical guide to research methods. Edited by: Smith JA. 2008, London: Sage Smith JA, Osborn M: Interpretative phenomenological analysis. Qualitative psychology: A practical guide to research methods. Edited by: Smith JA. 2008, London: Sage
24.
go back to reference Henderson C, Knapp M, Fernández JL, Beecham J, Hirani SP, Cartwright M, Rixon L, Beynon M, Rogers A, Bower P, Doll H, Fitzpatrick R, Steventon A, Bardsley M, Hendy J, Newman SP: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. Br Med J. 2013, 346: f1035-10.1136/bmj.f1035. doi:10.1136/bmj.f1035CrossRef Henderson C, Knapp M, Fernández JL, Beecham J, Hirani SP, Cartwright M, Rixon L, Beynon M, Rogers A, Bower P, Doll H, Fitzpatrick R, Steventon A, Bardsley M, Hendy J, Newman SP: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. Br Med J. 2013, 346: f1035-10.1136/bmj.f1035. doi:10.1136/bmj.f1035CrossRef
25.
go back to reference Berg M: Implementing information systems in health care organizations: Myths and challenges. Int J Med Inform. 2001, 64: 143-156. 10.1016/S1386-5056(01)00200-3.CrossRefPubMed Berg M: Implementing information systems in health care organizations: Myths and challenges. Int J Med Inform. 2001, 64: 143-156. 10.1016/S1386-5056(01)00200-3.CrossRefPubMed
26.
go back to reference Lehoux P, Sicotte C, Denis J, Berg M, Lacroix A: The theory of use behind telemedicine: How compatible with physicians’ clinical routines?. Soc Sci Med. 2002, 54: 889-904. 10.1016/S0277-9536(01)00063-6.CrossRefPubMed Lehoux P, Sicotte C, Denis J, Berg M, Lacroix A: The theory of use behind telemedicine: How compatible with physicians’ clinical routines?. Soc Sci Med. 2002, 54: 889-904. 10.1016/S0277-9536(01)00063-6.CrossRefPubMed
27.
go back to reference May C: Nursing work, nurses’ knowledge, and the subjectification of the patient. Sociol Health Ill. 1992, 14: 472-487. 10.1111/1467-9566.ep10493107.CrossRef May C: Nursing work, nurses’ knowledge, and the subjectification of the patient. Sociol Health Ill. 1992, 14: 472-487. 10.1111/1467-9566.ep10493107.CrossRef
28.
go back to reference May C: Subjectivity and culpability in the constitution of nurse-patient relationships. Int J Nurs Stud. 1993, 30: 181-192. 10.1016/0020-7489(93)90067-5.CrossRefPubMed May C: Subjectivity and culpability in the constitution of nurse-patient relationships. Int J Nurs Stud. 1993, 30: 181-192. 10.1016/0020-7489(93)90067-5.CrossRefPubMed
29.
go back to reference May C: The clinical encounter and the problem of context. Sociology. 2007, 41: 29-45.CrossRef May C: The clinical encounter and the problem of context. Sociology. 2007, 41: 29-45.CrossRef
30.
go back to reference May C, Allison G, Chapple A, Chew-Graham C, Dixon C, Gask L, Graham R, Rogers A, Ronald M: Framing the doctor-patient relationship in chronic illness: A comparative study of general practitioners’ accounts. Sociol Health Ill. 2004, 26: 135-158. 10.1111/j.1467-9566.2004.00384.x.CrossRef May C, Allison G, Chapple A, Chew-Graham C, Dixon C, Gask L, Graham R, Rogers A, Ronald M: Framing the doctor-patient relationship in chronic illness: A comparative study of general practitioners’ accounts. Sociol Health Ill. 2004, 26: 135-158. 10.1111/j.1467-9566.2004.00384.x.CrossRef
31.
go back to reference Sicotte C, Lehoux P: Teleconsultation: Rejected and Emerging Uses. Method Inform Med. 2003, 42: 451-457. Sicotte C, Lehoux P: Teleconsultation: Rejected and Emerging Uses. Method Inform Med. 2003, 42: 451-457.
32.
go back to reference Gagnon M, Godin G, Gagné C, Fortin J, Lamothe L, Reinharz D, Coultier A: An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. Int J Med Inform. 2003, 71: 103-115. 10.1016/S1386-5056(03)00094-7.CrossRefPubMed Gagnon M, Godin G, Gagné C, Fortin J, Lamothe L, Reinharz D, Coultier A: An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. Int J Med Inform. 2003, 71: 103-115. 10.1016/S1386-5056(03)00094-7.CrossRefPubMed
Metadata
Title
Nurses’ and community support workers’ experience of telehealth: a longitudinal case study
Authors
Urvashi Sharma
Malcolm Clarke
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-164

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