Barriers to and Facilitators of Implementing Overnight Nursing Teleconsultation in Small, Rural Long-Term Care Facilities: Qualitative Interview Study
Notice bibliographique
Résumé
BACKGROUND: Teleconsultation has expanded rapidly in recent years, especially during the COVID-19 pandemic, and has become standard practice among physicians. The benefits of teleconsultation, namely, improving access to care, ensuring continuity and quality of care, increasing patient satisfaction, and reducing costs and wait times, are well documented. However, its use in nursing practice, especially in long-term care settings, remains underresearched despite its significant transformative potential, particularly in resource-limited and rural settings, where it could address major challenges such as nursing shortages and access to care. OBJECTIVE: This study aimed to identify barriers to and facilitators of implementing overnight nursing teleconsultation in rural residential and long-term care centers in Quebec, Canada (centres d'hébergement et de soins de longue durée [CHSLDs]), with ≤50 beds. METHODS: A 6-month pilot project was rolled out sequentially in 3 rural CHSLDs in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 38 semistructured interviews were conducted with managers (n=27, 71%), nursing staff members (n=9, 24%), and resident committee presidents (n=2, 5%) between February 2023 and July 2023. RESULTS: The study identified several barriers to the implementation of teleconsultation. The main barriers reported included union opposition (managers: 23/27, 85%), network instability (resident committee presidents: 2/2, 100%), limited technology skills (nursing staff members: 7/9, 78%), a perceived increase in workload (nursing staff members: 8/9, 89%; resident committee presidents: 2/2, 100%), and a low volume of teleconsultations (nursing staff members: 8/9, 89%). Despite the barriers, participants also identified key facilitators. These included the care setting (nursing staff members: 9/9, 100%; managers: 21/27, 78%), buy-in from senior management and managers (managers: 27/27, 100%; resident committee presidents: 2/2, 100%), collaboration between the departments (nursing staff members: 9/9, 100%), nursing staff motivation (nursing staff members: 9/9, 100%), and improvements in professional practices (nursing staff members: 8/9, 89%). Finally, the relative benefits of teleconsultation, such as enhanced mutual vision, faster assessment of clinical situations, improved resident care management quality, and greater flexibility and safety, were unanimously recognized (38/38, 100%) as contributing to its acceptability and potential for success. CONCLUSIONS: This study provides an in-depth understanding of the barriers to and facilitators of implementing overnight nursing teleconsultation in small rural CHSLDs. This constitutes a sound basis for developing tailored strategies aimed at overcoming identified barriers and optimizing facilitators. The results also provide practical guidelines for decision makers, highlighting the need to adapt implementation approaches to the unique context of each facility. Furthermore, this study highlights the importance of further research to broaden our knowledge on the dissemination and scale-up of health care innovations. This includes the development of learning health systems capable of responding in an agile and effective way to the needs of rural and vulnerable populations both in Quebec and elsewhere.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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