Barriers to and Facilitators of Implementing Overnight Nursing Teleconsultation in Small, Rural Long-Term Care Facilities: Qualitative Interview Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".