Abstract:

The healthcare industry is undergoing a rapid transformation. Telehealth has emerged as an innovative technology that is providing effective medical services to people all around the globe. It is a very effective tool for the patient living in remote areas or who are unable to visit the hospital due to the severity of their medical ailment. However, this technology has its challenges for the nurses. Through this systematic review, an attempt will be made to identify the challenges or barriers faced by the nurses in providing telehealth services to patients. A qualitative methodology is utilized to retrieve data related to the perceptions of the nurses regarding the challenges faced by them. The data collection is done by the telehealth service providers of both public and private hospitals. Thematic analysis is done to determine the different themes of challenges and predict patterns based on these. The study is conducted after taking all the necessary approvals from ethical and legal committees. The findings of the study will help in suggesting strategies and interventions that can be used to mitigate these challenges faced by telehealth nurses. It will ensure that high-quality patient care is provided with the help of this new technology in the healthcare industry.

Introduction:

The Background to the Study

The healthcare industry is continuously transforming to provide more affordable and accessible healthcare services. Telemedicine is an innovative technology, which utilizes telecommunication and clinical data, to provide remote medical consultations to the patient (Steingass & Maloney-Newton, 2020). It is further classified into three types of models namely synchronous (uses real-time electronic communication), asynchronous (uses store and forward communication), and remote monitoring (uses Internet of Things devices). The World Health Organization, in 2010, reported four major services provided under telemedicine namely tele-pathology, tele-radiology, tele-dermatology, and tele-psychiatry (Amjad et al., 2023).

The Significance of the Study

Telemedicine is revolutionizing the field of the healthcare industry. It is enhancing the quality of patient care and increasing the accessibility of healthcare services (Cormi et al., 2020). However, the effective implementation of telemedicine has its challenges. It involves providing high-quality medical services in compliance with the regulatory standards of telemedicine, maintaining the confidentiality of the patient data, and inaccurate reimbursement policies, and developing trust among the patients for choosing telemedicine. In addition to this, the nurses encounter a different category of technological and language barriers to increase the participation of patients in remote medical consultations and provide high-quality medical care (Ghaddaripouri et al., 2023).

The Purpose of the Study

The primary objective of the study is to perform a cross-sectional survey and identify the challenges faced by nurses in delivering high-quality clinical care with the help of telehealth. It will provide valuable insights regarding the different domains such as building rapport with the patient, accessibility of internet services, and using a standard language for online consultations which create hindrances in the effective implementation of telehealth. The outcomes of the study will help in identifying the challenges of telemedicine services, from the perspective of the healthcare professional. Gaps in the existing are also determined. It will help in upgrading the regulatory standards related to telemedicine, provide a more patient-centered approach to medical consultations, and increase the participation of the patients in choosing telehealth facilities.

Research Question

1.What are the key challenges faced by nurses in providing care through telehealth?

2. How do these challenges impact the quality of nursing care delivered through telehealth?

3. What specific areas do nurses encounter difficulties in when delivering care through telehealth?

4. What recommendations can be made to address the identified challenges and improve the delivery of nursing care through telehealth?

5. What are the gaps in the current literature on the challenges faced by nurses in providing care through telehealth, and what areas require further research and exploration?

Research Aim

The aim of this study is to identify the different challenges faced by nurses in providing high quality patient care by using telehealth.

Research Objective

• To identify key challenges faced by nurses in providing care through telehealth.

• To identify the key domains where nurses encounter difficulties in delivering care through telehealth.

• To suggest interventions that will address the challenges and improve the patient care with the help of telehealth nursing.

• To identify gaps in the literature regarding the challenges faced by telehealth nurses.

Literature Review

Telehealth services provided promising results during the Covid-19 pandemic. The use of this facility increased rapidly due to its effective and standardized methods of delivering high-quality patient care. However, the prevalence of telemedicine in the healthcare industry is facing certain challenges and controversial issues (Jonasdottir et al., 2022).
Telehealth is an easily accessible and cost-effective method for receiving medical services. The patients prefer to receive medical consultation from these services and avoid in-person visits to the hospital. They use these facilities for those medical issues, which would not have triggered a hospital visit normally. It has been reported that approximately 90% of online consultations are not a replacement for the hospital visit. They are additional appointments for receiving medical guidance remotely. The exceedingly increased use of these services is also developing a burden for managing healthcare costs for the government (Mahtta et al., 2021).

Telemedicine involves the use of digital technologies such as online video calls, zoom meetings, and other teleconferencing applications. This acts as a disadvantage for nurses to provide medical assistance to patients who live in remote areas with no internet connectivity and have very little knowledge of using these digital technologies. In addition to this, a lack of fluency in commonly spoken languages such as English creates a language barrier between the patient and the online medical service care provider. This leads to disparities in the quality of care and experience of telehealth services for patients living in remote areas or less knowledgeable about the languages (Blandford et al., 2020).

The nurses working in the healthcare industry already have a very high workload. They must manage hundreds of physical patients daily. Thus, they find it difficult to use their spare time to provide telemedicine consultations. Also, telehealth services make the process of accurately diagnosing the disease very difficult. Physically assessing the patients helps the nurse to identify their ailments with the help of examination. But, with online consultations, the nurses only get to know the symptoms told by the patient and cannot identify the other hidden parameters related to the medical condition (Tedeschi, 2020).

Methodology:

Study Design

The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA, 2020) is selected as the research design for the study. It is an appropriate methodology for evaluating the outcomes of systematic reviews.

Inclusion and Exclusion criteria

The studies containing relevant data to telehealth nurses and the challenges faced by them are included in the study. The studies which are not based on telehealth services are excluded.

Search Strategy

Peer reviewed journals such as PubMed Central, Science Direct, Springer, PsycINFO, Medline and Embase are used for detailed literature search. The websites and organizations are also well-known and their content should not be older than 5 years (Zhang et al., 2024).

Search Terms

The complete list of the search used in the study are as follows: telehealth, nurses, challenges, barriers, patient care. Boolean operators namely AND, OR are utilized to logically frame the search terms and retrieve relevant data and research papers from the sources (Masotta et al., 2024).

Quality Assessment

There are various tools and resources available for assessing the quality of the retrieved data from literature search. CASP tool (Critical Appraisal Skills Program) is a systematic method for assessing the quality of different types of research studies.

Ethical considerations

Ethical considerations are of utmost importance while conducting the study. The study participants are briefed about the objectives and the protocol followed for the study. The nurses willing to participate in the study are recruited as study samples. Informed consent is taken from the participants before recruitment. To ensure there is no breach in the privacy of the study participants, strict measures are taken to maintain the anonymity of the nurse, and confidentiality of the responses obtained. Access to the data is restricted to the researchers directly involved in conducting the study (Nejadshafiee et al., 2020).

Expected results:

The literature review for this study involved retrieving 600 studies from the databases and 250 studies from the registers. 9 records are removed before the screening of the studies as they are duplicates and marked as irrelevant by different automation tools. 941 records are screened , out of which 5 are excluded. 936 reports are sought for retrieval and 3 are not retrieved. 933 are evaluated for their eligibility among which 5 reports do not have relevant content , 3 studies do not follow the required intervention and 2 studies do not give the desired outcomes. 919 records, in the end are extracted from databases and registers.
In addition to this, 250 records are obtained from websites, 100 from organizations and 150 from citation searching. 17 records are excluded from retrieval and only 500 records are retrieved. 583 records are then examined for eligibility, where 8 records are excluded as they are extracted from websites older than 5 years, 9 records did not belong to an esteemed organization and 4 records are not relevant to the study. In total, 562 studies are included in conducting the systematic review.

Limitations:

There are certain limitations involved with the study. Firstly, the selection of the study participants can be biased. A majority can be observed for participants belonging to either public or private telemedicine services. It is important to ensure the study sample consists of a diverse range of participants from different expertise, and different public and private hospitals. Secondly, biases can also be observed in the subjective nature of evaluating the qualitative data. This can be resolved by regular discussions to obtain accurate insights into the viewpoints of the nurses for telehealth services.

Timeline:

Conclusion:

The study concludes by providing qualitative insights related to the viewpoints of the nurses for the challenges faced by them in telehealth services. According to nurses, it is a very innovative technology for enhancing the quality of patient care. However, the nurses face technological barriers and increased workload due to excessive appointments of telehealth services. Lack of internet connectivity, digital knowledge, language, and data privacy are some of the other issues faced by them. There is a need to introduce new healthcare policies and standardization of telemedicine services. The data obtained from the qualitative study will help in effectively determining the challenges along with the interventions suitable for addressing these issues. This study will ensure that high-quality medical assistance is provided to all patients through telehealth services.

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