JMIR Publications

ABSTRACT

Background:

Innovative solutions to nursing care are needed to address nurse, health system and patient/caregiver concerns related to nursing wellness, work flexibility and control, workforce retention/pipeline, and access to patient care. PocketRN is one such innovation - a telemedicine tool that enables nurse-led virtual care.

Objective:

This pilot study aimed to evaluate initial launch of PocketRN in home wound care from the perspective of nurses and patients. Specifically, we: 1) identified and addressed early problems in implementation and functionality; 2) assessed implementation science outcomes of feasibility, adoption, acceptability, and clinical appropriateness in the wound care context; and 3) informed scalability and next steps in intervention roll out.

Methods:

Patients and part-time or per diem nurses were recruited through Stanford Medicine Advanced Wound Care Center in 2021 and 2022. For this mixed methods evaluation, qualitative data included semi-structured interviews with nurses and patients, and document review. Quantitative data were obtained from the PocketRN app and included: app utilization, and brief end-of-interaction satisfaction surveys of nurses and patients.

Results:

This pilot study suggests that utilizing nurses in a new virtual care delivery model via PocketRN is acceptable, clinically appropriate, and feasible, with barriers in terms of initial uptake and patient technological literacy. Low tech literacy appeared to have a modest effect on patient adoption initially, but barriers were addressed by trial modifications that built in outreach. PocketRN was highly acceptable for users, despite total adoption numbers that were lower than anticipated. Patients who used PocketRN were satisfied and reported reduced patient anxiety with real-time advice after hours. Nurses appreciated working from home, and in terms of clinical appropriateness, reported comfort with the scope of practice; there was interest in additional wound care-specific training for non-specialized nurses.

Conclusions:

PocketRN addressed known gaps for telehealth, with positive feedback on integration into standard healthcare services. Specifically, utilizing nurses from the target clinic/system (e.g., wound care, who had access to EHR and some of whom had specialized knowledge) facilitated integration and was seen as highly beneficial by patients and nurses alike. PocketRN also succeeded in satisfying top nursing desires for flexibility in terms of where nurses are working. Capitalizing on trends towards remote work, PocketRN met nurses where they are: at home. Finally, patients who engaged with PocketRN reported that simply having access to nursing on-demand through PocketRN reduced anxiety, which according to the literature should reduce major risks of post-operative wound care, such as increased pain and infection risk. Concerns around low patient technology literacy and equity issues surrounding technology and language appeared to negatively impact PocketRN feasibility for some patients, with room to grow in terms of additional training for patients and providing language support for equitable access.