JMIR Publications

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, as well as reducing costs and wait times, are well documented. However, its use in nursing practice, especially in long-term care settings, remains under-researched 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 and facilitators to implementing overnight nursing teleconsultation in Quebec’s rural residential and long-term care centers (“Centres d’hébergement et de soins de longue durée”; CHSLDs) with ≤50 beds.

Methods:

A six-month pilot project was rolled out sequentially in three rural CHSLDs in two administrative regions of Quebec between July 2022 and March 2023. A total of 38 semi-structured interviews were conducted with managers (27/38), nursing staff members (9/38), and resident committee presidents (2/38) between February and July 2023.

Results:

The results highlight several barriers to implementing teleconsultation. Among the main barriers identified by the study were union opposition, network instability, limited technology skills, a perceived increase in workload for nursing staff, as well as a low volume of teleconsultations. However, participants also identified a number of facilitators, namely the care setting, the on-call nursing culture, buy-in from senior management and managers, and support from project leaders and site managers. Collaboration between the Nursing Department (ND) and the Support for the Autonomy of Seniors Department (SASD), the transfer of knowledge and experience, nursing staff motivation, the development of nursing roles and improved professional practices were also identified as significant engines of success. Finally, the relative benefits of teleconsultation, such as enhanced mutual vision, faster assessment of clinical situations, improved quality of resident care management, as well as greater flexibility and safety, played a significant role in its acceptability and potential for success.

Conclusions:

This study provides an in-depth understanding of the barriers and facilitators to 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, the study highlights the importance of further research to broaden our knowledge on the dissemination and scale-up of healthcare 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.