Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies

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Telehealth was introduced already in the 1960s but the real breakthrough came in the 1990s, thanks to advanced technology and innovations in the field of health care 1. In the early days, telehealth services mostly involved the use of videoconferencing systems. More recently, Internet applications and mobile phones have been taken into use in communication between healthcare professionals and patients 3. According to the World Health Organization (WHO), telehealth means ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities' 4. This definition provides basis for this review.
In Western countries, the use of ICT is common in healthcare services and operations. The range of possibilities provided by ICT in the healthcare sector is enormous 5. Electronic patient record systems are the most commonly used applications. However, telemedicine and telecare services, health informatics networks, decision support systems and Internet‐based technologies are used only to some extent 6. A previous study by Gibson et al. indicates that nurses do not necessarily use telehealth applications despite considerable distances between patients and care providers 8.
Electronic exchange of information between institutions has gradually become more common 9. eReferral and eDisharge summary systems for the communication of patient data have proved to be useful methods for sharing information between professionals and organisations 10. Citizens are also accustomed to use ICT. With the help of Internet services, people can search public health‐related information, but also personal information based on their own health needs 11.
According to some recent studies, nursing care is gradually being more often delivered at home than in institutions, such as hospitals 14. The expectations concerning telehealth adoption are high. It has been said that telehealth solutions have the potential to increase patients' self‐management and empowerment 7. Effective communication between the patient and nursing staff has a significant role in patient care. Nurses help patients to become empowered regardless of their illness and to assert their role as partners in decision‐making 7. The use of telehealth applications may significantly change the quality of communication and nurses' working practices 17. The use of telehealth is seen as a means to improve communication 18 and to enhance patient‐centred care 19.
In daily duties with patients, nurses want to use telehealth applications that support nursing interventions with patients. However, there is variation in how nurses accept ICT in their daily work. Some nurses accept it extremely well and use it efficiently 21. However, lack of familiarity and uncertainty about the skills related to the use of ICT applications can affect acceptance of the systems 22. Additionally, staff members may have insufficient knowledge of computers and difficulties handling the applications 23. If applications are easy to use and users are well educated in utilising them, they feel more satisfied with ICT and are more likely to continue to make use of it 22.
In earlier studies, the focus of interest has mostly been on different patient groups as users of telehealth applications. Some studies have found little evidence of clinical benefits of using eHealth technologies when comparing telemedicine with face‐to‐face patient care 6. These interventions may improve quality of life and reduce costs as well as save nurses' working time 20. Delivery of health services by real‐time video communication was assessed to be more cost‐effective than ordinary home visits 28.
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