Best Practices for Telehealth in Nurse-Led Care Settings—A Qualitative Study

Abstract

The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.

When “virtual” works and when it doesn’t: A survey of physician and patient experiences with virtual care during the COVID-19 pandemic

“…Findings from this study are largely consistent with what has been reported elsewhere. 17 , 18 , 32 Virtual care existed pre-pandemic but was not widely adopted and the imposition created by the pandemic necessitated everyone to quickly open up to the possibility of this as a viable mode of healthcare delivery. 17 The positive attitudes among both physicians and patients reflect findings from work that predated the pandemic and have been found in numerous other studies done across a variety of settings and health conditions.…”

“…Many individuals still prefer to attend in person in the absence of other barriers, as they see this as an important aspect of their assessment and relationship with the provider. 23 , 32 , 33 Providers also may not feel confident in their ability to accurately assess, diagnose, and manage illness in the absence of visual cues. 31 Interestingly, we saw some individuals feel that virtual was superior for certain health needs while others felt it was inferior for the same conditions (e.g.…”

“…It can also be a useful tool to follow up on an in-person encounter, to review results, and treatment response, and provide education and counseling. Both parties may be most comfortable in the context of a pre-existing relationship or known condition, 10 , 32 however, in many situations a virtual visit between a new patient and provider or for a new problem can likely achieve the desired outcome. While the telephone offers convenience and has fewer technological issues, expanding the availability and adoption of other virtual means such as videoconferencing will offer additional options that allow patients and providers to “see” each other, interpret cues, and give visual evidence of a health concern.…”