Interprofessional collaboration in telemedicine for long‐term care: An exploratory qualitative study

Abstract

BackgroundWidespread and sustained adoption of telemedicine in long‐term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations.AimsTo explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations.MethodsA qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi‐structured online interviews were conducted, and data were thematically analyzed.ResultsThree themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision‐making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse–physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians.ConclusionInterprofessional collaboration in teleconsultations is challenging because of lack of in‐person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international‐dominated healthcare workforce in long‐term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse–physician collaborative practice.Clinical RelevanceTelemedicine is increasingly adopted in long‐term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

Healthcare professionals’ perceived barriers in providing palliative care in primary care and nursing homes: a survey study

“…69,70 Other interventions and innovative models of collaborative palliative care that involve different HCPs are needed to improve interprofessional collaboration between HCPs and therefore multidemensional care. Concrete examples of such interventions and innovative models are telehealth services, such as videoconferencing, telephonic communication, or remote symptom monitoring, 71 interprofessional collaboration in teleconsultations, 72 such as telephone-based collaborative care, 73 and regionally organized collaborative palliative care. 74 Several studies showed that this care improved patients' quality of life, reduced emergency department visits and the risk of dying in the hospital, the access to HCPs, and decreased caregiver depression and burden.…”

“… 73 – 76 Interventions support HCPs to assess patient care needs, 71 , 77 to optimize information flow 77 and can improve interprofessional collaboration. 72 HCPs experienced this collaborative model as positive, with improved knowledge exchange, collaboration and communication, and more comprehensive care. 78 …”

Care Practices Produced by Primary Care Nurses in the Territory: A Study in Boa Vista, Roraima

“…Dentre suas atribuições de valor específico destacam-se a elaboração de plano de cuidados interprofissionais e colaborativos com a equipe de saúde, centrado nas singularidades das pessoas presentes no território; realização do acolhimento com escuta qualificada, continuidade das ações de saúde orientado por rotinas, protocolos e fluxos assistenciais relacionados a sua área de competência na UBS. (6,7) De outra forma, a atuação do enfermeiro no território também perpassa pelas práticas de busca ativa, consultas domiciliares, coordenação de equipe multiprofissional e agentes comunitários de saúde, registros de ações e atividades vinculadas a educação e promoção da saúde, prevenção de doenças e agravos, proteção e recuperação, além de criar estratégias de abordagem familiar e social. (8) Isso porque ao encontrar com as pessoas, famílias e as comunidades o enfermeiro da UBS, atua como administrador, produtor de práticas preventivas, promocionais, assistenciais e controlador social, o que contribui para o bom funcionamento da dinâmica de saúde no território.…”