Telenursing Home Care and COVID-19: a Qualitative Study
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Original research BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003001 on 29 June 2021. Downloaded from Telenursing home care and COVID-19: a qualitative study Zeynab Kord,1 Zhila Fereidouni,2 Mohammad Saeed Mirzaee,3 Zeinab Alizadeh,4 Mohammad Behnammoghadam ,5,6 Malihe Rezaei,7 Naeem Abdi,8 Fatemeh Delfani,9 Parisa Zaj10 ► Additional supplemental ABSTRACT Key messages material is published online Background The COVID-19 pandemic has led only. To view, please visit the journal online (http:// dx. doi. to many challenges such as increased number of What was already known? org/ 10. 1136/ bmjspcare- 2021- patients and the risk of the disease progress in the ► Telenursing was one of the most important 003001). world’s healthcare systems, especially nursing. The methods for nursing care. Telenursing capacity of technology can help nursing in such For numbered affiliations see end can improve quality of care and patient of article. conditions. The aim of this study was to explore the outcomes. lived experiences of patients with COVID-19 with What are the new findings? Correspondence to home care by using telenursing. Mr Mohammad ► The results of the present study revealed Behnammoghadam and Ms Methods The present study is a qualitative research that accurate identification of the Malihe Rezaei, Department of conducted using the descriptive phenomenological facilitators and barriers of telenursing for Nursing, Yasuj University of method. The participants were selected using the home care of COVID-19 patients could Medical Sciences, Yasuj, Iran; purposive sampling method and considering the contribute to the effective and efficient mbehnam1363@ gmail. com, maliherezaei8954@ gmail. com inclusion and exclusion criteria. After obtaining implementation of this technology ethical approval, data were collected through What is their significance? Received 18 February 2021 semistructured interviews. Open- ended questions ► Clinical: Caregiving facilitators can Accepted 2 June 2021 copyright. and follow-up were used in the interviews. The facilitate the implementation of nursing interviews were conducted using Skype application care and, consequently, improve the and telephone. All data were recorded, and health of patients. MAXQDA software was used to manage the data. ► Research: to apply the results of this Data analysis was performed using Colaizzi’s seven- research with regard to the use of step method. Lincoln and Guba’s criteria were used telenursing as quickly as possible in the to evaluate the trustworthiness of the data. field of care, education, patient support, and patient follow- up and counseling Results The main themes and their subthemes through conducting strong field research included ‘facilitators’ (improvement of relationships, adequate education and http://spcare.bmj.com/ counselling, adequate care and support, 1 improvement and promotion of health) and and vomiting in patients. As a pandemic, ‘barriers’ (lack of previous knowledge and the COVID-19 crisis has given rise to many problems in the health system of different experience, infrastructure problems, confusion in 2 hospital programmes and the pressure caused by countries. A large number of patients the COVID-19 pandemic). and referrals to hospitals has increased the Conclusion Given the potential capacity number of hospitalisations, treatment costs and work pressure on nurses.3–5 From the of telenursing, strong field studies are on October 2, 2021 by guest. Protected recommended to be conducted in this area. outset of the pandemic, nurses as health- The results of such studies can contribute to care staffs have always provided a variety of hospital, social and home services.6 7 Given © Author(s) (or their the rapid and serious use of telenursing in the employer(s)) 2021. No area of care, education, support, follow-up and the various conditions and care needs of commercial re- use. See rights counselling of patients. patients with COVID-19, continuity of care and permissions. Published by for these patients is important as it may BMJ. facilitate the treatment process, improve To cite: Kord Z, Fereidouni Z, the condition of the disease and control its Mirzaee MS, et al. BMJ complications.8 Home care is an aspect of Supportive & Palliative Care Epub ahead of BACKGROUND continuity of care which can be effective print: [please include Day COVID-19 is a viral disease that causes in facilitating the treatment process of the Month Year]. doi:10.1136/ various respiratory symptoms and other patients who do not need hospitalisation, bmjspcare-2021-003001 symptoms such as taste problems, nausea and their care needs can be managed and Kord Z, et al. BMJ Supportive & Palliative Care 2021;0:1–9. doi:10.1136/bmjspcare-2021-003001 1 Original research BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003001 on 29 June 2021. Downloaded from followed at home.9 10 Continuity of home care is one of phenomenological method in the period from April to the important duties of nurses, which can be done either July 2020. The study setting was a hospital in yasuj city in- person or in- absentia.11 In- absentia methods such in Iran. The study aimed to investigate and determine as remote care through technology are used to provide the lived experiences of patients with COVID-19 with necessary and fair care services to the patients who home care through telenursing. are at home and do not have access to some particular 12 13 services. Nurses can use available technologies such Study participants as mobile phones, computers and existing communica- In this study, 20 participants were selected using tion applications such as Instagram, WhatsApp and Tele- purposive sampling method. Determining no sample gram in order to continue care and provide ongoing care size, sampling was continued until data saturation services.10 14 It is also possible to manage and provide care was reached. The samples included patients with services through using precreated e- learning programmes COVID-19 who were discharged from the hospital such as Medscape or creating training programmes which and were continuing their care at home and through can be installed on electronic devices. Telenursing involves telenursing. Inclusion criteria consisted of having a the use of technology tools and facilities for providing positive COVID-19 test, history of hospitalisation in remote healthcare services.15 Nowadays, the use of COVID-19 ward, literacy, ability to use Skype and technology is inevitable in the life of people16 17 so that mobile phone, ability to communicate and having it can be used effectively in different critical situations. adequate time for interview. Exclusion criteria were Telenursing provides access to health services, which can the patient’s reluctance to participate in the study, affect the condition of remote patients.18 Nursing services limited cooperation caused by the patient’s connection performed in telenursing include patient triage, symptom to ventilator or other restrictive devices at home. management, education and control of using care tools such as oxygen capsules and masks through telephone Data collection procedures and at home.19–22 Counselling, education, diagnosis and Semistructured interviews were used for data collec- record of patients' information are also possible through tion. The time of each interview ranged from 40 to 90 telenursing.23 Among advantages of telenursing, mention min. The following are examples of questions asked may be made of continuous equitable care and access to in interviews: ‘Tell us about your experience of tele- 10 24 25 remote services. Telenursing is also effective for nursing in home care.’ Or ‘How has been your daily copyright. telecommunications and the use of technology for inac- experience of telenursing in home care?’ Follow- up cessible regions such as villages.26 27 Telenursing and the questions were used during the interviews to access use of technology are increasingly developing in remote more data and deepen understanding of the patients' nursing care.28 Understanding the experiences of patients experiences. In order to maintain social distancing and will help us how to use telenursing for investigating the prevent the transmission of the disease and as it was barriers and facilitators of it in patients with COVID-19. impossible to attend the patients' home, remote inter- Qualitative research is the best way for understanding the views were conducted by Skype application and via experiences of patients with COVID-19 with life as well mobile phone based on the patients' preferences. The as care processes, facilitators and barriers.29 Qualitative interviewer was experienced in conducting qualitative research, without intervention, examines the experiences interviews. With the permission of the patients, all http://spcare.bmj.com/ of individuals as they actually happen. The most appro- interviews were transcribed and then typed verbatim priate method of qualitative research for investigating by the interviewer. In order to manage the information the lived experiences of patients is a phenomenological and text of the interviews, MAXQDA V.10 software method.30 Phenomenology represents experiences which was used with respect to the principles of confidenti- have occurred in one’s life.31 Descriptive phenomenolog- ality and privacy. ical method is used to investigate the main structure of people’s experiences and explain them as completely and Data analysis on October 2, 2021 by guest. Protected accurately as