Østervang Christina, Vestergaard Lene Vedel, Dieperink Karin Brochstedt, Danbjørg Dorthe Boe
Department of Oncology, Odense University Hospital, Odense, Denmark.
The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Nyborg, Denmark.
J Med Internet Res. 2019 Mar 25;21(3):e12584. doi: 10.2196/12584.
In cancer settings, relatives are often seen as a resource as they are able to support the patient and remember information during hospitalization. However, geographic distance to hospitals, work, and family obligations are reasons that may cause difficulties for relatives' physical participation during hospitalization. This provided inspiration to uncover the possibility of telehealth care in connection with enabling participation by relatives during patient rounds. Telehealth is used advantageously in health care systems but is also at risk of failing during the implementation process because of, for instance, health care professionals' resistance to change. Research on the implications for health care professionals in involving relatives' participation through virtual presence during patient rounds is limited.
This study aimed to investigate health care professionals' experiences in using and implementing technology to involve relatives during video-consulted patient rounds.
The design was a qualitative approach. Methods used were focus group interviews, short open interviews, and field observations of health care professionals working at a cancer department. The text material was analyzed using interpretative phenomenological analysis.
Field observational studies were conducted for 15 days, yielding 75 hours of observation. A total of 14 sessions of video-consulted patient rounds were observed and 15 pages of field notes written, along with 8 short open interviews with physicians, nurses, and staff from management. Moreover, 2 focus group interviews with 9 health care professionals were conducted. Health care professionals experienced the use of technology as a way to facilitate involvement of the patient's relatives, without them being physically present. Moreover, it raised questions about whether this way of conducting patient rounds could address the needs of both the patients and the relatives. Time, culture, and change of work routines were found to be the major barriers when implementing new technology involving relatives.
This study identified a double change by introducing both new technology and virtual participation by relatives at the same time. The change had consequences on health care professionals' work routines with regard to work load, culture, and organization because of the complexity in health care systems.
在癌症治疗环境中，亲属常被视为一种资源，因为他们能够在患者住院期间给予支持并记住相关信息。然而，与医院的地理距离、工作以及家庭责任等因素，可能会给亲属在患者住院期间亲自参与造成困难。这促使我们去探索远程医疗保健在方便亲属参与患者查房方面的可能性。远程医疗在医疗保健系统中得到了有益应用，但在实施过程中也可能因例如医护人员对变革的抵触等原因而面临失败风险。关于医护人员在患者查房期间通过虚拟在场让亲属参与其中所产生影响的研究有限。
本研究旨在调查医护人员在视频会诊患者查房期间使用和实施技术以使亲属参与其中的经验。
采用定性研究方法。所使用的方法包括焦点小组访谈、简短开放式访谈以及对癌症科室医护人员的实地观察。运用解释现象学分析对文本材料进行分析。
进行了为期15天的实地观察研究，共观察75小时。总共观察了14次视频会诊患者查房，撰写了15页实地笔记，同时对医生、护士和管理层工作人员进行了8次简短开放式访谈。此外，对9名医护人员进行了2次焦点小组访谈。医护人员认为使用技术是一种在亲属无法亲自到场的情况下促进其参与的方式。而且，这引发了关于这种查房方式是否能满足患者和亲属双方需求的问题。发现时间、文化和工作流程的改变是实施涉及亲属的新技术时的主要障碍。
本研究发现，同时引入新技术和亲属的虚拟参与带来了双重变革。由于医疗保健系统的复杂性，这种变革在工作量、文化和组织方面对医护人员的工作流程产生了影响。
