Brown-Johnson Cati G, Lessios Anna Sophia, Thomas Samuel, Kim Mirini, Fukaya Eri, Wu Siqi, Kling Samantha M R, Brown Gretchen, Winget Marcy
Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
PocketRN, Palo Alto, CA, United States.
JMIR Form Res. 2023 Aug 23;7:e43258. doi: 10.2196/43258.
Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth.
This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients.
Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys.
This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2).
This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.
需要创新的护理解决方案，以解决护士、卫生系统、患者和护理人员在护理健康、工作灵活性与控制权、劳动力保留与人才输送以及获得患者护理方面的问题。一种创新方法包括一种新型医疗服务模式，即由护士主导的非工作时间伤口护理（PocketRN），用于对紧急问题进行分诊，并通过远程医疗提供额外的患者健康教育。
本试点研究旨在从护士和患者的角度评估PocketRN的实施情况。
2021年和2022年，通过斯坦福医学高级伤口护理中心招募了患者以及兼职或按日计酬、具有伤口护理认证的护士和普通护士。定性数据包括对护士和患者的半结构化访谈以及临床文档审查。定量数据包括应用程序使用情况和互动结束时简短的应用程序内满意度调查。
本试点研究表明，基于应用程序的护理服务模式是可接受的、临床适用的且可行的。技术素养较低对患者最初采用该模式有一定影响；通过内置的宣传推广以及简化患者体验（如通过电话而非视频通话）解决了这一障碍。尽管患者登记和使用数量低于预期（N = 49；17/49，35%的患者在入职电话会议之外至少使用过一次该应用程序），但这种方法对用户来说是可接受的。我们采访了10名患者：7名使用过该应用程序的患者对其感到满意，并表示非工作时间的实时建议减轻了焦虑；3名登记后未使用该应用程序的患者表示有其他获取医疗保健建议的资源，并指出他们认为该工具适用于紧急问题，而他们并未遇到此类问题。接受采访的护士（n = 10）对在家工作表示满意，他们对实践范围以及视频功能带来的护理质量提升感到安心；他们对为非专科护士提供额外的伤口护理特定培训很感兴趣。护士能够通过网络直接为患者提供护理，包括少数无法进行面对面护理的参与护士（n = 2）。
本评估为将技术整合到标准医疗服务（如门诊伤口护理）中提供了见解。使用能够访问电子病历并具备专业知识的系统内护士促进了应用程序的整合和护理的连续性。这种护理服务模式满足了护士对灵活和远程工作的需求，并减轻了患者的焦虑，可能减少术后伤口护理并发症。可行性受到患者技术素养和语言选项较少的负面影响；需要额外的患者培训、教育和语言支持以支持公平获取。采用率受到对额外护理需求认知不足的影响；就诊间隔时间较长且接触较少或病情较重的环境可能更适合这种由护士主导的护理模式。
