The Use of Video-Consulted Patient Rounds With Relatives-Possibilities and Barriers in Clinical Practice: Qualitative Study
The Use of Video-Consulted Patient Rounds With Relatives-Possibilities and Barriers in Clinical Practice: Qualitative Study
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DOI：
10.2196/12584
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发表时间：
2019-03-25
影响因子：
7.4
通讯作者：
Danbjorg, Dorthe Boe
中科院分区：
文献类型：
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作者：
Ostervang, Christina;Vestergaard, Lene Vedel;Danbjorg, Dorthe Boe
背景：在癌症环境中，亲属通常被视为资源，因为他们能够支持患者并记住住院期间的信息。然而，距离医院的地理距离、工作和家庭义务可能会导致亲属在住院期间身体参与困难。这为揭示远程医疗保健的可能性提供了灵感，使亲属能够参与患者查房。远程医疗在医疗保健系统中的使用具有优势，但在实施过程中也面临失败的风险，例如，由于医疗保健专业人员抵制变革。关于医疗保健专业人员在患者查房期间通过虚拟存在让亲属参与的影响的研究是有限的。目的：本研究旨在调查医疗保健专业人员在使用和实施技术以让亲属参与视频咨询患者查房期间的经验。方法：该设计是一种定性方法。使用的方法包括焦点小组访谈、简短的公开访谈以及对癌症科工作的医疗保健专业人员的现场观察。使用解释现象学分析对文本材料进行分析。结果：现场观察研究进行了 15 天，观察时间为 75 小时。总共观察了 14 次视频咨询患者查房，并撰写了 15 页的现场笔记，以及对医生、护士和管理层工作人员的 8 次简短的公开访谈。此外，还对 9 名医疗保健专业人员进行了 2 次焦点小组访谈。医疗保健专业人员体验到使用技术作为一种促进患者亲属参与的方式，而患者亲属无需亲自到场。此外，人们还质疑这种查房方式是否能够满足患者及其亲属的需求。研究发现，时间、文化和工作习惯的改变是实施涉及亲属的新技术的主要障碍。结论：本研究通过同时引入新技术和亲属的虚拟参与发现了双重变化。由于医疗保健系统的复杂性，这一变化对医疗保健专业人员的工作量、文化和组织方面的日常工作产生了影响。
Background: 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.Objective: This study aimed to investigate health care professionals' experiences in using and implementing technology to involve relatives during video-consulted patient rounds.Methods: 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.Results: 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.Conclusions: 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.