Online Telehealth Services Discussed
Online Telehealth Services Discussed
Online Telehealth Services Discussed
REV I EW ART ICLE
Nursing professionals’ experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies
Marita Koivunen PhD (Adjunct Professor, Nursing Director)1,2,3 and Kaija Saranto PhD, RN (Professor)2,4
1Department of Nursing Science, University of Turku, Pori, Finland, 2The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs
Institute Centre of Excellence, 3Satakunta Hospital District, Pori, Finland and 4Department of Health and Social Management, University of
Eastern Finland, Kuopio, Finland
Scand J Caring Sci; 2018; 32; 24–44
Nursing professionals’ experiences of the facilitators
and barriers to the use of telehealth applications: a
systematic review of qualitative studies
The aim of the study was to synthesise the best available
research evidence on nursing professionals’ experiences
of the facilitators and barriers to the use of online tele-
health services in nursing practice. Telehealth is used to
deliver healthcare services and health-related information
by means of information and communication technology
(ICT). The systematic review of qualitative studies was
conducted using thematic synthesis of previous studies.
International electronic databases PubMed, CINAHL, Eric,
Web of Science/Web of Knowledge and Scopus, and Fin-
nish databases Medic and Ohtanen were searched in
spring 2013. In addition, the search was complemented
in fall 2015. Following critical appraisal, 25 studies from
1998 to fall 2015 were reviewed and the findings were
synthesised. Both facilitators and barriers were grouped
into five main categories which were related to nurses’
skills and attitudes, nurses’ work and operations,
organisational factors, patients and technology. The high-
est number of facilitators and barriers was found in the
category focusing on nurses’ work and operations. Based
on the findings, nurses’ skills and attitudes are prevent-
ing factors in the implementation of telehealth. There is
also a need to focus on patients’ role in telehealth usage
although the findings support positive adoption of ICT
tools among patients. The findings call for further devel-
opment of technological tools used in nursing practice
and healthcare services. The change from traditional
face-to-face nursing to the use of telehealth calls for local
agreements and further discussions among professionals
on how this change will be accepted and implemented
into practice. In addition, organisations need to make
sure that nurses have enough resources and support for
telehealth use.
Keywords: communication, information technology, sys-
tematic review and meta-analyses, qualitative approaches,
telenursing.
Submitted 9 August 2016, Accepted 22 January 2017
Introduction
Telehealth was introduced already in the 1960s but the
real breakthrough came in the 1990s, thanks to advanced
technology and innovations in the field of health care (1,
2). In the early days, telehealth services mostly involved
the use of videoconferencing systems. More recently,
Internet applications and mobile phones have been taken
into use in communication between healthcare profes-
sionals and patients (3). According to the World Health
Organization (WHO), telehealth means ‘The delivery of
health care services, where distance is a critical factor, by
all health care professionals using information and com-
munication technologies (ICT) for the exchange of valid
information for diagnosis, treatment and prevention of
disease and injuries, research and evaluation, and for the
continuing education of health care providers, all in the
interests of advancing the health of individuals and their
communities’ (4). This definition provides basis for this
review.
In Western countries, the use of ICT is common in
healthcare services and operations. The range of possibili-
ties provided by ICT in the healthcare sector is enormous
(5). Electronic patient record systems are the most com-
monly used applications. However, telemedicine and
telecare services, health informatics networks, decision
support systems and Internet-based technologies are used
only to some extent (6, 7). A previous study by Gibson
et al. indicates that nurses do not necessarily use
Correspondence to:
Marita Koivunen, Satakunta Hospital District, Sairaalantie 3, FI-
28500 Pori, Finland.
E-mail: mhkoivu@utu.fi
24 © 2017 Nordic College of Caring Science
doi: 10.1111/scs.12445
telehealth applications despite considerable distances
between patients and care providers (8).
Electronic exchange of information between institu-
tions has gradually become more common (9). eReferral
and eDisharge summary systems for the communication
of patient data have proved to be useful methods for
sharing information between professionals and organisa-
tions (10). Citizens are also accustomed to use ICT. With
the help of Internet services, people can search public
health-related information, but also personal information
based on their own health needs (11–13).
According to some recent studies, nursing care is grad-
ually being more often delivered at home than in institu-
tions, such as hospitals (14–16). The expectations
concerning telehealth adoption are high. It has been said
that telehealth solutions have the potential to increase
patients’ self-management and empowerment (7). Effec-
tive communication between the patient and nursing
staff has a significant role in patient care. Nurses help
patients to become empowered regardless of their illness
and to assert their role as partners in decision-making
(7). The use of telehealth applications may significantly
change the quality of communication and nurses’ work-
ing practices (17). The use of telehealth is seen as a
means to improve communication (18) and to enhance
patient-centred care (19, 20).
