Online Telehealth Services Discussed

Online Telehealth Services Discussed

Online Telehealth Services Discussed


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; 24–44Online Telehealth Services Discussed

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,


Submitted 9 August 2016, Accepted 22 January 2017


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


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.


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).


Online Telehealth Services Discussed