Background
Palliative care aims to improve the quality of life for patients and their families facing life-threatening illnesses by preventing and reducing suffering through early detection and treatment of pain and other issues [
1]. According to the World Health Organization (WHO), over 56.8 million people require palliative care each year, including 25.7 million in the last year of their life [
2]. However, only 14% of patients globally have access to palliative care, and this number is expected to almost double by 2060 due to the increasing number of the ageing population and the incidence of the non-communicable disease [
2].
In China, there are 10.4 million of the population in need of palliative and end-of-life care, accounting for 17% of the total people globally, according to the Serious Health-Related Suffering (SHS) Database, which is produced by the Lancet Commission on Global Access to Palliative Care and Pain Relief (GAPCPR) [
3]. The majority of those nearing the end of their lives in China prefer to receive palliative care at home and have expressed their desire for nurses to provide continuity of high-quality palliative care services [
4,
5]. However, there are challenges for nurses providing home-based palliative care due to the limited number of palliative care specialist nurses and the increased workload of travelling to rural and remote areas [
6,
7]. There is a need for a system to reduce workload while ensuring that patients receive satisfactory healthcare irrespective of their geographical locations.
With the rapid integration of global information and communication technology into the field of the healthcare system, a healthcare service model - telehealth (TH), defined as the use of information technology by health professionals in remote contexts to support and promote clinical healthcare, patient and professional health-related education, and health administration, has vastly expanded the scope of healthcare services [
8]. TH provides an opportunity for efficient communication, continuity of care, and meets the growing demands of care services across remote areas with limited resources [
9]. Previous studies reported that TH could potentially reduce unnecessary hospital admissions and increase end-of-life patients’ quality of life by improving their independence, self-management, and access to high-quality of home-based palliative care services [
10‐
12]. In 2022, the National Health Commission of the People’s Republic of China issued the National Nursing Career Plan 2021 to 2025, which clearly states that nursing services should be innovated with the full use of TH to provide convenient and efficient care for palliative care patients [
13]. Nurse-led TH-based palliative care services have increased with the advancement of relevant policies [
14,
15].
The readiness of healthcare professionals plays a vital role in the successful application of the TH services [
16]. However, nurse-led telehealth-based palliative care services are still in the pilot implementation phase in China. It is necessary to comprehensively evaluate and discuss the TH readiness among palliative care specialist nurses and develop training programs to ensure the successful application of TH. Innovative self-efficacy, defined as the individual’s belief in their ability to innovate and adopt new technology [
17], was identified as one of the most critical factors related to the TH readiness of healthcare professionals [
18]. Healthcare professionals with a high level of innovative self-efficacy were more willing to participate in and successfully adopt the TH services, as the high level of innovative self-efficacy could unleash their creative thinking, stimulate active exploration of new things, such as new innovative methods and technologies of care, and will continue to turn these innovative ideas into reality through practice [
18]. However, the current situation of TH readiness and innovation self-efficacy among Chinese palliative care nurses has yet to be investigated, which hinders the ability to develop tailored interventions to improve their TH readiness. Therefore, this study aims to (1) Examine the level of TH readiness among Chinese palliative care specialist nurses; (2) Assess the level of innovative self-efficacy among Chinese palliative care specialist nurses; and (3) Explore the relationship between innovative self-efficacy and TH readiness among Chinese palliative care specialist nurses.
Discussion
To the best of our knowledge, this is the first study to explore the TH readiness and its related factors among Chinese palliative care specialist nurses. The total TRAT-C score of palliative care specialist nurses was 65.31 ± 9.09 in our study, which indicated that they had a moderate level of TH readiness and they encountered certain factors that could adversely affect their ability to implement TH. Palliative care specialist nurses who had used TH platforms or services, expressed willingness to provide TH services to patients and had a higher level of innovative self-efficacy exhibited a higher degree of readiness to implement TH.
Recently, nurse-led TH-based palliative care services have increased with the advancement of Chinese government policies on the uptake of TH to provide convenient and efficient care for palliative care patients [
13]. However, the finding of this study suggested that the level of TH readiness among Chinese palliative care specialist nurses are still at a moderate level, indicating that there are still barriers hindering the adoption or the implementation of TH in the field of palliative care. Prendergast et al. reported that lack of TH training was one of the obstacles for nurses to implement TH [
24]. Currently, there are no standardized TH training courses available for specialist palliative care nurses in China. Nurse may lack access to the necessary knowledge about TH concepts and specific clinical practice models, which in turn impacts their perception of the usefulness of TH and their readiness to provide TH services. In 2019, List and his team integrated TH into a traditional Nurse Practitioner Training Program, and developed learning outcomes and a one-hour didactic TH presentation intervention, which significantly improved the confidence levels in TH knowledge and the readiness [
25]. Therefore, It is crucial that future research focuses on developing a comprehensive Chinese TH training curriculum system to strengthen nurses’ perception of TH and enhance their level of readiness for providing TH services. A similar study was conducted by Muigg et al. in 2017, which examined the TH readiness was 58.2 (95% CI 53.9–62.5) among 41 Australian medical practitioners in diabetes care, slightly lower than that of Chinese palliative care nurses [
26]. In addition to different sample sizes, the difference in results may be due to the fact that our study was conducted during the prevalence of Coronavirus disease 2019 (COVID-19). Face-to-face care services were extremely limited in China between 2020 and 2022 due to the COVID-19 pandemic [
27]. During this period, the Chinese government provided strong support and promotion for TH services [
28,
29]. TH services have proven to meet patients’ needs for medical care and improve the utilization of human resources for healthcare during the epidemic, further accelerating the development and implementation of TH services in China [
30,
31]. It may explain why our participants’ had slightly higher scores on TH readiness than in other studies.
Of the factors studied, we found that nurses who had previously used TH platforms or services had higher scores on TRAT-C than those who had not. This may be due to the fact that nurses with previous experience of using TH platforms or services have a deep and clear understanding of the benefits of TH and have accumulated valuable experience in engagement and successful implementation. To some extent, this could enhance the readiness and capability of providing TH services to palliative care patients. In addition, we found that nurses who were willing to provide TH for patients had higher scores on TRAT-C than the counterparters, which was supported by a study conducted by Tian et al. [
27]. In our study, 93.2% of palliative care specialist nurses were willing to provide TH for patients, demonstrated that the majority of them had a positive attitude towards TH. China is currently struggling with a challenge where the limited number of palliative care specialist nurses cannot meet the increased demand for home-based palliative care, as most patients prefer to die at home [
6]. TH-based palliative care services may be considered as a potential solution to alleviate the current shortage of palliative care specialist nurses. Furthermore, compared to traditional face-to-face home care, the implementation of TH-based palliative care services have been shown to save healthcare costs, enhance nurse’work efficiency, and improve job satisfaction [
32,
33]. As the nurses gain more experience and benefits with TH service, they may gradually recognize its usefulness and availability, which can increase their willingness to incorporate TH in their clinical practice.
In our study, palliative care specialist nurses had a moderate to high level of innovative self-efficacy. The level of innovative self-efficacy of this study is slightly higher than that of non-specialist clinical nurses [
34]. The reason may be that the responsibility of specialist nurses to adopt the nursing technology innovation, conduct research, and resolve various challenging problems related to nursing service, they are more likely to generate more creative thinking than the non-specialist clinical nurses [
34]. Additionally, our findings suggested that palliative care specialist nurses who had a higher level of innovative self-efficacy with a higher degree of the TH readiness. Nurses with a strong sense of innovative self-efficacy tend to be more open to new methods and technologies, and they are more likely to embrace change and view new technology as an opportunity rather than a challenge. Moreover, they are more inclined to proactively seek out information and resources to support their learning and development, leading to more innovative behaviors. They are willing to overcome the difficulties encountered in the innovation process and constantly explore new methods to solve the problems that arise in their clinical practice [
18,
35]. Innovation is vital in ensuring organizational success and sustainability in an increasingly competitive work environment [
36]. McHugh et al. pointed out that the innovative capability of nurses can improve the quality of patient care [
37]. Therefore, nursing managers can develop an innovative culture and provide incentives to improve the level of TH readiness of palliative care specialist nurses by promoting the innovation self-efficacy level.
Limitations
There were limitations to this study. First, the TART used in our study to assess the TH readiness is a self-report scale, which could involve recall and social desirability bias. Additionally, we used a cross-sectional survey that could not track the changes in the TH readiness of nurses over time. Future study will consider to conduct a longitudinal study to explore the changes in TH readiness among nurses over time.
Conclusions
With the increased demanding of home-based palliative care and the limited number of palliative care specialist nurses in China, TH is considered one of the most important alternative approaches to balancing conflicts between demand for and the supply of home-based palliative care. However, the TH readiness among Chinese palliative care specialist nurses needs to be improved. The experience of using TH platforms or services, the willingness to provide TH services, and the innovative self-efficacy of nurses were closely related to the TH readiness. Measures such as providing incentives to promote nurses’ innovation self-efficacy by nurse managers, and establishing a comprehensive telehealth training system for palliative care specialist nurses should be taken to facilitate the implementation of telehealth services in the field of palliative care.
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