Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden
Introduction: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
James Cook University
2022-12-01
|
Series: | Rural and Remote Health |
Subjects: | |
Online Access: | https://www.rrh.org.au/journal/article/7404/ |
_version_ | 1811178305433370624 |
---|---|
author | Hanna Dubois Mia Bergenmar Maria Härgestam Johan Creutzfeldt |
author_facet | Hanna Dubois Mia Bergenmar Maria Härgestam Johan Creutzfeldt |
author_sort | Hanna Dubois |
collection | DOAJ |
description |
Introduction: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden.
Methods: A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted.
Results: A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories.
Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'.
Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'.
Conclusion: This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.
|
first_indexed | 2024-04-11T06:17:26Z |
format | Article |
id | doaj.art-660c72dfdee642049092f28e8ee420fa |
institution | Directory Open Access Journal |
issn | 1445-6354 |
language | English |
last_indexed | 2024-04-11T06:17:26Z |
publishDate | 2022-12-01 |
publisher | James Cook University |
record_format | Article |
series | Rural and Remote Health |
spelling | doaj.art-660c72dfdee642049092f28e8ee420fa2022-12-22T04:41:01ZengJames Cook UniversityRural and Remote Health1445-63542022-12-012210.22605/RRH7404Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural SwedenHanna Dubois0Mia Bergenmar1Maria Härgestam2Johan Creutzfeldt3Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, SwedenDepartment of Care Science, Sophiahemmet University, Stockholm, Sweden; and Department of Oncology–Pathology, Karolinska Institutet, 171 77 Stockholm, SwedenDepartment of Nursing, Umeå University, 901 87 Umeå, SwedenDepartment of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, Sweden Introduction: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden. Methods: A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted. Results: A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'. Conclusion: This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made. https://www.rrh.org.au/journal/article/7404/emergency medicinepatient participationqualitative researchSwedentele-emergencytelemedicine. |
spellingShingle | Hanna Dubois Mia Bergenmar Maria Härgestam Johan Creutzfeldt Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden Rural and Remote Health emergency medicine patient participation qualitative research Sweden tele-emergency telemedicine. |
title | Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden |
title_full | Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden |
title_fullStr | Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden |
title_full_unstemmed | Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden |
title_short | Patient participation in tele-emergencies – experiences from healthcare professionals in northern rural Sweden |
title_sort | patient participation in tele emergencies ndash experiences from healthcare professionals in northern rural sweden |
topic | emergency medicine patient participation qualitative research Sweden tele-emergency telemedicine. |
url | https://www.rrh.org.au/journal/article/7404/ |
work_keys_str_mv | AT hannadubois patientparticipationinteleemergenciesndashexperiencesfromhealthcareprofessionalsinnorthernruralsweden AT miabergenmar patientparticipationinteleemergenciesndashexperiencesfromhealthcareprofessionalsinnorthernruralsweden AT mariahaumlrgestam patientparticipationinteleemergenciesndashexperiencesfromhealthcareprofessionalsinnorthernruralsweden AT johancreutzfeldt patientparticipationinteleemergenciesndashexperiencesfromhealthcareprofessionalsinnorthernruralsweden |