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The nursing role significantly changed following reforms in the nurse training process. Nowadays, nurses are increasingly trained to promote and improve the quality of clinical practice and to provide support in the assistance of patients and communities. Opportunities and threats are emerging as a consequence of the introduction of new disruptive technologies in public health, which requires the health care staff to develop new digital skills.
The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge in a continuously evolving health care scenario that relies increasingly more on technology and digital solutions.
This scoping review was conducted using a thematic summary of previous studies. Authors collected publications through a cross-database search (PubMed, Web of Science, Google Scholar) related to new telemedicine approaches impacting the nurses’ role, considering the time span of 2011-2021 and therefore including experiences and publications related to the first phase of the COVID-19 pandemic.
The assessment was completed between April and July 2021. After a cross-database search, authors reviewed a selection of 60 studies. The results obtained were organized into 5 emerging macro areas: (1) leadership (nurses are expected to show leadership capabilities when introducing new technologies in health care practices, considering their pivotal role in coordinating various professional figures and the patient), (2) soft skills (new communication skills, adaptiveness, and problem solving are needed to adapt the interaction to the level of digital skills and digital knowledge of the patient), (3) training (specific subjects need to be added to nursing training to boost the adoption of new communication and technological skills, enabling health care professionals to largely and effectively use new digital tools), (4) remote management of COVID-19 or chronic patients during the pandemic (a role that has proved to be fundamental is the community and family nurse and health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory), and (5) management of interpersonal relationships with patients through telemedicine (a person-centered approach with an open and sensitive attitude seems to be even more important in the framework of telemedicine where a face-to-face session is not possible and therefore nonverbal indicators are more problematic to be noticed).
Further advancing nurses’ readiness in adopting telemedicine requires an integrated approach, including combination of technical knowledge, management abilities, soft skills, and communication skills. This scoping review provides a wide-ranging and general—albeit valuable—starting point to identify these core competences and better understand their implications in terms of present and future health care professionals’ roles.
Over the years, the nursing profession has been exposed to relevant changes, from the mother-rescuer’s role to the intuitions of Florence Nightingale [
Thanks to higher education curricula and advanced educational training, nurses have become increasingly prepared, competent, and autonomous [
This new scenario highlights the need for highly skilled nursing staff, able to adapt to new contexts and challenges that are constantly and quickly emerging within the digital health revolution [
In this rapidly changing context, the training of nursing skills and competences need to include the use and administration of new technologies, as well as the capacity to support the use of technological tools for patients and caregivers [
The whole process has been inevitably accelerated by the COVID-19 pandemic, which is highlighting the limited amount of resources in terms of health care staff and in terms of technological tools. The pandemic is also pushing health care institutions in reshaping service delivery, the management of patients’ journeys, and the use of telemedicine [
The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge, considering the changes that have occurred in the health sector in the past decade (2011-2021). The COVID-19 pandemic has led to an exponential increase in the use of telemedicine, and consequently, this has led to a radical change in the health care organization and in the role of professionals as well, particularly in the past couple of years. In fact, a large part of the available literature (including reviews) is related to a pre–COVID-19 period. Despite a considerable number of current reviews including robust systematic and statistical analysis, these papers (1) mainly address the issue of telemedicine only as case studies or isolated experiments, focusing on the perception of its use among nurses and students and on possible future prospects, underlining the main limitations [
In the continuum of experiences that have occurred in the past 10 years in the field of digitalization of the health care sector, this review also covers the recent COVID-19 outbreak that has contributed to largely expand telemedicine across several countries, with the aim of mapping the key concepts and implications underpinning the fast/changing role of the nurse in the digital era, as well as exploring the boundaries of the role and the skills that need to be acquired as they are redefined through the COVID-19 pandemic.
Therefore, this paper can be considered a preliminary—albeit necessary—exercise prior to conducting a structured systematic review.
The core objective is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge that have emerged before and during the COVID-19 pandemic (2011-2021). The review maps present (and future) skills that nurses are expected to develop when using new technologies, considering the novel organizational assets that are emerging in the digitalization process of health care.
From a methodological viewpoint, the scoping review has been identified as the most suitable tool as this approach is particularly useful for exploring new evidence, embracing evidence from heterogeneous sources of data, and providing a broad overview of the current and rapidly changing health care scenario [
The search strategy was defined as follows:
Participants: nursing professionals, researchers, and university professors
Interest: application of telehealth in nursing practice
International electronic databases: PubMed, Google Scholar, and Web of Science, considering the time span of 2011-2021
Keywords used: “telenursing,” “nursing,” and “telemedicine”
Search strings: (telenursing) AND (role of the nurse in telemedicine), (nurse's role) AND (eHealth), (nurse's role) AND (telemedicine COVID-19), ((community nurse) AND (telemedicine)) AND (COVID-19), and (telenursing) AND (telemedicine)
Authors conducted the research through the Perugia University library (Italy) using PubMed, Google Scholar, and Web of Science. The search was planned considering a 10-year span from 2011 to 2021.
Papers from 2011 to 2021 were identified using the keyword search strings through the PICO (population, intervention, control, outcome) method. During screening, all papers meeting the following selection criteria were selected: written in English; being of international significance; being searched through a cross-database search (PubMed, Web of Science, Google Scholar), considering elimination of redundant papers; including a reference to the nursing figure and the role of the nurse, with reference to the leadership role; and including the use of telemedicine systems. In addition, papers considering at least 1 of the following issues/topics were selected: nursing education and introducing clinical practice supported by telemedicine systems into the curriculum, interpersonal and communication skills in terms of telemedicine systems, and telemedicine experience (see
Paper selection process.
Step | Process |
Identification |
In total, 250 papers written in English, with international significance, in the time span of 2011-2021 were identified through the PICO method based on the keywords selected: (telenursing) AND (role of the nurse in telemedicine), (nurse's role) AND (eHealth), (nurse's role) AND (telemedicine COVID-19), ((community nurse) AND (telemedicine)) AND (COVID-19), and (telenursing) AND (telemedicine). No additional records were found from other searches. |
Screening |
A cross-database search (PubMed, Web of Science, Google Scholar) allowed the elimination of 8 (3.2%) redundant papers. The remaining 242 (96.8%) papers were reviewed, and 156 (64.5%) that did not have free full text and did not meet the purpose of the research were excluded. |
Eligibility |
All the remaining 86 (35.5%) papers with free full text were considered eligible. Of these, 26 (30.2%) papers with redundant topics not in sufficient detail were further excluded. |
Included |
Finally, 60 (69.8%) papers were included. |
An assessment of the risk of bias in the publications is usually not performed in the framework of a scoping review; therefore, no assessments of the papers' quality were performed [
After collection, the papers were divided and analyzed. The results of authors’ analysis are presented in Tables A1-A3 in
In the initial phase, authors selected many papers from international peer-reviewed journals. In total, 250 papers were found matching the topic of the review. After reading the abstracts, papers that were not in line with the inclusion criteria of the review were removed. A total of 60 (24%) papers were selected to be reviewed. Of these 60 papers, 22 (37%) covered the period 2011-2018 and were therefore not affected by the COVID-19 pandemic (process summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart in
Specific recurring themes and fundamental constructs that emerged in this review are presented in the following sections and then elaborated in the Discussion section.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart for the scoping review process.
This scoping review highlighted the importance of communication skills that appear to be even more important for nurses in the case of telemedicine compared to in-person visits [
From this perspective, the following list [
Technical skills to use telemedicine (system use and troubleshooting telemedicine software and hardware issues)
Skills in terms of using mobile communication devices and wireless remote patient-monitoring applications for treatment support, chronic disease management, and disease surveillance
Skills in designing patient-centered health informatics systems
Skills in understanding specific health informatics issues and suggesting/designing technological solutions
Skills to assess data integrity and health data analysis
It is therefore possible to affirm that there is a need to recommend specific skill training; however, a clear and effective training method to properly train clinicians is far from being determined yet. The current education based on traditional lectured instruction methods is presumably not sufficient for proper adoption of new technologies, leading to bottlenecks in integrating monitoring technologies into daily practice.
Telehealth nursing primarily focuses on patients’ long-term wellness, self-management, and health. According to the American Telemedicine Association, information technology (IT) solutions provide the delivery of nursing care, regardless of distance, while expanding the care providers’ ability to monitor, educate, follow up, collect data, and provide multidisciplinary care, including remote interventions, pain management, and family support, in an innovative fashion [
Another relevant item to consider is the nurses' working environment, which should be carefully considered. A quiet, disturbance-free environment was clearly indicated as a core issue when delivering telemedicine sessions in order to promote a contextual environment supporting mutual understanding and smooth interaction [
A role that has proved to be fundamental is the community and family nurse. Health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory [
From this perspective, community nurses play a key role in integrating health and social care services, particularly supporting self-care that has also proved to be beneficial during the pandemic. Community nurses have shifted from FTF care to teleconsultations to keep services accessible during the pandemic [
eHealth can be supported by rapid counseling models based on remote calling by health care professionals, as shown in a randomized controlled trial [
This study, therefore, allows us to understand the positive effect of this approach (monitoring via phone calls) and confirms the effectiveness of the home remote control method, mainly as an educational strategy, for flexibility of schedules, optimization of times and resources, and the ability to reach many users who encounter difficulties related to geographical and financial barriers to access the health service.
The nurse is increasingly becoming a key figure for the implementation of telemedicine in clinical practice. This requires specific leadership skills. Leaders set standards, develop plans, and remove barriers to implementation. The leader understands and can deliver and adapt evidence-based practice knowledge. The leader supports the efforts of others to learn and use evidence-based practice, as well as supports the implementation of evidence-based practice in a consistent and deliberate way [
If the technology is not optimal, more experienced nurses can compensate the suboptimal technology with their clinical experience, while younger nurses often face bigger challenges, despite their higher digital skills. In some cases, it is emphasized that digital natives often have more doubts about the correct application of digital tools in health care. The study titled “Telehealth and Telenursing Perception and Knowledge Among University Students of Nursing in Poland” [
This review aimed at exploring the present (and future) nursing role, considering the new digital health era where the use of telemedicine is becoming a standard in health care delivery. From a methodological viewpoint, the scoping review represents the most suitable tool for this exercise, as this approach is appropriate when exploring emerging evidence from heterogeneous sources of data [
Revising the literature published within a 10-year span, authors were able to outline (1) the emerging skills and attitudes nurses are required to master within a digitalized health care system, (2) the new responsibilities that are emerging for health care staff (and nurses in particular) when digital health approaches are adopted, and (3) the (potential) impact of digital innovation in terms of requirements for the nurses’ university curricula.
Among the core emerging issues highlighted in this paper, the leadership role that the nurse plays is key when new technologies are structurally part of the health care process and service delivery. In fact, nurses are (and will increasingly be) the cornerstone of communication and coordination among different professional stakeholders (eg, general practitioners, specialists), patients, and caregivers. Another important point emerging from our analysis is the need for developing new communication, adaptation, and problem-solving capabilities to flexibly adapt the use of technologies to the level of digital literacy (digital skills) of patients. This implies the capacity to assess not only the clinical profile of a patient but also the extent to which new technologies can be used in managing a specific case. This is even more important, considering an increasing body of publications [
The authors acknowledge some limitations of this review. First, the level of eHealth literacy of nurses was assessed only in a limited number of papers, in many cases outdated, as in the case of Norman and colleagues [
As highlighted in this review, the role of nurses has widely changed over the past decades, with tremendous acceleration in the past few years and in the COVID-19 era. Studies included in this scoping review provide insight into present and future skills that might constitute the core abilities of the nurses’ curricula. At the same time, additional information is needed to better understand how these skills can be included in the training and nurses’ formal curricula, particularly considering the radical transformation we are witnessing, where the traditional models of care are continuously modified and sometimes replaced with advanced approaches enabled by up-to-date technologies. Our research can be considered a starting point to outline the core areas of development for the future nurse, in terms of technological, organizational, and relational skills [
Results of authors’ analysis of 60 papers selected for this study.
electrocardiography
face-to-face
information technology
mobile health
nurse practitioner
population, intervention, control, outcome
None declared.