As a Visiting Nurse working with the older adult population for the past 27yrs, I fully appreciate the use of Telehealth technology in the home care setting to assist with medication reconciliation, since nurses in the home health field are frequently unable to make desired visits based on financial restraints, limited nursing staff and the Covid pandemic that occurred during the above-mentioned study. Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life, and as a fellow home care nurse, we are in a key position to assist theses older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. Telehealth is an option, but nurses first must accept this technology in order for it to be successful.
The study utilized Rogers five-step Diffusion of Innovation theory as a lens to explain how nurses proceed from having knowledge of an innovation to confirming the decisions to adopt or reject the idea . The Diffusion of Innovation theory is often regarded as a valuable change model for guiding technological innovation where the innovation itself is modified and presented in ways that meet the needs across all levels of adopters. It also stresses the importance of communication and peer networking within the adoption process Rogers et al., . While Rogers’s Diffusion of innovation was effective as a lens to explore visiting nurses’ acceptance and adaptation to telehealth technology, the Knowledge, Attitudes and Behavior (KAB) theory was instrumental in exploring the behaviors of the visiting nurses. Specifically, the KAB theory provided a lens for exploring the cognitive constructs associated with intervention, allowing a justifiable reason for innovation acceptance.
As practicing clinical nurses, we all know that becoming familiar with and accepting new technology can be overwhelming and frustrating if proper education and mentorship is not offered. In the study Telehealth was not used by many agencies prior to the Covid Pandemic, many nurses that were interviewed were unfamiliar with not only Telehealth technology but were older in age and not tech savvy. It was surprising to see that nurses who were older were not only accepting of its use but were also willing to further their education to improve patient care. Nurses of all age groups ranging from 37yrs to 70yrs were supportive of Telehealth use and were willing to continue using it. All interviewed nurses stated that agency education via, in services, e-links, mentorships, colleague’s support and hands on application were provided and were essential to the acceptance of telehealth and its advancement.
As a Visiting nurse in the role of a Case manager this reviewed study reflected the importance of advancing telehealth technology in the home care environment, not only for medication compliance strategies but to further interdisciplinary care approaches, enhance pt autonomy, and provide communication to decrease social isolation and loneliness in the older population. Given the obstacles that visiting nurses have daily, making it difficult to visit patients as often as needed, telehealth technology can be incorporated to improve these aspects of health care.
Participants of this study accepted telehealth technology in their practice, were supportive of its continued use, and were willing to be educated on future advancement in this technology to assist older home care patients with medication compliance strategies. Participants also stated they enjoyed utilizing telehealth technology, that it is easy to use and convenient, and it enabled them to fill visit voids. Visiting nurses and the agencies to whom they were employed demonstrated exceptional collaboration and support, these actions enhanced telehealth use and encouraged nurses to further their education on new advancements in telehealth technology.
The findings of this study support telehealth use to manage medication compliance for the older adult home care population. Home care nurses’ positive attitude and behaviors support them in their role as change agents who encourage and promote telehealth use in the home care environment. Nurses must be supportive and willing to mentor young nurses who enter the nursing profession in order to provide effective patient care. Adherence to medication plans in the home care setting is one of the many major issues impacting the ability of older adults to live safely.
This study offers foundational insight that use of telehealth technologies by home care nurses can enable older adult patients to live well at home. Competent and effective utilization of telehealth technology by nurses in the provision of healthcare must be a goal . Therefore, ensuring all home care nurses are educated and ready to take on this role is imperative. Ultimately, nursing educational programs and home care agencies must provide evidence-based educational opportunities that promote nurses’ ability and confidence when utilizing telehealth technology in order for them to be successful .