In the eHealth @ Hospital 2- Home study we have asked two different patient populations and two different clinical groups to help us in exploring how a remote patient monitoring intervention with additional nurse support might alter people’s self-care abilities after a hospitalisation.
A year after starting recruitment the nurses who have been recruiting and supporting people with colorectal cancer in the eHealth @ Hospital-2-Home study have finished recruitment. Excitingly they have recruited more people than our original goal, a rare occurrence in a research study.
Ramesh Batol Khajavi-Larsen and Tommy Stråbø Brakstad have shared their experiences as nurses in recruiting and following up patients in our research study.
Ramesh has worked as a nurse in intensive care units, has a master’s degree in health sciences, and works as a research nurse at the Stavanger University Hospital (SUS). Tommy is a Gastro-Intestinal (GI) specialist nurse, the head nurse for 6H (GI surgical ward at SUS). Both shared their experiences of being involved in the study. They both experienced how patients discharged from hospital, outside the research project, they had limited support during this vulnerable time. Resulting in patients to have to try multiple options to get help with concerns or changes in symptoms.They saw that the eHealth @ Hospital-2-Home research project would contribute to the evidence and maybe improve the support of patients they nurse.
I saw this research project as a possible way to improve things for them. Before this study patients would say that they tried to call the hospital, but no one answers. Patients say they called here, called there, called everywhere and no one answers them properly. This research project represents a better, easier, supportive transition from hospital to home.
While Tommy was unable to join in from the beginning of the study, when other nurses involved in this research moved on to different jobs, he found a way to merge research into his nursing roles. His passion for this project was amplified by the number of calls that he received as a specialist nurse from discharged patients who were requesting more support from specialized healthcare system – which currently is not available to these patients. This is not unique problem to Norway, most healthcare systems around the world, similarly do not provide supportive care in the transition from hospital to home.
Since his involvement in the study, he has seen how the patients in the intervention group who he remotely monitors and supports as part of the research study enjoyed a greater sense of security and peace knowing that someone is there as a resource for them.
I was afraid I would be overwhelmed with patients calling from this study but there were less interactions than I had expected. This intervention allowed me to provide more supportive care in the transition from hospital to home. It also meant that I was able to see more of their journey and see them recover.
There were challenges to the research study and both Tommy and Romesh spoke about how people who were older and those who were female needed greater support when it came to the use of the technologies. The device used to capture the participants temperature was a “problem child”, but they were both impressed by how committed people were to the project even using their own equipment and manually entering body temperatures when the provided devices acted up.
Older people and women (even if younger than their male counterparts) appeared to struggle to accept technology more. If healthcare moves to more digital and remote monitoring care, there will need to be simple explanations and greater support for such interventions.
They both felt that their experiences in this research have, to them anyways, demonstrated the power of a more supportive discharge from hospital to home. While the results and impact of this project have yet to be discovered based on his experiences, Tommy is already changing his nursing practice. Now with patients who contact him, outside of the research project, following a hospital admission, he offers them more supportive care.
My phone number is already in the clinic letters that are given to patients, but now if a patient calls me and is really anxious, I’ll offer a call back at a separate time and their relief is instantaneous.
While the experiences of Tommy and Ramesh are more heavily connected to people in the intervention group, Ramesh recruited all the participants with colorectal cancer in the randomised control trial. She felt that all participants in the study felt a little more secure knowing that there was additional support and follow-up for them.
After this experience, Tommy and Ramesh feel that there is a future for interventions that have a degree of remote patient monitoring especially where there is a human (nurse) element in the intervention. They feel that this type of care helps in decreasing the complexity that patients need to navigate to access expert care quickly. It has given them new experiences of evaluating patients in a different context. While this may help improve the feelings of security of patients there are somethings that are unlikely to transfer to digital care.
When it comes to assessing wounds, while patients can take a photo. As a specialist nurse I still need to see it in person: feel and smell the wound or even do small procedure like taking a sample or removing a stich in order to decide the best clinical actions.
Both have enjoyed being involved in this study. Tommy spoke for the other nurses involved in the remote patient monitoring, by sharing that they only reported positive experiences in their role in supporting patients in the research project. He feels that especially for more senior nurses this type of role adds variety to your workload and it improved his job as a nurse due to the good feelings that it gave him while working with participants.
What next?
All the nurses from the GI team are looking forward to hearing what the results of the study will be. As for Tommy and Romesh, they are already thinking about how the intervention might be improved if it shows positive results and if hospitals begin to implement remote patient monitoring services.
The transferability possibilities for this intervention are exciting, for example in GI people who have other conditions that require more complex surgeries may also benefit from a more supportive transition from hospital to home.
For the research team we can’t thank Ingrid Enersgård, Ingrid Rasmussen, Margareth Vestrheim, Jonas Kristiansen, Ramesh Batol Khajavi-Larsen, and Tommy Strabo Brakstad enough for all their hard work in this project. Once we have completed recruiting the other group of patients (people with heart failure) we will work quickly to get the results published and shared with everyone who made this project possible. For now, we celebrate and thank you all for doing such an incredible job with recruitment to the eHealth @ H-2-Home research project.
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