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To review current evidence on the implementation and impact of virtual nursing care in long-term aged care.
An integrative rapid literature review.
Medline, CINAHL, Web of Science, Embase, Ageline and Scopus.
The review included studies involving virtual care interventions provided by nurses (or by a multidisciplinary team including nurses) to older people in residential aged care that reported health outcomes or stakeholder experiences. Consistent with PRISMA guidelines, databases were systematically searched in July and August 2024, focusing on literature published since 2014. Studies were screened in Covidence by three team members, with conflicts resolved by additional reviewers. Studies not involving nurses or not set in aged care were excluded.
The search identified 13 studies, which included quantitative, qualitative and mixed-method approaches, conducted in both Australian and international settings, as well as in rural and metropolitan locations. Nurses were often involved as part of an existing virtual care programme, typically located in a hospital setting. The training and credentials of nurses delivering VN varied in terms of specialisation and advanced practice. The model of care in general was ad hoc, though in some cases there were regular, scheduled VN consultations. The time requirements for onsite staff and nurses were not well articulated in any of the studies, and information on the funding models used was also lacking.
There is some evidence that VN interventions in aged care may improve communication, enhance person-centred care and reduce emergency department presentations and hospitalisations.
Rigorous, ongoing evaluation of VN interventions is required to ensure their appropriate application in residential aged care.
To develop a grounded theory explaining the psychosocial processes older adults use when adapting to life in residential aged care.
An evolved grounded theory methodology was used.
Semi-structured interviews were conducted with 20 residents and three staff members across four residential aged care homes in Victoria, Australia, supplemented with ethnographic observations. Theoretical sampling continued until theoretical saturation was achieved.
The theory of Adapting to a shrunken world comprises three categories: realising the need for care; facing a life in care; and living with loss. Adaptation is an active, ongoing process shaped by accumulating losses. Positive adaptation requires residents to recognise and accept care needs while ceding aspects of independence, autonomy and control. This theory extends transition-focused accounts of adaptation by showing that, while early phases of adjustment and acceptance are important, adaptation to life in residential aged care remains an active, ongoing, psychosocial process shaped by continual change and accumulating loss across residents' lives in care.
Adaptation continues throughout residents' lives in care. Acceptance of care needs is critical, as perceived losses of independence and control can lead to resistance or resentment that inhibits adjustment.
This theory provides a framework for person-centred policies and practices that support positive adaptation. Healthcare professionals can recognise early signs of maladaptation and implement interventions that foster acceptance while maintaining resident autonomy.
This study addresses gaps in understanding long-term adaptation to residential care, informing nursing practice, aged care policy and care models internationally.
Data were analysed using grounded theory methods. The COREQ checklist was applied to guide transparent reporting of study design, data collection and analysis.
This study did not include patient or public involvement in its design, conduct or reporting.
Previous studies suggest Ireland has the smallest osteoporosis treatment in Europe and very little inappropriate prescribing, in contrast to our experience. In this study, we examine the osteoporosis treatment gap in Ireland by assessing the prevalence of appropriate and inappropriate prescribing in 2 subgroups of the Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) Project. Treatment eligibility was defined using established intervention thresholds, including prior fracture, femoral-neck T-score ≤–2.5, glucocorticoid use, or Fracture Risk Assessment Tool (FRAX) major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%.
Secondary cross-sectional analysis of a subgroup of the DXA HIP Project Cohort.
3 hospitals in the West of Ireland. DXA referrals come from primary care providers, hospital consultants and the osteoporosis service.
5564 participants of a previously described convenience cohort including: (i) 3474 subjects referred for a DXA scan, and (ii) 2090 patients who completed a DXA scan.
82.4% were female with a mean age of 66.6 years, 59.6% of whom had a prior fracture. Prescribing data of calcium and vitamin D were available for 3738 (67.2%) subjects, and osteoporosis medication for 4157 (74.7%) subjects. Prescribing information was available for more than 99% of the DXA group, but just over 50% of the referral group. When examined in aggregate, the treatment gap is 6% for calcium and vitamin D and 38% for osteoporosis medication, in line with prior publications. However, among those with prescribing information and at least one indication for treatment, only 58.3% were prescribed calcium and vitamin D and 39.1% an osteoporosis medication. Furthermore, among patients without a clear indication for treatment, 50.6% were prescribed calcium and vitamin D, and 32.5% an osteoporosis medication.
These data suggest the majority of patients with osteoporosis or at high risk of fracture in Ireland today do not receive appropriate osteoporosis treatment, while inappropriate prescribing is substantial. These findings suggest that the true treatment gap in Ireland is substantially larger than aggregate estimates imply.
Establishing comparability between measured outcomes in clinical trials poses a significant obstacle for systematic reviewers. Core outcome sets (COSs) were developed to address this issue. The macular degeneration (MD) COS is designed to standardise outcome measurement across clinical trials for MD. This study investigates the uptake of the MD COS in standardising outcome measurement across clinical trials.
Cross-sectional analysis
We conducted a search on ClinicalTrials.gov to locate MD clinical trials that were registered 5 years prior to COS publication through the search date of 26 June 2023 and obtained a pool of 2152 registered studies. After applying various inclusion and exclusion criteria, we analysed 159 trials. We then analysed the COS uptake using an interrupted time series analysis (ITSA) and performed performed analyses of variance (ANOVAs) and Pearson correlations to evaluate associations between trial characteristics and outcome measurement.
ITSA showed no significant change in uptake following the MD COS (2016): mean percentage of completion of the COS increased by 0.24% per month before publication (p=0.27) and by 0.07% per month after publication (p=0.62), indicating no meaningful post-publication slope change in COS use. For context, visual acuity was most commonly measured, while several patient-reported and disutility domains were infrequently captured.
No discernible patterns in COS usage for MD trials were observed. We recommend further collaboration between regulators and COS developers to help with COS uptake. Additionally, we suggest that further studies analyse adherence to COSs in respect to regulatory recommendations.
To identify the proportion of Advanced Practice Nurses' workload that takes place virtually in the delivery of direct patient care.
An observational study was conducted for this research.
An overt non-participatory time and motion study was undertaken using a predefined data collection tool to identify the activities of the study participants, and the mode used for delivery of the activities identified.
Fourteen Advanced Practice Nurses were observed. A total of 5190 min of observation time was conducted. The time participants were observed delivering direct patient care virtually (care delivered without in-person contact) was recorded in minutes and calculated as a percentage of their overall observation time. The proportion of time recorded in the delivery of virtual direct patient care was calculated as 22% of participants' work time. The primary modes of telecommunication technologies used in this research were landline telephones and desktop computers. The most frequently performed direct patient care activity was gathering and interpreting assessment data to formulate a plan of care.
This is the first research to calculate the proportion of Advanced Practice Nurses' time that is spent delivering direct patient care virtually. The findings indicate that a substantial proportion of Advanced Practice Nurse time is spent delivering virtual care.
No patient or public contribution in this research.
Implications for the profession and/or patient care.
What problem did the study address? There is an increase in the digitalisation of healthcare delivery, resulting in virtual care provided by nurses. It is therefore important to explore what and how much virtual care is delivered by Advanced Practice Nurses in Ireland. The study calculated the proportion of Advanced Practice Nurses' time spent in the delivery of virtual direct patient care. What were the main findings? A significant volume of work is conducted virtually. It should be conducted in a secure environment using secure devices. The nurses conducting virtual direct patient care ought to be adequately resourced with appropriate technology supported by electronic recording of care delivered to ensure accurate communication between healthcare professionals. Education for nurses conducting virtual work should be provided from the outset. Where and on whom will the research have an impact? The research will impact nurse leaders by providing them evidence of the delivery of virtual direct patient care by nurses. This leads to an opportunity to explore funding models where direct patient care is delivered yet unseen. There is a requirement to provide nurses with the necessary equipment to support the delivery of virtual patient care. Further research is recommended on the virtual role of nurses in healthcare delivery.
The STROBE cross-sectional guidelines were followed to report the research.
This article on realist reviews is the second in a four-part series on realist research.
Realist reviews (or realist evidence syntheses) are a theory-building, interpretative approach to evidence synthesis. Realist reviews aim to go beyond seeking whether interventions work (ie, are effective), to generating explanations as to...
This article is the first in a series exploring realist research, a methodological approach well suited to the complexity of nursing practice. Unlike traditional approaches such as randomised controlled trials (RCTs) and systematic reviews, which focus on whether interventions work, realist research examines how and why interventions work when implemented in specific groups; reflecting the individualised care nurses provide. By introducing the key concepts of realist research, this article highlights its relevance to nursing and lays the groundwork for using realist research to drive meaningful improvements in healthcare.
Realist research offers a unique lens to examine the complexity of healthcare delivery. While traditional research methods often seek to determine if interventions work or not in controlled environments, realist research seeks to explain how, why, for whom and under what circumstances interventions succeed—or fail—in real-world settings.
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