Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units

Ruth Kleinpell, RN, PhD, APRN-BC, CCRN; Connie Barden, RN, MSN, CCRN-E, CCNS; Teresa Rincon, RN, BSN, CCRN-E; Mary McCarthy, RN, BSN; Rebecca J. Zapatochny Rufo, RN, DNSc, CCRN


Am J Crit Care. 2016;25(1):E14-E20. 

In This Article


Eligible participants included nurses who were currently working in tele-ICU settings, including remote monitoring sites and units that interface with the sites. The study was conducted in 2 phases. In phase 1, nurses working in tele-ICUs and in ICUs that interface with tele-ICUs in the United States were surveyed on the nurses' perceptions of the benefits of and barriers to telemedicine and on the impact of tele-ICU on nursing care. A descriptive survey was used with an electronic survey tool (SurveyMonkey). The eICU Acceptance Survey[9] was adapted, with permission, to include questions on barriers to and benefits of the implementation of telemedicine on nursing care and on priority areas of care. The eICU Acceptance Survey was developed to assess nurses' acceptance of telemedicine technology in the ICU. The tool consists of 58 items divided into sections that include perceived usefulness, perceived ease of use, nurses' attitudes toward telemedicine, intention to use, and knowledge and awareness of telemedicine. Reliability and content validity were established in a study with 117 nurses to assess the acceptance of telemedicine technology.[9]

The reliability (coefficient α) was 0.88 and the corrected item-correlation ranged from 0.52 to 0.83, indicating that each item correlated well with other items. The coefficient α of each construct ranged from 0.91 (nurses' attitude toward eICU construct) to 0.96 (perceived usefulness construct). Collectively, the results provided psychometric evidence of reliability and validity.[9]

In order to conduct phase 1, a comprehensive database of nurses working in tele-ICUs and in ICU nursing units that interfaced with the tele-ICUs was developed. All tele-ICU sites in the United States were identified, and contact information was obtained. Sites were divided among the study coinvestigators, and directors of each tele-ICU program were sent an e-mail invitation to participate in the study. Surveys were sent to the operations directors of all 43 tele-ICU sites known to the investigators at the time. The directors were asked to distribute the surveys to their staff both in the tele-ICU and at the bedside. Three reminders were sent in the same manner before the closing date for return of the survey. The study was approved by the appropriate institutional review board as an expedited study because no personal identifiers were collected and participation was voluntary.

For phase 2, a 2-round modified Delphi technique was used to rank priority areas of care identified by the participants of phase 1. The Delphi method is a systematic, interactive method in which a panel of experts answer questionnaires and provide ratings in 2 or more rounds.[10] The Delphi technique was designed to gather input from participants without requiring face-to-face contact. The process is often used to find consensus among groups. In the modified Delphi technique, mail or e-mail is used to gather information, provide feedback, and report conclusions.[11] The modified Delphi technique consists of a series of rounds to define the issue to solicit responses, compile responses, and prioritize responses. A total of 60 nurses from phase 1 who expressed interest in continued participation in the study completed phase 2. The modified Delphi study consisted of 2 rounds of electronic surveys: round 1 to identify the top 25 areas of priority care for nurses working in tele-ICU nursing and round 2 to take those identified areas and rank the top 15 areas of priority focus. Responses were compiled and prioritized on the basis of the participants' rankings.

Use of the Delphi technique protects the anonymity of participants while allowing researchers to examine consensus of broad analytical perspectives on a topic and enables sharing of information and reasoning among participants.[12] A challenge to Delphi surveys is encouraging participation in all rounds of the study. A $25 stipend in the form of an electronic gift card (AACN bookstore) was provided to those participants for phase 1 of the study; an additional $50 electronic gift card was provided to the participants from phase 1 who also participated in phase 2.