Telecare legislation priorities: A Delphi study grounded in ethical challenges

BackgroundThe growing incorporation of telenursing into the conventional healthcare system has raised urgent ethical and legal questions concerning the scope and standards of nursing practice. As nursing expands beyond traditional in-person care into digitally mediated environments, the lack of a legal framework in South Korea presents challenges to protecting patient rights and ensuring professional accountability.AimThis study aims to support the development of a regulatory framework for telecare nursing by identifying and prioritizing key legislative challenges affecting professional autonomy and ethical care delivery.Research designA two-round Delphi technique was employed.Participants and research contextA panel of twelve experts in nursing, health law, and digital health, each with over ten years of professional experience, participated. An initial set of 16 legislative items was developed through content analysis of legal documents and guidelines and reviewed by two subject-matter experts. Through iterative expert consultation, the item pool was refined and expanded to 24 statements for use in the Delphi process.Ethical considerationsThe study was approved by the institutional review board. Informed consent was obtained, and confidentiality was maintained throughout.ResultsEight items met all consensus criteria (necessity and feasibility ≥4.0; ≥80% agreement), including data security, documentation standards, identity verification, nurse certification, and informed consent. Seven ethically significant items such as scope of practice, liability, and reimbursement lacked feasibility consensus, suggesting major implementation barriers. Nine items were considered lower priority. The panel also highlighted three preparatory tasks: building public consensus, forming a multistakeholder steering committee, and legally recognizing nursing roles in telecare.ConclusionsLegislative priorities for ethical telecare were identified, though feasibility gaps indicate challenges to implementation. Legal frameworks should uphold ethical principles while supporting information governance, patient-centeredness, and professional empowerment. These findings offer timely guidance for integrating telecare into nursing practice and enhancing patient trust.