Nurses' Experiences With Tele-Acute Care in Nursing Homes: A Qualitative Study of the EAGLEcareACT Model

Tele-acute care models have been proposed to support timely clinical decision-making, but evidence from frontline nursing staff experiences, particularly outside Western settings, remains limited. This study explored the nurses' experiences using the model across multiple nursing homes in Singapore.

Qualitative descriptive study.

EAGLEcareACT (Enhancing Advance Care Planning, Geriatrics, and End-of-Life Care Acute Care Team) is a hospital-nursing home collaborative model combining structured training, standardized care pathways, and synchronous acute teleconsultation. Fifty-seven nursing staff members across 6 nursing homes in northeast Singapore participated.

Ten focus group discussions were conducted across EAGLECareACT nursing homes. Discussions were audio-recorded, transcribed verbatim, and analyzed inductively using Braun and Clarke's thematic analysis. Coding was iterative and collaborative, supported with NVivo (Lumivero).

Four themes were identified. First, a sprocess change happened through normalizing escalation with structured workflows and responsive teleconsultation. Second, building clinical confidence for acute care decision-making. Third, there are tensions between remote clinical recommendations and on-site care realities. Fourth, tele-acute care serves as an extension of medical oversight in physician-limited settings.

An integrated tele-acute care model was experienced by nursing home nurses as strengthening on-site acute care capability and reducing reliance on hospital-based services. Addressing resource restraints and communication barriers may strengthen the program's sustainability.