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Nurse-Led Telenursing in Inflammatory Bowel Disease: A Qualitative Study Using Sociotechnical Systems Mapping
Aki Kawakami1, Makoto Tanaka1, Kayoko Sakagami2
1Department of Adult Health Nursing, Graduate School of Health Care Sciences, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan.
Aim:
To explore the sociotechnical factors underlying the perceived benefits and challenges of nurse-led telenursing for inflammatory bowel disease.
Design:
A qualitative study using a two-phase analytic approach.
Methods:
Semi-structured interviews were conducted with 20 registered nurses providing outpatient inflammatory bowel disease telenursing across 11 facilities in Japan between June 2023 and June 2024. Inductive content analysis identified perceived benefits and challenges, which were then mapped to sociotechnical system domains (people, processes, technologies and environment) to examine interactions and identify potentially modifiable system-level levers.
Results:
Four themes were identified: clinical assessment challenges; variability in triage decision-making; workload burden and workflow fragmentation; and barriers to access and patient-context misalignment. Challenges and benefits reflected interactions among system components. Key issues included limitations of voice-only symptom assessment, variability associated with the absence of standardised protocols, and inefficiencies arising from fragmented workflows. These interaction patterns highlighted potential system-level levers, including information structuring, decision standardisation, workflow integration, and flexible care pathways.
Conclusion:
The quality of inflammatory bowel disease telenursing appears to depend on sociotechnical alignment rather than communication modality alone, particularly for timely recognition of and response to disease flares.
Implications For Practice:
Structured assessment, standardised but adaptable triage and workflow redesign may strengthen early identification and management of exacerbations in nurse-led telenursing.
Impact:
This study presents a transparent qualitative approach linking frontline nursing experiences to system-level insights that may inform telehealth service design in chronic disease care.
Reporting Method:
Standards for reporting qualitative research.
Patient Or Public Contribution:
Patients and members of the public were not involved in the design, conduct, analysis, interpretation, or reporting of this study.
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