Clinical Nurse Specialist The Hospital for Sick Children Toronto, Ontario, Canada
Background: With a widening gap in access to homecare there is a pressing need for capacity building among homecare nurses for children who depend on medical technology (e.g., tracheostomy, enteral feeding). A virtual platform addresses the need for education and support by providing e-consultation through text, talk or video from expert pediatric hospital nurses to nurses caring for children with medical complexity at home. Objective: The aim of this exploratory sequential study using mixed data sources was to conduct an evaluation of the virtual platform’s usability and end-user experience with the service. Design/Methods: Convenience sampling was used to recruit diverse users based on roles, experience, region, and uptake of the platform. Nielson’s model of system acceptability and the PACMAD usability model guided data collection. Data was retrieved from daily activity usage, focus groups with web polling, online surveys using the System Usability Scale, and semi-structured interviews analyzed for content analysis. The study was conducted at a tertiary pediatric hospital in Canada (The Hospital for Sick Children) and funded by SickKids Foundation, Baxter Grant. Results: During the study period, more than 1000 homecare nurses registered, and 600 unique virtual consults were supported between January 2019 and April 2021. The platform received high traffic to self-directed education resources. Participants reported 98% (n=317) agreement on a measure of real-time satisfaction. In focus groups, participants (n=18) outlined that the platform was easy to navigate, visually attractive, and self-directed resources were informative. Gaps in experience were identified with one-third reporting the platform was challenging to learn, download from, or recover system errors. Four enablers of usability were identified from ten qualitative interviews which included promoting quality and safety, bridging gaps in information, building confidence and capacity, and personalizing approaches and care. Barriers to usability included managing privacy and risk and balancing technology use and direct care.
Conclusion(s): Evaluation of the virtual platform signals positive appraisal for usability and suggests it is an acceptable e-consultation solution for use by nurses caring for children with medical complexity at home. It offers potential for scalability in development of an integrated model of virtual services crossing populations and geographies. Study findings have informed iterative improvements to usability and extension of the e-consultation service to include family caregivers of children with new medical technologies at home.
