The Management of nurses in Internet-based home care in tertiary general hospitals in China: Mixed Methods Study

Abstract Background China is currently implementing a “Internet-Based Home Care” program that refers to medical institutions use institution-registered nurses to provide door-to-door nursing services to patients discharged from hospitals/illnesses with limited mobility through an "online application and offline service" model. And tertiary general hospitals are playing a leading role in this program.The management of nurses in the program is crucial. But the overall development situation of Internet-based home care in tertiary general hospitals is still unclear. Purpose: To understand the current situation and problems in the management of nurses' participation in Internet-based home care in tertiary general hospitals in China, and to propose corresponding recommendations and strategies. Methods: From March 1 to December 31, 2022, a two-stage mixed method approach was used in this study. Phase 1 employed an online survey to explore the current situation and problems in the management of nurses' participation in Internet-based home care in Chinese tertiary general hospitals. Based on the findings of phase 1, phase 2 included a focus group interview to collect nurses' views and opinions on the program. Results: The survey results showed that the coverage of Internet-based home care in Chinese tertiary general hospitals was 64.1%. According to the survey results of these hospitals that had carried out Internet-based home care, 51.3% of these hospitals had less than 5% of all nurses participating in the program. And 85% of the 75 hospitals provided this service less than 50 times per month. 97.33% of the 75 hospitals provided pre-job training and assessment for nurses who participated in the program, but there were no uniform training and assessment standards. And there still were legal risks and medical safety risks in this program. The mechanisms for distributing benefits among the involved parties have not yet been well established. In addition, a total of 3 main themes were identified in the interviews, including (1) attitudes of nurses, (2) proposals, and (3) expectations and supports. Conclusion: This study investigated the current situation of nurses' participation in Internet-based home care services in tertiary general hospitals in China. Meanwhile, it explored the problems and recommendations related to human resources, safety assurance, training and assessment, performance, and incentive mechanisms for nurses participating in the program. It is suggested that relevant departments in China should learn from the mature experience of home care abroad, combine it with the actual situation in China, explore the training system, formulate implementation rules, clarify the process, and guide the standardized development of Internet-based home care.